Classical Combination of Points

Classical Point Combinations and Clusters of Points in Acupuncture Therapy

Shmuel Halevi Ph.D

This work will present the thesis that, both clinically and theoretically, point-combinations in acupuncture therapy and especially classical classical point combinations, constitute the most reliable form of treatment in Chinese acupuncture. We shall try to demonstrate as many such combinations as possible, p ossible, dealing with their logic, i.e. theoretical foundations within the framework of Chinese medical philosophy and other aspects such as:  Analysis of each point in regard to its place in the prescription.  Comparison of certain point-combinations to herbal formulae used to treat the same patterns of disharmony.  When possible, comparison of each point in the formula with a specific herb used for the same energetic action. h istories demonstrating the efficacy of a specific  Relevant and real case histories point combination. u tilizing POINT COMBINATIONs like:  Technical data of importance in utilizing

1. Needle manipulation of various points in the combination (i.e.strengthening, reducing, dispersing, heating, etc.). 2. Sequence of needling procedure. 3. Other techniques of stimulation like: moxibustion, pressure, cupping, lectro-acupuncture and more. In addition, we shall examine a few major methods of formula composition existent in Chinese medicine for ages. These methods are very important to our thesis as they form the theoretical basis from which many of the pointcombinations have evolved. Another important facet of this subject is the tendency of students and practitioners alike, to regard point-combinations as formulae for treatment. In this work, we shall show that point-combinations are not formulae and that they serve only as solid "brick constructions" so to speak for a good formula. A comprehensive formula has to be formulated entirely on diagnosis.

1. Needle manipulation of various points in the combination (i.e.strengthening, reducing, dispersing, heating, etc.). 2. Sequence of needling procedure. 3. Other techniques of stimulation like: moxibustion, pressure, cupping, lectro-acupuncture and more. In addition, we shall examine a few major methods of formula composition existent in Chinese medicine for ages. These methods are very important to our thesis as they form the theoretical basis from which many of the pointcombinations have evolved. Another important facet of this subject is the tendency of students and practitioners alike, to regard point-combinations as formulae for treatment. In this work, we shall show that point-combinations are not formulae and that they serve only as solid "brick constructions" so to speak for a good formula. A comprehensive formula has to be formulated entirely on diagnosis.

CONSTRUCTION This work consists of the following chapters: A. Point-combinations general rules. B. The various laws for combining points. C. Formula building in acupuncture therapy utilizing POINT COMBINATIONs. D. Survey of popular and effective point combinations .

DETAILING

CHAPTER A - This chapter discusses the nature of point combinations in general terms and will demonstrate the general principles of their existence. CHAPTER B - Chapter B discusses in detail the various laws and principles from which the art of combining points has evolved. CHAPTER C - In this chapter, we discuss the difference between treatment formulae and point combinations . There are a few examples of the way in which a treatment formula is constructed, utilizing one or more point combinations. CHAPTEL D - This is the last and the lengthiest chapter in which we have surveyed 18 effective point combinations, each of which includes the parameters that we have mentioned above.

REMARKS

The assumption of this work is that the reader is completely familiar with the concepts, philosophy and terminology of Traditional Chinese Medicine (T.C.M.). Therefore, basic concepts such as: Qi, Blood, Yin, Wind, Heat and the like, have not been discussed or explained. Some of the ideas presented in this work, particularly those dealing with the practical aspects of T.C.M., have no roots other than the clinical experience accumulated by me during my years of practice and my personal observation. Nevertheless, in most cases, there is a numbered reference throughout the paper, pointing to a bibliography at the end of the work.

CHAPTER A

POINT COMBINATION GENERAL RULES A point combination in Chinese medicine is a term used to describe a well known collection of acupuncture points from two up to, usually, no more than five or six points. Generally, this collection of points has a long history of clinical use based both on theoretical foundations and experience. Since most of T.C.M. (Traditional Chinese Medicine from now onward) clinical means, herbs and acupuncture alike, have evolved from solid theoretical ground, it is not surprising that almost all classical pointcombinations are the result of logical reasoning of the same valid principles. Moreover, the fact that so many classical combinations have survived throughout the ages (and we are speaking of some thousands of years) (1), and have proven themselves clinically successful, only emphasizes and reaffirms the stability and truthfulness of these theoretical principles. Basically a point combination, or point cluster (which is a different thing) (2), is supposed to have a very specific energetic impact on the body, thus enhancing the effectiveness of the whole treatment of which it is a part. In order to illustrate this idea more clearly, here are a few examples: A. A nasal congestion and/or sinus infection is supposed to clog the Yang Ming meridian system in the region of the nasal cavities and forehead. There is an age old point combination dealing with this phenomenon, based on the points: Hequ (LI 4), Ouchi (LI 11) and YIngx1ang (LI 20). These three points together, which belong to the Shou Yang Ming system, if punctured in the above mentioned sequence, have a pushing, obstruction clearing action on the meridian thus, resolving the stagnation in the affected region. B. Another example, which is based on the principle Shu Mu combinations, will show an effect directed toward a specific internal organ in the body. For instance the points: Feishu (B 13) and Zhongfu (L 1), which serve as the Back Shu (associated) point of the Lung organ and the Front Mu (alarm) point of the Lung organ, deal successfully with problems such as asthma, painful breathing, pulmonary bleeding etc. These problems need a soothing, calming and harmonizing action which this combination can provide. Yet, other combinations are capable of even more fantastic effects. There are combinations based on more complex principles, which are capable of multi system overall effects. Such a combination is Liehchueh (L 7) and Zhaohai (K 6).

These two form the Master and Coupled points of an extra meridian the Jen Mai. As such, they have a vast influence over the organs and functions in the domain of this vessel. This may include the breathing, digestive and sexual-urinary systems; it may also include fluid metabolism in general, as well as hormonal imbalances affecting the uterus (3). Besides "opening" the Jen Mai by activating its Master and Coupled points, these two points bind the mutual assistance function of the Lung and Kidney systems (4). Liehchueh activates the downward flow of the lung energy, thus setting in motion the lung's activities such as breathing properly, dispersing extra fluid from the body (perspiration, urine, etc.), sending extra fluid to the kidney and eliminating phlegm (5). Zhaohai, in response, causes an upward movement by activating kidney functions associated with Yin (water, phlegm metabolism) (6), thus harmonizing the activities in the Kidney's domain, such as sexual urinary functions. In addition, as mentioned above, these two points form the link between the Lung and the kidney, by aiding the kidney to "grasp" lung Qi (which descends), and preventing it from "rebelling" upward (i.e. dyspnoea, asthma) (7). In these three examples we can see that point-combinations may have a local effect on a meridian, on an internal organ, on a specific disease focus in the body as well as on general functions or activities of various systems in the body. It is, therefore, of primary importance to make a proper diagnosis which will enable the practitioner to choose the proper point combination in order to assist the treatment formula in the desired way. Still, it will be difficult to choose the proper point combination just by memorizing them all. A profound comprehension of the logic which lies behind each combination is needed. This brings us back to the "laws" of acupuncture and to its very core the theories of Yin Yang, Five elements, Tsang Fu etc. Only by a thorough understanding of these principles can one understand or even memorize the manifold point-combinations and then apply them correctly.

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CHAPTER B

THE VARIOUS LAWS OF POINT COMBINATION 1. The Shu Mu Law (8) This technique of point combination is based on two specific point groupings, one on the front of the body and one on the back, i.e., the Associated and Alarm points. The concept is that both sets have a direct influence on the organ with which they are associated, like Feishu (B 13) and Zhongfu (L 1) on the lung, or Pishsu (B 20) and Zhangmen (LIV 13) on the spleen etc. Furthermore, if each point alone has a strong influence on its organ, combining it with its vis a vis point, will boost its effect and enhance the therapy. Clinical experience has shown that this combination principle usually has a better effect in Shi conditions when a sedating and soothing action is needed. It is used less in Xu conditions where other techniques are applied. Both Shu and Mu points are chosen when an internal organ is afflicted thus, combining these two points together has a strong effect on the organ, most frequently, a sedating one. The principle of Shu Mu is based on an even more basic law, the law of "opposites".

2. The Law of the Opposites The use of the "law of opposites" suggests that a disease located in one part of the body should be treated on the opposite part. For Instance, a disease located in the right part of the body should be treated on the left side. A disease located in the back should be treated in the front and vice versa. A

disease located in the upper part should be treated in the lower part of the body and so on. Practical examples of this law is treating Weizhong (B 54) for back pain (lower upper), or treating Hegu (LI 4) left for a toothache in the right mandible, etc. An extension of this law gave birth to many sets of point combination, using two effective points from each of the opposites. Thus, in the case of lower back pain, the use of the point below Weizhong (B 54), is happily "married" with the most effective point in the upper part, i.e. Shenshu (B 23). These two points together form the very basis for any lumbago treatment, taking advantage of the law of opposites.

3. Combining Yin Channel Points with Yang Channel Points This law is another example of how Chinese thinking makes use of the philosophy of duality or rather, contrasting and complementary phenomena such as Yin Yang etc. The Comprehensive Text of Shanghai College states: "As we know, the primary Yang channels are connected to the primary Yin channels in a Yin/Yang relationship. By combining a point on a Yang channel with another on its paired Yin channel, the cumulative effect is greater than needling either point separately. Examples: combining S 36 (Zusanli) on the stomach channel (Yang) with SP 4 (Gongsun) on the spleen channel (Yin) for stomach disease. Or, combining L 9 (Taiyuan) on the lung channel (Yin) with LI 4 (Hequ) on the large intestine channel (Yang) for coughing. The most well known combinations of this kind are between the Source points on the channel primarily affected by a disease, and the Connecting point on the channel paired with the first, in the Yin Yang relationship. In this combination the Source point is called the "host" and the Connecting point the "guest"."(p.58). This principle of combining points has created renowned combinations such as Hegu (LI 4) with Liehchueh (L 7) for upper respiratory tract ailments. Taichong (LIV 3) with Guangming (G37) for eye disorders, Taiyuan (L 9) with Pianli (LI 6) for cough from phlegm aetiology, etc.

The idea behind this form of combination is to divert excess energy from the diseased organ to its parallel Yin/Yang related channel. Thus, by puncturing the "host" point which is a Source point, one directly drains an overactive organ (Source points are in close relation with their organ (9)). The stimulation of the Luo point of the parallel meridian ensures that the excess Qi would thus leave by the closest possible gate. (Luo points form a passage between two Yin/Yang meridians). (10)

4. Master and Coupled Points of Extra Meridians The master and coupled points of the eight extra meridians form eight pairs of points each attributed to one extra meridian. Each pair is said to "open" its extra meridian, thus enabling it to absorb extra energy like a "sea" or "reservoir" of energy. (11) Two techniques exist by which these combinations are used. one way stimulates the two master points and then the two coupled points. The second advocates puncturing right master point and left coupled point in women and vice versa in men. (12) Many of the eight pairs have been found so successful in clinical practice that they are often used with no regard to their original assignment as master and coupled points of an extra meridian. A good example would be the pair Neiguan (P 6) and Gongsun (SP 4). This couple with the addition of Zusanli (ST 36) form the best point combination to treat morning sickness or any nausea, of different etiologies. Another couple: Liehchueh (L 7) and Shaohai (K 6) which is also used quite frequently, has already been discussed in the previous chapter. More of these couples will be discussed later in our last chapter.

5. Combining Local with Distant Points This is a general law for combining points in acupuncture. The law takes advantage of the experience gained from the use of various points and binds together effective points in the vicinity of the disease, with other effective points from distant parts of the body.

It has been found, for instance, that Ligou (LIV 5) is an effective point in treating maladies of the external sex organs (by virtue of its task as a Luo point of the meridian that encircles these organs). Zhongi (CV 3) is also an effective point for treating such problems (13). Thus, binding the two together, one close to the disease focus, and one from afar, makes a good combination in any formula for this purpose. This law also has a deep root in the concept of "Root and Branch" and "Origin and End". This concept is an ancient observation that all primary meridians have reciprocal relationships between points situated on the upper and lower reaches of the body, respectively. Thus, the bladder meridian has its root area in the vicinity of Fuyang (B 59) and branch area around Jingming (B 1). Or, the spleen channel makes its root around Sanyiniiao (SP 6) and its branch in Pishu (B 20) as well as Lianchuan (CV-23). (Acupuncture A Comprehensive Text, p. 61).

6. One Point Above. Two Points Below An extension of the previous law this extraordinary law achieves wonders in acute processes, if applied correctly. This law makes use of the previous law: "combining local with distant points", with two additions. One is that all the points should be on the same meridian segment (i.e. Shaoyang, Yangming, Taiyin etc.). The second, emphasizes that only one needle should be planted near the disease, while far from it two needles. This may, at first, sound bizarre, but the logic is clear. Taking, once more, the example of sinusitis, the point-combination which is the outcome of this law would be: Hegu (LI 4), Yingxiang (LI 20), Zusanly (ST 36), Nelting (ST 44). Hegu, as the strongest point in the hand Yangming, will set the whole Yang Ming energy in motion. Yingxiang serves as the local point to cause a

dispersion effect in the area and Zusanli, together with Neiting, are "the two points below". These two points below provide a strong stimulation to the other end of the meridian accelerating its energy and flow while eliminating the stagnation in its upper part. This same law formulates another very important point-combination, used to effect Dampness elimination from the intestines (purgation of the intestines). The combination is: Tianshu (ST 25), Zusanli (ST 36), Shangjuxu (ST 37)and Xiajuxu (ST 39). Tianshu is the local strong point for the intestines (the Mu point of the colon), the other three points po ints being situated on the same s ame stomach meridian and creating the weight to cause a strong downward flow of the stomach meridian energy (15).

7. Empirical Point combinations There are dozens of point-combinations in acupuncture which have emerged through sheer clinical experience. Every practitioner, who has spent a considerable length of time in clinical work, has probably noticed that some points yield better results when combined with certain other points. p oints. It is only logical that after so many generations of accumulated accumulated experience in the field of acupuncture, such empirical combinations have become the inheritance of the majority of practitioners. In comparison with the other forms of point-combinatio p oint-combinations ns that have so far been detailed, this form lacks their theoretical background in most cases. Nevertheless, clinical clinical success is after all the ultimate judge and thus, these combinations have earned their position in clinical work. Here are a few examples of point-combinations whose source is entirely empirical:  The addition of Sibai (ST 2) to the combination of Dannangxue (extra), Tianshsu (ST 25) and Guanyuan (CV 4), have a great soothing effect on

biliary ascariasis. Manipulating Manipulating Sibai in a sedative fashion, usually eliminates the very sharp pain which this illness causes (16). There is no theoretical explanation explanation for this phenomenon.  Hegu (LI 4) on the opposite side, combined with Liangqiu(ST 34) on the affected side, is a quick relief for strained muscles or tendons of the knee  joint (usually due to to a sport injury). In order to obtain the full effect of this combination, one should first puncture Hegu, at an oblique angle towards the metacarpal bones, two Cun deep, and then manipulate Liangqiu to cause numbness or distension around the knee (17).  Shaoze (SI 1) has an undeniable influence on the breasts. Hence, all breast diseases, including agalactia (lack of milk), are treated with the aid of this point. When combining Taiyang (extra) to Shaoze (SI 1), we make an effective point combination for swollen breasts. This formula's sour ce is also classical (Song of the Jade Dragon Ca. 1500) (18).

It is worthwhile mentioning, in this connection, that many empirical combinations include extra points, and there are a few that are composed entirely of extra points. The reason for this is clear. Since extra points themselves have originated from clinical experience, and in many cases as Ahshi points, they lack the theoretical basis that most of the meridians' points have. It is no wonder then, that many empirical combinations include extra points, for they too have originated from clinical observation. Example No. 3 (above) may illustrate this phenomenon, or this very popular combination: Yintang (extra), Shenmen (H 7), Sanyinjiao (SP 6). This formula is often used to calm the mind, especially in cases of insomnia (19), or mental anxiety. Shenmen and SanyinJiao harmonize Fire and Water elements, or heart and kidney functions, while Yintang places an emphasis on calming the mind. Thus, an extra point (Yintang) contributes to the principal effect of the two meridian points, with its empirically found soothing properties.

8. Point Clusters A point cluster is a grouping of a few points in the same area of the body, whose mutual effect on this area is beneficial. In many cases, these clusters are formed from extra points like Sishencong on the vertex or from Ahshi points (tender points) in the vicinity of the disease focus. An example of a point cluster would be "Three needles at the ankle". I.e. Kunlun (B 60), Jiexi (ST 41), 4 1), Taixi (K 3). This cluster serves as a local treatment to disperse any blood stagnation caused by trauma in the ankle  joint, or paraplegia (20). Another "Three needles at the ankle" serves the same purpose, and is a combination of three different points: Qiuxu (G 40), Jiexi (ST 41), and Shangqiu (SP 5). This is indeed a very effective trio for a sprained ankle, etc. The majority of the point clusters, though not all of them, are concerned with localized influence. Making use of the T.C.M. principle that any pain, swelling etc. is caused by stagnant energy or blood, or both, (21) the use of powerful local points in conjunction, is supposed to resolve this stagnation, and dislodge the barrier. Needless to mention, the utilization of such a combination would need a special dispersing technique, one that would enhance the flow of energy in the region, and disperse blood or fluid from the joint. Other point clusters serve the same purpose as regular point combinations, i.e. to cause any pre-calculated pre-calculated therapeutic effect, with the difference, as we mentioned above, that they are located in close vicinity. The articulations of the body, such as: shoulder joint, ankle, knee or elbow  joint, are considered considered the most vulnerable vulnerable parts of the body, in relation to the smooth flow of Qi (22). Rheumatic pain which is caused by weather Influences, according to T.C.M. thinking, is usually u sually lodged in the joints, thus hindering the smooth flow of Qi.

It is not surprising, therefore, that many clusters of points have originated in the vicinity of the joints for the purpose of removing the stagnant pernicious influence that has lodged there. Such clusters are the "three ankle points" that we have already mentioned or "the three shoulder points" and the "three knee points", some of which will be discussed later.

9. Balancing and Mutual Assistance This very traditional principle of Chinese medicine is responsible for dozens of point combinations, which have been formulated over the millennia. The idea of balancing is, after all, the core of Chinese thought, originating from the basic conception of Yin and Yang (23). All phenomena in our body can actually be attributed to Yin and Yang, and its balanced or imbalanced state. Without pondering too deeply upon this subject's philosophy, which is beyond the scope of this work, it is sufficient to say that the balancing of Yin and Yang, Hot and Cold, Shi and Xu, is the ultimate goal of Chinese medicine (24). Therefore, besides the various rules of point-combinations that we have summarized above, there is the principle of balancing Yin and Yang activities, which dictates what points to use in each case of imbalance. One of the most frequently encountered imbalances in clinical practice is that of the elements of Fire and Water. Most often symptoms such as heart palpitations, insomnia, dream disturbed sleep, anxiety etc., are the outcome of this imbalance. According to the poetic and imaginative Chinese physiology, kidney Water is insufficient and unable to control heart Fire, which blazes upward. This may cause palpitations and a restless heart, as well as a disturbed Shen (spirit), since Shen resides in the heart organ. To rectify this, the Chinese have originated many combinations, formulated

from points having the ability to restrain or dredge the heart activity on the one hand, and to strengthen or supplement kidney Water, on the other. Such combinations are: 1. Shenmen (H 7) and Sanyinjiao (SP 6) 2. Tongli (H 5) and Dazhong (K 4) 3. Tongli (H 5) and Zhaohai (K 6). (26) Another frequently encountered balancing method is to harmonize activities, either of organs or of functions. This is also based on the concept of deficiency or excess of specific activities. A good illustration for this would be the combination of Hequ (LI 4) and Fuliu (K 7). This combination is used primarily to treat cases of either excessive or lack of perspiration. In case of excessive perspiration, Wei Qi is deficient, so Hegu has to be tonified in order to fortify the protective abilities of Wei Qi. (Please note that Wei Qi is responsible for the tonus of the sweat pores, thus controlling perspiration). At the same time Fuliu has to be reduced, since its activities are closely linked to "water" movements in the body. In the case of the absence of perspiration, one should use these very points, only with reversed manipulation. For example: Hegu sedated, in order to release tightness of the sweat pores which are controlled by Wei Qi. Fuliu tonified, in order to increase "Water" movement In the body (27). Another principle of point combination, which was included under this heading, is the principle of mutual assistance. In the same way that herbs are frequently chosen to assist and strengthen each others action, so are points, by this principle of combination. This method is often relevant in cases where the elimination of a pathogenic factor is needed, much like herbal treatment. For instance, where the elimination of a Wind Heat factor in the head region is needed (i.e. tonsillitis), Hegu (LI 4) is of major importance. To strengthen its action we shall most probably choose Quchi (LI 11), a point quite powerful by itself, for eliminating Wind Heat. Clinical observaton has verified, that this couple of points has a much better impact on the head region than each of them alone (28).

By the same logic, Sanyinjiao (SP 6) and Yinlingquan (SP-9) are often combined together, for the purpose of eliminating Damp Heat pathogen from the Lower Burner. SanyinJIao is indicated, among many other qualities, to resolve Damp and Damp Heat from the Lower Burner, mostly by facilitating urination (29). Yinlingquan is also indicated to resolve Damp and Damp Heat from the Lower Jiao, and it treats: edema, ascites, retention of urine, urinary tract infection, diarrhea, etc. (30). Again, clinical experience has shown that putting together these two points, enhances the therapeutic effect of each of them, and this combination has become a valuable asset of Traditional Chinese medicine (31).

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CHAPTER C

FORMULA BUILDING IN ACUPUNCTURE THERAPY, UTILIZING POINT COMBINATIONS

1. Diagnosis Diagnosis is of prime importance in T.C.M. Actually, it is impossible to construct a treatment formula, unless one has reached a sound diagnosis. Knowing that, in ancient times the Chinese developed a unique diagnostic skill, based on procedures that matched their medical doctrine.

Remaining faithful to their basic concept that via the meridians' system, the inside of the body can be perceived by the outside of the body, most diagnostic procedure was based on techniques of how to best decipher these outside signs. Thus, the famous four methods of diagnosis emerged. These four methods are:  I. Looking  II. Listening and smelling (which is the same word in Chinese)  III. Asking  IV. Touching (32)

Without giving a fully detailed description of each of these steps of diagnosis, suffice it to say that they consist of:  Looking especially at the tongue shape, colors and fur.  Listening - to the pitch of voice, or cough (moaning or groaning and other sounds) whether loud or low, labored breathing such as wheezing etc.  Asking which is an interrogation of specifities of the patient's complaints, and especially some pointed questions, unique to T.C.M.  Touching especially the art of taking the pulse, but also the palpation of the abdomen or of some special acupuncture points.

