| The Theories Behind the Logic of Clinical Point Selection |
1. Principles of point selection.
Point selection may be divided into three broad groupings:
Diseases of the limbs and superficial diseases of the body are commonly treated by this method.
Pain of the wrist is needled at SJ 4, Sj 5, or LI 5, SI 6.
Many diseases of the head and body may also be treated through local points.
Eye diseases can be treated at UB 1, GB 1,
Ear diseases at SJ 21, SI 19, GB 2,
Asthma at Ren 22, UB 13, Stomachache at Ren 12, St 21 UB 21.
The efficacy of needling local points to treat disease can be explained not only on the basis of traditional channel theory, but more recently by neural segment theory as well. For example in acupuncture anesthesia, the point SI 18 is used for surgery on the cranium, and the point LI 18 for operations on the thyroid.
Similarly in the clinical treatment of diseases of the Viscera, it is common to select a vertebral point on the same horizontal plane as the affected organ. Choosing a point in the same or neighboring neural segment as that of the pain or disease is also compatible with the rules of traditional local point selection.
Examples:
Lung 6 for coughing blood.
PC 6 for chest pain.
ST 36 for abdominal pain.
This method may also be used for diseases of the head and trunk.
Examples:
LI4, ST 44 for toothache, the LI channel enters the lower gums and can stop toothaches on the lower jaw. The Stomach channel enters the upper gums, St 44 can stop toothaches on the upper jaw.
SI 3 for stiff neck. because SI 3 is one of the Eight Confluent Points, intersecting with the Du Channel. Du Channel runs through the neck.
UB 54 for lower back pain. Because the UB channel runs through the lower back.
The technique of needling distal points is related to the channel theory of root and branch, whereby a disease above is treated by a point below, and vice versa.
In addition to selecting distal points according to traditional theory, they may also be selected on the basis of nerve distribution. Generally, this is most useful for treatment of disorders on the limb, whereby a point located on a nerve trunk or root above the diseases is selected for needling.
Examples:
Diseases of the fingers may be treated via points on related nerves. PC6 on the median nerve near the wrist and LI 11 on the radial nerve near the elbow as well as point on the more distant brachial plexus.
Diseases of the lower limb may be treated at GB34 on the peroneal nerve and more distally at points along the sciatic nerve or sacral plexus.
UB 17 for diseases affecting the blood (the influential point of blood)
Ren 17 for diseases of the Qi. (influential point of Qi)
Lu 9 for diseases of the vessels. (influential point of vessels)
GB 34 for diseases of the tendons. (influential point of tendons)
GB 39 for diseases of the marrow. (influential point of marrow)
UB11 for diseases of the bones. (influential point of bones)
Liver 13 for diseases of the Yin Organs, Lung, Spleen, Heart, Kidney, and Liver.
Ren 12 for diseases of the Yang organs, stomach, large and small intestine, urinary bladder, San Jiao and G.B.
Stimulation of these points has proven effective in relieving the disorders with which each is associated. The same is true of the other special point groups. Certain individual points have also traditional been useful in treating specific symptoms:
Du 14 for reducing fever, (because Du 14 is the crossing point of the 6 yang channels and Du Mai)
Du 26, for reviving patients form unconsciousness. (Du channel enters the brain.)
Pricking and Bleeding Lu 11 and SI 1 for sore throat.
LI11, Sp 10, Sp 6 for pruritus. (Itching) LI11 cleans wind and heat, Sp 10 and Sp 6 to nourish blood and expel wind evil.
Ren 4, St 36, for general weakness. Ren 4 tonifies Yuan source Qi, and Stomach 36 tonifies digestive function hence increasing Gu Qi.
Similarly in the clinical treatment of diseases of the Viscera, it is common to select a vertebral point on the same horizontal plane as the affected organ. Choosing a point in the same or neighboring neural segment as that of the pain or disease is also compatible with the rules of traditional local point selection.
