Yoshio Manaka, MD with Kazuko Itaya and Stephen Birch ·
'
CHASING THE DRAGON'S TAIL THE THEORY AND PRACTICE OF ACUPUNCTURE IN THE WORK OF YOSHIO MANAKA
Yoshio Manaka Kazuko Itaya Stephen Birch
PARADIGM PUBLICATIONS
BROOKLINE, MASSSACHUSETTS
1995 /
Chasing the Dragon's Tail The Theory and Practice of Acupuncture in the Work of Yoshio Manaka Yoshio Manaka, Kazuko Itaya, Stephen Birch © 1995, 2008 Paradigm Publications ISBN 10: 0-912111-32-1 ISBN 13: 978-0-912111-32-2
Library of Congress Number: 95-10827 All rights reserved. Under penalty of law, no part of this publication may be reproduced, stored in a retreival system, or transmitted in any form by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher. Printed in the U.S.A. Paradigm Publications www.paradigm-pubs.com Distributed by Redwing Book Company 202 Bendix St Taos, NM 887571 www.redwingbooks.com
Cover illustration and chapter headings by Yoshio Manaka Cover design by jack Boyce Illustrations and Drawings by Herb Rich III
Fourth Printing 2008
TABLE OF CONTENTS DEDICATION
iii
PREFACE
v
ACKNOWLEDGEMENTS
viii ix
INTRODUCTION GLOSSARY OF TERMINOLOGY
xxix xxxvii
DESIGNATION SECTION
1: SIGHTING THE DRAGON
CHAPTER 1: ACUPUNCTURE; TRADITION
1 & TRANSMISSION
CHAPTER 2: THE X-SIGNAL SYSTEM
SECTION
3 17
2: IN PURSUIT OF THE DRAGON:
RESEARCHING AND EXAMINING TRADITIONAL THEORIES
3: YIN-YANG THEORY CHAPTER 4: THE CHANNEL SYSTEM: f!NGLUO CHAPTER
39
CHAPTER 5: THE 8 EXTRAORDINARY VESSELS AND THE OcTAHEDRAL MODEL
41 49 81
CHAPTER 6: THE FIVE PHASES
87
THEORY
SECTION 3: REACHING FOR THE TAIL: TRADITIONAL CONCEPTS IN PRACTICE: REGULATING THE SIGNAL SYSTEM CHAPTER 7: SYNTHESIZING DIAGNOSIS & TREATMENT
109 111
CHAPTER 8: DIAGNOSTIC ASSESSMENT
127
CHAPTER 9: CLINICAL TREATMENT: STEP ONE
155 183 205 245
CHAPTER 10: CLINICAL TREATMENT: STEPS TWO AND THREE CHAPTER 11: SYMPTOM CONTROL TREATMENT: STEP FOUR CHAPTER 12: HOME THERAPIES: STEP FIVE
SECTION 4: RIDING THE DRAGON: CASE STUDIES FROM CLINICAL PRACTICE CHAPTER 13: CASE STUDIES FOR STEPS ONE AND TWO CHAPTER 14: ILLUSTRATIVE CASE STUDIES FOR TOTAL TREATMENT
263 265 285
APPENDICES APPENDIX 1: PRESSURE PAIN: PATTERNS, INTERPRETATIONS, ORIGINS APPENDIX 2: SELECTED RESEARCH PAPERS OF MANAKA AND ITAYA APPENDIX 3: YI f!NG SYMBOLS AND SIGNALS IN ACUPUNCTURE APPENDIX 4: ON THE SAYOSHI AGENT APPENDIX 5: A MATHEMATICAL MODEL FOR THE FIVE PHASES APPENDIX 6: FURTHER THOUGHTS ABOUT THE NATURE OF THE X-SIGNALS
311 327 363 375 391 413
BIOGRAPHY OF YOSHIO MANAKA
425
BIBLIOGRAPHY
421
INDEX
429
/
DEDICATION Dr.Yoshio Manaka died November 20th, 1989. Many mourned the loss of a gentleman and a genius, a true Renaissance man. The manuscript for this text had been approved in all but its printed form by that date. It has been particularly difficult for those of us working on this book to break our tangible connection with the master and get the book to press. Finally we have been able to make this transition. We hope that our efforts have been worthwhile and we apologize for the delays.
Shu Ha R i
PREFACE
As a young man preparing for medical school, I was absolutely convinced that everything my science teachers taught was "true." I had no doubts; the world was secure and comfortable. Studying medicine was to be the extension and application of all that I had learned, and was expected to learn; the body's "ultimate truths" would soon be revealed to me. I began preparing in advance and bought a large medical textbook. I read this book with great excitement, from cover to cover. There were descriptions of the increasingly complex inner world of the body, biochemistry and biophysics applied in a seemingly endless manner. But why this doubt, these nagging unanswered questions, a sense of disappointment? Where were those truths I knew existed, but had not yet studied? Was it possible that medicine had overlooked something? Memory of an earlier experience was flooding my mind. I recalled my arrival at the age of eight at English boarding school. Departure from home and familiarity had left me emotionally unsettled for a period of time. I had spent the first several years coming down with one malady after another, and was constantly in and out of the sick room. One day, when returning from such an episode to confront two weeks of study to be done in one, I had decided that enough was enough. It was another five years before I even caught a cold! Because of this experience I knew with absolute certainty that I had decided when I would get sick, when those bronchial and upper respiratory infections would set in. It was not a purely biochemical event. This was experiential knowledge that none could deny. Yet, years later as I read the medical text, I discovered that medicine seemed to know nothing about this phenomenon. I was distressed. I had expected that an increase in the complexity and detail of what I studied would explain my own experience. But, it was completely absent! Was this experience true only for me or was it a more general truth? Could many (or possibly all) diseases come from mental and emotional distress? I did not know. But I did know that medicine's picture of the world neither asked nor answered my question. For me, this was an unacceptable flaw. This and other questions lead me to study philosophy instead of medicine. What better place could one turn to find answers? I could not have been further from the truth. I did learn the great thinkers and the assumptions that had spawned the modem world, its science and medicine. I did learn the reason for the unwillingness or inability of medical science to tackle my question. But I came no closer to answering the question myself. In all its wondrous complexity, philosophy came no closer to explaining the reality of my experience. And, if a theory were incapable of explaining the most elementary of things - one's own experience - what use was the theory?
/
vi
Preface
In hindsight, it is easy to explain these conflicts. I wanted truth and found only contradiction and assumption. The more I studied, the ~ore complex the questions became. Truth was not, after all, out there for the takmg. It was. an elusive, slippery devil. These conflicts and questions steered me towards Ind1an and Chinese thought, where I found more acceptable truths, that is, truths that served my need. I discovered that everything was relative. My appreciation of these simplistic yet adaptable metaphysical descriptions finally led me to study acupu~c ture. Here, I hoped, I would learn not just another truth, but how to do somethmg with the truths I knew. I could help people improve the quality of their lives. I soon learned that acupuncture was not a truth. Instead, I found a host of seemingly contradictory systems that came laden with perspectives, viewpoints and different assumptions, all of which seemed to have some clinical validity. I also found that there was a price to pay for this knowledge. All the science that I had studied seemed irrelevant and cumbersome. These systems were no more accepting of science than science was of mental and emotional factors. Truth again proved elusive and exclusionary. At first this was acceptable; I was gaining knowledge about a phenomenon I had experienced, and I was learning how to use this knowledge to good purpose. But, as my studies broadened my earlier questions resurfaced in new guises. Surely there must be someone addressing these issues and conflicts? Elusiveness made the problem interesting, but contradiction and exclusivity were unacceptable. Wasn't there a middle ground, some way of reconciling different truths? It was in this context that I first encountered the work of Dr. Yoshio Manaka of Japan. My introduction to his work came in 1982 while working on a variety of book projects as a teaching assistant. I was intrigued and delighted by his ideas and his gentle and effective treatments. As I continued to work, I was gradually introduced to more of his ideas, research, and theoretical descriptions of acupuncture. I was once again confused. It was satisfying to find someone who was attempting to bridge science and acupuncture, but he was using terms - topology, isophasality, octahedrality- that were unfamiliar. It was not easy to grasp how these concepts related to acupuncture. His ideas seemed vast and sophisticated, but adrift.
By the time of Dr. Manaka's 1985 seminar in San Francisco, I was beginning to piece parts of his model together, but still it seemed like shimmering moonlight on a heaving ocean. When he invited me to study with him at his hospital in Odawara, Japan, I was very honored. I was to help with the writing of this book, so my studies intensified and my reading was directed to new areas as I tried to keep pace with his teaching. I was not prepared for the intellectual shock, the breadth and depth of his work and practice. This was more than just the shock of losing a naive expectation, an experience that was hardly new. I had met a sensitive and brilliant giant, the equal of whom I had never known before. I was a minor composer confronting the genius of Mozart, a petty magician in the company of a real wizard. I watched Dr. Manaka transform the so-called "pseudoscientific speculations" of an obscure, traditional medical theory into a rational scientific model. His unusual experiments and models suddenly became clear for the first time. I could see the importance of his work. Here were the foundations of a new model that was capable of explaining and exploring both traditional and modem theories without trivializing either. Here, the elusive nature of truth was assumed, not hidden by the parochial exclusivity that dominated so many others. Dogma was transformed to inclusivity and freedom of thought.
Preface
vii
Neither was this a merely theoretical edifice. Almost every aspect of the model he proposed was based on clinical tests, observations, and years of successful clinical practice, not merely his own, but that of a network of skillful and dedicated workers many of whom were honored experts. Dr. Manaka's co-worker, Dr. Kazuko Itaya, had taken these seeds and germinated her own original research and undertaken years of dedicated research. In more than twenty years of work evidence after evidence had been compiled. I knew that their work was significant; in it lay answers to my questions. I came to this work forewarned. I knew of my disposition to search for truth; I was aware of my rational and irrational inclinations. I understood the phased acquisition of knowledge. We move from one stone to another as we cross the river of ignorance. But the work of Manaka and Itaya is more than just a stone in the river. It is a significant island over which we cannot see, and the distance to its furthest bank is as yet unkown. I believe the importance of their achievements is multi-levelled, requiring careful examination. It is here that my work begins. It is a great honor for me to work on this book. I hope that my journey of discovery and daily clinical use of their ideas has made me capable of the task and that my efforts will achieve at least two major goals: - First, I hope that I can clearly and systematically organize and make accessible their theoretical, experimental, and clinical materials. As we will see, this systematization is both a necessity and a travesty. I hope I have erred on the side of necessity. - Second, in the introduction, I would like to delineate some of the important levels of Manaka and Itaya's work. There are crucial philosophical, methodological, and clinical issues that are ignored by most authors and researchers of acupuncture. I believe that these are addressed by the work of Manaka and Itaya. It is here that I would like to begin my examination and expressing my respect for the junzi, :ft =f , for his ineffable kindness, wisdom, and wit. In the garden of his home in Odawara, Dr. Manaka had a bust which he sculpted of the famous English philospher, Bertrand Russell. In recognition of his admiration for Russell, I offer a parallel between their work with this short quote from Russell's later life: I am in no degree ashamed of having changed my opinions. What physicist who was active in 1900 would dream of boasting that his opinions had not changed?