After these procedures have been performed, the practitioner has to form a diagnosis, based on the eight principles of T.C.M. These principles are: Yin or Yang (1+2) Hot or Cold (3+4) Shi or Xu (5+6) Internal or External (7+8) In addition, the information gathered so far must include the site of disease (whether the spleen, colon, or any of the meridians) and, of no less importance, the cause of the disease. All these details and knowledge have a strong impact on the planned treatment, as well as on the prognosis. When all of this information has been collected and processed into a logical and workable diagnosis, then we must determine our treatment approach. This approach is based entirely on diagnosis. Thus if we have diagnosed a

simple case of a Wind Heat condition, the approach would be: the elimination of Wind Heat and restoring normal balance. Or, in a more complicated case, where our diagnosis leads us to a conclusion of disharmony of stomach and spleen and a kidney Yin deficiency, our approach should be to tonify spleen Qi and sedate stomach Fire, while placing an emphasis on strengthening kidney Yin. At this stage, the practitioner must assess whether Stomach Fire is more severe than the deficiency condition of the kidneys, and this conclusion must lead him either to put an emphasis on sedating the stomach, or on tonifying Kidney Yin and Spleen Qi. It is no less important to educate the patient as to how to behave in the future, enabling him to keep his reharmonized state of health intact. This education cannot be of value unless the real cause of disease has been grasped by the practitioner. When a specific approach has been determined, as we have illustrated above, our next step is to choose a specific technique for the treatment. A specific technique may actually be comprised of several techniques, with one goal: to induce a general effect on the patient, in order to achieve the aims of the approach. A technique may be a tonifying technique, based on choosing points that usually tonify. It may use moxa, in order to enhance the tonifying effect, and it should apply certain needle manipulations that cause an effective tonification. A technique may need to disperse stagnant blood that causes pain, swelling and immobility. Therefore dispersion techniques should be adopted such as: drawing blood with a cup, or, again, certain needle manipulations like: "needling one point in four different directions" (33), etc. While discussing the technique, we must also bear in mind that at this stage, we have to set the course of the whole treatment. We have to decide whether we treat the Ben first, or the Biao (i.e. the symptoms, or the cause), or we have to decide whether we treat an externally inflicted disease, before we treat an internal imbalance or, sometimes, vice versa. In the same manner, we shall have to decide whether to treat the Shi condition or the Xu condition first and make many other difficult decisions.

As a rule, all these decisions, and others, will be the outcome of a careful assessment of our patient's condition, which will dictate the treatment technique, its impetus, its rhythm, and above all the treatment formula. Building the treatment formula is really the climax of the practitioner's intellectual ability. By composing the formula, the practitioner's diagnostic skills, as well as his thorough memorization of points, combinations and actions, will come to full realization. There are many methods and approaches as to how to construct a formula. Some of these approaches even contradict each other. Some approaches state that any formula should have close points, medium points and distant points (34), in order to have a full effect. Some approaches advocate the use of the Five Elements school, as the basis for any treatment. Other approaches recommend prescriptions by the new China T.C.M. approach. There are even practitioners who are trained to build a treatment formula that will match their patient's astrological map, and some that use the famous I Ching trigrams hexagrams and to construct a formula. The methods are numerous, and differ entirely. However, the China T.C.M. stream is the main, and this is the method that yields the best results, according to Chinese researchers (35). The T.C.M. method of formula building relies most of all on empiricism. It relies also on strong foundations of sound traditional medical theories. Its main theoretical source is syndrome differentiation according to the Tzang Fu system, but, nevertheless, it adopts any treatment procedure that has proven itself valuable throughout the ages. It is no wonder that a method that relies most of all on clinical experience, will use as many point-combinations as does this method. We have already shown that point-combinations have both theoretical and empirical background as their backbone. Thus, we can rarely find a treatment formula that does not include, at least, one practical points combination. In order to illustrate this assumption, the following is a casually chosen list of treatment formulae, for various complaints in which I have marked the point combinations:

I. Ganshu (B 18), Qimen (LIV 14), Danshu (G 24), Changman (LIV 13). This is a formula for infectious hepatitis, combined by two pairs of pointcombinations according to the Shu Mu principle. II. For acute enteritis: Tianshsu (ST 25) with Shangjuxu (ST-37). This combination is one point above and one point below, on the same meridian. III. For bronchitis: Chitze (L 5), Hegu (LI 4) and Liehchueh (L 7). In this formula, Hegu and Liehchueh form the "Host Guest" relationship combination. IV. Ermen (T 21), Tinggong (SI 19), Tinghui (GB 2), Yifeng (T17), Waiguan (T 5) and Chungzhu (T 3), is a recommended formula to treat deafness. Ermen, Tinggong, Tinghui and Yifeng, make a cluster of points for ear problems. V. For rectal prolapse we may choose Paihui (GV 20), Changqiang (GV 1), Zusauli (ST 36), Sanyinjiao (SP 6), Qihai (CV 6) and Shenchueh (CV 8) the last two points, and probably Paihul too, with moxa. Paihu, Qihai and Shenchueh together make a very strong point combination that powerfully raises Yang Qi thereby elevating prolapsed organs, like the rectum. This combination is based on the mutual assistance principle (see previous chapter, paragraph No. 9). Changqiang and Paihui is another combination in this formula, built on the principle of "one point above, one point below," on the same meridian. While puncturing both ends of the meridian, we balance its activities, and if it is on an extra meridian, like the Du Mo meridian, by doing so we drain its excess energy (36, 37). VI. For the treatment of palpitations caused by ventricular septal defect with symptoms such as: general weakness and shortness of breath, the following formula may be utilized (38): Neiguan (P 6), Shenmen (H 7), Tanzhong (CV 17), Zusanli (ST 36), Qihai (CV 6), Sanyinjiao (SP 6), Shaohal (K 6), Jueyinshu (B 14), Xinshu (B 15), Keshu (B 17). In this formula, several classical point-combinations were used, in order to bring about the desired effect. This is obviously a case that needs a direct effect on the main symptom, palpitations, while not neglecting the rest of the problem which is Qi and blood deficiency. The points Neiguan, Shenmen and Tanzhong serve as a well known combination to relax the heart, calm the Shen and "open the chest". ("Open

the chest" is a Chinese metaphor used to describe functions such as: to improve blood circulation between heart and lungs, or to relax symptoms such as sensations of fullness or congestion and tightness in the chest). Jueyinshu and again, Tanzhong, is another combination which uses the principle of Shu Mu. In this case, adding mutual assistance to the previous combination to enhance heart circulation. Zusanli, SanyinJiao and Qihai constitute an even more frequently used combination whose goal is to tonify the Qi and eliminate lassitude. In this case, it also has another task of helping in creation of blood, since "Qi is the mother of blood" (39. Tonifying the Qi will help produce new blood. But, this excellent formula creator has made another important link and added Shaohai and Sanyinjiao to the formula. This pair have a mutual assistance effect on the general Yin Qi. Since blood is Yin, it is important to tonify both Qi and Yin, in order to supplement blood. The last combination in this formula is Sanyinjiao, Xinshu and Keshu. This is also a blood strengthening combination (based on Keshu which is the associated point of blood), only it puts an impetus on the heart's blood. We have to bear in mind that according to Chinese physiology, blood is also formed in the Tanzhong area with the aid of the heart. From the few examples above, we can see that treatment formulae may vary considerably from one another. A formula may contain, or even be composed of one point combination and it may have as many as four or even more point combinations. In any case, the purpose of including these combinations so deliberately in the formula, is to ensure that certain influences shall be exerted as decisively and promptly as possible. Since many of the point-combinations have proved themselves most valuable in clinical work, it is obvious that one should use these combinations while composing a treatment scheme. Thus, besides taking advantage of the use of already clinically proven combinations and giving our formula a solid basis, there is also a benefit in utilizing pre-made segments for the formula, liberating us from the necessity to build them by ourselves.

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CHAPTER D

SURVEY OF POPULAR AND EFFECTIVE POINT COMBINATIONS

Foreword to this chapter Most of the combinations in this chapter have been taken from the book: ACUPUNCTURE A COMPREHENSIVE TEXT, by the SHANGHAI COLLEGE OF TRADITIONAL CHINESE MEDICINE. The majority of the combinations form the backbone of the clinical knowledge of every practicing acupuncturist and as such, they should certainly not be expected to be innovations or rare information. Moreover, the eighteen point-combinations analyzed here, are only a drop in the ocean when compared with the myriad combinations which have evolved throughout the history of T.C.M. However, the aim of this analysis is to understand the principles by which a point combination has been formed, as well as its clinical value and application. The functions of the various points in the following combinations as well as their classical indications and qualities, were taken from two main sources: 1. The same COMPREHENSIVE TEXT (see above). 2. THE ACTIONS OF ACUPUNCTURE POINTS by Peter Deadman which was published in several parts in the JOURNAL OF CHINESE MEDICINE.

The rest of the material, including the analysis of each point, the theoretical background of the combination, the practical application and the comparison with a herbal prescription, were all taken from my own clinical experience and personal observation, unless otherwise stated. Needless to say, all the case histories in this chapter are of persons treated by me in my practice. The source for all information presented here regarding herbs, including herbal prescriptions, is the book: CHINESE HERBAL MEDICINE MATERIA MEDICA of Eastland Press, by Dan Bensky et al. However, comparison of the point-combinations with the herbal prescriptions in this chapter, is mine alone. ----------------------εφ---------------------

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1. SANYINJIAO (SP 6), GUANYUAN (CV 4), QIHAI (CV 6).

Main effect and clinical purpose This point combination is commonly used as a general tonic for Qi and Blood. It is therefore frequently used in cases of severe lassitude, anemia, impotence, spermatorrhea and the like. Because of this point combination's main effect, it is used with a tonifying manipulation and/or moxa.

Point discussion Sanyinjiao (SP 6) is the point of intersection of the liver, spleen and kidney meridians and functions to regulate and tonify the Oi in these channels. It also has a strong effect on the reproductive, as well as on the urinary systems and is therefore used to regulate Yin Qi either to tonify, or drain.

Sanyinjiao belongs to the spleen meridian and has a great influence on all the functions of the spleen organ. That includes: regulating the digestive system, improving appetite, creation of blood and elimination of Dampness (40). Guanyuan (CV 4) The meaning of Guanyuan is "the passage for the Source Qi". This is the point of intersection of the three Yin channels of the leg on the Conception Vessel (41). Needling this point tonifies the Yuan Qi which is the prenatal Qi. It therefore strengthens the kidneys and actually the whole body. Due to its location, it is primarily used to tonify Yin Qi but it can be used to tonify Yang Qi as well. It is hardly ever used to sedate. Qihai (CV 6) is also located on the Conception Vessel, Ren Mai. Its name implies that it controls the sea of Qi which lies exactly on this spot, known as the "Lower Dan tien". Qihai is therefore used to regulate Qi, especially post natal Qi (42) and strengthen kidney Qi, Yin and Yang in general. Combining Guanyuan and Qihai has a strong strengthening effect on the Qi of the whole body. These points together stimulate pre and post natal Qi and the kidneys. Adding Sanyinjiao to these two, gives a further impetus to creation of Yin and blood, improved liver and spleen functioning, thus making the best tonifying point-combination. There is another similar point combination that uses Zusanli (ST 36) instead of Sanyinjiao (SP 6). The difference between these two is that the latter is used mainly for general strengthening purposes, with an emphasis on digestive irregularities, blood and general stamina. The previous combination has a more uro genital bias.

Needling sequence, manipulation and stimulation

For purposes of general strengthening of Qi, one generally punctures in this order: Guanyuan, Qihai and then Sanyinjiao. But, if our aim is to s trengthen Yin Qi, or treat the uro-genital system, Sanyinjiao precedes the other two points. As we have stated before, the goal of this combination is primarily to tonify. In order to do so, we must use a tonifying manipulation, i.e. penetrate the point gently in three stages. While manipulating, we need to push into the

point more strongly than when withdrawing the needle. Often we may utilize the "Burning the Mountain" technique. In this technique the needle is first inserted to a superficial level and is then advanced to a middle and finally to a deep level. At each level the needle is forcefully thrust, and gently raised, nine times. Then, the needle is left in the superficial level. This manipulation is repeated until the patient experiences a warm or burning sensation. It is also very common to use moxa on these points, either direct moxa, or "warm needling". Moxa is used mainly in cold/deficient diseases.

Herbal eguivalent It is adequate to compare the use of Guanyuan and Qihai to radix Panax Ginseng. This herb is mainly used in severe Qi deficiencies or even collapse. It is also known to tonify the Yuan Qi and both Yin and Yang Qi. We can also find similarities between Angelica Sinensis, Dan Gui and the actions of Sanyinjiao. This herb, too, is used to tonify the blood and treat uro-genital disorders. Along with this, Dang Gui is also used for abdominal pain, constipation, Damp Bi etc., for all of which Sanyinjiao is also useful.

Case history Mr. A.M. of Arab origin, age 27, occupation: building worker, married for two years. Complaint infertility, spermatorrhea especially at night and premature ejaculation.

Diagnostic features 1. Red face, cold feet. 2. Feels generally fine, except sometimes dribbling urine. 3. Pulse slippery, big. 4. Tongue pale, soft 5. Abdominal tenderness under umbilicus and right hypochondriac region.

Diagnosis 1. Weakness and looseness of the "gate of sperm" ("Ming Men"), due to excessive sexual intercourse and hard physical labor. 2. Excitement of Heart Fire.

Treatment 1. Sanyinjiao (SP 6), Gyanyuan (CV 4), Qihai (CV 6) and Taling (P 7). 2. Refrain from sexual intercourse until spermatorrhea subsides.

Explanation Sanyinjiao, Guanyuan and Qihai together tonify the Yuan Qi thus enlivening the sperm and strengthening the Ming Men. Taling is used to decrease Heart Fire and thereby helps the patient control his sexual enthusiasm. Taling was punctured against the flow of Qi, i.e. needle pointed proximally, in order to cause sedation.

Results After two sessions the spermatorrhea ceased. After three months the patients wife became pregnant.

2. HEGU (LI 4), YINGXIANG (LI 20), ZUSANLI (ST 36), NEITING (ST 44), XIANGU (ST 43) [43].

Main effect and clinical purpose

This is a point combination based on the law "one point above two points below" (see previous chapter). Its purpose is to clear obstruction from the Yang Ming system, mainly sinusitis. It has a clear sedating effect and is therefore used for excess patterns characterized by Heat and Dampness.

Point discussion Hegu is one of the most frequently used acupuncture points. It is the strongest point on the hand Yangming channel and is often used for all complaints of the head. It is used to eliminate Wind heat or Wind cold. Hegu is an analgesic point and it relieves pain. It is anti-phlogistic, anti-pyretic and used for all inflammatory processes in the head region. Yingxiang is the last point of the hand Yangming channel. Its indications are for all diseases of the nose and to dispel Wind heat from the nasal cavities. It is also an intersection point between the large intestine and stomach meridians. Zusanli is also one of the most frequently used points in acupuncture. It is the most powerful point on the stomach meridian and is used for all digestive complaints. In this context it is used to eliminate Dampness and Heat from the Yangming channel. Zusanli may be either tonified or sedated, depending on the nature of the disharmony. Thus, among its manifold activities, it may be used to eliminate Wind and Dampness, to regulate circulation of Qi and blood, to tonify weakness and promote anti pathogenic Qi. Neiting is a point of choice in the treatment of excess patterns in the stomach or stomach meridian. It is mainly used to reduce Heat in the channel or in organs under control of this channel. This includes the nasal cavities, the upper teeth and gums, the stomach and intestines. Its indications are also to regulate Qi and relieve pain. Xiangu is indicated mainly for facial edema, for pain and elimination of Wind. Sinusitis is characterized as a Wind Heat disease and it causes accumulation of fluid (Dampness) in the face due to a Heat stagnation.

As we have explained in the previous chapter, this type of combination places an emphasis on regulating the Qi in the channel, making it flow more vigorously in the proper direction, by utilizing more points situated on the desired direction. Therefore, points Zusanli, Neiting and Xiangu provide a heavier weight than Hegu and Yingxiang, in order to promote the flow of Qi in their direction. This invigoration of Qi is said to clear the obstruction (sinusitis) where the hand Yangming and leg Yangming meet (the nasal area). It is worthwhile mentioning that all of these points have a clear Dampness and Heat clearing functioning among their other qualities.

Needling sequence. manipulation and stimulation The needling sequence is of major importance in this combination. Since the whole idea is to propel the energy along the meridian in the desired direction, we have to stimulate the points in the appropriate order. By needling these points in succession, we propagate both the needle sensation and the effect towards the oriented direction. The fact that Neiting is needled before Xiangu is because Neiting is a stronger point than Xiangu and therefore plays a more important role in the "see saw" balance of the combination. The points are naturally manipulated in a reducing, or sedating technique. This may be either the anti clockwise rotation of the needles, or pull thrust maneuvering. When an excessive hot condition is observed, it is possible to perform the "Cooling the Sky" technique. By this technique the needle is inserted rapidly to the desired depth and then forcefully raised up a fraction, then gently inserted again. This manipulation is repeated six times. The procedure is repeated at three different levels, from the deepest to the most superficial position, until the patient senses coolness. This is exactly the opposite procedure to "burning the mountain" which was described under the previous combination (44). As a rule, for sedation purposes the needle manipulation requires stronger

movements by the practitioner, with larger amplitude and angles than the tonifying manipulations. On shallow surfaces it is often sufficient to point the needle tip along or against the energy stream, in order to tonify or sedate, respectively.

Case history Mrs. S.A., age 40, has suffered from chronic sinusitis for 12 years. She had some 4 5 acute incidents each year, for which various antibiotics had been prescribed. Twice she had undergone nasal operations and sinus pumping without long term satisfactory results. She came to see me three years ago, suffering an acute attack which did not respond to antibiotic remedies. She had a low fever, felt very weak and sick and had unbearable pain around the supra-orbital area, especially of her left eye. Mrs. S.A. had a purulent yellow, foul smelling nasal discharge, dry mouth and constipation. Both her pulse and tongue indicated an excessive Damp-Heat condition. Her pulse was also weak and indicated her general weakness. Mrs. S. received six treatments. The prescription was built from the above combination, with the addition of Zanshu (B 2). Zanshu was manipulated by a dispersion technique, i.e. was punctured in three directions one after the other, and then was left intact. Zanshu was chosen due to its local effect, in order to disperse the purulent liquid around the eyes' orbit. After two treatments Mrs. S. experienced significant relief and after the fifth appointment she proclaimed that she was free of all symptoms. Hence, she was given another treatment to consolidate the effect and the treatment was terminated. During the last three years Mrs. S. suffered one more attack which responded to treatment in the same fashion.

3. JIANYU (LI 15), JIANEILING (EXTRA), JIANLIAO (T 14)

Main effect and clinical purpose The combination above is a point cluster of the shoulder. It is frequently used to disperse stagnation in the shoulder joint and to facilitate the flow of Qi there. The cluster is usually effective in cold stagnation of the shoulder or Damp Bi (cases of frozen shoulder, perifocal inflammation of the shoulder joint etc.). It may also be of value for traumatic pain from sports or accidents.

Point discussion Jianyu in Chinese "shoulder bone", is the main point for all shoulder diseases. Its indications are:  to eliminate Wind  to remove obstruction from the Jingluo, and promote circulation of Qi and blood.  to soothe the Joints, relieve pain and scatter Bi.

Jianyu is either punctured deeply, with the arm abducted, towards Jiquan (H 1), for inflammation of the joint bones, or along the deltoid muscle, for Damp or cold Bi, affecting the muscles and tendons. It is often cauterized with moxa, by all the variations: direct (scarring) moxibustion, the warm needle technique and moxa on ginger. These techniques are applied for Cold, or Damp-Cold induced problems. For the "frozen shoulder" syndrome, Cold penetrating to the bone level, one may use the "Fire needle" technique. By this technique a long needle is heated by fire, and immediately introduced into the deep level of Jianyu, then withdrawn. This technique was already mentioned in the "Ling Shu  and the Ming dynasty physician, Wu Hegao, recommended it for Cold Bi of the shoulder.

In any case, utilization of moxa or heat at this point, accelerates the flow of Qi, disperses the cold and damp stagnations and returns the joint and muscles to normal functioning. However, it is imperative to stress that any shoulder inflammation exhibiting heat condition, (i.e. febrile Bi) should no t be treated with moxa which can undoubtedly aggravate the condition. Jianneiling is an extra point situated exactly between Jianyu and the top of the anterior axillary crease. Its indications are the same as Jianyu s. Jianliao "Shoulder Seam" in Chinese, also has exactly the same indications as Jianyu. It is more often used for pain located on the posterior aspect of the shoulder, on the route of the Sanjiao channel. Needling these three points together affects the shoulder from three different angles and causes an acceleration of the Qi that passes through this joint. The various methods of stimulation, when properly applied, deal with the cause and nature of the stagnation accordingly.

Needling sequence, manipulation and stimulation The needling sequence in this combination is usually related to the site of the pain. If the pain is in the anterior part of the shoulder, Jianneiling is usually needled first, and then the other two. If the whole shoulder is painful, Jianyu is needled first, as the strongest point of the trio. Besides moxa stimulation, of which we have already spoken, the "cupping" treatment over these points is also frequently used. Cupping is generally applied on spots where we need to enhance circulation of Qi and Blood and is widely used in China and in T.C.M. clinics. Also electrical stimulation of these points is often applied, as shoulder problems usually involve pain. Electrical stimulation is usually applied with a dense disperse wave, for periods of 10 20 minutes. Cupping is usually applied after needling the points, or over the needles, also for 15 20 minutes. When the "warm needle" technique is utilized, only one needle of the trio is generally cauterized with moxa. It is usually the needle that is situated in the

most painful site of the shoulder. This is a small variation of a technique called Qici which was already mentioned in the Nei Jing (45). Another technique which is often used to disperse stagnation of Qi and Blood and to resolve pain quickly, is called "Huici", and has also been mentioned in the Nei Jing. By this method a 1.5 inch needle is inserted and manipulated until "Deqi" is obtained. The needle is then raised and redirected to the left or right, and manipulated again for 3 minutes. The needle is then raised and redirected toward another direction and manipulated once again. It is then raised to a superficial level and left intact.