C1 | Treat the head, (though we use Du 15, 16, GB 20, UB 10) | Neck | Upper limb pain or numbness |
C2 | |||
C3 | Chest organs (lungs and heart) | ||
C4 | |||
C5 | |||
C6 | |||
C7 | Stop asthma | ||
T1 | |||
T2 | |||
T3 | |||
T4 | Angina Pectoris | ||
T5 | Abdominal cavity organs | ||
T6 | |||
T7 | |||
T8 | |||
T9 | Stomach | ||
T10 | |||
T11 | |||
T12 | |||
L1 | Pelvic cavity organs | ||
L2 | Lower limb pain or numbness | ||
L3 | |||
L4 | |||
L5 | |||
S1 | |||
S2 | |||
S3 | |||
S4 | |||
S5 |
In addition to selecting distal points according to traditional theory, they may also be selected on the basis of nerve distribution. Generally, this is most useful for treatment of disorders on the limb, whereby a point located on a nerve trunk or root above the diseases is selected for needling.
Diseases of the fingers may be treated via points on related nerves. PC6 on the median nerve near the wrist and LI 11 on the radial nerve near the elbow as well as point on the more distant brachial plexus.
Diseases of the lower limb may be treated at GB34 on the peroneal nerve and more distally at points along the sciatic nerve or sacral plexus.
Example:
Stomach disease, both St 21 on the abdomen and UB 50 on the back could be needled in tandem.
Among the most commonly used front-back combinations are two special point groups. The Back-shu points and the front-mu points. Because these points are closely related to diseases of the Zang-fu organs.
Example:
Ren 12 (St Front Mu) and UB 21 (Stomach Back-Shu) for Stomach diseases.
Examples:
Combining Stomach 36 on the yang channel with Sp 4 on the yin channel for stomach diseases.
Lung 9 with LI 11, on the paired Yang channel, for coughing.
The most well-known combinations of this kind are between the Yuan-Source points on the first channel, primarily affected by a disease, and the Luo-Connecting point on the paired channel. In this combination the source point is called the "host," and the connecting point is called the "guest."
Example:
Diseases affecting the Lung channel may be treated through that channel's source point (Lu 9) in combination with the Luo-connecting point (LI 6) of its paired Yang partner, the Large Intestine channel.
Conversely, a disease affecting the Large intestine channel could be treated by that channel's source point, (LI 4,) together with the connecting point, (Lu 7) of its Yin partner, the lung channel.
The method would also encompass the use of a single point, the Luo connecting point of the paired channel.
Example:
For a disease associated with the kidney channel, UB 60, the Luo-connecting point of the Kidney's paired meridian would be chosen. Conversely, diseases of the UB can be treated by Kidney 4, the Kidney's Luo-Connecting point.
Example:
UB 21 on both left and right sides of the spine, or St 36 on both legs can be needled to treat diseases of the stomach.
Further, because of the intersection of the channels on the right side with those on the left, a point on the right may be chose to treat a disease of pain on the left side of the body, and vice versa. Example:
In the case of "stroke," not only may a point on the side affected by the paralysis be selected, but the same point on the healthy side may be used as well.
Example:
In the case of stomach diseases, PC 6 on the arm maybe combined with St 36 on the leg.
For toothache, LI 4 of the hand can be combined with St 44 on the foot.
Traditionally, a distinctive use of the above-below combination was made with respect to the confluent points of the eight extraordinary channels. A confluent point on an extraordinary channel affected by a disease above, would be combined in an acupuncture prescription with a meeting point on a extraordinary channel below.
Example:
For diseases of the heart, chest, abdomen, PC 6 on the arm may be combined with Sp 4 on the foot.
For ear ringing, SJ 5, on the arm can be combined with GB 41 on the foot.
Example:
When there is stomach problems, the local points Ren 12 and UB 21 or the distal points St 36, PC 6 and Sp4, could be used separately. The combination method, however, uses both the local and distal points together.
The five transporting points may be selected according to their therapeutic properties.
Jing-well points are selected for fullness in the epigastrium. (Liver/wood element disharmony)
Ying-spring points are for febrile diseases. (Heart/fire element Difficulties)
Shu-stream points are for a heavy sensation of the body and/or painful joints. (Spleen/earth element problems)
Jing-river points are for cough and asthma due to pathogenic cold or heat. (Lung/metal element ailments)
He-sea points are for diarrhea due to rebellious Qi or Zang organ disharmony. (Kidney/water element afflictions)
Ying-spring for Febrile diseases and Heart disharmony.