Dr. Manaka's ideas have evolved continually. At the pinnacle of his life, his ideas reached a level of refinement that could only come after many years of practice, research and study. It is only natural that ideas which seemed advanced in the past, seem a little unrefined or unfinished today. This is a struggle that many experience with their work. I see it as the mark of a true creative genius. There are more things in heaven and earth, Horatio, than is dreamt of in your philosophy. - William Shakespeare, Hamlet I:v, p. 166.
STEPHEN BIRCH
ACKNOWLEDGEMENTS
I feel extremely fortunate to have been able to study with Dr. Yoshio Manaka. It is not often that one meets a teacher who is truly gifted, talented, and generous. I cannot thank Dr. Manaka enough for his great kindness, for extending his hospitality and educating me at his hospital in Odawara in the summers of 1986 and 1988. Nor can I thank him sufficiently for his enthusiasm, his warm support, and his continued generosity. I can only hope that my efforts in this work have gone some way towards expressing my gratitude. I am profoundly grateful to his associate, Dr. Kazuko Itaya, for her generosity, kindness, and support. Their work is truly inspiring, and I hope it will now reach a wider audience. My thanks must go to many others in Japan. In particular, Dr. Junya Manaka and his wife Setsuko Manaka were very kind and helpful. The whole staff of the Manaka Hospital also showed great consideration and patience with my bumbling ways. Dr. Manaka's assistants, Morii-san, Okusada-san, Komiya-san, and Takumisan, were extremely thoughtful and generous of their time; in particular Hiromasa Okusada-san. The two of us spent most of my evenings in Japan in 1986, as well as several months here in Boston, in 1987, working together, translating, sharing ideas, brainstorming. Without his support and his contributions, I probably could not have completed my work on this book. I think he will go far in the field. Last, but not least, I must thank my family and friends for supporting and helping me. In particular, my wife Junko, for her invaluable assistance with translation, and for her constant understanding and support. I thank my father, who helped me with research particulars and made important contributions; my mother, sisters, and brother for their nurturing and patience. Thanks go to Bob Felt and Martha Fielding for their unswerving support and friendship; to Nigel Wiseman, Marty Feldman, and Mark Friedman for their suggestions; and to my patients for teaching me about health and healing.
STEPHEN BIRCH
~~
~
INTRODUCTION To fully understand the work of Yoshio Manaka, it is important to place it in its wider context. If we examine the diversity of approaches and theories in acupuncture, and the paradigmatic issues confronting the field, we can see clearly that Manaka's research arose from knowing that for acupuncture to be accepted in the West it would be necessary to explain the diversity of the field while simultaneously bridging the traditional East Asian and Western scientific paradigms. It is here that Manaka was uniquely qualified to make significant contributions.
THE CURRENT ''CRISIS" In the late twentieth century, acupuncture and East Asian or Oriental traditional medicine - herbal medicine - have sewn many new seeds and germinated many young shoots around the world. This has occurred both because of the impact of Western science and culture on the East and the reciprocal impact of Eastern culture and science on the West. There has been transmission and communication. In Eastern traditional medicines there have always been many different schools of thought. Now, there are a great many more, both from the global migration from these centers and from the influx of Western science, methodology, and medicine. Everywhere that acupuncture and East Asian medicine have traveled, some form of intermarriage has occurred. New theoretical constructs, new lines of research, new emphases grow; new methods of measurement, new methods of diagnosis and treatment spring forth. In contrast, and partially in response to this heterogeneity, attempts to preserve "original truths" also have been put forward. Many traditionalist schools have arisen, each of which carries its own banner, each of which quotes the classics to justify an often singular point of view. There is perhaps more research and debate in the fields of acupuncture and East Asian medicine today than during any other time in history. We can divide these new traditions roughly into three general categories or approaches. In the first, only the traditional language of the medicines is permitted. Everything is defined within that language. Little or no attempt is made to use or incorporate scientific or medical language and concepts. These traditions attempt to retain the original integrity of the medicine. In my earliest work with Kiiko Matsumoto, I adhered to this approach, assisting in the presentation of previously untranslated traditional ideas [FE, EV]l Other examples of this approach include the keiraku chiryo, or "channel treatment" school that began more than
x
Introduction
fifty years ago in Japan, and is now slowly emerging in the U.S. and Europe. Another, the "Traditional Acupuncture" school, was first articulated in England during the 1960's and then spread to the U.S. in the 1970's. Perhaps the most widespread example can be found in the approach of the "Traditional Chinese Medicine" (TCM) advocates who follow the ba gang bian zheng school which gained popularity in China during the 1960's and spread to the U.S. and Europe in the 1970's and 1980's. The historical developments of this system are quite interesting. The ba gang bian zheng first surfaced in the early 1700's in a little known herbal treatise, gradually gaining popularity in the field of herbal medicine. It was incorporated into the theoretical and diagnostic language of Chinese acupuncture in the 1960's, during the turmoil of the early Mao years. Though the system itself used only the language of traditional medicine, a concerted effort was made to present it in a scientific and terminological framework that was acceptable to Western medical standards. The language of the system remains technically that of traditional medicine, i.e., the terms used are traditional terms (yin, yang, qi). Thus it is classified according to the definitions above as a "traditional approach." However, because its creators actually intended it as a kind of scientific approach, it could arguably be classed in the third approach described below, the "integrationist approach."2 These schools of thought select from, and adhere conservatively to, variations of the traditional theories described in the early Chinese medical classics. Qi, yinyang, five phase, channel and zang-fu theories, are the essential premises of the medicine. They are derived from ancient texts that provide an inspirational validity, confirmed by more than two thousand years of clinical practice. These, I label "traditional approaches." In the second approach, anything not scientifically measurable (or already measured), or anything couched in non-scientific language, relying on concepts such as qi or channels, is dismissed as pseudoscience, or worse, metaphysics and superstition. For the proponents of this approach, the only valid models of acupuncture and East Asian medicine are those based in scientific study and observation that strictly adhere to scientific methodology. This approach is characterized by the dismissal or trivialization of concepts that do not easily relate to modem ideas. For example, these systems often dismiss all acupoints that do not correlate with known neuroanatomical structures, or which cannot be related to trigger or motor points that are already scientifically validated.3 This approach demands the dismissal of traditional methods of diagnosis and patient assessment, such as radial pulse palpation, considered irreconcilable with modern Western medical practice [ATP, 29]. I label these the "scientific" approaches. Their proponents, including Mann, Baldry, and Ulett, consider "scientific truths" to be determined only by the strict methodology that is the single acceptable justification of medicine. This conceptual school has gathered adherents parallel with the growth of the practice of acupuncture in the West, finding favor among those who are unwilling to dismiss the clinical evidence that acupuncture "does something," but who cannot accept a rationale based on traditional concepts and measurements. Importantly, and to an extent rarely discussed, this hard science approach actually accounts for a considerable body of Chinese work and is in practice often found in works favored by the TCM school of thought.4 While the traditional concepts are maintained, they are often defined in reductionistic terms. The Chinese, for example, frequently label such things as qi, jing, shen, etc., under the rubric "fundamental substances" in a quasi-scientific manner.s
Introduction
xi
A third approach tries to find correlations of acupuncture and East Asian medical models with Western medical systems, explaining the terms and concepts of each in the language of the other. This is the "integrationist" approach. It attempts to avoid rejection of the models and concepts of either system, seeking instead to create a delicate symmetry between them. A good example of this approach is Yves Requena's Terrains and Pathology in Acupuncture. Dr. Requena's broad and brilliant attempt to explain concepts from traditional literature in the clinical and theoretical terms of Western biomedicine is perhaps the most sophisticated of the integrationist approaches. Often the analysis and technology adopted by these approaches discovers information and correlations not described in the traditional literature. This has led to the development of adapted versions or new syntheses. Good examples of this can be seen in the work of Dr. Voll in Germany, and from Japan, in the work of Dr. Nakatani.6 Both these methods base their starting point on findings that the channels and their acupoints are measurable electrically. From this common base, each group has evolved unique equipment, techniques and theories. Each of these three general approaches to acupuncture and East Asian medi- . cine is important. These categorizations are not inclusive of all styles of acupuncture. There are a series of new non-traditional therapies that fit none of these categories. The auriculotherapy of Dr. Nogier from France and the Koryo Sooji Chim hand acupuncture of Tae Woo Yoo from Korea are each modem systems that cross the boundaries of these general categories. As an overall schematization, however, these three categories define the various guidelines for acceptance of the truths of the medicine. Within and between each of these three categories there is much discussion, debate, and conflict. In large part this serves to exhaust the resources and distract the proponents of each system from issues that remain unaddressed. Yet the existence of disagreement is integral to attaining medical and scientific growth. These three approaches are necessary as part of a developmental process. Unfortunately, the axiomatic truths of each system are defined so as to exclude the truths of any other system. This is particularly obvious between the first and second approaches, where the various traditional and scientific practitioners find little basis for agreement. While less obvious in the third approach, the exclusivity built into both Eastern and Western paradigms allows hidden contradictions to remain unchallenged. Problems are posed at many levels, one of which is terminology. For instance, in the Western practice of acupuncture and East Asian medicine, the term gan .Iff means something a little different depending on who uses the term. It denotes a rough correspondence to the Western term, "liver." The Eastern usage of gan refers to something different than the liver, although it may include that organ, or some anatomical and functional component. Consequently, the use of terms is confusing and contradictory between different schools of thought. The problem is worse with the most common terms of acupuncture and East Asian medicine, such as qi ._ or jing luo ft. , which have no historical counterpart in the West or epistemological parallel in science. There are not even equivalent terms that can be used. Sinologists, translators, and scientists have struggled with this problem for years. While some headway may have been made,7 only the surface has been scratched. Underlying paradigmatic questions remain unaddressed. A further and related problem is that of social acceptance. For all we know, acupuncture and East Asian medicine may actually work better in the East than in the West because its basic concepts are already familiar. Further, the sociological