Case history Mrs. D.B., a teacher by profession, was born in 1951. On April 18, 1990 she consulted me, complaining of severe pain in her right shoulder which hindered her sleep and disabled her right hand preventing almost any movement. X ray examination at "Rambam" Hospital in Haifa revealed excessive calcium deposits in the shoulder joint, hence she had been advised to undergo the calcium pumping operation, as well as steroid injections to the affected joint. Mrs. D. was reluctant for such "adventures" as she expressed it, and since she had had a previous successful experience in my clinic for another problem, she made an appointment. An examination by means of Chinese medicine brought me to the diagnosis of a Cold Bi condition in the shoulder, and kidney hypo-functioning (Kidney Yang Xu). The main signs were: 1. Fear of cold in general and especially a need for warmth around both shoulders. 2. Pallid face and lips. 3. Pale, wet tongue, with a thin white fur. 4. Thin, soft and deep pulse, weak on third position.

The only sign which did not match the diagnosis entirely, was the pulse, which should have been tighter. Nevertheless, I interpreted the thin pulse as a sign of a Blood Xu to some extent due to her kidney Yang Xu condition which prevented her from a proper creation of blood. The relative weakness and depth of the pulse was due to her kidney weakness. The prescription for treatment was: Right side: Tiaokou (ST 38), Jianyu (LI 15), Jianliao (T 14), Jianneiling. Both: Taixi (K 3), Shenshu (B 23). Tiaokou is an excellent empirical point for acute shoulder pain. It was inserted toward Chengshan (B 57) and manipulated for 5 minutes (46). on Jianyu I burnt four moxa balls on top of the needle, in every treatment session. The three cluster points of the shoulder were manipulated by the dispersal "Huici pattern (see above). This was done prior to the application of moxa, and in order to disperse the stagnant Cold which lodged in the area. Taixi and Shenshu were chosen to stimulate and reinforce kidney Yang. In order to ensure a full impact on kidney Yang, three moxa balls were burnt over the left Shenshu needle. Since all the Yang go to the left and all the Yin to the right, Shenshu left is also considered to belong to Yang, and was given an extra stimulation there. Mrs. D. experienced significant pain relief following the first session and could sleep the whole night through. After the second and third treatments her condition improved even more and on the fourth, the treatment was performed without moxa. After the fourth treatment her condition worsened, probably due to a cold change in the weather. Five more treatments were required to establish a full recovery, all of them with moxa.

4. FENGCHI (G 20), TAIYANG (EXTRA), XINJIAN (LIV 2), YANGLINGCHUAN (G 34)

Main effect and clinical purpose This point combination works primarily on the liver and gallbladder channels and has a strong Yang, or Fire reducing action, as well as Wind clearing, especially liver Wind from the head. As a result of these properties, the combination is widely used to treat hypertension of liver Yang, or liver Fire origin. It may also treat headaches, migraine, or pressure behind the eye (glaucoma) stemming from the same etiology.

Point discussion Fengchi is an important point, situated on the gallbladder meridian, below the occipital bone. It is involved in almost every formula that treats headaches, especially of a Shi nature. The point is indicated to eliminate Wind (external, or an internal liver Wind), to pacify the liver and reduce Yang Qi, to clear the mind, brighten the eyes, to benefit the ears and to reduce heat. Fengchi is usually punctured toward the eyeball of the opposite site, with care not to point the tip upward, the direction of the medulla oblongata. Since its use is most often indicated to calm hyperactive Yang or sedate Wind, it is manipulated to sedate by a leftward twirling, or forcefully withdrawing and gently thrusting back. Fengchi is often combined with Hegu (LI 4) for various headaches and this is a basic combination for headaches. Hegu has a strong effect on the face, forehead and the anterior half of the head, whereas Fengchl has the same effect on the posterior half. Both points therefore, circulate the Qi and Blood of the whole head and disperse Wind and stagnation. Taiyang is an extra point situated on both temples. Its indications are also to

disperse Wind and Heat from the head and eyes. It is often used for migraine headaches, red and painful eyes, fever or high blood pressure. Taiyang has a close relationship to the Gallbladder meridian, firstly because of its location, as well as its functioning. It is punctured up to a depth of one cun perpendicularly and it is often pricked with a triangular needle to release a few drops of blood. This is usually done in acute conditions, involving pain, heat, severe inflammation, etc. Xinjian also has similar properties. It is widely used to reduce liver Fire, but it is located on the other end of the body, i.e. the foot. Besides draining the excessive liver Fire, Xinjian is also said to spread the stagnant Qi of the liver. This is usually a heat stagnation, which is one of seven stagnations that exist in classical Chinese medicine: stagnations of Qi, Blood, Dampness, Cold, Heat, Phlegm and Food (47). This stagnation of heat often involves the blood too, as it causes the blood to coagulate. Since blood and heat both have a close physiologic link with the concept of liver in T.C.M., it is not surprising that hypertension in its most common etiology, is treated via the liver or Gall meridians. Xinjian therefore, is an important point for this disorder, as it treats both heat and stagnation. Yanglinchuan also has the ability to cool liver heat, as well as to clear dampness. It regulates and benefits the liver and gallbladder and strengthens the tendons, sinews and bones. After analyzing each point in the combination, it is clear that this point combination is built on the concept of mutual assistance. Actually, all the mentioned above points have the quality of lowering Yang, and subduing liver Fire. The most frequently encountered etiology for high blood pressure in T.C.M. is hyperactive liver Yang. This pattern usually involves symptoms such as: headache, glaucoma, red eyes and face, dizziness, tinnitus, etc., all of which are very common in the modern concept of hypertension. According to Chinese medical philosophy, when the liver lacks Yin Qi (due to a kidney deficiency, most often), or blood (due to spleen deficiency), or

its Qi stagnates due to other causes, it creates heat. Heat tends to climb up, or float to the head region, via the gallbladder meridian, which is the liver coupled meridian, or via the internal branch of the liver meridian itself. The heat rushes up the blood, thus creating the hypertension as well as the accompanying symptoms.

Needling sequence. manipulation and stimulation The needling sequence in this combination is from above downward, in order to lower or bring down liver Yang. It is therefore necessary to use the head points first, in order to sedate liver Fire or Wind in the head region, then Xinjian which is more important for this purpose and finally Yanglingchuan. Manipulation of the needles is effected to sedate liver Yang and therefore, the amplitude and strength should be as high as the patient can tolerate. Nevertheless, care must be taken in cases having a fragile constitution, or a pattern which includes a Xu condition, at the same time. In this case the practitioner must assess which is predominant, the Shi or the Xu condition and stimulate accordingly. It is also advised, in any case, not to be too vigorous with the manipulation at the first session. As we have stated before, in cases which involve an acute head or eye pain, with inflammation or Fire signs, it is possible to bleed Taiyang and release a few drops of blood with the prysmatic needle.

Herbal equivalent The effect of this point combination may be compared to the use of Spica Prunella Vulgaris (Xia Ku Cao), together with Flos. Chrysanthemi Morifoli (Ju Hua). The first herb is cold in nature and acrid and is used to clear the liver and brighten the eyes. Very much like Taiyang and Xinjian. The latter herb is slightly cold and bitter and is used to disperse Wind and clear heat. It therefore clears Wind-Heat in the liver channel and pacifies the liver and relieves headache, dizziness, red and painful eyes, etc. Its action resembles

that of Fengchi. The two herbs together are therefore classically used for headache, dizziness, vertigo, painful and red eyes and high blood pressure.

Case history Mr. G., age 46 a businessman, has suffered for the past eight years from hypertension and occipital headaches. During this period he has regularly taken hypotensive drugs (50 mg Convertin), which have adversely affected his sexual abilities. With the drugs, his blood pressure was 140/110 Hg. Mr. G. had a shiny red face, red eyes and darkish lips. He spoke loudly and was very talkative. Examination of the tongue revealed red rims, and a slippery yellow coating. His pulse was moderate and first and second positions of his right h and were Shi. It was apparent that Mr. G. had an excess heat condition. The problem was whether it was of liver Yang origin, or stomach Fire. As neither of these possibilities involved other symptoms, it was decided to clear the heat from the Yangming system through a combination renowned for this purpose. The combination is: Quchi (LI 11), Zusauli (ST 36) Neiting (ST 44). Actually, the Yangming channel was chosen to operate upon because of the pulse, which showed predominance on the right Guan position. A few treatments were carried out by this method, but the patient showed no improvement. The diagnosis was then reconsidered, and changed to hyperactive liver Yang. The pulse abnormality was thence interpreted as an overactivity of the right liver channel, rather than both channels, a fact which has shown itself on the right hand pulse. The formula for treatment was thus changed to the following: Fengchi (G 20), Taiyang, Xinjian (LIV 2), Yanglingchuan (G 34), Qimen (LIV 14) on the right side only, and Fuliu (K 7).

All points, except Qimen and Fuliu, were sedated in a broad angle twirling and raise thrust manipulation. Qimen was manipulated in an even manner, in order to regulate liver Qi and Fuliu was tonified so as to tonify kidney Yin. After the first treatment, Mr. G s blood-pressure decreased to 140/100 Hg. and after five more treatments to 140/90 Hg. He was advised not to take any more hypotensive drugs, advice which he accepted readily, and his blood pressure remains stable. Since Mr. G. was not prone to anger, he was only advised to regulate his diet, to exclude Yang nourishing foods (coffee, sea food, fried food, pepper, alcohol, etc.) and to tend his business in a more relaxed manner.

5. QUCHI (LI 11), XUEHAI (SP 10), WAIGUAN (T 5)

Main effect and clinical purpose The above point combination is widely used to treat skin disorders, mainly characterized by heat and Wind of either internal or external origin. These disorders include allergic skin reactions, various types of eczema, rash, hives, and other conditions. With added points like Yinlingchuan (SP 9), or Sanyinjiao (SP 6), it may also treat skin conditions in which Dampness exists, i.e. weeping eczema, furunculosis, etc.

Point discussion Quchi is the most effective point for skin diseases, especially those characterized by wind and heat. Its traditional functions are: 1. Eliminates Wind and exterior conditions.

2. Cools heat and alleviates Dampness. 3. Regulates the Blood. Quchi is situated on the large intestine meridian, a meridian most of whose functions deal with exterior conditions or with the outer layers of the body, such as: skin, muscles, etc. As its most pronounced function is to eliminate heat and therefore it is used in cases of fever, and since it is very influential at the skin level, Quchi also removes heat from the skin. By removing heat from the skin, it improves Ching I (fluid) circulation at the cellular level, thus facilitating skin nutrition. Quchi is also an important point to clear heat from the blood. We know that the large intestine meridian carries the largest amount of blood in comparison with other meridians, as it belongs to the Yangming system. As a result of this fact, Quchi is able to act directly on the blood, regulate it and drain excess heat therefrom. In this regard, we should bear in mind that many skin diseases are the result of "heat entering the blood level", according to T.C.M. theory. The heat in the blood concept may be paralleled to the western concept of toxins in the blood. This phenomenon of toxins is of a hot energetic nature, often manifesting itself as red skin eruptions of various kinds. In its most extreme variation it is defined even in T.C.M as Fire-toxin. This definition is often attributed to the western medical diseases such as furunculosis, purulent abscesses and the like. Xuehai "Sea of blood" in Chinese, is situated on the spleen meridian. The Spleen governs the circulation of blood (i.e. keeps the blood in the blood vessels) and governs the volume of blood, as it stimulates its creation. Xuehai therefore, is the point which serves to regulate and invigorate blood circulation, on behalf of the spleen. In its indications Xuehai is said to harmonize blood and Ying Qi (the nourishing Qi) and to cool heat. In accordance with these qualities Xuehai is used to tonify blood, improve its circulation and drain excessive heat from it. Waiguan is used in this prescription for its quality to relieve exterior and hot conditions. It is called the "Outer Gate" in Chinese and thus serves as a gate keeper against exogenous pernicious influences. Traditional Chinese Medicine teaches that in order to control wind, the

blood must be first regulated. Wind subsides by itself when normal blood flow is restored, i.e., it is expelled naturally when it has nothing to cling to. The use of Xuehai and Waiguan for invigorating the blood and dispersing the wind, combined with Quchi for clearing the heat, is an important combination of points for treating the itching due to stagnation of Wind and Heat in the skin." (48).

Needling sequence, manipulation and stimulation The needling sequence in this combination is from the upper limb to the lower limb. This follows the general acupuncture rules accordingly: 1. Generally apply needles first to the upper parts of the body and then to the lower parts. 2. First apply to points situated on the back and then on the abdomen. 3. Apply needles first to the left side and then to the right side. Manipulations of the needles are, in most cases, in order to disperse wind and heat, which are Shi conditions. In any case, Xuehai may sometimes be tonified, when the blood is xu, or dry, or more often, be manipulated evenly so as to tonify the blood and at the same time drain the pathogenic heat. In very acute conditions it is possible to bleed these points with the triangular needle, but it should not be done too often, as it might damage both Qi and Blood.

Herbal equivalent The functions of Xuehai are very similar, in many aspects, to those of Radix Rehmainia Glutinosa (Sheng Di Huang). This herb has these properties: 1. Clears heat and cools the blood. 2. Indicated for cases of hemorrhage, where heat has penetrated the blood level (in cases like excessive menstruation and premature menstruation, for

which Xuehai is also indicated). 3. Nourishes the Yin and the blood. The whole point combination may be compared to a classical herbal prescription that has about the same properties. it includes: 1. Periostracum Cicade (Chan Tui) 2. Herba Mentha (Bo He) 3. Radix Rehmania Glutinose (Sheng Di Huang) Chan Tui and Bo He belong to the cooling herbs that relieve exterior conditions. Therefore their main activity is to disperse wind and clear heat. Both of them are also used to speed recovery in measles, as they are said to encourage rashes to rise to the surface. Sheng Di Huang, as mentioned above, acts on the blood level. By tonifying the blood it assists in dispersing Wind conditions and by cooling the blood it removes the basis for any skin hot conditions.

Case history Miss O.S., age 9, has suffered for one month from a pruritic rash on her right costal surface, anteriorly and posteriorly. Various allergic examinations did not reveal any special sensitivity and local application of ointments had not improved her condition. Questioning revealed that the rash had appeared suddenly and that it was very itchy. Observation showed that the rash consisted of tiny red points, giving the impression of sand on the skin. It also showed a red rimmed tongue with a very thin white moss. The diagnosis was an externally contracted Wind-Heat, affecting the liver/gallbladder meridians. (Wind-Rash, in Chinese). The fact that the rash appeared only on the surface of the right rib cage, along with the red rimmed tongue, pointed to the involvement of the liver

and gall meridians. The sudden appearance of the disease, together with its red color, plus the thin white coating of the tongue, indicated an externally contracted Wind-Heat. The formula chosen for treatment was: Quchi (LI 11), Xuehai (SP 10), Waignau (T 5), Talchong (LIV 3), Sanyinjiao (SP 6). Taichong and Sanyinjiao were added to the prescription in order to resolve stagnation of the liver and hasten the recovery. This is another well known point combination, used to promote the function of the liver and spread Liver Qi. After two treatments which were carried out on two consecutive days, there was no itchiness at all and the rash had significantly diminished. After the fifth treatment the problem was entirely resolved.

6. NEIGUAN (P 6), TALING (P 7), LIEHCHUEH (L 7)

Main effect and clinical purpose This point cluster helps facilitate the flow of Qi and blood to the palm and fingers. It is used in cases of Metacarpal Tunnel Syndrome, where Qi and Blood are blocked in the matacorpal joint tunnel and the symptoms exhibit numbness, pain and weakness of the fingers.

Point discussion Neiguan is the most important point on the pericardium channel. It is mainly used to treat chest or abdominal problems and its functions spread from regulating the stomach activities, to improving blood circulation in the heart. One of its manifold characteristics is to regulate the Qi. The fact that it

belongs to the pericardium liver system, the Chueh Yin energetic segment, suggests that it is also closely linked with blood circulation problems. (In fact some authors call the pericardium meridian "Circulation Sex meridian") (49). As a tribute to its anatomical location near the metacarpal tunnel, it influences Qi and blood circulation in this area. Due to its major role in improving blood circulation in general, Neiguan has a double effect on this area: one merely as a local effect and the second as an influence on systemic circulation in the whole body. Another unique characteristic of Neiguan is that contributing to its anatomical location above the medial nerve of the arm, it is very easy to propagate the needle sensation as far as the finger tips. As Metacarpal Tunnel Syndrome usually exhibits numbness of the middle finger, or even of the other fingers too, we can manipulate Neiguan to transmit a clear sensation to those fingers, thus facilitating the flow of Qi and blood up to the desired foremost target. Taling has much the same characteristics as Neiguan, with one advantage over the latter. Its location is exactly above the metacarpal bones and joint, a fact which makes Taling a barrier point for this area. Its needle sensation is also most often felt through to the finger tips, and puncturing this point has a direct effect on the joint tunnel itself. Taling has a more cooling effect than Neiguan. It is a point often used to clear Heart Fire and resolve heat in the meridian or the organ. In many cases Metacarpal Tunnel Syndrome also exhibits heat symptoms due to the pressure of the stagnation there. The use of Taling is very beneficial for such a condition. Liehchueh is the Luo point, or connecting point of the lung meridian. The connecting channel of the lung, after leaving the main lung channel at point Liehchueh, travels to the large intestine meridian and connects with it at point Pianli (LI 6). Another branch follows the lung meridian into the palm and spreads there through the thenar eminence. Due to its course, Liehchueh is also used for wrist joint problems or abnormalities of the palm, such as: pain, hot palms, eczematous or numb palms. Liehchueh needs to be punctured with the tip of the needle pointed toward the thumb, for maladies of the palm. The needle sensation must follow the route of the lung meridian or to spread into the palm.

In this point combination we can see that besides its quality as a point cluster, there is a combination of two points, Taling and Neiguan, whereby each enhances the action of the other. Thus, there is the principle of mutual assistance as well as the facilitation of the normal flow of Qi and blood that any point cluster would achieve.

Needling sequence, manipulation and stimulation The order of needling these points is from Neiguan to Taling, so as to follow the ordinary flow of Qi in this meridian. These are also the more significant points of the trio and the pericardium meridian is more significant than the lung meridian for this prescription s purpose. Liehchueh is punctured last. As was hinted above, after Deqi has been obtained, needles must be pointed towards the palm and manipulated in dispersion so as to cause needle sensation to travel downwards toward the fingers. In Metacarpal Tunnel Syndrome, where specific heat signs are absent, it is recommended to apply moxa stimulation on the points after needling. In severe cases, direct moxibustion is usually applied and scars are formed. In less severe conditions it is possible to lay the moxa cones, the size of beans, on a thin layer of fresh ginger (Sheng Jiang). The layer is punctured through, in order to allow the heat to penetrate easily and the cones are placed one after the other, until the whole area becomes red. Another technique advocates the use of white pepper mixed with flour to make a paste and spread over the point. The thickness of the layer should be 0.1 inch, and a hole is made in the center. A moxa cone is set upon it and ignited. This method is indicated usually for numbness and stiffnss, and is most suitable for the Metacarpal Tunnel Syndrome (50).

Case history Mrs. O.T., age 35, is the owner of a goat farm and she is also the mother of case history number 5 ( see above).

A year and a half prior to her first visit to my clinic, she began experiencing numbness along the anterior medial aspect of her right arm, extending towards her fingers. It was more pronounced at night, while sleeping. Later, she experienced pain when numbness reached its climax. In the last few weeks she started having the same phenomena, though to a much milder extent, in her left hand too. Routine checks at Nahariya Hospital revealed no signs on her cervical vertebrae, where they had projected their suspicion. The diagnosis given was of a Metacarpal Tunnel Syndrome and she was advised to undergo an operation. On questioning, Mrs. O.T. revealed that sometimes when she awakens in the morning, she senses a sharp prick in her heart region, experiencing difficulty in breathing deeply, for a while. The sensation then disappears. Questioning also revealed that she is in the habit of milking her goats for many hours and that she rides a motorcycle in the fields. Observation revealed a red tipped tongue with red points and red rims. She also had peeled areas. Her right palm was dry and eczematous, she said that she had been told that it was a fungal infection, but it did not respond to medications. I diagnosed her condition as follows: 1. A pre existing state of slight heat stagnation of the pericardium which gave rise to the shape of the tongue, to the stabbing pain in the chest, and to disturbances along the pericardium meridian. 2. Hard labor of milking had strained the brachial muscles, especially the flexor group. This strain had impeded the flow of Qi and blood to the palm and had laid an extra burden on the pericardium channel. 3. Due to impeded flow of Qi and blood to the palm, the palm became dry, undernourished and had developed the eczema. The reason for aggravated numbness at night, was that rest hindered the flow of Qi and blood even more due to lack of movement or activity, thus making the numb sensation more pronounced. The treatment was constructed from the three cluster points, plus Tanzhong (CV 17). Tanzhong was utilized to build the formula due to its task as the Mu point for the pericardium. It has a strong influence on blood circulation

and is said to propel Qi in the Upper Burner, thus enhancing blood formation and Qi and blood circulation (51). By choosing Tanzhang, I dealt with the local carpal stagnation, as well as assisting from afar by viewing the local problem in its holistic background. After needling Neiguan I applied seven moxa cones on the point, using a layer of a paste made from flour and white pepper underneath. After seven treatments over a two weeks period, Mrs. O.T. improved by 90% as she proclaimed. About one year later she came to me again, saying she was afraid that her previous symptoms were returning. She was then given four more treatments, after which she felt better again.

7. JIANYU (LI 15), OUCHI (LI 11), HEGU (LI 4)

Main effect and clinical purpose This frequently used point combination has been devised in accord with the principle of choosing points on the same meridian, for mutual assistance. It is used in many different problems of the arm, involving the shoulder, arm, hand and fingers. Its main use, however, is to invigorate the flow of Qi and blood in the upper limb, for problems such as painful Bi syndrome of different etiologies, or paralysis. The fact that all these points are situated only on the large intestine meridian and not on one or more of the other five meridians of the arm, is because

this meridian is known to have the richest supply of Qi and blood (together with its Yangming counterpart, the stomach meridian). The Nei Jing states: "When treating flaccidity of the limbs (Wei syndrome), use points only from Yangming" (52).