Heart belongs to fire. Febrile diseases are "fiery."
Signs and symptoms include: Irritability and sleeplessness, sores on the tongue and the lips, flushed face, thirst, painful and dark colored urine, dry stool, hematemesis (vomiting blood), nosebleeds, delirium or mania in severe cases, red tongue with yellow coat, rapid pulse.
Again, Tonifying the grandmother of fire, (water) which is found at the Ying-spring points of the Yang channels will sedate the fire element's fire. Sedating the Yin channel's Ying-spring (fire) points will help to turn down the fire in the heart or elsewhere.
Shu-stream points for spleen diseases and/or a heavy sensation of the body and/or painful joints.
Shu-stream points are for heavy sensations in the body and painful joints due to spleen Qi deficiency. This Qi Xu will also diminish the efficiency of the Spleen's function of transportation and transformation. With this hypofunction, dampness will be stored up within the body, or lead to a Splenic disorder due to cold-damp retention within the Spleen proper.
Signs and symptoms include: sensation of fullness in the abdomen, anorexia, nausea and vomiting, weakened limbs, loose stool, pale tongue with white greasy coat, and slow, soft pulse.
Sedating the grandmother of earth (wood) which is found at the Shu-stream points of the Yang channels will serve to tonify earth. Tonifying the Shu-stream points on the Yin channels will help to build up the strength of the earth element and the end of Splenic disharmony.
Jing-river for lung diseases and/or cough and asthma due to pathogenic cold or heat.
Jing-river points are for cough and asthma due to pathogenic cold or heat. Lungs belongs to metal, when lungs are attacked by pathogenic wind-cold or wind-heat, obstruction of the Lung Qi results.
Signs and Symptoms include: Cough, asthma, dry throat, sore throat hoarseness, and nasal obstruction.
Sedating the grandmother of metal (fire) which is found at the Jing-river points of the Yang channels will serve to tonify metal. Tonifying the Jing-river points on the Yin channels will help to build up the strength of the metal element and the end of Metal disharmonies.
He-sea for Kidney diseases and/or diarrhea due to rebellious Qi.
When the Kidney Qi is deficient, it is unable to grasp the Da Qi of the lungs.
Signs and symptoms include: Shortness of breath, dyspnea, and difficult inhalation (normal exhalation).
Another area affected by Kidney Qi deficiency is its reinforcement and astringent functions.
Signs and symptoms include: enuresis (withholding of urine), spermatorrhea, diarrhea, pale tongue with white fur, and a deep and weak pulse.
Sedating the grandmother of water (earth) which is found at the He-sea points of the Yang channels will serve to tonify water. Tonifying the Jing-river points on the Yin channels will help to build up the strength of the water element and the end of water disharmonies.
Channel | Jing-Well | Ying-Spring | Shu-Stream | Jing-River | He-Sea | |||||||||||||||
Lung | Lu 11 | Lu 10 | Lu 9 | Lu 8 | Lu 5 | |||||||||||||||
Pericardium | P 9 | P 8 | P 7 | P 5 | P 3 | |||||||||||||||
Heart | H 9 | H 8 | H 7 | H 4 | H 3 | |||||||||||||||
Spleen (Pancreas) | Sp 1 | Sp 2 | Sp 3 | Sp 5 | Sp 9 | |||||||||||||||
Liver | Liv 1 | Liv 2 | Liv 3 | Liv 4 | Liv 8 | |||||||||||||||
Kidney | K 1 | K 2 | K 3 | K 7 | K 10 | |||||||||||||||
Large Intestine | L.I. 1 | L.I. 2 | L.I. 3 | L.I. 5 | L.I. 11 | |||||||||||||||
San Jiao | SJ 1 | SJ 2 | SJ 3 | SJ 6 | SJ 10 | |||||||||||||||
Small Intestine | S.I. 1 | S.I. 2 | S.I. 3 | S.I. 5 | S.I. 8 | |||||||||||||||
Stomach | St 45 | St 44 | St 43 | St 41 | St 36 | |||||||||||||||
Gall Bladder | GB 44 | GB 43 | GB 41 | GB 38 | GB 34 | |||||||||||||||
Urinary Bladder | UB 67 | UB 66 | UB 65 | UB 60 | UB 40 |
On the Yin channels, the order, from the Jing-well point upward from distal to proximal, is wood, fire, earth, metal, and water.