xii
Introduction
process of disease and healing that is regarded by some as important in health and disease already impacts medical systems in their native countries. Hidden expectations and psychological attitudes can, of course, play a significant role in the healing process. Again, progress has been made, but even this investigation has only just begun [FCM, xvii-xxxvii]. However, these too are essentially surface issues; the most critical differences lie at the level of the Eastern and Western knowledge paradigms. In his Introduction to Fundamentals of Chinese Medicine, Ted Kaptchuk begins to define this question, though he leaves it largely unanswered. He argues for the integration of Western psychological and psychosomatic concepts into the acupuncture and East Asian medical models so that practitioners may address the greater emphasis on those issues in the West. While it is greatly to Kaptchuk's credit that he has recognized and framed the issues, questions of emphasis in the somatic and psychological origins of disease are at root philosophical and not sociological. Until the underlying assumptions are examined and explored, the anthropological and sociological issues remain isolated and unresolvable [FCM, xviixxxvii]. The assumptions which support social, mental, and linguistic differences are more significant. The conflict at this level gives rise to many of the surface conflicts, like a submerged leviathan that disturbs the surface of the sea. If we are to make any headway in resolving these problems, we need to recognize that conflicts are only useful when they engender negotiation, mutual acceptance, and a recognition of the need to strive for compromise. Refusal to examine these issues cannot change the mutually exclusive standoff where the various schools of thought are mired. Compromise has been sought in several avenues, none of which have resolved fundamental differences. The integrationist approach has evolved technical means for finding common ground and constructing a model that is at least partially acceptable to both views. For sinologists and translators, the solution has required avoiding the established terminology of any and all the schools so that methods capable of distinguishing the subtle nuances of both the English and East Asian languages could develop apart from the charged atmosphere of loyalty to approach. For medical anthropologists, proffered solutions outline methods of adapting medical systems so that they may recognize social and attitudinal differences. These are all admirable approaches, representing honest and necessary attempts to solve existing problems. Without the lessons of parallel and similarity in the works of authors such as George Soulie de Morant and Yves Requena, the field's source of study and imagination is impoverished. Without the linguistic precision of a translator such as Wiseman,B we are afloat on a sea of unspoken assumptions where both similarities and differences are lost to examination. Without the anthropological insights and precise methods of an Unschuld,9 we have no means of study or comparison. But, for the traditional and scientific practitioners, these approaches cannot reconcile their differences. These two groups logically exclude one another. Without a paradigmatic solution, the translational and anthropological attempts of the integrationist approaches must ultimately fail to direct the course of acculturation. The compromise which we seek must do much more. It must address issues and resolve conflicts at the most fundamental level. World views, the fundamental assumptions and axioms of knowledge itself, must be examined. If we construct a broader paradigmatic model and develop a language capable of embracing the
Introduction
xiii
opposing viewpoints, we are then able to resolve conflicts and aid in the mutual acceptance of Eastern and Western medicine. As we shall see in Manaka's work, the theories of acupuncture and East Asian medicine stand on the same theoretical ground with Western science. Apparent conflicts exist because we ignore or refuse to acknowledge twentieth century science itself, which has moved beyond the older Newtonian sciences that dominate medicine and biology. Modem Western science shares premises with acupuncture and East Asian medicine. This has been noted before [TaoP], but as yet has been given little attention in science, acupuncture, or East Asian medicine. The parallels and similarities are so strong that they can not be ignored. Western science, Western methodology, and their offspring, Western medicine, require a reinvestigation of their own roots in the nineteenth century. So too must acupuncture and East Asian medicine reexamine their roots in earlier eras. The traditional schools of thought that depend on ancient classics, and the scientific schools of thought whose rationale are inextricably tied to the assumptions of an earlier science, share this responsibility. Because we must meet issues that cross the boundaries of these disciplines, everything should be investigated. If similarities can give us a common language, we will possess a powerful tool for resolving both intertraditional and interdisciplinary conflicts. However, let us remember, as Max Planck admirably stated: A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows that is familiar with it [SMR, ix-x].
The current political realities and power struggles may not surrender to a common solution, but they will simply fade as the confluences of personal, financial, and intellectual interests age and are replaced. Nor will the development of an embracing philosophical model magically resolve all conflicts. Yet the synthesis and development of a new language and model, such as those Manaka offers in the pages of this book, may well serve as a lighthouse to guide us away from the rocks of exclusionary dissent, assured mutual discontent, and probable destruction. It can protect us from unacceptable alterations of the medical system, what Kaptchuk aptly termed "a mutant based on fantasy" [FCM, xxxvi].
PARADIGMATIC WORLD VIEW ASSUMPTIONS With the exception of politically influenced modern Chinese works on acupuncture and East Asian medicine, both practitioners and scholars agree that these medical systems are founded on a non-reductionist paradigm [SCC, 2:556]. All things in the world interact with all other things in varying degrees. This is typically, and most generally expressed, by the following schema: heaven I person I earth This image of the most basic levels of interaction is found in the Yi Jing, in many early philosophical and scientific texts, and throughout the medical literature. Human existence (and in fact all forms of life) are the result of the interaction of heaven and earth, relative symbols referring to general cosmic organizing principles or forces. Inherent in this world view is the idea that one cannot really describe separate objects. Everything exists in a web of relations. They are thus nonreducible. Almost all the early medical texts take these ideas as first premises. Joseph Needham has written a beautiful characterization of these interrelationships:
xiv
Introduction
Things behaved in pa:ticular ways not n~cessa:i.ly ~ecause of prior. actions. or impulsions of other thmgs, but because thetr posttwn m the ever-movmg cycltcal universe was such that they were endowed with intrinsic natures which made that behaviour inevitable for them. If they did not behave in those particular ways they would lose their relational positions in the whole (which made them wh~t they are), and turn into something other than themselves. They were thus parts m existential dependence upon the whole world-organism. And they reacted upon one another not so much by mechanical impulsion or causation as by a kind of mysterious resonance [SCC 2, 281].
Reductionism, on the other hand, is the mainstay of modern Western biology, chemistry, and medicine [SMR, 29p]. All things are seen as reducible to their separate parts (atoms, molecules, cells, etc.). The study of these parts allow us to describe the thing studied by combining the properties of the separate parts: The basic tactic of natural science is analysis: fragment a phenomenon into its components, analyze each part and process in isolation and thereby derive an understanding of the subject. In physics, chemistry, even biology, this tactic has worked splendidly [SMR, 62].
Today both scientists and philosophers take ontological reduction for granted. Vitalism is dead. Organisms are "nothing but" atoms, and that is that. [SMR, 51].
It is also clear that the Eastern theories are non-dualistic in nature. No clear distinction between mind and body and no separation of mind and body exists.lO This is generally held to be true, although there are examples in the traditional literature where the reverse opinion is also held. This has led one author, in a thorough analysis of the issue, to conclude:
What we have found is that this heterogeneous collection of early Chinese medical writings reflects many still-evolving, ambiguous, even conflicting views on this subject. Much of the evidence is in line with the basic perspective of a unified body and mind; yet, not to be denied or overlooked, other important evidence reveals that conceptions of the mind are at points definitely distinguishable, if not sharply divided, from conceptions of the body. In other words, high-level generalizations made in the past about Chinese approaches to the mind-body problem are basically correct; but they do not go far enough.ll
While thus not altogether "correct," this view of the non-dualist nature of acupuncture and East Asian medicine must be accounted for in a treatment of the subject, all the more so since most of the literature supports this view. Discussions in the medical literature clearly reflect this non-dualistic attitude. It is typically said, for example, that anger will "injure" the gan (liver),12 yet if the gan develops a problem, anger and irritability may result [ECA, 68; FCM, 236; EV, 256]. In modern medicine and biology, dualism is prevalent. Ever since Descartes' famous "cogito ergo sum" ("I think therefore I am,"), the mind and body have been studied and treated as separable and separate entities. The body is viewed as a machine that can function independently of the mind [SMR, 24]. In the West this has presented a considerable difficulty to medicine [SMR; TSM, 59p ], whereas in acupuncture and East Asian medicine, Humpty Dumpty never fell from the wall and no effort was required to put him back together again. No clear separation of mind and body was made, thus there was no need to reassemble the parts [HD]. It is significant that in the modern Western literature on acupuncture and East Asian medicine, there is little reference to the non-dualistic nature of Chinese thought.l3
Introduction
xv
A third distinct difference between East Asian philosophical views and ~estern philosophical views is thatof causality versus acausality. Western science
1s based on a cause-effect model where all things--fullow-adirect causal logic. A moving object striking a stationary object will cause that object to move in a particular direction, with a particular velocity, that is directly calculable from the velocity and angle of collision, and the masses of both objects. The presence of streptococcal bacteria will cause a streptococcal infection. Disease is seen as a disorder of mechanisms [STM, 14], and mechanisms are pure cause and effect models. While it is recognized that the cause and effect model of disease is becoming unmanageably complex [STM, 60], causality is still assumed even where it cannot be empirically demonstrated. Yet acupuncture and East Asian medicine are, for the most part, acausal. Causality for the Chinese was quite different. It was, as Needham states, based on a philosophy of organism: Nothing was un-caused, but nothing was caused mechanically. The organic system in the prompter's book governed the whole. And the characters in the eternal dramatic cycle were, as has been said, in existential dependence upon the totality of the system. [SCC 2, 283].
There are the Yin and the Yang. All things have their chi-kang [fixed positions and motions with regard to other things in the web of nature's relationships]. The sun, moon and stars signify punishment or virtue, and their changes indicate fortune and misfortune. Metal, wood, water, fire and earth conquer each other successively, the moon waxes and wanes alternately. Yet these normal (changes) have no ruler or governor.If you follow it [Heaven's way] virtue will be attained, if you violate it there will be misfortune. [SCC 2, 255].