Point discussion As stated above, all the three points are situated on the large intestine meridian and are considered important points. The title of important points is usually given to those points which have a broad spectrum of activity and that play a major role in many formulae. All three have in their indications qualities such as: invigorating Qi and blood circulation, removing obstruction from the Jing Luo, relieving pain, scattering Bi and the like. By choosing these three points, we combine their abilities to assist each other and to have a mutual impact on the disease, which is far better than any one of them alone. The fact that all the three are situated on the same meridian, enables each point's sensation to travel to the next point and thus propagate the needle sensation along the whole limb. When needle sensation is propagated, so is Qi and thereafter blood. There is a saying in T.C.M. that "Acupuncture is only effective when the Qi reaches the affected area". Many contemporary researchers have verified this concept. They also found a significant correlation between the degree of  induced propagated needle sensation, and therapeutic success (53). As we have mentioned above, the Nei Jing has recommended the use of the Yangming system for diseases characterized by flaccidity, numbness and hypertrophical features. The fact that the Yangming has been recommended for such tasks is due to its abundance of Qi, and especially blood. Recent researchers in China have verified for instance, that the use of these points in a C.V.A. sequelae, like hemiplegia, has no substitute. The reasons are those mentioned above. Hemiplegia, as an example, is a paralysis of half  of the body, caused by blood stasis (or hemorrhage) in the brain. This

stagnation has caused a Qi and blood circulatory impediment and in fact a real blockage in half of the body, usually longitudinally. Thus, these three points (among other points), are manipulated to invigorate the blocked circulation and return the limb to its normal function. By the same token, these points help eliminate pain caused by a Xu condition like paralysis, or a Shi condition such as painful obstruction of the  joints. The only difference is in the technique of stimulation and in the combination of other points within the formula.

Needling sequence. manipulation and stimulation The needling sequence in this combination is usually performed in accordance with the nature of the disease. In Xu conditions, when paralysis, numbness or weakness of the arm and fingers exists, the needling sequence is applied from Jianyu to Hegu. This is done in order to drive the Qi sensation toward the fingers which, in most cases, are in a worse condition. In painful Shi conditions Hegu is most often punctured first due to its generalized analgesic effect, followed by the rest of the points. It is, nevertheless, possible to start with Jianyu, especially if there is a marked stagnation there. In the conditions of paralysis or atrophied muscles, the stimulation is by tonification. The method of tonification varies, but in most cases it is a strong tonification for two reasons: A. The paralytic state of the limb does not allow a satisfactory Deqi sensation in many cases, if the manipulation is too weak. B. This is a severe condition which generally will not respond satisfactorily to a mild stimulation. In this context we may compare the amount of stimulation, or degree of needle manipulation, to a measured dose in medication or a herbal formula. In severe conditions the dose will generally be increased. The difference however, between acupuncture and other remedies, is that only a well experienced practitioner is able to develop the "touch" or sensitivity for the right amount of manual stimulation. In orally taken remedies the dosage is measurable and recommended in the formula.

In many cases of Xu conditions, especially the most severe or those in which cold is a part of the condition, the preferred type of tonification is the "Burning the Mountain" (54) technique, which was discussed under case number 1 in this chapter. Xu conditions of the upper limb are very often treated with moxa too. The warm needle technique is highly recommended, as it warms the channel, tonifies the Qi and accelerates its flow. Massage techniques, Tui Na with warming and activating oils and ointments, are also very popular and widely used. The massage is carried along the limb meridians, with rubbing and pinching, and scraping movements, pressing on the acupressure points and activating Qi and Blood. For such conditions also the plum blossom, seven star hammer needle is applied by tapping it along the meridians, until the whole route is reddened. In Shi conditions, such as painful Bi of the shoulder, elbow, carpal and phalangeal joints, the needle technique is in sedation and dispersion. The needle is inserted against the energy stream of the channel or manipulated in sedating procedures, or in the HuiCi technique which was described earlier in this work. Cupping is also applicable, as it drains excess and disperses stagnation. Also electro-acupuncture is possible, usually combining two points from the trio in a disperse wave.

Case history Mr. G., age 63, a barber by profession, left handed, had, a month before he came to see me, a marked decrease in the power of his left hand, fingers and leg. He had a sudden decrease of mental acuity, of his usual sense of humor, as well as physical abilities of hand and leg. Mr. G. had to cease working in his barber shop, since he was left handed. A week before coming to me, he suddenly felt very unwell and almost lost consciousness. He could not speak properly, and suffered a staggering

headache. He was taken to Nahariya Hospital where he underwent a C.T. scan of the head. The diagnosis was a cerebro vascular infarct in his right brain lobe. Upon examination it was obvious that he had significant difficulty in moving his left fingers freely and his gait was a little clumsy. His tongue was big, red and peeled. The pulse was moderate and big at the Cun and Guan positions. Mr. G. confessed to a long history of moderate hypertension. My diagnosis was a basic Shi condition of liver Yang, complicated by a Xu condition, after the brain damage had occurred. The treatment principle was, therefore, to invigorate the flow of Qi and blood in his left hand and leg, subdue liver Yang and invigorate the blood circulation in general. The points chosen for these purposes were: Jianyu (LI 15), Ouchi (LI 11), Hegu (LI 4), Baxie (extra), Biguan (ST 31), Zusanli (ST 36) all in the left side only and, Taichong (LIV 3), Sanyinjiao (SP 6), Xuehai (SP 10) bilaterally. Jianyu, Ouchi and Hegu were manipulated in a strong tonification. Baxie, are eight points situated between the knuckles of the fingers. These were stimulated in order to facilitate the flow of Qi and blood in the fingers. Biguan and Zusanli are a combination of two points on the leg Yangming channel, and the principle of their choice and use is exactly the same as for the three Yangming points of the arm. Taichong and Xuehai act on the blood level, in general. Taichong reduces liver Yang and improves blood circulation by facilitating liver Qi and Xuehais role in blood disorders has already been discussed in case Number 5 of this chapter. Mr. G. felt mental improvement after the first treatment. Following this treatment he never again experienced any episode of losing consciousness or difficulty in speaking. After the third treatment, which took place during the same week, his leg returned to normal and he had lost his clumsy gait. After the seventh treatment his hand and fingers regained their normal

flexibility and strength. Mr. G. was advised to come once a month for a check up for his liver Yang and was consulted about his way of life for the same purpose.

8. SHAOZE (SI 1), TANZHONG (CV 17), RUGEN (ST 18)

Main effect and clinical purpose This point combination was mentioned in the "Great Compendium of Acupuncture and Moxibustian" (Zhenjiu Dacheng) written in 1601 in China during the Ming Dynasty by Yang Jizhow (55). Since those ancient times the relevance of the combination has not diminished and its validity serves us today equally well. The combination is suitable for all breast diseases, especially those of a Shi nature. It is used with great efficacy in cases of breast abscess, mastitis, benign tumors of the breast and the like. This same formula is also utilized in mastosis or agalactia (insufficient lactation) which are primarily Xu conditions.

Point discussion Shaoze is the Well point of the samll intestine meridian and its main indications show: 1. Disperses Wind and Heat. 2. Facilitates the flow of milk in the breast.

Its first indication, which is in accord with its role as a Well point, makes it useful in acute conditions of febrile diseases, coma etc. Its second indication points to its soothing effect on the breast. The breast is where milk is originates and is produced in the female body. It is anatomically located in the Upper Burner, where blood is also produced. Milk, according to Chinese medical theory, is made of seven parts blood and one part Qi (56). The mechanism of milk production in the female body, is closely related to the functioning of the Chong Mai (the extra meridian which is also called the Sea of Blood) and which traverses the breasts (57). The Stomach meridian also traverses the breasts and this meridian too, as we know, is very rich in blood, thus both meridians nourish the breasts. The close location of the breasts to the lungs and lung meridian, permits the access of Qi from the air to the blood of the breasts. Thus the intermingling of Qi and blood in the proper amounts, make the formation of milk possible. Still, in order not to accumulate and become stagnant, milk needs a harmonizer which will activate and supervise its flow. For this purpose liver Qi is responsible, for two reasons:  This is the main task of liver Qi in the whole body, as the liver is responsible for the free flow of Qi anywhere in the body.  The liver meridian itself traverses the breasts.

Milk flow, therefore, is very dependent on the free flowing of liver Qi, in the same manner as blood flow (like menstrual flow) is also dependent on liver Qi. (Nei Jing: Qi is the ruler of Blood"). When liver Qi stagnates due to emotional problems, then blood and/or milk tends to stagnate too. In nursing mothers, this stagnation causes heat (due to the pressure) and then mastitis, breast abscesses, etc. Shaoze, both due to its milk flow facilitating quality, as well as its heat dispersing quality, is a first choice point for such problems. Tanzhong was partially discussed in this paper under case history number 6. It is the master point of the Upper Burner, and the Mu point of the pericardium. Its stimulation sets in motion the Upper Burner Qi, in order to eliminate stagnation in the Upper Burner. It thus helps facilitate the function

of the lungs, aids in dispersion of phlegm in the chest in cases of asthma, facilitates the flow of heart Qi and resolves angina pectoris, circulates the Qi of the breasts and eliminates stagnation there. In accord with these qualities, Tanzhong was selected for this combination. In cases of agalactia due to a Xu pattern, Tanzhong is stimulated with moxa, to tonify the activities of the Upper- Burner for milk production. Rugen is situated in the fifth inter-costal space, directly below the nipple. Due to its location in the vicinity of the breast and to its belonging to the stomach meridian, its function is to regulate the breast. Rugen, therefore, assists either by tonification in Xu conditions or by sedation in Shi conditions of the breast. The combination, as we can see, was based on the principle of joining points which can assist each other by influencing the same organ. Shaoze and Rugen are specific points fox breast problems, while Tanzhong is the most powerful point in the vicinity of the breast. Tanzhong has some systemic influences in addition as we have seen above, influences that help regulate breast functioning through general physiological functioning.

Needling sequence. manipulation and stimulation Usually, Shaoze is first punctured so as to direct the influence of the treatment to the breast. Then Tanzhong is stimulated due to its prime importance and then Rugen. Shaoze is punctured 1 2 fen deep, slantingly, in the direction of the wrist. Tanzhong is punctured either pointed upward or downward, until Deqi is obtained. When this is done, the needle is lifted to the skin level and redirected towards the diseased breast. Manipulation of the needle is then performed by twirling and lift thrusting movements, allowing the sensation to project to the breast. In cases of abscesses or mastitis, it is imperative that needle sensation should project inside the diseased breast. If both breasts are diseased, the same procedure is applied to the other breast as well.

In Xu conditions of the Upper-Burner leading to agalactia, the use of moxa is very beneficial. It is possible to apply direct moxibustion, taking proper care not to cause a scald. It is possible to warm the point with a moxa stick or by indirect moxibustion on a thin ginger layer. It is forbidden to stimulate Tanzhong with electricity, or cupping, as it may have an adverse effect upon the heart. Actually there are some texts that forbid the stimulation of this point even by acupuncture, and recommend only the use of moxa (Points of Chinese Acupuncture by Dr. J. Lavier, or Chinese Acupuncture by Dr. Wu Wei Ping for instance). In any case, contemporary experience in China strongly advocates acupuncture in this point, plus moxibustion. With Rugen, the procedure of needling is the same as with Tanzhong. After obtaining the Qi the needle is directed proximally toward the breast and then manipulated.

Herbal equivalent This point combination, especially when performed in order to soothe Shi patterns, resembles a herbal prescription generally used to treat the same disorders. 1. Pericarpium Citri Reticulata (Qing Pi) 2. Semen Vaccaria (Wang Bu Liu Xing) 3. Radix Salvia Miltihorriza (Dan Shen) This herbal prescription is used to treat pain and swelling of the breasts, palpable masses or lumps in the breasts, due to congealed blood or constrained Qi. It is also used to promote lactation. Much like the point-combination, it is a basic prescription, on which other herbs are usually added according to the various necessities of any specific case. Qing Pi is a major herb to regulate the free flow of liver Qi. It reduces Qi accumulations due to constrained liver Qi in the breasts and therefore alleviates pain and distension. Dan Shen invigorates blood flow and breaks up congealed blood. It may be

used also for palpable masses in the chest, cysts and lumps. Dan Shen also clears heat and may be used therefore to treat breast abscess due to heat stagnation. Wang Bu Liu Xing, with its qualities regarding the breasts, may be adequately compared to point Shaoze. It also promotes lactation and treats breast abscesses and swellings. The meridians it enters are those of the stomach and liver, exactly the same meridians that play such a large role in breast physiology. This formula, when tonifying herbs such as radix Astragali (Huang Qi) are added to, may be used to treat agalactia due to Qi Xu conditions which have led to constrained Qi. On the other hand, when herbs like Taraxacum (Pu Gong Ying) are added, it may treat breast abscesses, due to fire and poison origin and constrained liver Qi.

Case history Miss K., age 27, a stage actress by profession, complained of a large abscess on her left breast. A month prior to that, she had another abscess on her right thigh, on the path of the liver meridian near Yinlian (LIV 11). She was treated at that time with antibiotics which caused the former abscess to disappear and the new one to appear on her left breast. The antibiotics, she proclaimed, had made her very weak, lethargic, and depressed. On arrival at my clinic, she had a fever and suffered great pain in her left breast, a pain that radiated along the pericardium channel of her left arm. The abscess was large, situated under her left nipple, inflamed and resembled a second red, big nipple. Miss K.'s pulse was moderate and choppy, deep and weak. The Cun position on both sides was very choppy. Her tongue was red purple with even redder rims. The inside of her eyelids showed a red shaded line on the upper part of the lids a blood stasis

indication. In reply to my question as to whether she had had any problems with her liver, she said that she had suffered a severe jaundice five years earlier. Thus, in accordance with all the symptoms and signs, I diagnosed Miss K. as suffering from liver heat stagnation, affecting the meridian. The abscess on her left breast was of the Fire Poison category and also involved blood stagnation. This blood involvement had caused the fever and the involvement of the pericardium channel. The pericardium channel is in continuum with the liver channel, as a partner in the Chueh Yin segment. The formula for treatment was devised as follows: Left side: Shaoze (SI 1), Tanzhong (CV 17), Rugen (ST 18), Zulinqi (G 41), Waiguan (T 5) Both sides:Quchi (LI 11), Zusanli (ST 36). This formula was actually constructed from three well known point combinations. on the first combination there is no need to elaborate, it is sufficient to say that in this case all the criteria existed in order to utilize this combination. Zulinqi and Waiguan are the Master and Coupled points of Dai Mai the Girdle Vessel. This extra meridian harmonizes liver and gallbladder activities and its areas of influence are the waist, ribs and chest and the head. Dai Mai, as an extra-meridian, absorbs excess energy from the liver and gall channels and adjusts their functioning. Moreover, Zulinqi is indicated for liver Qi stagnation affecting the breast and that includes mastitis and abscess. Waiguan, in addition to its role as the coupled point of the Dai Mai, is the Luo point of the hand Triple Burner (San Jiao) meridian. Its coupled (YinYang) meridian is the pericardium meridian. Puncturing Waiguan may be thus used to divert excess from the pericardium and to adjust its functioning. All this is due to the Luo points' role as a "tap" that may be used to balance two coupled (Yin Yang) meridians. Quchi and Zusanli, both situated on the Yangming segment of channels, drain excess heat, relieve fever and invigorate and regulate the blood. They

are therefore widely used in hypertension due to excess heat a fact which has already been discussed in this paper. The first session lasted thirty minutes, in which Tanzhong and Zulinqi were manipulated every ten minutes. The patient experienced a "sucking" sensation traveling from Tanzhong to the abscess. Following the treatment, she experienced the same "sucking" sensation plus pain along her left arm, for about six hours. After six hours the abscess burst open and a great deal of pus and blood were discharged. Afterwards, she experienced a sudden relief. The pain subsided almost completely, as did the fever and the depression. Miss K. came for six consecutive treatments thereafter, following which her breast healed completely. Miss K. came to me a year later for a different problem and while examining her I noticed that her breast did not bear even the slightest mark of the episode she had undergone.

9. HEGU (LI 4), TIANTU (CV 22), FUTU (LI 18)

Main effect and clinical purpose The point combination above is mainly used to treat conditions in which phlegm has accumulated in the region of the throat, giving rise to problems such as: hoarse voice, asthma with a sensation of blocked throat, lumps in the throat, goiter etc.

Point discussion Hegu is a point which possesses many qualities, some of which have been discussed in various parts of this work and especially under cases numbers 2

and 7. Hegu was chosen in this point combination due to its key role in the large intestine meridian which makes its route through the neck and throat. We have already discussed the invigorating quality of Hegu, which, when stimulated, sets in motion and invigorates the flow of Qi in this channel, thus clearing any blockages along its route. In case number 2, for example, the point was utilized to unblock stagnation in the area of the nasal sinuses. Here, the point serves to resolve phlegm, or Phlegm-Fire, or Damp Phlegm in the region of the throat, conditions that may cause, if untreated, grave problems in that area. Due to Hegus other qualities it may be used just as well for externally contracted dampness that has transformed into phlegm, or an internally originated Phlegm. We already know that Hegu is a first choice point for externally contracted situations. That may include in fact all the patterns. Wind, Heat, Cold, Dampness, plus any combinations of them. Internally, Hegu is the Yuan point of the large intestine, therefore in close relation with the organ itself. The large bowel is responsible for eliminating toxins and waste through the lower orifice and thereby, Hegu plays an important role. Moreover, Hegu also belongs to the Yang Ming system and thereby, exerts an influence over the stomach too. Since we know that the stomach/spleen malfunctioning is responsible for phlegm creation, we can imagine how Hegu may have an influence on the internal origins of phlegm. Tiantu is probably the most important symptomatic point in the case of asthma. It is located in the base of the throat and forms the barrier between the trunk and the head region. In this area, people sometimes feel a sensation as if "something" is stuck in their throat, a sensation metaphorically related to as "plum seed" in Chinese. This sensation is typical of the formation of phlegm accumulations in the throat. Since phlegm has a dense energy, or "dirty" energy, it is stuck in the narrow passages of the throat and blocks liver Qi, or the "Clear Yang" of stomach Qi from ascending to nourish the brain (58). Stimulation of Tiantu disperses the phlegm in this area and facilitates both

the ascent of Qi to the head and the absorption of air Qi in the lungs. Tiantu is also indicated when Fire exists in the throat. Fire may present on its own, but in the throat region it is usually combined with phlegm, creating the phenomenon of Phlegm Fire. Phlegm Fire exists in cases of throat cancer, abscess, acute goiter, etc. Futu is also a point on the large intestine meridian and is located on both sides of the neck. It is combined with Hegu which is on the other end of the meridian, forming the bond of one point in the vicinity of the diseased organ and one distant point. Futus traditional indications are: Coughing and wheezing, excessive mucous, difficulty in swallowing, hoarse voice, and "duck like" sounds in the throat. It is therefore in mutual assistance with Hegu on the same meridian and with Tiantu in the vicinity of the focus of the disease.

Needling sequence, manipulation and stimulation As with other conditions which are basically Shi, needling is initiated with distant points and continued with close points (59). Hegu is stimulated in sedation in order to invigorate the flow of Qi In the meridian and to disperse phlegm in the throat. Then, Futu is punctured, to make a continuum with Hegu and take advantage of the propagated Qi that Hegu has transmitted upward. Tiantu is lastly utilized to produce its effect on the whole area. In Taiwan I have watched practitioners using the "warm needle" technique on Hegu in this context, when there were no heat signs. The idea behind this is that the Nei Jing states that in cases of abundant dampness "warm needle" technique is superior (60). The logic is that the heated needle conveys warmth through the point to the meridian. This warmth helps dissipate the phlegm by drying it.

I have occasionally used this technique myself with very good results. Futu, in cases of goiter or neck lumps, is sometimes stimulated with indirect moxibustion over a layer of ginger. This is applied after the point has been needled and the needle is withdrawn right afterwards. In cases of lumps in the vicinity of Futu, it is often seen that the lump itself is pierced rather deeply, to follow right afterwards with the indirect moxibustion procedure. Regarding Tiantu there are two main possibilities. The first is to insert the needle parallel to the sternum posteriorly, until Deqi is obtained and then to withdraw it. The second is to do likewise, but suspend the needle until the whole treatment is terminated.

Herbal equivalent A herbal formula consisted of the following herbs: 1. Thallus Algae (Kun Bu) 2. Herba Saragassi (Hai Zao) 3. Radix Cynanchi Stautoni (Bai Qian) is very similar in action to the above mentioned point combination. Kun Bu and Hai Zao assist each other in dissipating phlegm nodules in the neck region or they are used together to treat goiter. Their nature is cold and salty and they clear heat and reduce phlegm. Bai Qian is very similar in action to point Futu and probably Tiantu as well. It is used to treat phlegm conditions in the throat and to redirect rebellious lung Qi, which means asthmatic conditions. Its traditional indications also mention that Bai Qian is effective in treating "gurgling sounds in the throat" which is a sign of accumulation of DampPhlegm,. This indication in particular reminds us of the classical indication of the point Futu which we have mentioned above, that it treats: "sounds in throat like a duck".

Case history Miss S., age 26, also a stage actress and a close friend of Miss K. from case history number 9, was diagnosed five years before as having a benign tumor on her vocal cords. She exhibited symptoms of hoarse voice, a fact that was not at all unwelcome in her profession and a constant sensation of mucous in her throat. She had an odorless vaginal discharge, occasional stomachache and not very frequently also nausea. All four methods of Chinese diagnosis revealed a state of lung and spleen Qi Xu as a basis for formation of phlegm and the obstruction of her throat by phlegm. Her pulse was thin, soggy and weak, especially on right Cun and Guan positions. Her tongue body was slightly flabby and covered with a thick, white, transparent and slippery coating. Changmen (LIV 13) on the left side was tender but very ticklish, and Zhongwan (CV 12) was very tender as well. Miss S. was a ten year smoker and used to smoke at least 20 cigarettes a day. The principle of treatment was to eliminate phlegm in the throat and to tonify spleen and lung Qi. I therefore chose the following points for treatment: Hegu (LI 4), Futu (LI 18), Tiantu (CV 22), Panglianquan (extra), Liehchueh (L 7), Fenglong (ST 40) Since there were no heat signs despite the fact that Miss S. was quite a smoker, Hegu was acted on by the warm needle technique.

Panglianquan are two points located 0.5 cun on both sides of Lianquan (CV 23). These are special points for diseases of the vocal cords. One should insert the needle there transversely, along the skin, in an upward proximal direction, until the patients feel as if they "had swallowed fish bones"  Liehchueh and Fenglong make a very effective point-combination to treat phlegm in the upper respiratory tract. Liehchueh is the Luo point of the lung meridian and is very useful in resolving damp conditions of the lungs, as well as redirecting rebellious lung Qi. It is also the master point of the Ren Mai, the extra meridian which passes through and nourishes the throat and which is very prone to Damp Phlegmatic diseases. Liehchueh was also chosen because of the leucorrhea of the patient, a problem which is also subject to the functioning of the Ren Mai. Fenlong is the point to treat any phlegm condition in the body, as it adjusts the functioning of the spleen and stomach meridians. The last point combination in this formula is Hegu and Liehchueh which follow the "Host Guest" principle and have a renowned ability to harmonize the lungs, dissipate phlegm and redirect lung Qi. The patient was instructed to cut off her cigarette consumption, as well as coffee and milk products. She made efforts to eat more regularly and to avoid junk-food and too much salt. Miss S. received seventeen treatments, after which all her symptoms had practically disappeared. She would not agree to undergo another examination of her vocal cords in order to check upon the tumor there. She was completely satisfied with the way she felt and said she could not care less whether or not the tumor was still there.