On the Yang channels, the order, from the Jing-well point upward from distal to proximal, is metal, water, wood, fire, earth.
One way in which these points can be therapeutically utilized is by selecting them according to their relationships in the five element model.
Inter-promoting (mother to son), interacting (grandmother to grandson), overacting (too much grandmother to grandson), and counteracting (grandson pushing back to grandmother).
Beginning with the interpromoting relationship of the five elements, each channel has a "mother" point and a "son" point. The "mother point" of a channel has a reinforcing effect on that channel, while the "son point" has a reducing effect. In the case of an excess condition, one can reinforce the mother and reduce the son on the affected channel.
In clinical practice, the two needle method as was just described can be used on the mother and son points of the affected channel, or on the points along the mother and son channels.
The deficiency state of the Liver channel can be treated by tonifying Liver 8, because this is the water point on the Liver channel, and water is the mother of wood, so when mom feels good, she can better nourish her son. Liver 8 is the mother point of the Liver channel. This is using the principle of "tonifying the mother for deficiency syndrome."
Then there is the technique of using the same principle, but on the mother and son channels, rather than the mother and son points on the same channel
Deficiency syndromes of the Liver channel can be treated by tonifying the horary point on the mother channel which is the kidney. Kidney 10 is the horary point (water point on the water channel). This technique is based on the principle of "tonifying the mother for deficiency syndromes."
Excess syndromes of the Liver channel can be treated by reducing GB 38, the son point of the GB channel. Because GB 38 is the fire point and hence the son point on the Yang wood channel.
Yin diseases of the Zang-Fu organs can be treated with Back-Shu points. Yin diseases (this includes Zang organ syndromes, deficiency syndromes and cold syndromes) can all be treated with the Back-shu points. Yin diseases reach Yang. The Evil Qi of the Yin diseases may reach the back-shu points. This is called "Treating Yang for Yin diseases." Another deep thought is "Lead Yin evil out through Yang points." So, needling the Back-shu points to treat Yin diseases leads the evil Qi out through the Back-shu points.
For example, UB 13 on the back is needled to treat productive cough, fullness in the chest, etc. due to Yin-type diseases of the lung, in this case, Wind cold.
Yang diseases can be treated with the front-Mu points. Yang diseases may include Fu organ syndromes, excess syndromes, or heat syndromes. "Yang diseases reach Yin." The Qi of Yang diseases may reach the Front-Mu points. The treatment principle is then called "Treating Yin for Yang diseases". Utilizing the therapeutics of "leading Yang evil out through the Yin points." Thus, needling the front-Mu points to treat Yang diseases is leading the evil Qi out through the front-Mu points.
For example, Ren 3 (the Front-Mu of the U.B.) is needled to treat copious, frequent urination, burning pain in the urethra, dark yellow urine, etc. due to Damp-Heat in the U.B..
The back-Shu points above (and including) UB 17 can, in addition to the Yin diseases described above, treat Yang diseases such as Exterior cold or heat, chest or back pain (due to Lung heat, or wind heat or cold). UB 13 can treat common cold expelling wind heat or wind cold evil. Which explains why the Lung Shu point is so versatile for Lung or exterior disharmonies.
The Front-Mu under the level of Ren 8 can treat Yin diseases as well as Yang in the same way as the Back-Shu points above UB 17 can treat Yang. For example, Ren 4 can treat leanness due to consumption; Qi, Yang, Yin, or Jing collapse; or stroke associated with extreme Qi, Yin, Yang, or Jing Xu. It's a strong point.