These quotes state succinctly what I have termed the acausal model of acupuncture and East Asian medicine, when seen in distinction to Western science's causality model. It is the network of relationships that provides an indeterminate result. If one is able to follow the rules of this network, the dao (tao), one will remain virtuous and healthy. Conversely, not following the rules will lead to poor health and disease [SW, ch 1,2p]. Multiple factors taken together are seen as causing disease. This is not cause and effect in the normal sense; rather it is the interaction of a multiplicity of phenomena, which under the right circumstances will lead to disease. Stomach pain develops as a result of an increased caffeine intake irritating a patient's already complex condition, where factors such as poor diet, alcohol consumption, cigarette smoking, menstrual difficulties, tight musculature, poor exercise habits, home and work stress, each contribute. In a recent lecture, Paul Unschuld drew attention to the fact that traditional Chinese medical theories are rife with reductionist and causal theories and references, what he has identified as the "ontological" approach, while we in the West have as yet only really focused on and selected from the holistic or "functional" aspects.14 It is true that not all the theories of acupuncture and East Asian medicine fall within the category of this synthetic or holistic approach to health and disease, yet many of the important theories do, specifically those of yin and yang and the five phases, which are particularly important in acupuncture. Thus a valid approach to acupuncture and East Asian medicine must address both levels, but first we must at least solve the not inconsiderable problems associated with understanding the "functional" approach, which is essentially non-reductionist, acausal, and non-dualist. The "ontological" approach mostly seems to occur in reference to the origins and causes of disease, while the "functional" approach refers to and
xvi
Introduction
describes the healthy dynamic systems. In this regard, the principal difficulty for the traditional, the scientific, and the integrationist approaches to acupuncture resides in the following question: - How can we describe the non-dualist, non-reductionist and acausal medical systems of acupuncture and East Asian medicine in the dualist, reductionist, and causal language of the West, especially Western science and medicine? Indeed, can we make such a description?15 Clearly, this is a problem for the scientific and the traditional approaches, but it is particularly problematic for integrationist approaches where a reciprocity of description is taken for granted. With their backs to the wall, the proponents of the scientific approaches can always argue that there remains a logical possibility that one day all the mechanisms of acupuncture and East Asian medicine will surrender their secrets to scientific methods [SMR, 138p]. But, as we will see, this too runs into difficulty. With the advent of subatomic physics, relativity, and quantum theories, twentieth century science overturned the basic assumptions of a dualist, reductionist, and causal world that are implicit to modem medicine and the scientific approaches to acupuncture and East Asian medicine. Thus, the question applies for not only their approach to Eastern ideas, but to all Western science itself. As a consequence, serious methodological questions arise. The problems for the traditional approach are many-leveled. There are obvious scholarly and anthropological difficulties that must be addressed. As soon as we translate acupuncture and East Asian medical literatures into our language, as soon as we import these medicines with all their cultural underpinnings into another culture, we meet this problem. The language and concepts we use in these transitions contain implicitly all the paradigmatic assumptions of the new culture. In the U.S. and Europe, these are essentially dualist, reductionist, and causal. Thus in the Traditional Acupuncture schools of Britain and the U.S., an emphasis on the "psychospiritual" components of disease has developed. This does not accurately reflect the original acupuncture literature, because the distinction made could not have existed. The two terms, psychological and spiritual, cannot be made whole as easily as they are combined to make the single term "psychospiritual." This raises the question as to whether this particular school of thought should be considered an integrationist adaptation rather than a traditional, conservative movement. In a further confusion of conceptual terms, the school places great emphasis on the diagnosis of a "causative factor" (CF), the single underlying cause of disease. It is clear that this school must attend to at least the dualist- non-dualist, causal- acausal dualities in its rationale. In the traditional Chinese medicine (TCM) approach, the Chinese Marxist reliance on empirical findings (i.e., what works), sacrifices methodology and theory. The logical view of TCM in the West lies somewhere between the non-reductionist, non-dualist, and acausal logic of the traditional literatures and the reductionist, dualist, causal logic of Western biomedicine. Much of the traditional literature is ignored as it cannot be made to fit the mold of empirical theories [FCM, xxxii-xxxv; MCHI, 229p]. This is epitomized in the following statement, which presents an inherently unacceptable position: Retaining only the theories that have practical value will do no damage to the theoretical body of Chinese medicine. Indeed, it will help eliminate the constraints, develop it further, and raise it to the standard of a modern medicine. [FCM, 18].
Introduction
xvii
This ignores correct scientific methodology to such an obvious extent that such statements are more often than not deleted by Western translators whose views permit such expurgations. The assumption that the clinical techniques utilized in China today have no bearing on the outcome of clinical studies of systems and ideas outside of the current Chinese model is simply and prototypically bad study design. Applications of particular techniques are rooted in the theories that produce them. It is poor inquiry to use those techniques for investigation of the practical value of other systems and theories. These assumptions do not allow accurate judgments about the practical value of a particular theory. To think that no damage is done to the theoretical body of Chinese medicine is naive at best. By attempting to modernize and Westernize its presentation, traditional Chinese medicine has created a conceptual void. Without an acceptable methodology, it cannot be acceptably Western. Using materialist and Marxist logic, it cannot be traditionally Eastem.16 Traditional systems must be able to explain themselves to the modem (and Western) world. Logically, it is not acceptable to subsume ideas from both paradigms, thereby attempting to create a new vision of the medicine, without addressing their fundamental contradictions. Nor is it logically acceptable to ignore these fundamental questions by focusing instead on a plethora of clinical results. The issue is not that acupuncture and East Asian medicine observably work (although this too is an important question, sorely in need of appropriate resources and rigorous studies); it is rather, what consistent logical description can we make of what we observe? A system which addresses and answers this paradigmatic conceptual question stands on firmer ground. If it is possible to generate a larger world view that sacrifices neither the conceptual integrity and ingenuity of the traditional theories nor the conceptual richness of modem science, we will have a model capable of carrying acupuncture and East Asian medicine successfully and globally into the twenty-first century. Indeed, if this model is to be successful, it must mutually embrace both paradigmatic systems [SSR]. Before examining and detailing such a model, one already in parallel development for Western medicine, it is important to discuss those developments in the physical sciences that demand the revolution in biological and medical thought. If we ignore these developments, we will miss the most promising solutions to our problems, and be consigned by the future to "the museum of medical oddities." If anything is clear, it is that all the social, political, or intellectual schools of thought now used to define acupuncture and East Asian medicine will be unable to meet this challenge.
THE WESTERN PARADIGMATIC DISSOLUTION
Since the major developments of twentieth century theoretical and experimental physics are known through many technical and popular works, little needs to be said here. It will be sufficient to look at conclusions relevant to our discussions, with regard to the paradigmatic world view. These developments are not the only developments of this century that have radically challenged the old paradigm. Troubling discoveries in the study of chaotic and thermodynamic systems, especially mathematical models of these, are also bearing the layman's paradigm to its grave. Besides these changes in scientific speculation, equally important changes in inquiry methodology have occurred. It is now clear that not only have the reductionist, dualist, and causal assumptions of the old paradigm been called into question, but that non-reductionist, non-dualist, and acausal methods must be used. There is simply no other option. At the leading edge of many fields of inquiry,
xviii
Introduction
such systems are developing, with the outcome that rich vocabularies and models with which to examine acupuncture and East Asian medicine are now available. With Einstein's original formulations of the theory of relativity and the development of quantum mechanics, the notion of a world reducible to its separate components came under fire. In physics, at least, this concept met its end, but in the life sciences, biology and medicine, for example, it still prevails. Foss and Rothenberg, Dossey, Capra, and others argue for the need to update the life sciences so that they come into line with these developments. Probably the clearest and strongest theoretical and experimentally validated expression of the non-reducible nature of the world can be seen in Bell's theorem from the 1960's.17 Bell's theorem continues an argument begun by Einstein. He shows that it is possible for any particle in the universe that has interacted with another to afterward respond instantaneously to a change in the second particle, regardless of the distances separating them. The implications of this are enormous. At the very least, the reductionist program will no longer hold its ground. It is possible, even probable, that all things in the universe are interacting with all other things, all of the time. It is only in our imagination that they are separate: This seems to imply that in some sense all these objects constitute an indivisible whole. [STM,100]
The Cartesian conception of reality as consisting of separate parts, joined by local connections, is incompatible with quantum theory. [TurP, 83]
This theory and its experimental validation further demonstrate that the cause and effect model is incorrect.
If the statistical predictions of quantum
theory are true, an objective universe is
incompatible with the law of local causes. [STM, 98].
In relying on simple perceptions and experiments, the influences of non-local phenomena can be neither measured nor ruled out. Thus, attempts to construct simple cause-and-effect models are doomed to failure. Modern physics tells us that the world does not function in such a manner. Note, too, that it is not that we have failed to construct adequate cause-and-effect models; it is that adequate cause-and-effect models cannot be constructed. The dualist program fares no better. Bell's theorem and the Einstein-RosenPodolsky thought experiment on which it was founded also show an interdependence and interconnectedness between mind and matter. This is clearly seen in Heisenberg's famous uncertainty principle, which places limits on our observations and measurements of nature: Heisenberg stressed that the laws of nature no longer deal with elementary particles, but with our knowledge of these particles- that is with the contents of our minds. [SMR, 144].
The conclusions and implications of this are well stated by Bernard d'Espagnat: The doctrine that the world is made up of objects whose existence is independent of human consciousness turns out to be in conflict with quantum mechanics and with facts established by experiment. [SMR, 145].
Introduction
xix
Thus the old scientific paradigm is no longer correct or appropriate. The world is non-reducible, non-dualist, and acausal; theoretical physics has experimentally confirmed this. We cannot separate the human subject from the world. We are the participator in an indivisible whole, both affected by and affecting all things. We are immediately reminded of the web of nature's relationships which lies at the heart of the traditional Chinese world view. What can we learn and use from this? By what methods, and with what language should we describe the world? These remarkable developments have prompted some scientists to describe quite different models of nature. The physicist David Bohm, for example, has developed a theory in which most of what is, is not perceivable or measurable; it is hidden or enfolded in space. The perceivable and measurable world, the world that our senses detect, is like the ripples on an ocean where everything beneath this surface is hidden from us, and all parts are derived from this ocean. He describes how the activities and rules of this hidden or implicate order have great significance relative to the observable or explicate order, that which we can sense.18 In this manner he can describe many of the findings of twentieth century science. He also uses the holographic paradigm to describe this implicate order. He proposes that the universe is a hologram, wherein all parts of the whole contain images of the whole. With this model and its vocabulary, he is able to describe the world in non-reductionist, acausal, and non-dualist language. His, and related models, have proven fruitful for describing mind-body interactions, in exploring wholeness and acausal events. As we will see, this is a useful starting point for developing a model and language for acupuncture and East Asian medicine. According to the second law of thermodynamics, the entropy of a closed system increases with time. Systems eventually degenerate to a state of disorder or chaos, or so it was believed. In the last few decades, researchers from around the world and from many disciplines have been discovering that the reverse is actually true.l9 As systems degenerate to disordered or chaotic states, they spontaneously show signs of order again. This may seem insignificant or unimportant, but it represents perhaps one of the most important scientific advances of the twentieth century. Hidden within chaotic systems are very fine, complex, ordered structures. Chaos brought an astonishing message: simple deterministic models could produce what looked like random behavior. The behavior actually had an exquisite fine structure, yet any piece of it seemed undistinguishable from noise. [Cha, 79]
Chaos was the end of the reductionist program in science: Simple systems give rise to complex behavior. Complex systems give rise to simple behavior. And most important, the laws of complexity hold universally, caring not at all for the details of a system's constituent atoms. [Cha,304]
In the reductionist view, properties of a system are seen as the result of the sum of the properties of the component parts of the system. In the new paradigm, properties of the whole system, which are not dependent on the component parts of the system, and which obey universal laws, are seen as being essential to the behavior and regulation of the system: Chaos brought to life a new kind of physiology, built on the idea that mathematical tools could help scientists understand global complex systems independent of local detail. [Cha,280].
xx
Introduction
These startling findings provide a rich language and conceptual framework for modeling properties of complex whole systems. Like Bohm's theory of the hidden or implicate order, they give us words for describing hidden or enfolded orders in the body, such as those described by the medical theories of China, which are not accessible through the reductionist, dualist, and causal logic and language of the old scientific paradigm. These changes in science have necessitated a change in the way we model nature and a change in the way we inquire into nature. It is here, in the development of appropriate models and language, that we find probable solutions to the questions raised above. They allow us to describe the concepts of acupuncture and East Asian medicine in terms that are remarkably similar to the original Chinese concepts. The language may at first seem strange, and until the necessary conceptual developments are complete, these technical languages must remain.2°
EMERGING FRAMEWORKS AND MODELS Two of the most common conceptual models that have been used to describe nature, and how humans interact with nature, are General Systems Theory and Information Theory. Some authors believe that the use of these conceptual frameworks may be the only possible solution to the very complex models of nature that have sprung up in this century and which bypass the usual reductionist, dualist and causal impasse [SMR]. General systems theory proposes that we model the hierarchical nature of life as a series of systems that mutually interact. This model implicitly recognizes the non-reductionist, non-dualist, and acausal nature that has been demonstrated by twentieth century physics. Systems are integrated wholes whose properties cannot be reduced to those of smaller units. Instead of concentrating on basic building blocks or basic substances, the systems approach emphasizes basic principles of organization. [TaoP, 266].