10. SHENSHU (B 23), WEIZHONG (B 54), KUNLUN (B 60)

Main effect and clinical purpose This is another point combination in existence for at least 400 years. This combination was first mentioned in the "Great Compendium of Acupuncture and Moxibustion", written by Yang Jizhow in 1601, as was combination number 8 above (61). It is structured on the principle "one point above two points below, on the same meridian" (see chapter B, number 6). It is perhaps the most popular combination treating low back pain of any etiology. It may definitely be of great value even in cases of middle and upper back pain, with the addition of some other local points.

Point discussion Shenshu is the Back Shu point of the kidneys. It is a very strong point, and one of the most frequently used in clinical practice. Shenshu's traditional functions include:  Regulates Kidney Qi.  Strengthens the lumbar vertebrae and knees.  Benefits the ears and eyes.  Eliminates dampness.

It reinforces kidney Qi in all kidney syndromes: Kidney Qi Xu or not firm, Kidney Yin Xu and Kidney Yang Xu. It is a well known fact in T.C.M that Kidney Qi is the actual source of all the energetic activities of the body. Kidney Qi is the Prenatal-Qi, as well as the storage of all reserves of postnatal, acquired Qi. It is also the source of Yang Qi, as the Fire of Ming Men resides between the two kidneys.

Shenshu, as the Shu point of the kidneys, is in close contact with the organ itself. It has probably the best influence over the kidney function and is therefore utilized in any disease involving the organ itself. But, besides diseases such as: nephritis, renal calculi, nephroptosis or bladder diseases, the physiologic spectrum of the kidney functioning is so broad that Shenshu is also applied in many other pathologies. This may include: skeletal problems, sexual problems, hemato-genesis, aging diseases, gastrointestinal, hormonal and other problems. In this point combination context, Shenshu is applied due to two of its manifold qualities: A. As a local strong point in the lower back which, like any local point, helps regulate local functioning and resolve local Qi stagnation. This is especially so when its indications include low back pain. B. Many etiologies of low back pain stem from Kidney Xu, leading to either skeletal deformations or muscular impairment in the lower back. Thus, these qualities make Shenshu the first choice local point for low back pain. Weizhong, according to chapter four of the "Spiritual Axis" (Ling Shu), connects behind the knee with its bladder meridian, as its "Lower Uniting Point". The bladder channel connects with the kidney meridian via the Yin Yang coupled meridians law. The course of the bladder meridian passes through the lower back and influences it. Moreover, in the classics, Weizhong is regarded as one of the Six Main Points classification, recorded as follows: "Take Sanli for the belly and abdomen, Weizhong for the waist and back, Liehchueh for the head and neck, Hegu for the face and mouth, Neiguan for the heart and thorax and Sanyinjiao for the lower abdomen". Therefore, two indications of this point show:  Relaxes tendons and invigorates collaterals.  Benefits the lower back and knees and strengthens the waist.

The other two indications may well be listed here, being:  Clears heat from the blood.  Dispels Summer Heat evil (pathogen).

From the above data we can see that even 3000 years ago, Weizhong was the first choice distal point, as much as Shenshu the local point, for treating low back pain. It is used therefore to treat acute back sprains or inflammations of lower back tendons and muscles, or, just as often, Xu conditions of chronic low back pain or weakness, etc. Weizhong is also a very important point in the treatment of sciatica. It is located above the trunk of the sciatic nerve behind the knee and its stimulation may cause an electric shock sensation all along the sciatic nerve  down to the toes. As we have mentioned in the case of Neiguan (P 6) (see under case number 6), this electric like sensation helps propagate the Qi along the channel and to resolve various stagnancies along it. The very distinct sensation that Weizhong produces, is thus considered the cause for its great efficacy in the treatment of low back pain and sciatica. Kunlun is another point on the bladder channel, whose indications also say: "To relax the sinews and muscles and benefit the lower back". It is very much used in the treatment of low back pain and sciatica, as much as stiff neck and head problems related to wind. Since "Dispersing the wind and clearing the channels" is its other indication, Kunlun is mainly used in low back pain related to Wind Bi. Wind Bi is a form of wandering rheumatism which may affect various parts of the body progressively. In the posterior part of the body, it is most often seen in people suffering alternately from stiff neck or back or buttocks. In such cases the addition of Kunlun to the formula is very rewarding. The law of "One point above, two points below" is very pertinent in the case of low back pain. The bladder meridian energy flows in a distal direction from the back. Shenshu serves as the local point that activates and invigorates the flow of Qi in the lower back, while the other two p oints attract the bladder energy downward, enhancing and accelerating its flow. Beside this principle, all the three points serve in mutual assistance to benefit the lower back and relax muscles and tendons there, as their indications imply.

In addition, Shenshu has a more fundamental task which is to act directly on the kidneys, which are the organs responsible for the lower back.

Needling sequences, manipulation and stimulation In very acute cases that involve pain, it is advisable to start with the most powerful distant point. Thus, Weizhong is usually the first point, then Shenshu and lastly Kunlun. In acute sprains of the lower back, Weizhong is may be utilized while the patient is standing. It is manipulated in sedation, as strongly as the patient can tolerate, while he or she is asked to gently rotate the waist. This type of procedure is often performed in acute, painful conditions of various parts of the body. A point is strongly manipulated while the patients are asked to rotate and maneuver their painful joint (62). In acute hot conditions Weizhong is frequently bled with the pyramid needle. This is done especially if congested veins are visible in the vicinity of Weizhong. Another popular method is to apply cups on Shenshu, with or without needles. Also recommended is the application of cupping on Weizhong in the case of painful knee, related to low-back pain. This is usually done after the needles have been withdrawn (63). Electrical stimulation of the points is also possible and often seen in the clinic, in cases of low back pain. Usually the right side is stimulated by one wire and the left side by the other. It is performed by a dispersion wave.

Herbal equivalent Radix Duhuo (Angelica pubescens) has very similar qualities to point Kunlun. It is in the category of Wind Damp expelling herbs and its indications are:  Expels Wind Damp that causes painful obstruction.

 Alleviates pain caused by the former indication.  Channels entered are kidney and bladder.  Used to treat low back pain and leg pain.  Also treats headache and toothache because of Wind Cold Damp.

With the addition of herba Assri cum radice (Xi Xin) and Radix Gentiana Macophylla (Qin Jiao), it constitutes a classic formula to treat soreness, pain and numbness in the neck, back and lower extremities due to Wind Damp Bi. With the addition of radix Dispaci (Xu Duan) this formula imitates our point combination very closely, as Xu Duan plays the role of point Shenshu. Xu Duan tonifies kidney Qi and Yang and it strengthens the sinews and bones. Xu Duan also promotes and invigorates blood circulation and is therefore useful even in cases of low back pain due to trauma and blood stagnation. In this, Xu Duan imitates the mutual effect of both Shenshu and Weizhong.

Case history Mrs. D., 40 years old, married plus two children, has suffered from chronic low back pain for years. Every weather change, especially cooler, or a damper weather, had affected her body. She could not tolerate cold weather in general, apart from its effect on her lower back condition. During the last seven years Mrs. D. has not used any contraceptives because she was certain she could no longer conceive. Her tongue was pale, flabby with "tooth marks", and covered with a thin layer of white, damp moss. Mrs. D.s pulse was sunken and weak, even more so in both Chi positions. It was apparent that her case was a kidney Yang deficiency, with Damp Cold Bi in her lower back. Treatment was administered three times a week, based on the point combination discussed above. In addition to these points, I applied direct moxibustion on her Mingmen (GV 4), every second visit.

Following the first session her lower back improved radically and after three more treatments it did not bother her at all. The frequency of treatments was then reduced to once a week, for four more treatments. Two months later, to Mrs. D. s great astonishment and delight, she became pregnant. Now Mrs. and Mr. D. have a three year old daughter in addition to their two former sons and she very seldom complains about her lower back.

11. DINGCHUAN (EXTRA), TIANTU (CV 22), TANZHONG (CV 17), NEIGUAN (P 6), FENGLONG (ST 40).

Main effect and clinical purpose The goal of this much used point combination is to relieve wheezing and to abate phlegm from the chest and respiratory tract. It is therefore used in cases of asthma with excessive phlegm or bronchitis, or any other lung disease characterized by much phlegm and difficult breathing.

Point discussion Dingchuan is an extra point located 0.5 cun lateral to the lower end of the spinous process of the 7th cervical vertebra. It is mainly used to stop wheezing and dyspnea and indeed, its effect is, in most cases, very dramatic. Dingchuan belongs to the Hua Tuo Jiaji points, named after the great Chinese physician who discovered them. Hua Tuo lived in the Han period, during the reign of the Emperors Shun (136 141 AD), and Huang Di (208

AD). The Jiaji points are located 0.5 cun from each vertebra, bilaterally. The Ding Chuan point, being so effective in treating difficult breathing, has won a unique name of its own. Dingchuan is also effective in treating urticaria, which is an allergic skin disease, often related to lung disorders. Dingchuan has a remarkable effect on bronchodilation, and relieving spasm of the bronchial branches. It is less effective in clearing the phlegm from the respiratory tract, and therefore it makes a first choice point in the case of acute asthmatic attack. Tiantu was discussed broadly under case number 9. Its indications are:  To disperse the lung.  To resolve and lower phlegm.  To regulate Qi.  To clear and reduce fire in the throat.  To stop cough.  To soothe asthma.

We can see that it is a very suitable point in all cases involving cough, asthma, excessive phlegm, etc. Tiantu is an important point on the Jen Mai, the vessel of conception. This vessel is the "reservoir" of all Yin energy in the body and therefore, one of its chief concerns is to regulate body fluids. Sedation of point Tiantu, may disperse accumulations of fluid, of which phlegm is one phenomenon. In order to perform this adequately via the Jen Mai, it is appropriate to "open" the Jen Mai by stimulating stimulating Liehchueh (L7) which serves as its master point, at the same time. Tanzhong, another point of Jen Mai, was also discussed in this paper, under case number 8. Besides playing a role in Jen Mai functioning, as described above, Tanzhong serves as the master point of all activities taking place in the chest and upper Jiao. Because of this, its major indication is to "regulate Qi in the chest,," and to

"relax, expand and dispel fullness from the chest". Another indication, much like the former point Tiantu, is: "To clear the lungs and resolve phlegm." Tanzhong is also considered the Mu (alarm) point of the Upper-Burner, as much as Zhongwan (CV 12) is of the Middle-Burner and Yinjiao (CV 7) of the Lower-Burner. Because of this role, Tanzhong is responsible for regulating Qi and blood in the Upper Burner and resolving any forms of stagnation there. The Qi collected in the chest is Zong Qi, and is the refined Gu Qi ("grain" Qi) which ascends as the essence of food, by the activity of the spleen. This Qi is responsible for the functioning of the heart and lung, including the Qi control over the blood. This Qi also dominates the voice and enhances blood circulation in the extremities. The place where Zong Qi gathers and acts in the chest is called "Sea of Qi", and Tanzhong is the point responsible for its activities (64). One of the commonest stagnations in the body and especially in the chest, is phlegm. By utilizing Tanzhong we activate Zong Qi, enhance its flow in a circular fashion in the chest and thus disperse phlegm. Neiguan has also been discussed in this work (See case number 6). It is considered the most powerful point of the pericardium meridian and is also its Luo point. Neiguan's functioning is closely related to the chest and diaphragm, mainly because of the route of the pericardium channel which traverses the chest, along with its Luo channel that connects with the heart. The function of Neiguan which relates to the chest says: "It expands the chest, regulates Qi circulation and stops pain." In this regard Neiguan's function is very similar to that of Tanzhong, as it improves Qi circulation in the chest, an activity which also disperses phlegm. ph legm. Fenglong is the connecting Luo point of the stomach meridian. The point connects with the spleen meridian which is the stomach coupled meridian in the Yin Yang relationship. The spleen, when malfunctioning, is considered the source of phlegm in the body. By stimulating Fenglong one restores harmony between the stomach and spleen, readjusts their functioning and, in this way, eliminates phlegm.

Fenglong's qualities are therefore:  It resolves phlegm, dampness and Phlegm Heat.  It calms and clears the mind.  It eliminates Phlegm Fire in the stomach.

Due to these qualities Fenglong is a very important point in any case where phlegm is abundant and that, of course, includes asthmatic conditions. These five points are combined, as we can see, in order to have a strong effect on phlegm accumulation in the respiratory tract. The points which were chosen share a mutual quality of phlegm abatement and regulating the Qi of the respiratory organs. The power and great efficacy of this combination is due to the fact that the points which were combined here belong to different systems thus, dealing with the problem from different angles. Dingchuan, for example, exerts its influence through the nervous system, directly on the trachea and the bronchus and relieves their spasm. Tiantu, achieves its main effect by eliminating phlegm from the trachea. Tanzhong affects the lungs and the bronchioles by eliminating phlegm and adjusting their function. Neiguan plays its role as a distant point that regulates from afar, the whole chest organs  function and last but not least, Fenglong deals with the very source sour ce of phlegm and abates it systemically. systemically.

Needling sequence, manipulation and stimulation In this point combination the needling procedure generally starts with Dingchuan, in a sitting position. The patient bends forward with his arms crossed beneath his forehead and then, Dingchuan is punctured 0.5 cun medially slanted, slightly below both sides of the prominence of seventh cervical vertebra. After needling, the point is manipulated in dispersion for 2 3 minutes. Usually the patient experiences an immediate relief from wheezing and dyspnea. After 5 15 minutes, the patient's position is changed to supine, and the rest

of the points are needled in this order: Neiguan, Tiantu, Tanzhong and Fenglong. All the points are needled to sedate and disperse phlegm. When it is desired to accentuate the needle sensation, the technique of "wagging the tail" is utilized (65). By this technique, after obtaining Qi, the needle handle is "wagged" back and forth, until the patient senses a strong reaction along the meridian. This procedure is said to move the Yang Qi and by so doing to disperse phlegm stagnation. In the case of children, Tinatu is usually removed after Deqi, whereas with adults the needle may be left in situ during the whole treatment. The procedure of "wagging the tail" may be performed on Neiguan, if the patient is robust enough to endure it, and on Fenglong as well. However, attention must be paid to avoid a strong reaction which might occur after the treatment. In some patients, Fenglong has a strong impact on phlegm movements in the body, and this may aggravate their condition at the beginning of the treatment. It is advisable in such cases, to instruct these patients to keep using their "Western medicine" broncho dilators until their basic condition has been significantly improved. It has been observed that scarring moxibustion is also very effective in stubborn asthma. The points suitable for this technique, from among this combination's points, are Neiguan, Tanzhong and Fenglong. In order to perform this correctly, a tiny cone of white moxa is placed over the point, preferably after needling it and burned to its end. Immediately afterwards the procedure is repeated, with slightly larger cones, on the same spot, three to seven more times. There are some specific ointments which may be utilized to heal the wound, after pus exudates. One of them and a very good one too, is the "Red Jade Ointment" (66), in the case of a serious wound, or simply egg white, for a relatively mild wound.

Herbal equivalent This point combination may be compared to the following herbal formula:  Semen Pruni Armeniaca (Xing Ren)  Fructus Perilla Frutescentis (Su Zi)

 Bulbus Fritillaria Thunbergi (Zhe Bei Mu)  Rhizoma Pinellia Teranta (Ban Xia)  Radix Cynanchi Stautoni (Bai Gian)  Stalactitum (E Guan Shi)

This herbal prescription is a combination of herbs that have an effect on cough due to rebellious Lung Qi, and accumulation of phlegm. One component though, is E Guan Shi which is a mineral, and has a general effect on strengthening Yang and transforming phlegm. It may be compared to point Fenglong, even though it does not affect the spleen directly. In order to achieve a more straightforward effect on strengthening the spleen and thereby resolving phlegm, it is suitable to add to the formula herbs such as Codonopsis Pilosula (Dang Shen), or Radix Glycyrrhiza (Gan Cao), b oth of which tonify the Qi via the spleen and also, have the effect of reducing phlegm. Xing Ren may be compared to both Dingchuan and Tiantu in its ability to stop wheezing and redirect Lung Qi downward. Su Zi is used to stop wheezing and dissolve phlegm. It is mainly used when copious phlegm obstructs the air passages. Zhe Bei Mu is also suitable for the same indications, only it is more appropriate for dealing with heat in the lungs, as well. Ban Xia and Bai Qian are both used to treat wheezing and cough due to rebellious Qi and phlegm.

Case history Mrs. M., age 36, suffered since childhood from severe hay fever and urticaria on her upper back and shins. Two years prior to her visit in my clinic, she began to experience occasional asthmatic attacks, until this condition became permanent. Mrs. M. had a "barking" cough and wheezing and congested chest, with a sensation of lodged phlegm which could not be expectorated.

Her pulse was very soggy and slippery. Chi position was not palpable at all, and the pulse of her lungs was small and hard. Her tongue was pink pale, wet and scalloped; the coating was white and damp. On evaluating the different aspects of this information, I came to the conclusion that Mrs. M. was on the verge of an externally inflicted disease turning into an internal disharmony. The history of many years of stubborn hay fever, along with the wet and white coated tongue, pointed to an external Damp, and probably Cold origin of the problem. The Slippery and Soggy pulse, along with the scalloped tongue, suggested a weak spleen and accumulation of dampness and phlegm. The congested pulse on the right cun position with chest stuffiness and wheezing, demonstrated a concentration of phlegm in her chest, probably phlegm which had become too viscose to allow itself to be expectorated. The point combination above was, therefore, utilized, in order to act directly on the phlegm, disperse and eliminate it. Point Neiguan was intermittently switched with the couple Hegu (LI 4) and Liehchueh (L 7). This couple has already been discussed several times in this work. (See Chapter B, paragraph III, case history number 9.) Here it was chosen for its marked effect on redirecting rebellious Lung Qi and eliminating stagnation in the upper respiratory tract. It is interesting to note here that whenever Mrs. M. had come to the treatment demonstrating dyspnea and wheezing, point Dingchuan, manipulated in the fashion described above, had, in five minutes, relieved her symptoms completely. After five sessions only, the urticaria and the itchy skin have both disappeared. Her asthmatic condition improved gradually, and after ten treatments Mrs. M. reported that she had no further dyspnea nor wheezing. I then changed her prescription in order to place an emphasis on the "BIAO" the root of her bodily condition. The principle was to tonify both lung and spleen Qi, strengthen Wei Qi, while still occasionally using points that

release exterior conditions, such as: Fengmen (B 12), Fengfu (GV 16) etc. Today, after one and a half years, Mrs. M. suffers no more from either asthma or urticaria. She nevertheless has, even though to a much lesser extent, occasional hay fever attacks. It is very important, during the course of such treatment, to emphasize to the patient the importance of avoiding phlegm, or damp producing foods. These would be especially milk products, sweets and very sweet food, overly greasy food, fried food with much oil, and salt. It is no less important to stress the essential role of physical exercise and breathing techniques.

12. NEIGUAN (P 6), ZUSANLI (ST 36), ZHONGWAN (CV 12)

Main effect and clinical purpose This point combination is the basic and most fundamental prescription for all stomach complaints. Its action is to regulate and harmonize Stomach Qi, resolve gastric stagnation of any kind and redirect the rebellious Qi of the stomach. It is therefore mainly used for gastric pain of different etiologies, nausea and vomiting, such as in the morning sickness syndrome.

Point discussion Neiguan is one of the most popular points in clinical practice. It is very often encountered in treatments and it has a broad spectrum of indications. This is

the third point combination in this work in which Neiguan is present. Under point combination number 10, we have already mentioned that Neiguan is one of six points considered "Main Points" in the classics. There, its indications say: "Take Neiguan for the heart and thorax." Actually, the two main organs that Neiguan is so much effective for, are the heart and the stomach. The influence that Neiguan exerts upon the stomach is reflected in its indications list: "To promote the function of the stomach, and regulate the Middle-Jiao." Neiguan is also used as an important point to regulate the heart and calm the mind. It is therefore used extensively in cases of anxiety and palpitations, etc. The fact that Neiguan is so helpful in these conditions, is probably due to its role as the Master point of the extra vessel Yin Wei Mai. This extra vessel is used primarily to treat emotional problems related to deficiency of Yin Qi and blood. It is a vessel that binds all the Yin meridians and controls the heart functioning, in relation to blood (67). Neiguan, as its Master point, is situated on the Chuehyin segment, which is the hinge of the Yin, and thus controls the Yin. In order to have an effect on blood production, so as to tonify the heart functioning, Neiguan must regulate Stomach Qi in order to permit the stomach and spleen to produce blood. Its coupled point in the Yin Wei Mai meridian, Gongsun (SP 4), actually complements Neiguan's influence upon the stomach due to its role as the connecting Luo point between the stomach and the spleen. Thus, Gongsun has a tonifying effect on the spleen, it pacifies the stomach and it regulates the Chong Mai, of which it is its Master-point. In summary, Neiguan has a regulating and tonifying effect over the stomach, due to its manifold connections with other vessels in the body. Zusanli is the lower He Sea point of the stomach. It is also called the Fissural point and its action is described in the Ling Shu as follows: "They (Fissural points) refer to the deep regions where the energy of the meridians gathers together, and they are more effective in relieving acute pain in the traveling regions of the related meridian, and also in the internal organ to which the meridian in question belongs."