The reason back-Shu points above UB 17 are good for Yang diseases as well as Yin, is because they are situated on the Yang (top half) of the Yang aspect of the torso (the back) . The are like "Yang within Yang" and since "Ultimate Yang becomes Yin", they begin to take on the Yin functions of treating Yang diseases. The same thing applies to the front-Mu points below the level of Ren 8. The are found on the Yin aspect of the body, and the lower, or Yin half of the abdomen, and hence they represent "ultimate Yin" which can begin to take on Yang attributes and thus, treat Yin syndromes.
UB 13 + Lu 1 = treatment of Lung diseases.
UB 18 + Liv 14 = treatment of Liver diseases.
UB 19 + GB 24 = treatment of Gall Bladder diseases.
UB 21 + Ren 12 = treatment of Stomach diseases.
UB 25 + St 25 = treatment of Large Intestine diseases.
UB 28 + Ren 3 = treatment of Urinary Bladder diseases.
Combining Front-Mu points with lower He-sea points on the Yang channels, treats Yang diseases (Fu organ syndromes, excess syndromes, heat syndromes)
Note: Lower He-sea implies the three extra He-sea points from the hand Yang channels as well as the three He-sea points on the foot yang channels as was discussed earlier.
For example: St 25 (L.I. Front-Mu) + St 37 (L.I. Lower He-sea) = treatment of Damp-Heat in the Large Intestine.
According to the Nei Jing. it is written that "Lower He-sea points treat Fu organ diseases."
For example:
UB 13 (Lung back-Shu) + Lu 9 (Lung Yuan-source point) = treatment of asthma due to Lung Qi deficiency.
UB 23 (Kidney back-Shu) + Kid 3 (Kidney Yuan-source point) = treatment of spermatorrhea due to Kidney Qi deficiency.
Back-Shu points and Yuan-source points can both treated deficiency diseases. Together, their effects are enhanced.
The Yuan-source points are closely related to San Jiao. Acupuncture on the Yuan-source points can dredge the source Qi in the San Jiao and regulate the functions of the internal organs. Hence, Yuan-source points can treat diseases of both the Zang and Fu organs.
This technique is beneficial when treating diseases that effect the entire body. Using the hand and foot Yuan-source points together, circulates the Qi's therapeutic action throughout the entire body. For example:
Yuan-source points combining with the Luo-connecting points (connecting internally, externally related channels).
Most beneficial when internally/externally related pairs of channels have a disease together.
Yuan-source points combined with Back-Shu points.
Back-Shu points and Yuan-source points can both treated deficiency diseases. Together, their effects are enhanced. What, you didn't get it last time this came up?
Yuan-source points combined with He-sea points or lower He-sea points.
Interior/Exterior channel relationships. Yuan-source points of Yin channels combined with He-sea or lower He-sea points of Yang channels. For example:
Liv 3 (Yuan-source point of Liver channel) combined with GB 34 (He-sea point of GB channel) for dizziness, bitter taste or dryness in the mouth, burning pain in the chest and hypochondrium due to Liver or G.B. fire.
This combination of points (Yuan + He-Sea) is used when the etiology of the disease is a disharmony between the internally/externally related organs.
Liver 3 (Yuan-source) combined with Liver 8 (He-sea) for distention. Cramping and cold pain in the perineum and lower abdomen, or pain from contraction of the scrotum due to accumulation of cold in the Liver channel.
Different Channels, not internally/externally related.
L.I. 4 combined with St. 36. Regulates Stomach and L.I. for treatment of dry stool.
LI 4 to tonify Jin (as in Jin/Ye) and St. 36 tonifies the stomach to push the fecal matter out the intestines.
Liver 3 combined with St. 36. Disperses stagnated Liver Qi, regulates Stomach Qi, for treatment of stomachache due to Liver Qi stagnation. Regulates liver qi and tonifies earth that has been attacked by wood.
For instance, Spleen 4, the Luo-connecting points of the spleen channel of foot tai yin, can treat not only the diseases of the Spleen channel, but also those of teh Stomach channel. Lu-7, the Luo-connecting point of the LUng channel of Hand Tai Yin can treat not only the diseases of the Lung channel (cough, asthma), but also those of the L.I. channel (toothache, head and neck diseases).