Each person consists of innumerable systems, the various organs, tissues, cells, molecules, atoms, subatomic particles. Each person is part of a small group, a family, which is part of a larger community, which is part of a larger group. Each level or system has its own organization and associated activities, but each level acts on each other level; it is an indivisible whole. Information theory allows descriptions of complex phenomena when the mechanisms and processes are either known or unknown: "Information" is a complex concept that has been given various definitions in such fields as thermodynamics, communications and probability theory. Generally speaking, it is a measure of the order existing in a system - a certain degree of order represents information - and it implies the deliberate selection of one event out of a number of possibilities. Information is any pattern of events in time and space ... The form or structure of the body has informational content. 21 It has been noted that organisms constantly exchange energy with the environment. This is part of life's adaptive processes; however, it is the informational exchange that is more significant in this adaptive process. The energy is of course important, but change results from the information content of the energy.22 The ingestion of food, fluids, air, the reception of sense data and behavioral stimuli all represent informational input. The excretion of waste (gaseous, fluid, solid), the
Introduction
xxi
e~p.enditure ~f energy through work, behavior, all represent informational output. L1vmg orgamsms are open systems, meaning that their information is both input and output.
In the systems model, what passes back and forth between each interacting system or level is information: Living systems exhibit multi-leveled patterns of organization characterized by many intricate and nonlinear pathways along which signals of information and transaction propagate between all levels, ascending as well as descending. [TaoP, 282].
Information theory thus allows us non-dualist, non-reductionist, and acausal descriptions of nature. Information rather than causality describes processes within or between organized systems. The most general model of a natural process on which scientific explanation may be based is no longer the movement of a particle under the action of a force, but the storage (or organization) and the transmission of information within a system. [SMR, 182].
This seems to fit the criteria for an appropriate language to describe living things in the manner of modem physics. The findings of modern physics have led to the conclusions that while processes in nature may follow simple rules, the processes themselves are actually complex. Biological systems are particularly good examples of this complexity. The systems described by physics are simple systems and are the exception not the rule; complexity is almost always encountered: [This will] demand a completely new vocabulary. Crucially, for example, the quantities that change will be informational in nature. Simple systems of the type traditionally studied in physics (where states and dynamical laws in the form of differential equations constitute a highly idealized scheme) from complex systems "describable by a web of informational interactions" [CB, 159].
Ideas called "software laws" by Paul Davies (see Dr. Manaka's use of this analogy in chapter four) allow such distinctions. Living systems are just such complex systems with a "web of informational interactions." The software laws are not logically derivable from the underlying hardware laws, the physical processes; they relate to emergent phenomena and properties, i.e., they relate to non-reducible properties which arise as a product of whole body activities. The use of information and systems theories as a framework for describing these properties, and for resolving the methodological problems of Western science and medicine, is encountered in many places.23 I would not be the first to point out parallels in traditional Chinese theories and systems theory,24 but repetition of these ideas is useful, as is noting the parallels of traditional Chinese ideas to information theory [HD, 417-422]. Numerous other parallels can be drawn. Needham's characterization of the web of relations within which everything in Chinese thought is seen to exist [SCC 2, 255,556], and the web of informational interactions characterized by Davies [CB, 159], represent significant similarities, not only for their similar language, but also for their paradigmatic similarities.
xxii
Introduction
In Chinese thought the three-leveled system of heaven-person-earth is described in many places. In the application of information theory generalized to open systems, i.e., biological systems, we find strong parallels [AC, 101-104]. The living organism receives information from both the terrestrial environment and the larger (solar) environment. This information feeds back to and constrains (interacts) through each level. In the three-leveled system, the various qi of heaven, earth, and people interact. The information subsets of the larger (solar}, closer (terrestrial}, and living organism (person) interact. In this many-leveled system (described in Hara Diagnosis), qi passes back and forth between all levels, as general and specific forms of qi, described by different traditional theories according to the levels involved in the exchange. Changes at any level eventually filter down through all levels. In the multi-leveled systems described in the modem scientific literature, information passes back and forth between each level. A change in any one level effects a change throughout all levels. As well as parallels in structure and language, we can see possible parallels in content. The term "qi" is used in the traditional literature in a manner that is in many respects identical to the use of the term "information." In the traditional literatures, the term qi is used to refer to both the body in its physiological stuff, and in its processes and derived properties; that is, in a quantitative-qualitative manner, and to identify tiny non-quantitative signals or relational properties that produce effects; that is, in a purely qualitative manner. In scientific literature, the term information is used to refer to the same properties. It can name the physiological stuff, various quantitative energies, and as well tiny qualitative signals which we can determine exist only through their actions. The term "qi" is at the heart of the ability of traditional theory to describe the web of nature's relations. The term "information" is likewise at the heart of the ability of modem science to describe the web of interactions now known to exist within nature. The term qi is used to refer to and describe both mental, emotional, and physical phenomena. The term information is also used in this non-dualist manner. The parallels of use, meaning, and context are numerous. Systems theory and information theory languages are clearly able to describe the paradigmatic world view assumptions of traditional Chinese theories. Thus, these languages and their theoretical frameworks meet the criteria for the development of a model that encompasses both the Western and Eastern paradigms, allowing logically consistent descriptions and the formulation of experimental procedures adequate to both models. · It is here, in the development of a model of acupuncture and East Asian medicine using systems and information theory models, that Dr. Manaka has made his most valuable contribution. Coming from his background of science, Manaka studied acupuncture and East Asian medicine extensively. Through years of clinical treatments, study, and research, and through the development of numerous innovative techniques, he arrived at a coherent model of acupuncture as a method of modifying the biological information systems. This idea culminated in the publication of a landmark paper in March of 1986.25 By implicitly recognizing the problems and contradictions between Western scientific practices, theories, and methods, and Eastern scientific practices, theories, and methods, he avoided the pitfalls that had trapped most researchers in the field of East Asian medicine and acupuncture. Further, by recognizing the far reaching implications of systems theory and information theory, and adapting them so as to describe the traditional Eastern framework, he developed a model connecting both Eastern and Western systems without contradicting either. This, in turn, has
Introduction
xxiii
allowed for systematic examination and testing of traditional theories and practices, something which is sadly missing in most current research. Manaka focused on the demonstration of anomalies - phenomena not explained in the scientific paradigm and thus was able to achieve significant progress in the study of traditional concepts. Manaka's model, still in its infancy, recognizes the following:
- Qi is difficult to measure and define. In the traditional literature it is an important concept and can be modeled after the concept of information. It does work and brings about (functional) change. - Qi, information, flows through the body in organized patterns, through pathways, generally the jingluo, the channel systems. Jingluo allow interpenetration of information from the superior to inferior, anterior to posterior, left to right, exterior to interior, and vice versa. (This is most evident in Manaka's octahedral model of the channel system.) It allows for the distribution of information throughout the body.
- Jingluo, information channels, may represent biological structures or systems that developed early in evolution and through embryological development. As such, it may be that they are regulated by simple rules and systems that have been in existence before the development of more advanced and sophisticated regulation systems, like the nervous and hormonal systems. Yin-yang antagonisms seem to define one such set of rules. The five-phase system seems to define another set of rules and systems. These may represent primitive biological systems or organizing principles that function in the global regulation and distribution of information. - Yin-yang and five-phase systems are operationally defined by signals. These signals have a very low energy content, but high information content. These signals can be changed or modified by applying appropriate low-energy signals to loci, the xue or acupoints of the channels. Specific acupoints are receptor sites for specific signal inputs; that is, they have yin-yang, five phase, and other characteristics. Thus, very exact changes in the channels and flow of information can be brought about with appropriate signals at the appropriate loci. -Essentially, this information system upholds the known physiological systems as a more primitive regulatory system. Ideas such as these have been alluded to by other authors, but not in such depth and detail, and usually only as a theoretical modei.26 Manaka's models key explicitly into methods of diagnosis and treatment thus representing a unique combination of theory, research, and practice. It should be noted that each stage and statement in the model is both theoretically justified by the traditional medical literature and verified by clinical research and clinical efficacy. This can be said for no other model. Dr. Manaka has called this the "X-signal system;" "X" because the exact nature of the signals are usually not known. While Katsumata and I speculate on the possible nature of these signals (see appendices 4 and 6), it is interesting to notice another parallel in structure. In the Dao De Jing of Lao Zi, the famous first line states: "The dao that can be spoken of is not the eternal dao." Perhaps in anticipation of future developments, Dr. Manaka has recognized the essentially unknowable nature of the signals. This model not only recognizes paradigmatic differences between Eastern and Western world views, it also addresses significant epistemological problems. The methods by which we inquire into or gather knowledge about nature -the decisions and judgments that sit behind what we will inquire about, how we will inquire into it, and by what standards or guarantors we judge our
xxiv
Introduction
inquiry as successful - are very important. John Ratcliffe from the University of California at Berkeley has written an important paper relative to these issues.27 He argues that the dichotomy between quantitative and qualitative research is false; all research is essentially qualitative, since subjective judgments lie behind all the facets of research: All data are theory-, method-, and measurement-dependent. That is, 'jacts" are determined by the theories and methods that generate their collection; indeed, theories and methods create the facts. This means that how the problem will be defined, which model(s) of inquiry will be considered to be relevant to the problem as defined, where one shall look (and, by implication where one shall not look) for evidence - and even what one shall consider to be constitutive of evidence - are all determined by the paradigmatic "map" or world view to which the scientist is committed.