Zusanli is also one of the "Six Main Points" of the classics described before and is indicated there for all diseases located in the abdomen and belly. As the lower He Sea point of the stomach, Zusanli adjusts the function of the stomach and spleen and is used as the major point to tonify the spleen. It is often used in conjunction with point Taiyuan (L 9) to tonify the Qi of the whole body, as the source of post natal Qi are the lungs and spleen. Zusanli also regulates the circulation of Qi and blood and tonifies anti pathogenic Qi in the body. In all stomach diseases it plays the most important role and is used to strengthen conditions of deficiency, as much as to sedate excess. Zhongwan is the Alarm Mu point of the stomach. It is also used in all stomach syndromes, both xu and shi. It regulates Stomach Qi and is therefore used in painful syndromes or nausea and vomiting. It relieves food stagnation and treats indigestion, abdominal distension and the like. It is also used to tonify the stomach and spleen and therefore treats anorexia, anemia, chronic diarrhea, etc. Zhongwan relieves abdominal pain and is used to treat gastric ulcers and gastrodynia of various etiologies. Zhongwan is also a confluent point of all the Fu organs and exerts its influence on all their activities. It is known, for instance, that the intestinal rhythm, or peristalsis, affects the stomach function and vice versa. Zhonwan, as the meeting point of all the Fu organs, is thus used to harmonize and regulate the peristalsis of the stomach and intestines. After analyzing the three points' functions, it is obvious now how these three points have a regulating effect over the stomach. It is important to bear in mind, however, that this is a very fundamental combination, despite its great efficacy. It is necessary, as a rule, to add other points to this trio, according to the various manifestations of the gastric stagnation. In order to further elaborate on this, let us take a few examples: 1. If we have diagnosed a gastric stagnation due to food and heat accumulation, it would be appropriate to add: Neiting (ST 44) and Weishsu (B 21). 2. If the stagnation is due to liver Qi invading the spleen, we may add: Taichong (LIV 3) and Changmen (LIV 13).

3. Or, in the case of phlegm accumulation: Fenglong (ST 40) and Yinlingchuan (SP 9) and so on.

Needling sequence, manipulation and stimulation Neiguan, as the Master-point of Yin Wei Mai and a distant upper point, opens the treatment by its regulating effect over the chest and abdomen. It is mostly proper to do so when nausea and/or vomiting exist, due to Neiguan's calming effect and its ability to diminish nausea. In Shi syndromes it is manipulated with lift thrust and twirling movements. In case number 6 we have stressed the very distinct Qi sensation of this point. It is important to direct this sensation in proximal direction (in contrast with case number 6 which was a distal direction). This may be done by pointing the needle tip in a proximal direction and gently massaging the route of the pericardium channel, from the needle upward (68). Zhongwan is then needled to produce a sore or tight sensation, usually in waves encircling the point. It is manipulated in the same way as Neiguan, with one difference. This is a point which "loves" heat stimulation and reacts extremely well to it. Thus, in cases where cold is the cause of disease or one of its manifestations, this point may be stimulated by all forms of moxa applications (which were discussed earlier in this work). Also the application of a moxa-box is recommended. This is a perforated metal box with a handle, in which moxa is lit until it gets hot. Then it is placed over the point, after a piece of gauze has been placed between the body surface and the instrument (69). In cases of nausea or heartburn, the needle tip at Zhongwan may be pointed downward, so as to redirect Somach Qi. In cases of prolapsed stomach due to Yang deficiency, the needle tip should be pointed upward and Zhongwan is stimulated by heat. Zusanly is also manipulated in the same fashion as Neiguan, only it is more difficult to cause its sensation to travel proximally. It is also not necessary, as it may sometimes aggravate the patient's condition. Quite often, also Zusanli is stimulated by moxa.

Herbal equivalent A proper herbal equivalent for this point combination is the following prescription:  Pericarpium Citri Reticulata Chen Pi  Cortex Magnolia Officinalis Hou Po  Rhizome Atractylodis Cang Zhu  Fructus Citri seu Ponciri Zhi Shi

This, too, is a basic prescription to regulate stomach and spleen Qi. It is used for epigastric and abdominal fullness, distension and pain from stagnant Qi and it treats nausea and vomiting due to rebellious Stomach Qi. Chen Pi moves stagnant Stomach Qi and tonifies Spleen Qi. It also redirects rebellious Stomach Qi and is used for any type of nausea and vomiting. In addition, it is an important herb to treat coughing due to excessive damp and phlegm originated by the spleen. Hou Po also moves the stomach stagnant Qi, redirects rebellious Qi with symptoms of nausea and vomiting and just like Chen Pi, it dries dampness and transforms phlegm. It thus complements Chen Pi, and accentuates its action. Cang Zhu too has more or less the same qualities, with the addition of tonifying the spleen. It is therefore used also for anorexia and diarrhea caused by weak spleen. Zhi Shi breaks up stagnant Qi and reduces accumulations and it deals therefore more adequately with the painful symptoms of stagnant stomach Qi.

Case History No. I Miss K. was ten years old when her parents brought her to see me on emergency call. Prior to her visit she had been hospitalized for one month in the paediatric In Patient department of Rambam Hospital, Haifa, but her condition did not improve.

Miss K. suffered acute gastrodynia with occasional nausea. Her epigastric region was very tender, her face very pale and she appeared very emaciated and in great pain. Her pulse was fast and her tongue had red points on its tip and both sides. I diagnosed her condition as a stagnation of Stomach Qi due to irregular eating habits and emotional problems. This conclusion was reached after an interrogation, during which her parents admitted the facts. She did not have the food stagnation signs, neither phlegm, nor blood stagnation. I applied the point combination with the addition of Liangqin (ST 34). Liangqin is the Xi Cleft point of the stomach. It is applied in cases of acute pain in the organ to which it is associated. All the points were manipulated in the regular sedation technique. During the first few treatments Miss K. experienced pain relief which sometimes lasted for a few hours after the treatment. After nine treatments, which were carried out over the course of eleven days, her problem was resolved completely. One year after the termination of the treatment there has been no recurrence of symptoms.

Case history No. 2 Mrs. G., age 37, married plus four children, was in her seventh month of pregnancy when she came to see me. Since the beginning of her contemporary pregnancy she had suffered severe nausea and vomiting. Since her fifth month she had been experiencing lassitude, anorexia, heartburn, vomiting and nausea. Furthermore, Mrs. G. complained of dry mouth, especially at night in addition to constant thirst and craving for fruit. In addition she felt abundant phlegm in her throat. Her pulse was very slippery and her tongue was scalloped. In this case, a Stomach Qi stagnation was also present, but the pattern was more complex.

In the first place it was obvious that her spleen and stomach were not in harmony. There were symptoms such as lassitude, anorexia and phlegm, along with a scalloped tongue, suggestive of Spleen Qi deficiency. On the other hand, her Stomach Qi was rebellious, she had heartburn, vomiting and thirst, all of which indicated a Shi/Hot stomach. The deficient condition of the spleen gave rise to abundant phlegm, a Shi pattern, which aggravated the situation of the patient. Thus, we could see that she was constantly thirsty and craved for fruit (a very Yin food. At the same time she was anorectic and nauseous because of phlegm stagnation in her stomach. It is very common, of course, to see nausea and vomiting in pregnant women. The T.C.M. explanation for this phenomenon is the heavy burden that pregnancy exerts upon the spleen and kidney. Both organs play a major role in the production of blood and Yin, essential substances for conception and maturation of the foetus. This burden weakens the spleen and kidney, giving rise to abundant phlegm and the weakening of Stomach Qi (70). The prescription for Mrs. G. included the point combination with the addition of the following points: Tiantu (CV 22) and Fenglong (ST 40) to reduce phlegm in the throat and in the whole body. The mutual functioning of these two points was already explained in the previous combination of points, number 11. In addition, two other points were also added: Neiting (ST 44), and Gongsun (SP 4). Neiting in order to decrease Stomach Heat and stagnation, and Gongsun, as the Luo connecting point of the spleen, to shift excess energy from the stomach to the spleen. symptomatically, Gongsun is capable of relieving nausea and it thus aids in the overall action of the point combination. It is important to note here that Zusanli was manipulated gently in tonificaiton, whereas the other points were manipulated in sedation. As Mrs. G. was somewhat frightened and sensitive to the treatment, the manipulation of the needles, even in sedation, was carried out rather gently. Mrs. G. felt much better immediately after the first session. After the third session, she had significantly less phlegm, her nausea and vomiting subsided and she felt much stronger.

The whole treatment lasted three weeks after which Mrs. G. felt that she had regained full strength. she gave birth in due time, without any complications and in good health.

13. CHANGQIANG (GV 1), CHENGSHAN (B 57), PAIHUI (GV 20)

Main effect and clinical purpose

This point combination has indeed a long history. The first two points, Changqiang and Chengshan, were already mentioned as a combination 500 years ago, in 1529, by the physician Gao Wu in his Bai Zheng Fu (Ode of a Hundred Syndromes) (71). This is the basic formula for treating hemorrhoids of any aetiology. This combination treats hemorrhoids symptomatically, including bleeding and prolapse, but it may need additional points in order to effectively treat the underlying cause of the hemorrhoids.

Point discussion Changqiang is the first point of the Du Mai channel and is also the connecting Luo point of Du Mai and Jen Mai. on its route, the Du Mai encircles the anus and then climbs up the spine to the brain and emerges at the vertex, at point Paihui. Due to its course, this channel is also associated with diseases of the anus, such as hemorrhoids.

Hemorrhoids, in most cases, is a Shi phenomenon, associated with inflammation and bleeding of the rectal area, causing veins there to bulge out and cause sharp pain. In most cases the disease involves heat symptoms such as redness, acute pain, bleeding and a burning sensation. In some cases dampness also exists when there is pus involved, diarrhea and a heavy sinking sensation. In some other cases the most salient etiology is a spleen Qi deficiency, an etiology that may also cause bleeding, prolapse and diarrhea, but then the symptoms will not be so acute, rather more chronic. In any case, even on the basis of a Spleen Qi Xu condition, a Shi condition may arise, including the previously described symptoms and signs, a condition which is both severe and acute at the same time. In order to drain excess from the rectal area and from the Du Mai, there are three main techniques: 1. Puncture in sedation the point Changqiang which is the Luo point with the Ren Mai, and thereby, to transfer excess from Du Mai to Ren Mai and disperse the stagnation in the rectal area. By doing so, we also take advantage of the fact that Changqiang too is a local point, situated in the rectal area and affecting this area symptomatically. 2. Any extra meridian, including the Du Mai, may be "opened" and drained by simultaneously puncturing two points, one at each end. Thus, puncturing Changqiang and Palhui simultaneously, would drain the excess and harmonize the Governing Vessel. 3. It is also possible to drain excess energy from an extra meridian by puncturing its master and coupled points. In this point combination, both techniques No.1 and No. 2 are u tilized, making use of two possible methods to drain the excess from the Du Mai and to resolve the hemorrhoids problem. Considering the facts mentioned above, it is no wonder that one of the main indications of Changqiang, is to treat hemorrhoids and prolapsed anus. Its traditional functions quote: "To regulate and remove obstruction from the Du Mai and Jen Mai, to promote the functions of the intestines, to treat hemorrhoids and rectal prolapse . Chengshan is a point located on the bladder meridian and is the first choice symptomatic point to deal with hemorrhoids. The bladder meridian traverses the anal region and therefore affects it.

Chengshan has an effect over all the Yang organs. Its indications are: 1. It regulates the Qi of the Yang organs. 2. It benefits hemorrhoids. Since hemorrhoids are situated on the "outer gate" of the large intestine which is a Yang organ, and because the bladder meridian itself connects with the same "outer gate", it is not surprising that Chengshan exerts such an influence over the anus. Paihui ("hundred meetings") is the highest point on the vertex. Pictorially it constitutes the other end of the body  in relation to Chengqiang. This point is used in the formula for two reasons: 1. It is located at the other end of the Do Mai channel and is thus used in conjunction with Chengqiang to drain this channel from excess. This function has already been explained above. 2. Paihui is the crossroad point on the vertex for all the Yang channels and it has the function of strengthening Yang, and elevating Qi. It is also known to raise the sinking Qi of the spleen and by this, arrest bleeding and raise prolapsed organs (72). It is important to remember here that the spleen is responsible in T.C.M. thinking, for the functions of "holding the blood in the blood vessels" and "keeping the organs in their places". Therefore, functional bleeding or prolapse of organs such as: rectum, uterus, stomach, etc., are attributed to Spleen-Qi Xu, and/or Yang Xu. It should be obvious by now how these three points together have a common calming effect on the hemorrhoids. Nevertheless, as with almost any other point combination, an assessment of the etiology and energetic manifestation of the hemorrhoids must be made. This done, a comprehensive formula may be built, utilizing also other points in order to deal effectively and holistically with the disease. To illustrate this more clearly, here are a few examples: 1. In chronic hemorrhoids due to spleen and kidney deficiency, Taibai (SP 3), Taixi (K 3), Sanyinjiao (SP 6) may be utilized in tonification. (Palhui too in tonification) 2. When damp and heat coexist, it is possible to add: Dachangshu (B 25), Chengfu (B 50), Quchi (LI 11) and Erbai (extra).

3. If massive bleeding is predominant, it would be appropriate to use: Yinbai (SP 1) in direct moxibustion, Xuehai (SP-10) and Qihaishu (B 24).

Needling sequence, manipulation, and stimulation In acute cases involving pain, it is usually recommended to begin the treatment with a distant point, manipulated in dispersion. In this case Chengshan is the appropriate point. It is very important to locate Chengshan accurately and then, manipulate it in a small amplitude by the pull thrust sedation technique. In cases of severe heat, it is advisable to utilize the "Cooling the sky" technique on Chengshan, until a cooling or numb sensation is achieved near the point or around the hemorrhoids. Next point is Chengqiang. This point is somewhat problematic, as many practitioners are reluctant to use it because of its anatomical location. Still, this is a very important point and the patient should be told to wash the region properly before coming to the clinic. The needle may be inserted there perpendicularly and manipulated by twirling movements after deqi has been obtained. Paihui is needled last. It is either needled in a posterior direction, or from the left to the right if the patient is lying on his stomach and his right cheek on the bed. In a sinking hemorrhoidal condition, after the heat and inflammation have subsided, moxa may be applied after needling, usually with the warming stick method. This moxibustion further enhances the raising of spleen Yang Qi thus, contracting the hemorrhoidal tissue inside. The same procedure, though, may be executed with Jenchueh (CV 8) which possesses the same quality.

Herbal equivalent Radix Sanguisorba (Di Yu) and Flos Sophora Japonica (Huai Hua Mi) are usually used together for hot and bleeding hemorrhoids. Both of these herbs

belong to the category of herbs that arrest bleeding. Both of them also cool the blood and are therefore suitable for ulcerations, burns, and similar skin problems. DI Yu, in addition, clears heat and promotes healing and is suitable for external application on such skin problems. In addition, it is common to find in a formula for hemorrhoids herbs that treat Damp Heat conditions such as Scutellaria Baicalensis (Huang Qin). This herb also enters the large intestine meridian and is used for Intestinal Wind which is blood in the stools and for intestinal abscess. Herbs like Corydalis (Yan Hu Suo) that invigorate the blood and stop pain, may also be found in such formulae. Minerals such as Succinum resin (Hu Po) which is ground Amber, is also suitable, due to its ability to reduce swelling and promote healing of ulcerations, carbuncles and swollen scrotum. In comparison with point Paihui, Radix Astragali (Huang Qi) may perfectly fit in. This herb has the function of raising the Yang Qi of the spleen and thus, it is used in prolapsed syndromes, or bleeding, due to deficiency. It is a warm herb, it tonifies the spleen and the lung, and it may be added to a herbal formula that treats prolapsed anus with hemorrhoids or sinking bleeding hemorrhoids.

Case history Mrs. M., age 42, suffered for several years from recurrent bleeding hemorrhoids. Her recent attack, which she defined as the severest of them all, had caught her abroad, on vacation. Various medicines prescribed for her were not of much help and she came to me suffering great pain and discomfort. Despite the fact that Mrs. M. was a physical fitness teacher, she was slightly obese. When asked to describe the pain, she said that it had been a sharp pricking pain, with a sensation of heaviness and sinking. Her pulse was Soggy, but Big in the Cun position. Her tongue was scalloped, somewhat purplish blue, and covered with many red points around the tip. It also had a thin yellowish layer.

As was evidenced by actually all the symptoms and signs, her case was a Damp Heat stagnation in the rectal region, plus a pre existing spleen Qi Xu pattern. A soggy pulse and scalloped tongue are basic qualities which point out a weak spleen condition. The red points on the tongue and the yellowish cover, exhibit a Damp Heat condition. The Big pulse, that had a Soggy quality as well in the Cun position, also showed a damp excessive condition in the domain of the large intestine. Her symptoms clearly matched those signs thus, she exhibited a case that "goes with the current". This is a Chinese saying that suggests that whenever the signs match the patient's symptoms, the case may respond well to the treatment (73). Mrs. M. was treated twice a day by the following formula: Chengshan (B 57), Changqiang (GV 1), Quchi (LI 11), Huiyang (B35). Quchi was introduced in the formula in order to treat heat and damp in the large intestine in general, as did Huiyang, locally. On the second day the pain decreased markedly and on the third day Quchi was substituted by Paihui (GV 20). After five more daily treatments with the revised formula, Mrs. M. was completely cured.

14. SHENMEN (H 7), NEIGUAN (P 6), YINTAMG (EXTRA), SANYINJIAO (SP 6)

Main effect and clinical purpose

Many points and combinations exist in acupuncture for the purpose of relaxing the nervous system. This combination, however, is probably the most renowned for this purpose. It is used to relax the heart and calm the Shen, relieve tension and anxiety and treat insomnia.

Point discussion Shenmen, which is the Yuan Source point of the heart h eart channel, is the most effective point used to relax the nervous system. Here, both clinical observation and theoretical background support each other and prove validity. According to the T.C.M. theory, the Shen-Spirit, resides in the heart. This means that any emotional disorder that one may encounter, will probably have its impact upon the heart system. This may also mean, that illnesses of the heart organ or the heart meridian, may influence the Spirit (74). Classical problems of the Spirit, according to T.C.M. are: insomnia, tension, anxiety, excessive dreaming, forgetfulness for the light problems and, for the more serious: s erious: hysteria, insanity, delirium, etc. Shenmen, as the Yuan source point of the heart meridian, is connected via the Yuan energy, directly to the heart. It is also considered the most important point on the heart channel. Its indications are: 1. To calm the Spirit. 2. To regulate Heart Qi. 3. To remove obstruction from the Jing Luo. Thus, besides being used to supplement heart Qi or to tonify Heart Blood or Yin, Shenmen is broadly used in all problems associated with the Spirit. It is believed in T.C.M. that when the heart lacks blood, b lood, there is restlessness, insomnia and palpitations. These symptoms arise because of shortage o f Yin energy that causes the heart Yang, or Fire, to flare up. To subdue this, Shenmen is utilized to "cool the heart", or sedate its fire, while, at the same time, other points are used to tonify the Yin and blood. By doing so, the harmony is restored and Yin and blood provide the substantial basis for

heart Yang. Neiguan has been discussed several times in this paper and there is no need to elaborate further. In this case, it was chosen because of its traditional function to tranquilize the heart and calm the mind". In addition, clinical practice demonstrates that Neiguan makes a very good couple with Shenmen, mainly because it is the most important point on the pericardium channel, an organ closely related to the heart. Thus, each of these two accentuates the other point s function of calming the Shen and relaxing the heart. Yintang is an extra point situated on the route of the Du Mai meridian, exactly between the eyebrows. Its indications in the classics are firstly to eliminate Wind Heat and secondly, to calm the Spirit. It is therefore used for rhinitis, sinusitis, headache and other Wind-Heat induced problems. As for its second indication, Yintang is often used for insomnia or restlessness. Traditionally Traditionally the point is situated where the mystic "third eye" is located. This "third eye" is the "window of the soul", and mysticism attributes great mental powers to those who are able to use their "third eye". Modern researchers have found that the stimulation of this point has an effect on producing electrical Alpha waves in the brain. The Alpha waves are typical of a state of deep sleep or meditation. There are even acupuncture laser stimulators that have a special switch for Alpha wave form, and the practitioner is instructed to stimulate point Yintang using this wave length (75) in cases of nervous tension, insomnia, etc. Sanyinjiao was discussed under combination number 1 of this work. It is one of the most important and frequently used acupuncture points. It is also a member in the previously discussed "Six main points" category. In this point combination it was added in order to balance the treatment treatment (please refer to Chapter B, paragraph IX). Sanyinjiao is perhaps the most frequently used point to tonify Yin Qi. It is the meeting point of the three leg Yin meridians: the kidney, liver and spleen and it has the effect of stimulating them all.

Due to its effect on the Yin in general g eneral and on these three organs in particular, Sanyinjiao Sanyinjiao is a major point to tonify the blood too. Taking into consideration the role that these three organs play in regard to the blood functioning, we can understand the importance of Sanyinjiao in relation to the blood. The kidneys are associated with blood production by ruling the bone marrow (Jing), where blood is created. At the same time, the kidneys provide the Yuan Qi for the spleen in order to produce blood. This Yuan Qi plays a major role also in the area called: The Sea of Qi under Tanzhong (CV 17), where blood is produced by the mutual energetic cooperation of the heart and lungs in the Upper Jiao. The spleen rules the creation of blood from the essence of food digested in the stomach. Thus the volume of blood is most dependent on the spleen. The liver stores the blood and rules its movement and distribution, due to its Qi sprinkling activities (76). Thus, point Sanyinjiao plays a role in supplementing deficient blood and in circulating and invigorating stagnant blood. We must keep in mind the most frequent causes of insomnia and restlessness, mentioned mentioned in relation to point Shenmen (H 7), in this combination. The "Heart blazing Fire", or "Heart Yang Shi", is due to, or in continuum, with Heart Yin Xu or Heart Blood Xu. In either case, Sanyinjiao is utilized here to supplement both Yin and blood and thereby to reduce, or eliminate, Heart-Fire. This point combination is constructed of three points that have a mutually assistant action on calming the Shen by reducing Heart Fire and regulating its activity. The fourth point gives the balance to the formula, by acting directly on the cause of the disharmony. On this very principle many other point-combinations have been developed, especially points that reduce Heart Fire on the one hand and points that supplement Kidney Water on the other hand. Such combinations are:

 Tongli (H 5) Dazhong (K 4)  Tongli (H 5) Zhaohai (K 6)  Shenmen (H 7) Taixi (K 3) (77)

Needling sequence, manipulation and stimulation Shenmen and then Neiguan are needled first. These two points have the strongest and fastest response, and they are used to calm the patient as quickly as possible. Both points are generally used in sedation. In cases of too weak or anxious patients, the stimulation should be mild, and skilful needle technique is important in order to cause minimal pain to the patient. Yintang is then needled in the same manner, and at last, Sanyinjiao, in tonification. It is not necessary in this combination to cause a propagated needle sensation, as there is no specific area of discomfort or pain. It is enough to suspend the needles in situ after Deqi has arrived, without further manipulation. When this combination is utilized for insomniatic patients, it is recommended to retain the needles for 30 40 minutes, and the treatment should be conducted as close to bedtime as possible (78).