As for Du 1, Ren 15, and Sp 21 (The Luo-connecting point of the so-called "Greater Collateral of the Spleen, rules collaterals and blood vessels), they are mainly selected to treat their respective diseased parts and disorders of the internal organs.
The Eight Confluent points are the points where the extra meridians connect to the 12 primary meridians.
There are four Luo-connecting points among the eight confluent points. They are Pc-6, Sp-4, SJ-5, Lu-7, and two Shu-Stream points which are SI-3 and GB-41. (UB-62, Kid 6 have no function other than their connections to the Eight Extras-Yin Qiao Mai and Yang Qiao Mai.)
In practice, the eight confluent points of extra meridians may be used independently.
The confluent points on the upper limb can be combined with the confluent points on the lower limb.
Sp-4 is combined with PC-6 to specifically treat diseases of the Heart, Chest, and Stomach. (The curative effect is wonderful!)
Lu-7 is combined with Ki-6 to specifically treat diseases of the Lung, chest, throat and diaphragm.
SJ-5 is combined with GB-41 to specifically treat diseases of the outer canthus, ear, shoulder, neck or cheek.
SI-3 is combined with UB 62 to specifically treat diseases of the inner canthus, nape, shoulder.
Xi-Cleft on the Yin channels can stop bleeding.
For example:
Xi-Cleft on the Yang channels can stop pain.
For example:
For instance:
For example: Sp-6, a crossing point for the three foot yin channels, used for diseases of the liver, spleen and kidney channels.
Liver 3, (Yuan-source point of the Liver meridian of foot Jue Yin) combines with L.I. 4, (Yuan-source point of L.I. meridian of hand Yang Ming) for dizziness, tinnitus, numb limbs and tight tendons due to Liver yin deficiency.
Sp 3 (Yuan-source point of Spleen channel) combined with St 36 (He-sea point of Stomach channel) for abdominal pain, diarrhea, nausea, and vomiting.Luo-Connecting Points
The Luo-connecting points are closely related to collaterals. A Luo-connecting point connects with its partner in the Interior/Exterior relationship. That's why the Luo-connecting points are indicated in the syndromes of their partners in the Interior/Exterior relationship.Eight Confluent points of the extra meridians.
"Yi Xue Ru Men" (Introduction to Medicine) says that "among the 360 points on the whole body, 66 points are located at the four extremities are important, and among these 66 points, the Eight Confluent points are considered the most important."
Sp-4 for diseases of the Spleen, Stomach, and Chong Mai.
Pc-6 for diseases of the P.C., Heart, San Jiao, and Yin Wei Mai.
Lu-7 for diseases of the Lung, L.I., and Ren Mai.
Ki-6 for diseases of the Kidney and Yin Qiao Mai.
SJ-5 for diseases of the San Jiao, Pericardium and Yang Wei Mai.
GB-41 for diseases of the Gall Bladder, and Dai Mai.
SI-3 for diseases of the Small Intestine and Du Mai.
UB 62 for diseases of the U.B. and Yang Qiao Mai.Xi-Cleft Points
Each of the 12 regular channels has one Xi-Cleft point. In addition one Xi-Cleft point can be found on each of Yin Wei, Yang Wei, Yin Qiao, Yang Qiao Channels. There are 16 Xi-Cleft points in all. The Xi-Cleft points are used primarily in treatment of the acute pain and diseases appearing in their corresponding channels and organs can stop pain and/or bleeding.
Lu 6 for hemoptysis.
Sp 8 for Menorrhagia
L.I. 7 for toothache, sort throat, headache.
St. 34 for StomachacheLower He-Sea Points
"The Disorders of the Six Fu organs can be treated by the He-Sea points" (Miraculous Pivot-Ling Shu) According to this theory, the lower He-sea points are selected to treat diseases of their respective Fu organs.
Dysentery and appendicitis is treated by St-37, because St 37 is the lower He-sea point of the L.I. channel.
UB 39 is used for retention of Urine due to dysfunction of San Jiao.Crossing Points:
These are points located at the intersection of two or more channels. The channels that cross can be primary, extraordinary, or both. They can be used to treat disorders of each of their pertaining channels. They are often used to treat the diseases simultaneously in meridians intersecting each other.
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