Judgments made by the researcher determine what will constitute knowledge. The guarantor of validity, that which is judged to be sufficient evidence, determines the acceptability of observed data as fact. It is interesting to note that these guarantors of validity have, over the centuries, gone through several evolutionary steps. Ratcliffe notes that the first inquiry system establishing a guarantor of validity was that of Liebniz, using the deductive system through which truth is grasped by analytical deduction. This was followed by the Lockean system, the inductive method, where truth is established through experience, that is, through empirical content. This was followed by the third system, Kant's synthetic system, where truth is established through a combination of the inductive and deductive inquiry systems. Hegel's dialectical system is the fourth system. Here truth is seen primarily as a function of conflict. This is a method that allows a further synthesis of the earlier systems. The fifth and most recent inquiry system is that of Singer, the relative inquiry system. This explicitly recognizes that assumptions, world views, govern the knowledge gathering process, that truth does not exist independent of the human mind. Thus, all truth is only true relative to the goals and objectives of the inquirer and inquiry. Each of these inquiry methods have specific uses today, being appropriate for tackling specific problems.28 Since traditional acupuncture, as well as we can determine, came with no inquiry methodology that we know of, it is important to determine our own methodology for investigating acupuncture and East Asian medicine. If we come to the study of acupuncture with preconceptions of what it is, how it might work, and with what methods it may be studied, we must also come with a considerable knowledge of its theories and practices. If not, we limit the scope of our study enormously and devalue whatever pronouncements our studies produce. Virtually all acupuncture research falls short of these requirements, either because the experimenter lacks knowledge, or because the inquiry methods applied to specific problems are inappropriate. This is not a reprimand, more a statement of fact. Almost all researchers in the field have come to their studies with good intentions, but almost none have asked the basic research questions. Since, as we have seen, the traditional Chinese world view is similar to the emerging twentieth century world view, the fifth inquiry method, the relative inquiry method, is most appropriate. This allows the theoretical components of the traditional theories to be treated seriously by the inquirer.29 Unfortunately, this is rarely the case. While Manaka did not use Ratcliffe's labels, he adopted a relative approach, taking all theoretical concepts seriously until they were shown to be either wrong or trivial. Further, he developed a flexible approach to his studies. This allowed him to examine many components of the traditional systems.
Introduction
xxv
In his study of acupuncture, Dr. Manaka brought a unique combination of knowledge and methods. He had a deep knowledge of the traditional literatures. In his large library he had all the major classics and their commentaries, as well as many texts on acupuncture from countries around the world. He was fluent in Japanese, Chinese, German, French, and English, with research skills in several other languages. He had an in-depth knowledge of the most significant traditional, integrationist, and scientific approaches to practice. He had detailed knowledge of the paradigms of both Western scientific medicine and traditional East Asian medicine, and was fluent in the paradigmatic conflicts. He also had a good working knowledge of theories on the cutting edge of science and an incredible knack for developing models and methods. This book is a product of his rare combination of skill and knowledge. Manaka was the first to have tested acupuncture on its own terms and to have developed scientific models not paradigmatically at odds with the theories and methods they set out to explain. This is truly a unique and valuable contribution. Others, such as you and I, must now undertake the daunting task of rigorously exploring Manaka's theories and claims. But only if we persevere will progress be made and will acupuncture attain its true potential. We cannot be so rich to disperse enough money to everyone. But we can be wise enough to enrich other people's knowledge with our own mental devotion. - Yoshio Manaka, 1987 STEPHEN BIRCH VVAL~,~SSACfnJSETTS,
1995
NOTES 1 A comprehensive reference listing of citations and abbreviations appearing in this introduction may be found following these notations. 2 Nathan Sivin has good discussions of this point: "One of the explicit aims of the Great Proletarian Cultural Revolution became to produce a synthesis of the two systems [i.e., the traditional and scientific] that would be fully scientific without being foreign or elitist." See Sivin, N., Traditional Medicine in Contemporary China, Ann Arbor: Center for Chinese Studies, 1987, p. 19. See below for further discussions of this point. 3 See for _example: Mann, F., Acupuncture: The Ancient Chinese Art of Healing and How it Works Scientifically, New York: Vintage Books, 1973; Gunn, C.C. et al, "Acupuncture loci: A proposal for their classification according to their relationship to known neural structures," Amer. Jour. Chin. Med. 4 (2): 183-195 (1976); and Ulett, G.A., Principles and Practice of Physiologic Acupuncture, St. Louis: Warren H. Green Inc., 1982. 4 See for example: Han, J.S., The Neurochemical Basis of Pain Relief by Acupuncture, Published privately by the author at Beijing Medical University. See also the books of abstracts from China, e.g., Anon., National Symposia of Acupuncture and Moxibustion and Acupuncture Anesthesia, Beijing, China, June 1979. 5 For examples of this in English, see: Kaptchuk, T., The Web That Has No Weaver (chapter 2), and The Essentials of Chinese Acupuncture, (p. 36). Nathan Sivin's translation of the Revised Outline of Chinese Acupuncture, in his publication, Traditional Medicine in Contemporary China, renders perhaps the most dil'ect expression of the modem Chinese opinion on this subject. This text states, for example, that "Ch'i, blood (hsueh), ching, and the dispersed body fluids (chin-yeh) are the indispensable material foundation of the body's vital activities"; and again, "Ch'i has two senses; one is physiological function or motive force and the other is subtle, refined matter which has a nutritive function." Sivin is very aware of the absurdity of this terminology - material foundation, refined matter, etc. He footnotes his own disagreement: "This account, although typical of recent writing, differs considerably from the classical understanding," and refers the reader to his discussion of the subject. See: Sivin, N. op.cit. p. 237. 6 Voll, Reinhold. "Twenty years of electroacupuncture diagnosis in Germany; a progress report," Amer. J. Acup. 3: 7-17 (1975); Voll, Reinhold, Special EAV issue, Amer. Jour. Acup. (1978). See also, Nakatani, Y. and K. Yamashita, Ryodoraku Acupuncture, Tokyo: Ryodoraku Research Institute, 1977.
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Introduction
7 See Nigel Wiseman's immense and important work, the Glossary of Chinese Medical Terms and Acupoints. In addition, see Paul Unschuld's important contributions to the field, Medicine in Ch~n.a: A History of Ideas; Medicine in China: Nan Ching: The Classic of Difficult Issues; and Approaches to Trad1tzonal Chinese Medical Literature. Joseph Needham made some interesting early comments on the problem of translation in East Asian medicine in his mid-1970's critique of Manfred Porkert's approach to the problem. See Needham, J., and Gwei-Djen Lu, "Problems of translation and modernisation of ancient Chinese technical terms," Annals of Science 32:491-502 (1975). 8 See Wiseman's translations and works based on his translations, including Fundamentals of Chinese Medicine, Fundamentals of Chinese Acupuncture, Grasping the Wind, Glossary of Chinese Medical Terms, and Illustrated Chinese Materia Medica. 9 See Unschuld's numerous translations, including Medicine in China, A History of Ideas; Medicine in China, the Nan-Ching Classic of Difficult Issues; Medicine in China, A History of Pharmaceutics; Medical Ethics in China; and Forgotten Traditions in Ancient Chinese Medicine. 10 Good discussions of this can be found in the following articles: Ikemi, Y., and A. Ikemi, "An oriental point of view in psychosomatic medicine," Advances 3:4 (Fall1986), pp. 150-157; and Shen, G.J. "Study of mind-body effects and qigong in China." Advances 3:4 (Fall1986), pp. 134-142. 11 Chiu, Martha Li, Mind, Body, and Illness in a Chinese Medical Tradition, Ph.D. diss., 1986, p. 165. 12 See for example, Huang Di Nei Jing Su Wen, chapter 5; Essentials of Chinese Acupuncture, p.45. Good discussions can be found in Shen, G.J .. "Study of mind-body effects and Qigong in China," op.cit. 13 Mention can be found in the Introduction of Acupuncture: A Comprehensive Text, p. 2. There is a further reference to this idea - though less directly stated - in the Introduction to Fundamentals of Chinese Medicine, pp. xxi-xxii in particular. 14 Unschuld, Paul, "The dual approach to healing in Chinese medicine: Ontological and functional understandings of illness," lecture given at the New England School of Acupuncture, April 11, 1989. See also: Unschuld, Paul, "Traditional Chinese medicine: Some historical and epistemological reflections," Soc. Sci. Med. 24:12 (1987), pp. 1023-29. More recently see, "Epistemological issues and changing legitimation: Traditional Chinese medicine in the twentieth century," in Leslie, C., and A. Young, Paths to Asian Medical Knowledge, Berkeley: University of California Press, 1992. Other authors have drawn attention to the "mechanistic" and thus causal nature of many of the early medical speculations. For an interesting and thorough discussion, see Epler, D.C., "Bloodletting in early Chinese medicine and its relation to the origin of acupuncture," Bulletin of the History of Medicine 54 (1980), pp. 337367. 15 Questions like this have been asked by some authors, typically not in the primary acupuncture literature, but rather in secondary literatures. See e.g., Aakster, C.W., "Concepts in alternative medicine," Soc. Sci. Med. 22:2 (1986), pp. 265-273. See also, Patel, M.S., "Problems in the evaluation of alternative medicine," Soc. Sci. Med. 25:6 (1987), pp. 669-678. 16 In the Essentials of Chinese Acupuncture (p. 11), yin and yang are described as a "naive concept of materialism and dialectics." In Fundamentals of Chinese Medicine (p. 18), yin-yang and five-phase theories are described as being based on rudimentary dialectics and necessarily incomplete. In the Zhongyi Mingci Shuyu Xuanshi (p. 1 p, p. 7 p), edited by the Chinese Medical Research Institute of the Guangdong Chinese Medical School (People's Hygiene Publishing Company, 1973), yin-yang and the five phases are described as primitive dialectical materialism. Perhaps the originators of yin-yang and five phase theories did not have Marxist dialectics in mind. Historically, at least, it would be better to say that Marx (albeit unintentionally) had Chinese philosophy in mind. Kaptchuk states the problem well in his Introduction to the Fundamentals of Chinese Medicine, p. xxxiv-xxxv:
The self justification of East Asian medicine was taken outside of its own methodology. By appealing to a combination of 19th century shallow positivism (i.e. "empirical practices of the masses") and 20th century watered-down dialectical materialism (i.e., "yin-yang is a rudimentary dialectic"), East Asian medicine ceased to be a coherent point of departure for illness and health and became a corpus needing rescue from modern science. The tendency that has existed for the last thirty years in China to be "interested in the empirical efficacy of traditional practice, not in the traditional theoretical framework, which supported these practices," reached full bloom . ... China's synthesis (which itself is always changing and itself has been affected by Western questions and research) is the product of complex cultural, historical and political forces. 17 For good discussions of this theorem see Dossey, Larry, Space, Time and Medicine, pp. 98-101, and Capra, Fritjof, The Turning Point, pp. 83-85. 18 David Bohm, Wholeness and the Implicate Order. See also: Ken Wilber, ed. The Holographic Paradigm and other Paradoxes.