Herbal equivalent There are many herbal prescriptions that deal with an unquiet heart and troubled spirit. There are even two categories of herbs that deal directly with these symptoms. One category is of herbs that "nourish the heart and calm the spirit" and the other is, "substances that settle and calm the spirit". The prescription that I have chosen to parallel this point-combination is constructed of four herbs. Two herbs that have a calming effect on the spirit. They simultaneously nourish the heart and regulate its function. The third herb, has a direct effect on calming the spirit and the fourth herb tonifies blood and Yin.

The herbs are:  Radix Polygale Tennifolia Yuan Zhi  Semen Ziziphy Spinosa - Suan Zao Ren  Sclerotium Poria Cocos - Fu Shen  Radix Rehmania Glutinosa Shu Di Huang.

Yuan Zhi is used to calm the spirit and facilitate heart function and is used mainly for nervous tension, anxiety and emotional problems hindering the heart function. Suan Zao Ren also calms the spirit, but, in addition, it nourishes the heart blood and Yin. Fu Shen is a fungus similar to Fu Ling, but it envelopes the root and is considered better for calming the spirit. Shu Di Huang is a widely used herb to tonify both Yin and blood in general, and it is used here to supplement the Yin substance for the heart function. Thus, the mutual action of Yuan Zhi and Suan Zao Ren is very similar to the action of points Shenmen and Neiguan. Fu Shen may be compared to Yintang, especially when even its name Fu Shen (Tockahoe Spirit) implies its influence upon the spirit (Shen). Shu Di Huang in this formula imitates the role of Sanyinjiao and its effect upon blood creation and Yin tonification. The whole formula is therefore effective in the treatment of: insomnia, dream disturbed sleep, anxiety, palpitations, weakness and anemia, forgetfulness, disorientation and lightheadedness and the like.

Case history Mrs. C., age 31, gave birth to her only child three years ago, after six years of sterility. She had been treated for her sterility with hormones and did not feel well during the course of the treatment. A year after she gave birth, she had suddenly experienced palpitations, pain in her left chest, left arm and left leg, lassitude and anxiety.

Since that time and for the last two years, her condition had not improved, despite different tranquilizers that she had been prescribed and sessions of conversations with her psychiatrist. Lately, she started having headaches in her temples and her vertex. Mrs. C. had a very fast pulse (around 110), of choppy and wiry quality. The Cun position was soft and thin and weak, on both wrists. Liver position was choppy and wiry. Kidney position was choppy and wiry and weak. Her tongue was purplish red, but underneath was pale. It was very flabby and the lung area showed small cracks. The tip of the tongue was red and had red pimples. However, it was moist, not dry. Mrs. C. had a pale complexion with red cheeks and in general, she had a thin and fragile figure. Her voice was low and weak, almost a whisper. On her first examination I measured her blood pressure which was 110/75 Hg. It was very obvious that Mrs. C. had a depletion of Yin and blood and deficiency of Qi, in general. This conclusion was reached owing to her weak  appearance, pale complexion and thin, choppy pulse. As a result, she obviously had a heart Yin/blood Xu condition, with a subsequent blazing of Heart Fire. This was evidenced by the fast pulse, palpitations, anxiety and red cheeks. The long period of Yin deficiency, led eventually to an ascending Liver Yang, which gave rise to the recent headaches. Furthermore, I suspected that blood stagnation was developing, relying on her choppy pulse and the red pimples on her tongue tip. The treatment plan was to put an emphasis on resolving the stagnation in the heart, reduce its fire and supplement the Yin and blood. To do so, I used the above point combination, with two additions: 1. Ximen (P 4), only on the left side, in order to invigorate the heart circulation, break the stagnation there and alleviate the pain. 2. Xingjian (LIV 2) on both sides, to reduce Liver Yang, disperse the liver, and treat the headache. Sanyinjiao was the only point that was reinforced in order to tonify the Yin.

Mrs. C.'s condition improved gradually, with some regressions, over a period of one month of treatments. When her headaches subsided, together with the chest pain, the point prescription was changed as follows: Shenmen (H 7) and Neiguan (P 6) were left in order to continue the treatment of calming the Shen and further facilitate Heart Qi. To Sanyinjiao, I added Guanyuan (CV 4) and Qihai (CV 6), in order to strengthen her constitution and general health. The last three points also form a point combination, which was discussed in combination number one of this work. After one more month, Mrs. C. felt much improvement in all respects and the treatment was therefore terminated.

Addendum Six months later Mrs. C. became pregnant, and in her second month she had recurrence of headaches, chest pain, together with morning sickness. She received five more treatments in the course of two weeks, after which all her symptoms had disappeared again. She gave birth to her second child in due course, without any complications.

15. ZHIGOU (T 6), QIMEN (LIV 14), YANGLINGQUAN (G 34), TAICHONG (LIV 3)

Main effect and clinical purpose This point combination is used to regulate the liver and gallbladder

meridians, to remove obstruction from their passages, and to resolve stagnation of Liver Qi. Therefore, it is often used in cases of flank pain, oppression and discomfort in the chest and distension of the breasts. Besides this it may also treat sciatica which occurs along the route of the Gallbladder meridian, or paralysis of one side of the body associated with this meridian.

Point discussion (79) Zhigou is a point on the hand Shao Yang meridian, which is in continuum with the leg Shao Yang, Gallbladder meridian. Its indications are mainly concerned with the domain of the Shao Yang system. It spreads and invigorates the Qi in this meridian and disperses obstructions which are located along its route. The axilla, side of the chest and the rib cage, are all irrigated by the Qi of the Shao Yang and Chueh Yin meridians. These meridians form the internal/external relationship, and points from each of them also affect the other. Zhigou is located at the beginning of the Shao Yang, which is literally the small Yang. The points at the beginning of the Shao Yang have an accelerating effect on the movement of the Yang from the upper parts of the body, to the lower parts. By accelerating this movement, we can disperse obstructions along the route, one of which is chest or flank pain (80). Symptomatically, Zhigou is very relevant in cases of flank pain and it is often mentioned in ancient works from China, thus: "In pain of the ribs and flank, needle Zhigou  was written in the BIAO YOU FU (Ode of the Standard of Mystery). Also, in the YU LONG GE (Song of the Jade Dragon), we find: "When there is pain and obstruction of the flanks, using Zhigou, will give excellent results." Zhigou is also frequently used in the treatment of constipation, due to its ability to remove obstruction from the intestines as well. Qimen is the Front Mu point of the liver channel. It is located in the costal

region and has a local effect on this area. Besides its location in the site of the pain, it has a similar action to Zhigou. It spreads and invigorates the Qi. Furthermore, it also has the ability to transform congealed blood and remove blood stagnation. Thus, even in cases of traumatic injury, such as a broken rib, Qimen is indicated. Qimen, as the Front Mu point of the liver, has a direct effect on this organ. Since the liver is the organ mostly associated with Qi stagnation, Qimen, as its Mu point, has an effect on invigorating the Qi in general. Therefore, even costal pain that is due to emotional problems (i.e. depression) or internal diseases (i.e. hepatitis), may be treated by Qimen. With regard to its effect on the flanks, we can find in the Zhen Jiu Dacheng (Great Compendium of Acupuncture and Moxibustion), written by Yang Jizhou in 1601, the following recommendation: "pain, fullness and obstruction of the flanks, when Qimen is used, great results will be achieved". Yanglingchuan constitutes the counterpart of Zhigou on the same segment of Shao Yang. It is the He Sea point of the Gallbladder, and has a strong effect on this organ. As we know, the gallbladder is anatomically situated under the costal region, and malfunctioning of this organ often gives rise to flank pain, distension and soreness of the whole area. Stimulation of Yanglingquan has a calming effect on the gallbladder and it regulates its function. Thereby it is beneficial for flank pain. Besides regulating the function of the liver and gallbladder, Yanglingquan is the confluent point of the tendons and ligaments. Its indications say in this respect that its use benefits tendons and bones. Thus, in cases of traumatic injury, this is a very important point to resolve stagnation in the costal region, brought about by accident. In the "Song of Points for Miscellaneous Diseases (Zabing Xuewei Ge), written in 1537, we find: "When there is flank pain, Yanglingquan must be used". Taichong constitutes a continuum in this point combination with Qimen. They are both situated on the liver meridian and Taichong is the Yuan Source point of the liver.

Yuan Source points are closely connected with the organ to which they are linked. In this respect, Taichong has the same qualities that we have mentioned under Qimen, only it operates from afar. Taichong is actually the strongest point in the treatment of stagnant Liver Qi. It is most useful in internal diseases caused by stagnation of Qi, but may be used in any form or cause of stagnation. Taichong has pain relieving qualities, due to its role as a destagnation point. It is so remarkably effective in relieving pain, that it has been used for generations in the renowned point-combination known as the "Four Gates". The combination is Hegu (LI 4), two points above, and Taichong, two points below. This combination has a strong sedative effect by activating and dispersing Qi and blood in the whole body. In the treatment of flank pain, Taichong plays its role by relieving pain, dispersing stagnant Qi, regulating the liver and liver channel and regulating the blood. In this point combination, two principles have combined in order to form the theoretical basis for its existence. One is the principle of mutual assistance, and the second Is "one point above two points below." We have demonstrated, under each point description, the influence that it has upon the costal region. We have seen that each one of the points is capable to affect the flanks, chest and the ribs. Together, they exert a much greater potency in resolving any kind of pain in this region, than any one of them alone. The Shao Yang and Chueh Yin meridians, form the external/internal Yin/Yang relationship. They thus influence one another and may also be treated, one by the other. In this combination we have two points belonging to the Shao Yang segment, Zhigou above, and Yanglingquan below, and two points belonging to the Chueh Yin segment, Qimen above, and Taichong below. By the principle of "one above two below", Zhigou, as was described above, accelerates the flow of Qi in order to unblock the stagnation in the costal region. Qimen serves as the local upper point, that invigorates Qi and Blood in the disease focus. Taichong with Yanglingquan constitute the weight on the other end of the see saw, so as to attract the energy and facilitate its flow.

It is very similar to the previously described sinusitis point combination, under combination number two of this chapter. The only difference being that the latter is based on one meridian segment, whereas the former, on two meridian segments. The effect, nevertheless, is the same.

Needling sequence, manipulation and stimulation The order of needling in this combination, is as in other combinations based on the "one above two below" principle. Zhigou is the starter, for the reasons mentioned above. Qimen, Yanglingquan and Taichong follow. The sequence, thus, goes in descending order and follows the appropriate direction of energy. The method of stimulation is dispersion, with an emphasis on conducting the Qi in the direction of the disease focus. It is possible to administer electrical stimulation in the case of acute pain, in the same way as we have discussed in other cases. In the case of traumatic injury of the rib cage, it is possible to apply moxa. This is usually done with a moxa stick above local points such as Qimen or Ahshi points. It is not recommended to apply moxa immediately after the injury has occurred, but a few days later. It is also not recommended if heat signs are evident.

Herbal equivalent The opening herb, much like Zhigou, was chosen in this prescription mainly because it enters both the Triple Burner and the liver meridians. This herb is Rhizoma Cyperi Rotundl (Xiang Fu). It regulates the flow of Qi in these two meridians and it resolves stagnation of Liver Qi. Together with Radix Bupleuri (Chai Hu), it is classically used for pain and distension in the chest and flanks. Chai Hu, together with its ability to release exterior conditions associated with the Shao Yang pattern, is also used to relax constrained Liver Qi. As

such, its indications include: chest and flank pain, a feeling of constriction in the chest and other symptoms not relevant in this context. Another herb that may assist the function of the former couple, is Pericarpium Citri reticulata (Qing Pi). This herb enters the liver and gallbladder meridians, is used to regulate their Qi and to alleviate pain. It is used for chest, breast, flank and hypochondriac pain due to Qi stagnation, and also for blood stasis to some extent. The last herb in this formula is used to invigorate the blood in the domain of  the Shao Yang and Chueh Yin channels. It is a major herb, and is used in many pain syndromes, including headaches. The herb is Radix Ligustici Wallici (Chuan Xiong). Due to its ability to invigorate the blood and break up congealed blood, it makes the whole formula valid even in the case of traumatic injury in the chest or flank regions.

Case history Mr. E. age 48, was a psychologist who had decided, a month prior to his visit at my clinic, to learn how to fly. Thus, he enrolled in a sky gliding course and in his first attempt to take off, he broke three ribs on his left side. After a month of suffering severe pain and sleepless nights, his X ray examination did not show any improvement. So, when he came to me for treatment, he was already weak and exhausted, not to mention his sincere repentance for his heroic aspirations. Mr. E. was given a course of six treatments, during two weeks, after which his pain and distension had left him completely. A week later he underwent another X ray examination which showed, this time, completely healed ribs. His treatments included our point combination, with the addition of Dazhu (B 11), and Shenshu (B 23). The point-combination was chosen because the broken ribs were in the domain of the Shao Yang and Chueh Yin channels. The combination, as already explained, has the ability to resolve stagnation and invigorate the Qi and blood in the flanks and costal region.

Dazhu was added due to its task as the confluent point of the bones and the effect it has on repairing skeletal damage and strengthening the bone structure. Shenshu, as the Back Shu point of the kidneys, joined the formula in order to strengthen the patient in general and to reinforce the kidneys which, according to T.C.M., rule the bones. Thus, by reinforcing the kidneys, the bones are also tonified.

16. ZHIGOU (T 6), ZHAOHAI (K 6), TIANSHSU (ST 25)

Main effect and clinical purpose This combination of points has a special effect on regulating the function of the intestines and eliminating constipation.

Point discussion Zhigou was broadly described and analyzed in the previous combination, number 15. There, we also mentioned that Zhigou is very effective in the treatment of constipation due to its ability to remove obstructions from the intestines. The explanation for this ability of Zhigou is in two of Zhigou's characteristics:

1. Being situated on the beginning of Shao Yang, this point has the ability to invigorate the movement of Yang Qi throughout the body, in a downward direction from above to the inferior parts of the body. Since all the Yang Qi travels downward, while all the Yin Qi starts from below and travels upward, Shao Yang is utilized to facilitate the Yang movement, as much as Shao Yin, by the same principle, the movement of Yin Qi. 2. As a point belonging to the Triple Burner, this point helps regulate the circulation of Qi in the three Jiaos. Along with Zhigou's ability to remove obstructions, it makes a powerful point in both regulating and cleaning the intestines. Zhaohai is located in the leg Shao Yin meridian. The ShaoYin starts the movements of the Yin Qi towards the upper parts of the body (81) and this makes Zhaohai one of the most important points to tonify the Yin. One of the most frequent causes of constipation is accumulation of excess heat in the large intestine. It dries the stools, making it hard and difficult to evacuate. Another frequent cause, is the lack of sufficient fluid in the large intestine, which causes dryness of the bowel and insufficient lubrication to allow smooth passage of the stools. The lack of fluid, or Yin, may be either because there is excess heat in the large bowel or, because of a Xu condition of systemic Yin or blood deficiency. Zhaohai, as a Yin tonic, supplies the large intestine with Yin Qi and thus provides lubrication for the constipated dry intestines. Another facet of these ingeniously combined two points, is the energetic outcome of the simultaneous use of both of them. Zhigou starts an accelerated movement of Yang Qi downward. Yang Qi makes peristalsis faster and better, as Yang Qi manifests itself in movement and function. Zhaohai, for its role, starts an accelerated movement of Yin Qi upward. Yin Qi brings coolness and fluid, as those are the manifestations of Yin. As the result of this bipolar movement, the intestines are moved to expel their contents, and at the same time are irrigated to allow its free passage. Thus, the use of these points together creates an energetic motion, harmonious and complementary, that has a regulating effect over the function of the large intestine.

Tianshu is the Front Mu point of the large intestine. In this way it is connected directly with the organ itself and is therefore associated with all the problems of this organ. In its indications we can find the following:  Tianshu adjusts the function of the intestines.  Tianshu regulates the Qi of the intestines.  It relieves stagnation of Qi, blood and food in the intestines.  It regulates menstruation.

Because of these qualities, Tianshu is used in both chronic and acute constipation. As do most of the Front Mu points, Tianshu also serves as a local point, close to the focus of disease. As such, it has a direct and immediate effect upon the large intestine, an effect that may be taken advantage of, even by hand manipulation of the Tui Na massage. Using Tianshu as a pressure point moves the intestines, relieves distension and helps achieve an evacuation, especially, in acute, painful constipation. The combination of Zhigou with Zhaohai was mentioned as an effective treatment for constipation, as far back as the year 1537. It was mentioned then in the Yu Long Ge (Song of the Jade Dragon), found in the Collection of Gatherings From Outstanding Acupuncturists (Zhenjiu Juying) (82). The methodology by which these two points were combined has already been explained previously. The introduction of Tianshu to the couple, centers their effect on the large intestine and adds the strong influence of Tianshu itself upon the intestine.

Needling sequence, manipulation and stimulation Zhigou and Zhaohai are needled one after the other to perform their energetic influence, as was described previously. Tianshu is then needled and manipulated. Zhigou is usually manipulated in a dispersion fashion.

Zhaohai has a better effect if its Qi is made to travel upward along the medial aspect of the shin, towards Sanyinjiao. Tianshu is also manipulated in dispersion usually. When the cause of the constipation is a deficiency of Yin and/or blood in the large intestine, usually due to old age, Zhaohai and Tianshu may be tonified. Otherwise, the condition of a constipation is Shi (obstruction, heat, congestion, stagnation) in general and the points should be sedated.

Herbal equivalent Semen Trichosanthis (Gua Lou Ren), Semen Cannabis (Huo Ma Ren), Semen Persica (Tao Ren), Semen Biota orientalls (Bai Zi Ren) and Semen Sesami Indici (Hei Zhi Ma), all treat constipation. Gua Lou Ren treats constipation due to heat in the lungs that penetrates into the large intestine, usually after fever. Huo Ma Ren treats constipation due to deficient Qi, especially in the elderly. Deficient Qi causes stagnation and dryness in the intestines. Tao Ren is an herb used to invigorate the blood and treat constipation due to congealed blood and heat stagnation. Bai Zi Ren tonifies blood and Yin in the intestines, as it is a nourishing herb, and is therefore used in the treatment of the elderly and debilitated. Hei Zhi Ma, may be used like point Zhaohai. It tonifies the Yin of the kidney and liver and lubricates the intestines. This formula actually encompasses all the possible causes for constipation, and each herb contributes its personal quality, plus a generalized effect common to all of them, namely, to lubricate the intestines and smooth their action. This prescription must be modified in any particular case, according to the diagnosis. Thus, if Blood Xu dominates the picture, then herbs such as Radix Angelica Sinensis (Dang Gui) must be added and so on.

Case history Mrs. K, age 45, suffered for many years from constipation. Sometimes she did not have a bowel movement for a whole week. In addition she

complained of halitosis and much gas in the abdomen. A month before our first appointment, she started experiencing weakness and sometimes even palpitations. She was slightly obese and had puffy bags below her eyes. Observation also revealed a bright red tongue, purplish in the center, with many red prickles around the tip and sides. It was peeled and slightly scalloped in the sides. The pulse was regular and soft, with the kidney position deep and weak. These symptoms were evidently a Yang within Yin condition, or a Xu condition giving rise to Shi symptoms. The basic pattern, as evidenced by the soft pulse, puffy eye bags, scalloped tongue and obesity, pointed out a spleen Qi Xu. Spleen Qi Xu affects the transformation transportation (Yun-Hua) function of the spleen, giving rise to obesity and lazy bowel movements hence constipation. Long term constipation causes stagnant Qi in the large intestine, which in turn develops into heat. Heat causes dryness of the intestines, hard stools, and may also cause blood stasis. Mrs. K. showed a shiny red tongue with a purplish center and red prickles. All these signs pointed to a heat stagnation, probably with congealed blood inside too. The treatment given to Mrs. K. included our point-combination to treat the basic stagnation and to lubricate the intestines. In addition, other points were combined, in order to form a comprehensive formula. Dachangshu (B 25) The Back Shu point of the large intestine, in order to activate the bowel and disperse the heat therefrom. Dachangshu and Tianshu together, make another point combination, based on the Shu Mu principle, that has a strong draining effect on the bowel. Taichong (LIV 3) and Sanyinjiao (SP 6) were also added as another point combination. These points regulate the Qi, disperse stagnant Qi and blood and tonify both the liver and spleen. Zusanli (ST 36) is perhaps the most important point to tonify spleen Qi and strengthen its transportation function. In addition, it has a strong influence on constipation, it tonifies the blood and strengthens its circulation in the gastro intestinal tract. Mrs. K. has been treated several times during the past three years. She

usually received a few treatments based on the above prescription. Her constipation improved for a year or so, until the next time. It is very important to educate the patient regarding the proper life habits for dealing with constipation. Fiber-rich foods are essential, along with Yin supplementing foods, such as: whole wheat, vegetables, fruit, oils, dried fruit, almonds, and so on. Physical exercise is essential for people with weak  abdominal muscles and, no less, regular eating habits.

17. YINBAI (SP 1), QIHAI (CV 6), XUEHAI (SP 10), SANYINJIAO (SP 6)

Main effect and clinical purpose This combination has a strong effect on the blood. Most of the points here have a regulating effect on the blood, and as a whole, it is used for astringent purposes. It arrests bleeding from any of the body nine orifices, but particularly uterine bleeding, or bleeding of the digestive tract.

Point discussion Yinbai is frequently used to tonify the spleen. One of the spleen's main functions is to contain the blood, or keep the blood in the blood vessels. This function of the spleen comes in continuum with its role in creation of blood. By commanding the digestive function of the stomach, the spleen extracts the pure essence of digested food and drink and transforms it into Qi and blood (83).

Thereafter, as the master of transportation too (i.e., the Yun Hua role of the spleen, translated as transformation and transportation), the spleen is responsible for keeping the blood flowing through its proper routes the blood vessels. Because of these functions, the spleen meridian, or points that tonify the spleen situated on this meridian, are used in diseases associated with blood disorders. Yinbai is the most important point on the spleen channel regarding its function of containing the blood. This function of Yinbal is probably d ue to its role as the "Well" point of the spleen meridian. Well points are used primarily in acute or dangerous conditions, as they connect the Yin and the Yang, exterior-interior channels. Thus they are commonly used in acute fever, delirium and excessive heat conditions, or resuscitation from fainting and coma. Loss of blood is also considered a dangerous condition. Loss of blood is a loss of Qi too. Thus, the Well point of the channel most associated with "keeping the blood in the vessels" function, is the most appropriate to deal with such problems. As stated before, the other function of Yinbai, is to strengthen the spleen. By strengthening the spleen in general, all the spleen's activities are strengthened, including digestion, blood and Qi production, containing the blood, holding the organs and tissues in their proper position, nourishing the muscles, transporting waste outside the body and additional functions as well. Qihai was already discussed under combination number one in this chapter. As the ruler of the "sea of energy" in the lower Dantien, this point has a strong impact upon the amplitude of Qi in the body. Since abnormal bleeding implies, first of all, a weak Qi which is incapable of "ruling the blood" properly, this point is called upon to draw out extra Qi from the reserves which are located at the "Sea of Qi . The special relationship between Qi and blood is one of the cornerstones of Chinese medical thinking. Qi is considered the commander of blood, and Blood is regarded as the mother of Qi (84). This means that Qi regulates the blood, moves it and keeps it in place, while the blood nourishes the organs that produce Qi.