Introduction
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19 For good discussions of this see: Gleick, James, Chaos, Making a New Science; Prigogine, llya, and Isabelle Stengers, Order out of Chaos; Davies, Paul, The Cosmic Blueprint; Mandelbrot, Benoit, The Fractal Geometry of Nature; also Foss and Rothenberg, The Second Medical Revolution; and Dossey, Larry, Space, Time and Medicine. 20 We are certainly not the first to draw attention to and use these parallels. The physicist Wing Y. Pon, a native Chinese living and working in California, has developed models using exactly these parallels. Some of his work was published privately, most is not yet published. See for example: Pon, Wing Y., Journey into a Science of Reality I-III, San Jose: East West Institute for Sciences and Philosophy, 1978. His use of these recently developed conceptual frameworks is unparalleled in my knowledge. 21 Cunningham, A.J., "Information and health in the many levels of man: Toward a more comprehensive theory of health and disease," Advances 3:1 (1986), pp. 32-45. 22 Ibid. 23 Foss and Rothenberg make the most extensive and cogent argument regarding these developments and their necessary inclusion in the medical model. They develop the notion of "infomedicine," rather than biomedicine, which they see as necessarily containing all the restrictions of modem science not grounded in twentieth century physics, where the infomedical model has none of these disadvantages. This is discussed throughout the Second Medical Revolution. Many other authors have used similar models and analogies. See for example: Capra, Fritjof, The Turning Point, pp. 265-304; Cunningham, A.J. "Information and the many levels of man: Toward a more comprehensive theory of health and disease," Advances 3:1 (1986), pp. 32-45; Engel, G.L., "How much longer must medicine's science be bounded by a seventeenth century world view?" in K.L. White (ed.), The Task of Medicine, Menlo Park, California: Henry J. Kaiser Family Foundation, 1988, pp. 113-136. For discussions of the biological extensions of these models, see for example: Schoffeniels, E,. Anti-Chance; Brooks, D.R. and E.O. Wiley, Evolution as Entropy. For interesting discussions of the origin of information, see: Gleick, James, Chaos, Making a New Science, pp. 255-262. 24 See for example: Ikemi,Y. and A. Ikemi, "An Oriental point of view in psychosomatic medicine." Advances 3:4, pp. 150-157, 1986. See also the works of Wing Y. Pon referenced above. 25 Manaka, Y. and K. Itaya, "Acupuncture as intervention in the biological information system. (Meridian treatment and the X-signal system)," Address given at the annual assembly of the Japan Meridian Treatment Association, Tokyo, March 29-30, 1986. Published in English in the Journal of the Acupuncture Society of New York 1:324, 9-18, 1994. In this paper he proposed that a low-energy signal system comprises the essence of the theories and effects of acupuncture. He provided preliminary evidence for this model from theoretical and experimental biology and his clinical research and practice. 26 For example, several Chinese researchers have concluded after extensive reviews of current research that the channels must be a "higher and more complicated system" linking all other systems in the body together. See Zhao Jianguo and Zhang Linying, "Review of the current status of acupuncture and channel theory," Amer. Jour. Acup. 14:2 (1986), pp. 105-109. One Chinese researcher has proposed that the channels function as a "third equilibrium system" which mediates between the body surface and the viscera. See Meng Zhaowei, "The third equilibrium system-meridian system," Jour. Chin. Acup. Moxib. 1:1-2 (1987), pp. 62-64. Other Chinese authors have proposed that the channels of acupuncture function as a "latent information feedback network of the human body's regulating systems," where information about the body's current state is conveyed by the channels between "special cells" that lie along its path, producing general regulatory effects in the body. See Chong Jang Xia and Jia Rui Lin, "A new kind of stimulator for dredging human body's channels," IEEE Eng. Med. & Bioi. Soc. lOth Annual Int. Con£. (1988), pp. 1250-1251. Other authors and researchers from different parts of the world have arrived at similar conclusions. William Tiller, in reviewing the literature and uses of electrodermal instruments, has drawn a model showing how it might be possible for information about the state of function of the internal organs to reflect to acupoints at the skin surface, and how information can be sent back from these points to their corresponding organs to produce functional changes. These points at the surface "become information access windows to the functioning state of specific organ and body systems." See Tiller, William, "On the evolution of electrodermal diagnostic instruments," Jour. Adv. Med. 1:1 (1988), pp. 43-72. Some researchers in Austria have specifically related the systems of acupuncture to "systems theory" and proposed physiological models that match these theories. See Feigl, W. and E. Feigl, "The pathophysiology of acupuncture: An abstract," Amer. Jour. Acup. 13:3 (1985), p. 280, originally from the Deutsche Zeitschrift fur Akupunktur 28:2 (1985), pp. 36-40. 27 Ratcliffe, J.W., "Notions of validity in qualitative research methodology," Knowledge, Creation, Diffusion, Utilization 5:2 (1983), pp. 147-167. 28 Ibid. 29 Ibid., p. 157.
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Introduction
ABBREVIATIONS USED IN THE INTRODUCTION [AC]: E. Schoffeniels, Anti-Chance. [ATP]: Baldry, P.E., Acupuncture, Trigger Points and Musculoskeletal Conditions. [CB]: Davies, Paul, The Cosmic Blueprint. [Cha]: Gleik, James, Chaos, Making a New Science. [ECA]: Essentials of Chinese Acupuncture [EV]: Matsumoto, K. and S. Birch, Extraordinary Vessels. [FCM] Wiseman, Nigel, et al., Fundamentals of Chinese Medicine. [FE]: Matsumoto, K. and S. Birch, Five Elements and Ten Stems. [HD]: Matsumoto, K. and S. Birch, Hara Diagnosis: Reflections on the Sea. [MCHI]: Unschuld, Paul, Medicine in China: A History of Ideas. [SCC]: Needham, Joseph, Science and Civilization in China. [SMR]: Foss and Rothenberg, The Second Medical Revolution. [SSR]: Kuhn, Thomas, The Structure of Scientific Revolutions. [STM]: Dossey, Larry, Space, Time, and Medicine. [SW]: Su Wen [TaoP]: Capra, Fri~of, The Tao of Physics. [TurP]: Capra, Fri~of, The Turning Point.
GLOSSARY OF TERMINOLOGY
A meaning of a word is a kind of employment of it. Giving grounds, however, justifying the evidence, comes to an end; but the end is not certain propositions striking us immediately as true, i.e. it is not a kind of seeing on our part; it is our acting, which lies at the bottom of the language game. -
Ludwig Wittgenstein, On Certainty
I ·am not a translator, I am a collector of ideas. I have helped describe and collate the ideas in this book, but do not claim the role of professional translator, nor is this book essentially a work of translation. The use of terms that are not of English origin is Dr. Manaka's, whose written English was excellent. Thus, I have transmitted his ideas as best I could in terms that strove to express his understanding. The Japanese, no less than the Chinese, use the characters of written Chinese. Thus Japan has never needed translations in the sense these are required in the West. Furthermore, this is not a generic work where the language must reflect the cultural scope of Chinese medicine, but a specific attempt to define ideas like qi, yin-yang, and five phases- something rarely attempted. As well, while Dr. Manaka clearly understood that written translation resources are essential for insuring the public access and scrutiny that Eastern no less than Western sciences require, he supplied this work with practical tests that others may confirm. For these reasons, very few comments on the use of terminology in this text are required. First, the viewpoint and assumptions of an inquirer cannot be separate from the inquiry. Translation and speculation are both methods of inquiry. To use terms which have technical meanings, without providing a glossary of technical definitions, is an invitation to misunderstanding, as readers assume that their own understandings apply. Failure to define is thus at best confusing; at worst, it completely invalidates the information. To use terms that have origin in another language, and thus depend on the assumptions of the inquirer to great extent, without providing the assumptions that lie behind the translations, is hardly honest. There are a number of terms used in the text that come from the traditional Chinese literatures. These have either been translated or only romanized. Terms such as qi and yin-yang are probably untranslatable in the usual linguistic sense. Indeed, as is argued in the text, it may be the language of mathematics that most effectively translates these terms. These terms typically feature in discussions throughout the text and are explored through analytic and comparative means; for example, describing how qi shares much with the concept of information. However, while translating the word qi as information would dramatically make that point, it would reflect a grandiosity quite unlike Dr. Manaka.