The Spleen, of all organs, is mostly involved in this relationship. It creates blood, as we have already seen, and if blood is abundant enough to feed the spleen itself, the spleen is capable of producing Qi. If Qi fails, however, it may be strengthened and supplied by tonifying the spleen itself and by drawing Qi from its reserves, namely Qihai. Xuehai was also discussed previously in this chapter, under combination no. 5. We would like to stress, however, that this too is a point on the spleen channel, mostly associated with blood. Xuehai drains heat from the blood and cools it. Since many of the abnormal bleeding syndromes occur due to this phenomenon of heat in the blood, causing reckless movement of blood and bleeding (85), Xuehai is perfectly appropriate for treating this kind of problem. In addition, Xuehai regulates the movement of Ying Qi (nutritive energy) and blood and is thus a counterpart for Yinbai in the function of keeping the blood enroute. Sanyinjiao was Also thoroughly discussed in this chapter, under combinations number 1 and 15. In short, Sanyinjiao tonifies Yin and blood and the three organs that produce and control blood, except for the heart. By tonifying the blood and its production, and by tonifying the spleen, this point is a substantial addition to this combination, whose aim is to stop abnormal bleeding. This combination, as we have shown, is constructed of three points that have a strong tonifying effect over the spleen itself. They have been chosen, from all the other points on the spleen channel, because of each one's personal characteristics as a blood regulator. Thus, their mutual effect on the spleen system strengthens this organ's functions of "building the blood", and "holding the blood", while the points themselves exert their symptomatic influence for the same purpose. The fourth point, Qihai, acts directly on the Qi, reinforcing it and enabling it to perform its duty as the "commander of blood", meaning: to prevent reckless movement and stop bleeding.

It is important to note here that the combination is effective primarily for digestive or uterine hemorrhage. It is less effective for epistaxis, coughing up of blood, blood in the urine, or bleeding hemorrhoids. The reason is that the involvement of the spleen channel is primarily in diseases associated with uterine function and digestive disturbances. It does not mean, however, that this combination cannot be used in other hemorrhagic problems, because as was explained, the spleen does have an effect on all occurrences of abnormal bleeding. Still, the combination should then be modified to deal with these problems specifically.

Needling sequence, manipulation and stimulation In this combination we start from below and proceed in an upward direction. The reason for this is twofold: 1. In order to tonify the blood it is necessary to act on the Yin, since blood is mostly Yin. Yin starts flowing from below (from earth) and travels upward, while Yang does the opposite. Thus, we start with Yinbai, go on to Sanyinjiao, and advance to Xuehai. 2. As we have shown, this combination has also the aim of tonifying the spleen. One of the rules of tonification is to needle the points in the direction of the energy stream. Since the spleen meridian is Yin and it flows from Yinbal upward, the needling order follows suit. Qihai is an additional point in this combination as we have demonstrated earlier. Therefore it is needled last, and it crowns the combination. The spleen points act directly on the blood, while Qihai balances the formula by acting on the Qi, the commander of blood. Clinical experience has shown that stimulation of Yinbai with tiny moxa cones, bears the best results. It is a tiny point at the angle of the thumb nail, so, tiny moxa cones, the size of rice grains, are placed directly on it and ignited. Usually, three cones suffice for every treatment. The rest of the points are punctured in tonification in case of a Xu condition and in even manipulation, in cases of heat in the blood that causes the bleeding.

In performing an even manipulation, it is important to distinguish the relative importance of Xu and Shi within a complicated syndrome. In our case, Xu means deficient spleen Qi and deficient blood, while Shi is usually the presence of heat in the blood and Ying Qi. When Xu symptoms are predominant one should reinforce with doubled effort and reduce with a single effort. One should also reinforce first and then reduce. Traditionally, the procedure is applied as follows: The needle is thrust nine times, emphasizing on thrusting forcefully while lifting the needle gently. After nine times, the same point is reduced by lifting the needle forcefully six times and thrusting it gently. When Shi symptoms are more pronounced, the procedure is reversed (86). Qihai is stimulated only in tonification. When Yang Qi is in deficiency, it is recommended to apply moxibustion, either by warm needling or indirect moxibustion upon a layer of ginger or aconite (Fu Zi). Moxibustion is, of course, permissible also on Sanyinjiao and Xuehai, if the patient's condition is a Cold/deficiency pattern. In such cases, the warming needle technique is superior, as it warms the channel, disperses cold and supports the Qi.

Herbal equivalent Terra Flava Usta (Fu Long Gan), which is actually the center of the ashes from the bottom of a cooking stove, where Radix Lithospermi (Zi Cao) has been burnt, is used to tonify the spleen Yang and stop bleeding. When added to Crinis Carbonisatus (Xue Yu Tan), which is actually charred human hair, this combination is effective in treating abnormal uterine bleeding. Both substances treat bleeding due to deficiency. Herba Agrimonia Pilosa (Xian He Cao) treats abnormal bleeding, no matter of which etiology. It may be added to other herbs according to a specific etiology. Radix Sanguisorba (Di Yu) cools the blood and stops bleeding, both

digestive and uterine. It may be, to some extent, compared to point Xuehai, especially because, like Xuehai, it also treats skin disorders. The last herb, which also has an astringent influence on bleeding, is chosen, like point Qihai, to tonify the Qi, raise the Yang Qi of the spleen and treat the problem from its core. This herb is Radix Astragali (Huang Qi). Actually, its qualities may be compared to the actions of several points together. These qualities are: 1. It tonifies the spleen in general and treats symptoms of anorexia, weakness, chronic diarrhea, etc. This quality may be paralleled to the influence that point Sanyinjiao has upon the spleen. 2. It raises the Yang Qi of the spleen and this may be compared to the mutual action of points Yinbai and Qihai. 3. It tonifies both Qi and blood and in this it is similar to points Xuehai and Qihai.

Case history

Mrs. H., age 30, has tried since she was 27 years old to become pregnant. At the age of 19 she had gone through an artificial abortion and according to her doctors, this was the reason why she could not retain her pregnancies. Since the age of 27, she has had four miscarriages. 48 hours before her visit to my clinic she had had another miscarriage, followed by heavy bleeding, pain and nausea. I observed a tall, slim woman, very pale, and very much in pain. Her lips were pale and dull and her finger nails were white. The pulse was moderate, wiry and weak, while the tongue was bright red. Mrs. H. also told me that she had a very weak digestion and that she felt weak most of the time. She suffered from heartburn, swollen and painful gums, and dry mouth. Her periods were always accompanied by excessive bleeding and contained blood clots. It was obvious that Mrs. H. suffered a basic spleen stomach disharmony, caused by spleen Qi Xu. The spleen deficiency caused deficient blood and an impairment of the spleen function of retaining the blood, or the fetus. The first goal of the treatment was to stop the massive bleeding and the pain

which followed the miscarriage. The second phase was planned to strengthen the spleen, tonify Yin and blood and re-harmonize stomach and spleen functioning. Thus, in the first treatment I used the point combination with an addition of Hegu (LI 4) and Taichong (LIV 3). This combination was supposed to "open the four gates", which means to regulate Qi and blood in the whole body and to stop the pain. In the second day Mrs. H. had much less pain and less bleeding. The second treatment was constructed of the same point combination, excluding Hegu and Taichong. Instead Zhiyin (B 67) and ZhongJi (CV 3) were added. These points were added in order to cause the uterus to expel the remaining tissue of the dead fetus. The next day there was almost no bleeding at all, but she felt contractions in her lower abdomen. Thus, the same formula was applied to her once again and in the next day she expelled some very big blood clots. Two days later, when she came to me again, there was no pain at all and no bleeding. Her pulse had changed dramatically and the wiry quality remained only at the stomach position.

18. TIANSHU (ST 25), SHANGJUXU (ST 37), SHANGQIU (SP 5), YINLINGQUAN (SP 9)

Main effect and clinical purpose

This combination is a classical point combination to clear damp and heat from the intestines. It is therefore used to treat problems such as chronic diarrhea, dysentery, enteritis and colitis.

Point discussion Tianshu was discussed in combination number 16, dealing with constipation. As the Front Mu point of the large intestine, this point actually deals with all the afflictions of the intestines. Its indications imply that it regulates and facilitates the functioning of the intestines and eliminates stagnation. This indeed covers all the possible diseases of the intestines. Theoretically, the Large Intestine is the organ by which the spleen applies its transportation function. The large intestine transports and evacuates the residues of the digested food and fluids (87). When the spleen Qi is weak, the transportation ability of the large intestine is impaired, giving rise to constipation or diarrhea. Another phenomenon which often exists when spleen Qi is weak, is the formation of dampness and phlegm. When this dampness "pours" into the intestines, there is a damp stagnation, giving rise to chronic diarrhea, colitis, etc. As a Fu organ which is in close contact with external influence, the large intestine may occasionally be involved with intoxication brought about by contaminated food or drink. This intoxication has usually the characteristics of damp heat or Fire Poison and it causes diseases such as severe colitis, ulcerative colitis, dysentery and the like. Tianshu, as the Front Mu point of the large intestine, is capable of eliminating stagnation in the organ and that includes Damp Heat, Damp Cold, blood stasis, etc. Shangjuxu is the lower He Sea point of the same organ, the large intestine. We have described already how the classics refer to He Sea points, in combination number 12, with reference to point Zusanli, which is the lower He Sea point of the stomach. Also Shagjuxu is connected directly with its organ and affects it very similarly to Tianshu. It regulates the Oi of the large intestine and stomach and eliminates pain. It eliminates accumulations and

stagnation, but mainly involving damp stagnation, characterized by various types of diarrhea. It clears and cools dampness and heat, treating Damp Heat conditions such as colitis, diarrhea with blood and pus and the like. It is important to note in this context, that Shangjuxu is one of a group of three points, situated along the muscle tibialis-anterior that have an influence over the whole gastro-intestinal tract. Zusanli (ST 36), the lower He Sea point of the stomach, Shangjuxu (ST 37), the lower He Sea point of the large intestine and Xiajuxu (ST 39), the lower He Sea point of the small intestine. These points, when used together, have a strong draining effect on the gastro intestinal tract and they are usually used in this form when a strong purgation is needed, in order to clean and clear the digestive tract of food intoxication. Shangqiu has a sedative effect on excessive conditions of the spleen, concerning the digestive system. It is the metal (Five-Elements) point of the spleen and as such it acts as the son of earth element, the spleen. Son points are used mainly for sedation purposes, which is in accord with the classics: "If a meridian is empty, tonify its mother. If it is full, sedate its child" (Zhenjiu Yixue). The most common excessive condition of the spleen is abundant dampness. Thus, Shangqiu is utilized to sedate the spleen and disperse the damp condition. In its classical indications, therefore, we can find that it is used to transform damp stagnation and thereby to strengthen the stomach and spleen. In the list of diseases that this point is capable of treating, we may find the following: gastritis, enteritis, indigestion, edema, diarrhea, intestinal noises and more. Yinlingquan is closely associated with the urinary and digestive systems, in all afflictions brought about by excessive dampness. Its main indication is to transform damp stagnation, very much like the former point Shangqiu, only it is equally beneficial for the digestive and urinary systems. Thus, in the digestive system it may treat diarrhea, whether acute or chronic, distension of the abdomen due to retention of fluids, ascites, enteritis, dysentery and more. The theoretical background for this point's indications, is, also here, related to the Five-Elements principles. Yinlingquan is the Water-point of the spleen meridian. Because dampness is

an energetic phenomenon related to the element water and the spleen is the organ mostly associated with damp conditions, therefore the water point of the spleen is sedated. Dispersion of this point is considered to abate dampness, improve water metabolism and balance the spleen. This point combination is actually two point-combinations combined together, in order to have a more comprehensive effect on a specific problem. Tianshu and Shangjuxu have a direct effect over the large intestine, as both of them are related directly to this organ. In fact, in many sources, both of the points appear as a combination by itself for the treatment of enteritis (88) or dysentery. Shangqiu and Yinlingquan represent, in this formula, a function which is related to the spleen, and this is to eliminate damp conditions. The connection of these two pairs together, have centered the effect of eliminating damp in the large intestine. Of course, as is in the case of other effective point combinations, Shangqiu and Yinlingquan are symptomatically helpful in large intestine afflictions, as is evidenced by their listed functions, as much as both Tianshu and Shangjuxu are effective in the treatment of excessive damp conditions. This is also evidenced by their list of functions.

Needling sequence, manipulation and stimulation Because this combination deals with problems of the large intestine, Tianshu and Shangjuxu are first to be needled. Shangqiu and Yinlingquan are secondary in importance and they are therefore needled secondly. In most of the cases all the four points are needled in reducing techniques, in order to disperse the excessive dampness and most of the heat. Most often, however, the Shi condition of the enteritis or diarrhea, is complicated with a basic Xu condition, usually of the spleen, and in such cases care must be taken not to over sedate the patient, as it might aggravate the condition.

Sometimes the basic condition is a Shi condition, such as with food intoxication (Sha zheng), and if prolonged enough the true Qi of the patient becomes damaged, resulting in a Xu condition. In such cases, the manipulation of the points must be performed with the utmost care and consideration, using other tonifying points as main points and this combination becomes secondary. When there is a cold dysentery, or diarrhea of the Xu type, and there are no heat signs, moxibustion is recommended on Tianshu and Yinlingquan. This may be done as a warming needle technique, or, in severe cases, also by direct moxibustion. In such cases, moxibustion therapy is imperative and the results are astonishingly decisive. In the case of bleeding along with the diarrhea, as in ulcerative colitis, dysentery, etc., other points must be introduced into the formula. Yinbai (SP 1) (please refer to the previous combination, number 17), or Paihui (GV 20) (89) and Keshu (B 17) are the points of choice.

Herbal equivalent A very familiar prescription for Damp Heat dysentery like disorders, is the following: 1. Radix Scutellaria Baicalensis (Huang Qin) 2. Rhyzoma Coptidis (Huang Lian) 3. Radix Peonia Lactiflora (Bai Shao) Huang Qin drains Damp Heat and is considered a major herb for Damp Heat in the stomach or intestines. This Damp Heat, as we know, may manifest as diarrhea with a burning sensation in the anus or, dysentery like disorders with pus and blood. Huang Lian has very similar qualities, especially in regard to the digestive system and it is used for the same problems. Its advantage, however, over Huang Qin, is that it is capable of arresting bleeding due to heat. Bai Shao is usually used to nourish the blood, but it is also capable of adjusting the functions of the liver and spleen and to alleviate abdominal pain associated with dysentery like disorders.

These three herbs imitate the functions of points Tianshu and Shanjuxu, which, as we have seen, regulate the Qi of the large intestine, stop pain, drain Damp Heat, cool and stop bleeding. Nevertheless, in order to provide a comprehensive herbal equivalent to the point-combination, two other herbs are added: Radix Saussaria seu Vladimiria (Mu Xiang) Sclerotium Poria Cocus (Fu Ling) Mu Xiang is a herb that regulates the Qi, and is used in Qi stagnations involving pain. It is often a partner in a formula that treats intestinal problems such as we have discussed here, as most of them involve pain. Its indications say that it adjusts and regulates stagnant Qi in the intestines and is used for diarrhea and dysentery like disorders, or for abdominal pain and tenesmus. This herb is said to enter the spleen meridian and to strengthen the spleen. The other herb, Fu Ling, also tonifies the spleen, and is the most important substance for draining damp conditions. Much like point Yinlingquan, it is useful both for excessive urinary and digestive conditions.

Case history Please refer to the case history described in my article: The Astringent Quality of Point Paihui in my homepage: http://www.acumedico.com/colitis.htm The article was originally published in Sept. 1989 in the Journal of Chinese Medicine in England. Even though point Shangqiu is missing from the point combination in this article, I decided to bring this case history as it is, for the following reasons:  The case history is very relevant to the examples of the disharmony for which this point combination is used.  Point Shangqiu has been substituted in the initiative formula of the case history by Sanyinjiao (SP 6) because of the blood and Yin deficiency pattern exhibited by the patient. Nevertheless, Sanyinjiao is also capable of performing the functions Shangqiu such as transforming damp stagnation in the intestines and strengthening the spleen. Its advantage, however, lies in its powerful influence over the spleen, an influence which makes it a better

associate for Yinlingquan in most cases.  This case history includes some other common point-combinations as well, also relevant to the treatment of Damp Heat dysentery like stagnations. They are mentioned and discussed briefly throughout the article.  This case history has been written by me as an article for the magazine, and it is more comprehensive and detailed than any of the case histories introduced so far in this work. It encompasses many facets of both diagnosis and treatment in T.C.M., as well as an interesting treatment process. It was therefore considered fitting as the last accord in this work.

BIBLIOGRAPHY AND NOTES

Abbreviations and bibliography

J.C.M. The Journal of Chinese Medicine N.S.T. Nanjing Seminar Transcript of Spring 1984, transcribed by Peter Deadman. W.N.W. The Web That Has No Weaver, by Dr. Ted Kaptchuk, published by Congdon and Weed, N.Y. A.C.T. Acupuncture a Comprehensive Text by Eastland Press, Seattle. A.C.H.C. Acupuncture Case Histories from China by Eastland Press, Seattle. N.A.C.A. The North American College of Acupuncture became licensed in 1976 in Salem, Oregon, by the State of Oregon Department of Education and the Board of Medical Examiners. T.D.A. Treatment of Disease with Acupuncture by Dr. James Tin Yao So, published by: Paradigm Publications, Brookline, Mass. P.D. Pulse Diagnosis by Li Shi Zhen, based on the Bin Hu Mai Xue, Paradigm Publications.

(1) The Journal of Chinese Medicine (J.C.M.) No. 9 p. 10. (2) Please refer to chapter B, for Points Clusters.

(3) Nanjing Seminar Transcript (N.S.T.) p. 1 2, J.C.M. No. 29, P. 6 7. (4) J.C.M., No. 29, pp. 6 7, W.N.W. p. 65 (The Kidneys rule the grasping of Qi). (5) The Web That Has No Weaver (W.N.W.) by Dr. Kaptchuk p. 55 (6) J.C.M. No. 29 p. 6 7. (7) W.N.W. chapter 3 p. 65. (8) Acupuncture a Comprehensive Text (A.C.T.) by the Shanghai College of  T.C.M., P. 558. (9) Acupuncture Case Histories from China (A.C.H.C.) p. 6 7. (10) Acupuncture Case Histories from China (A.C.H.C.) p. 6 7. (11) J.C.M No. 29 p.3 - 7 (12) J.C.M. No. 29 p.3 - 7 (13) J.C.M. No. 19 p. 18 (14) Lucien M. Deshepper lessons transcript from 1982. (15) Lucien M. Deshepper lessons transcript from 1982 (16) A.C.T. p. 152 (17) Dr. Wu Wei Ping, Taipei 1984, personal communications. (18) A.C.T. p. 241. (19) A.C.T. p. 144 (20) A.C.T. p. 306 (21) W.N.W. p. 40, 43 (22) Ling Shu (Spiritual Axis) chapter 71. (23) W.N.W. p. 7-15 (Yin and Yang) (24) W.N.W. p. 178  184 (The 8 principles) (25) J.C.M. No. 12 p. 5 (26) J.C.M. No. 27 p. 14 - 16 (27) A.C.T. p. 233, J.C.M. No. 32 p.24. (28) North American College of Acupuncture, (N.A.C.A.) courses by Prof. Leung Kok Yuen. (29) J.C.M. No. 13 p. 12 The clinical application of point Sanyinjiao. (30) J.C.M. No. 19 p. 14 (31) N.A.C.A. courses material. (32) W.N.W. p. 142. (33) J.C.M. No. 24 p. 5. (34) N.A.C.A. courses material. (35) J.C.M. No. 9 p. 14, W.N.W. p. 343 357. (36) The treatment of 100 common diseases by acupuncture, (Medicine and Health Publishing Co.). (37) The treatment of 100 common diseases by acupuncture, (Medicine and Health Publishing Co.). (38) A.C.H.C. p. 75 (39) Huang Ti Nei Jing, Su Wen, chapter 46

(40) A.C.H.C. p. 59, 25. (41) A.C.H.C. p. 56 (42) A.C.H.C. p. 44 (43) Lucien M. Deshepper lessons transcript of 1982. (44) A.C.H.C. p. 12. (45) J.C.M. No. 24 p. 5. (46) A.C.H.C. p. 181, A.C.T. p. 315. (47) Zhu Dan Xi 1280 1358. (48) A.C.H.C. p. 234. (49) Dr. Felix Mann, in his books for example. (50) A.C.T. p. 441. (51) J.C.M. No. 7 p. 6. (52) J.C.M. No. 29 p. 9, 15. (53) J.C.M. No. 22 p. 15. (54) J.C.M. No. 29 p. 16. (55) A.C.T. p. 177. (56) N.A.C.A. courses material. (57) N.C.T. p. 1. (58) J.C.M. No. 23 p. 29 30. (59) N.A.C.A. courses material. (60) N.A.C.A. courses material, Dr. Wu Wei Ping, Taipei 1984, personal communications. (61) A.C.T. p. 280. (62) A.C.H.C. p. 181, A.C.T. p. 315. (63) Dr. Wu Wei Ping personal communications. (64) J.C.M. No. 7 p. 6. (65) A.C.T. p. 526. (66) Treatment of Disease with Acupuncture (T.D.A.) by Dr. James Tin Yao So., p. 38. (67) J.C.M. No. 2 p. 2. (68) J.C.M. No. 22 p. 16. (69) T.D.A. p. 69. (70) J.C.M. No. 2 p. 8. (71) A.C.T. p. 216. (72) J.C.M. No. 31 p. 24. (73) Pulse Diagnosis (P.D.) by Li Shi Zhen (Paradigm Publications) p. 32. (74) W.N.W. p. 54. (75) Infra Red Laser LS1 2030 devised by Jossner Electronics GMBH, Muenchen. (76) J.C.M. No. 7 p. 7 8. (77) J.C.M. No. 27 pp. 13 16. (78) N.S.T. p. 34.