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Terms such as jing luo, wu xing, jing jin, bu, xie, shi, xu, have been translated in a variety of ways that depend on the viewpoints of various authors. ]ing luo are variably translated. The first European attempt came from France where they were translated as "meridians." Other common translations include "channels and collaterals," "channels and connecting channels," "conduits," "conduits and network vessels." A brief study of the etymology and use of these terms showed that they each capture some, but not all, of the meaning of the Chinese. For example, the term "meridian" has implications associated with celestial movements, the division of the heavens by invisible lines, and by extension, lines of force. The term channel generally refers to some pathway along which fluid moves, and secondarily has meanings such as "channels of information." The term conduit is not that dissimilar to the term channel, except perhaps in being more specifically used. Each of these words captures some of the connotations of jing luo. They have been analogized to passageways of water as the qi flows through them, a fact confirmed by the names of important acupoints. They are also insubstantial and nonvisible, and define the surface of the body from top to bottom, section by section. How to decide which term is most appropriate? Dr. Manaka used the term "meridian" when speaking or writing in English because this was the word commonly used by the English speakers he first encountered. The term seems to imply something more subtle, less gross than a channel, which is usually something tangible with a definite shape, depth, and size. "Meridian" implies a logical rather than physical quality. However, the argument that information flows in channels is telling, particularly since Manaka's work shows that the jing-luo are passageways for the flow of something (e.g.: signals, information). Thus, I decided on the term "channel." The term wu xing has been translated elsewhere as "five elements." While there are some who still wish to justify a relationship to the Western ideas of elements, this translation is now generally recognized to be less accurate than "phases." Phase implies change and interaction, key features of this logical system, where element carries with it the sense of immutability that is at the conceptual root. Manaka used the term phases and his research seemed to show that the wu xing are something similar to a phase. Manaka's own term, "isophasality" has been reserved for technical presentations of his ideas. Again, the practical value of an easily recognizable differentiation between the classic term and the proffered theory is of some value. The jing jin are more difficult; in the past they have been translated by European authors as the "tendino-muscular" meridians or channels. Recently they have been rendered as the "channel sinews" or "muscle meridians" or "conduits." The term jin seems to refer to anatomical structures that include the tendons, ligaments, muscles, and all the other associated structures, such as nerves and blood vessels. The term muscle is thus a limitation of scope. However, by extension it does include other related structures. The term "sinew" is relatively broad and encompasses all these structures. However, those who want a more physical and less functional reference to musculature do object. "Sinews" refer to the tendons in most medical dictionaries. The term "tendino-muscular" is interesting, but limited. In anatomical literature the term one encounters is "musculotendinous" not "tendino-muscular." I used the term "channel sinew" for this text because of the following considerations. First, Unschuld uses the term muscle with a footnote that defines this as including the sinews; Needham takes note of the nature of the jing jin as being neuro-muscular; Shibata argues that the term jin refers to the muscles and all their associated structures, tendons, ligaments, nerves and blood vessels. Thus there is good precedence among those who have offered a rationale.l
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The terms bu and xie used to be translated as "tonification and dispersion" or "tonification and sedation," and are more recently translated as "supplementation and draining." In this particular case, Dr. Manaka's clinical experiments and explorations determined the choice. In chapter one he explores the concept clinically and experimentally, rather than pedagogically (as we are doing here). This investigation shows that in any of these translations there is a great inadequacy, because they do not match the experimental results. As a consequence, the terms only appear when discussed where they are translated as "supplementation and drainage." The terms do not appear in the clinical sections, because the treatments there have different goals; they are designed to regulate the signal system, not to add to or subtract from the physiological system. The terms shi and xu suffered the same fate. Translations such as "excess and deficiency," "repletion and vacuity," "repletion and depletion" do not fit clinical and experimental findings. In the text, when they are encountered, they are rendered as "repletion and vacancy" because that was Manaka's choice, but then are shown to be neither. Surprisingly, this covers almost all the traditional terms that appear in the text. What is unique in Dr. Manaka's approach is that rather than pure scholarly and pedagogical analysis, he designed clinical experiments to explore the meaning of the terms. Most of the time he has found that the terms really do correlate to some entity or functional system, but often in a manner different than the implications of the popularly used English words. For those interested in the translation of terms from the Chinese, Nigel Wiseman and Paul Unschuld's contributions are by far the most significant.2 In the text proper, whenever the words "I" or "my" are used these terms refer to Dr. Manaka. Whenever the term "we" is used, it refers to Manaka and Itaya. I have tried to keep myself out of the text as much as possible. The reader will find a few notes that begin "S.B." This is where I thought I could clarify the text. There are other terms which arose in the Western literatures, especially scientific terminology not often encountered in the study of acupuncture. Often the text itself provides these definitions. Our reasons for inclusion of these terms in this text are numerous, but can be summarized as an attempt to highlight fundamental issues and formulate clear and sufficient models upon which and to which research can be carried out. We have selected theoretical paradigms and models that use languages capable of solving or avoiding these fundamental problems, i.e., capable of bridging the differences. These often utilize mathematical terms and concepts derived from theories that are forging new horizons in the fields of physics and biology. The following is a brief explanation of some of the terms used in this text. To a specialist knowledgeable in a particular area, these definitions will be inadequate since they are meant as summary explanations. References have been provided for readers wishing to research further. Finally, it should be noted that this text discusses many specialized techniques not yet described extensively in English, such as the techniques of Japanese needling, moxa, moxa on the head of the needle, intradermals, bloodletting, cupping, the Manaka wooden hammer and needle (peg), and the use of the Hirata zones. Readers desiring additional information regarding clinical applications of these techniques may look to a subsequent title, Birch, S. and J. Ida, Japanese Acupuncture, A Clinical Handbook, Brookline, MA: Paradigm Publications, 1995. STEPHEN BIRCH
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Glossary of Terminology
TERMINOLOGY DISSIPATIVE STRUCTURE: This term was first coined by Ilya Prigogine, who received a Nobel prize for his work on dissipative structures. It refers to a system's use of entropy (see below) for maintenance and development. In a closed system, order slowly breaks down and entropy ensues, but in the real world where open systems are the rule, systems interact continuously with their environment. This allows a continuous exchange of energy between the system and its environment, which is believed to underlie the development of order in the system. This is most clearly seen in systems that are far from equilibrium, i.e., that are on the brink of chaos. In these states, systems show self-organizing properties that push the system into a newly ordered state; they dissipate energy into the environment, allowing order to develop with the energy remaining in the system.
"A dissipative structure evades the degenerative effects of the second law lf thermodynamics- see also below] by exporting entropy into its environment."
Dissipative structures interact and exchange with their environment. "In all cases the system is driven from equilibrium by an external forcing agency, and adopts a stable form by dissipating away any perturbations to its structure. Because energy is continually dissipated, a dissipative structure will only survive so long as it is supplied with energy (and perhaps matter too) by the environment."4 ENTROPY: In a broad sense, entropy refers to a state of disorder in a system. The higher the entropy, the greater the disorder. The second law of thermodynamics states that the entropy of a closed system will increase over time. In a narrower sense, entropy is a measure of a system's unavailable energy. The more entropic a system is, the less available energy there is in the system. Recent studies in chaos have called the second law of thermodynamics into question, since it has been shown that the state of chaos (disorder/entropy) contains within it the seeds of order, or hidden orders. Chaotic systems can spontaneously give rise to ordered systems.S HOLOGRAPHY - HOLOGRAM, HOLOGRAPHIC PARADIGM, HOLOMOVEMENT:
Holography is the study of three-dimensional images created using light waves that interfere with each other. The image created is called a "hologram." An interesting fact about holograms is that each portion of the hologram contains within it an image of the whole hologram. This unusual feature has led a number of researchers in various fields to speculate that holographic modeling may explain how "holistic models" work. For example, the brain may use holographic modeling.6 The physicist David Bohm has gone much further in his modeling of nature. He argues that the entire universe is a hologram. 7 This model has allowed him to explain and resolve certain difficulties in experimental physics. The new model that he (and others) have evolved is called the "holographic paradigm" (see below for discussions of "paradigm.") The importance of this model is that it allows descriptions of how non-local events can produce local changes and how local events can produce non-local changes, that is, how every part of the universe communicates with· all the other parts of the universe. The term "holomovement" refers to that which carries the information specific to an "implicate order" (see below) in an undivided and unbroken totality. HOMEOSTATIC MECHANISMS- FIVE PHASE, YIN YANG INTERACTIONS: A homeostatic mechanism is a mechanism that serves to restore an original state of a system. In biological organisms homeostatic mechanisms are extremely important, since most biological activities occur within very narrow biochemical and thermal limits. Optimal biological activities are maintained when the homeostatic mechanisms are
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able to keep the internal environment within those limits. Any shift outside those limits can lead to decreased biological activity and malfunction, that is, disease. In the earlier chapters of this text we will show how many of the traditional Chinese theories, such as the five phase and yin yang theories, are partially descriptive of how the body regulates itself.
Yin yang interactions describe how antagonistic/syntagonistic parts of the body regulate each other, or at least how those antagonistic/syntagonistic parts can be utilized therapeutically to initiate such regulation. In the "octahedral structure" (see below), the yin yang antagonistic halves of the body serve to regulate the overall distribution of qi around the body. When problems occur, treatments can be given that activate these regulatory functions to restore a healthier balance (e.g., the general distribution of qi around the body.) The five-phase interactions also describe how different functional systems within the body regulate the activities of other functional systems. If one phase goes out, the others function to return it to its more normal state. Should this be insufficient, such that pathologies occur, treatments may be devised to activate the phasal interactions, thus helping the whole system restore a more normal state of balance. These two regulatory mechanisms represent significant first line homeostatic mechanisms in the body. {The nature of these phasal interactions and regulatory functions are analyzed mathematically in appendix 5.) INFORMATION- THEORY, SYSTEMS, FLOW: Information is a general term that refers to both energy and matter. It occurs within organisms and between organisms. In more general terms, it occurs within and between systems (see below); it describes the interactions between parts and wholes, between systems. Information theory is a theory that uses the concept of information to make broad statements about the object of the theory. "Information" is a complex concept that has been given various definitions in such fields as thermodynamics, communications and probability theory. Generally speaking, it is a measure of the order existing in a system - a certain degree of order represents information - and it implies the deliberate selection of one event out of a number of possibilities . ... Information is any pattern of events in time and space. ... The form or structure of the body has informational content.B In the sense of traditional physics, information is neither matter nor energy. Rather, the concept of information brings into play the two older antipoles of matter - namely, form and consciousness. . . . One must take "probability" and "information" as objective and, at the same time, as subject-related concepts.9
The term "information" and the informational view of nature are becoming increasingly central in science and in medicine. Basically, use of the term "information" allows descriptions of systems and the complex interactions within and between systems, in such a way as to give more accurate descriptions of the processes at work. It allows a logical description of nature in more comprehensive or holistic terms, which is more in keeping with experimental physics than the seventeenth century world view still prevalent in much of the scientific community. Many in the medical community demand the full development of information theory in medicine. The infomedical model is becoming more important as a replacement for the traditional model.lO IsoPHASALITY: This term was first coined by Dr. Manaka in relation to the ancient Chinese theory of the five phases. Each phase is described as having a series of (horizontal) interactions with each other phase, for example, the engendering and restraining cycles. Within each phase numerous (vertical) correspondences are described. For example, each phase has corresponding organs, channels, colors,
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Glossary of Terminology
sounds, tastes etc. In its broadest sense, the term "isophasal" refers to these vertical sets of relationships or correspondences. In a narrower, more clinically oriented sense, the term refers to a set of same (iso-) phenomena. For example, each meridian has an "earth" acupoint on it. These earth acupoints are all isophasal to each other. This means that they all manifest some similar characteristics. A specific signal produces the same response at all these acupoints but not other acupoints. For example, the color yellow when applied to earth acupoints elicits the same response from each meridian to which it is applied, but not at any other acupoints. A technical definition of the term can be found in chapter six. The term is occasionally used outside the field of acupuncture. (It does appear occasionally in topological theories and models; see below for a brief discussion of the term "topology.") MAGNETIC POLES: In this text we use the terms "north magnetic pole" and "south magnetic pole". We denote the north magnetic pole as a positive polarity agent, and the south magnetic pole as a negative polarity agent. In the context of our discussions, the north magnetic pole of a magnet is that pole of a magnet which repels the points of a compass, while the south magnetic pole of a magnet is that pole which attracts the point of a compass. This is based on the idea that the geographic north pole of the earth is the geomagnetic south pole. If one is using magnets that are denoted opposite to this definition, one would expect to see the reverse reactions to those described in this text. OCTAHEDRAL THEORY OF STRUCTURE-FUNCTION REGULATION: This theory was first formulated by Dr. Manaka. It refers to the ancient yin-yang categorizations of the body into antagonistic halves, for example inferior-superior, anterior-posterior. Examples of this ancient categorization have appeared in medicine and biology (see chapter five). Our own testing of the body also has shown these antagonistic tendencies (again, see chapter five.) Clinical methods designed to take advantage of these ideas have proven useful and have led us to formulate the theory that there is a hidden structure or symmetry in the body that probably arose early in evolutionary and embryological development. This structure is more a kind of "structure-function" regulatory mechanism; e.g., in traditional terms, the circulation and distribution of qi is regulated in part by this yin-yang, antagonistic-syntagonistic structure. ORDER- IMPLICATE ORDER, EXPLICATE ORDER: The term "order" has multiple meanings. In this text, the term is used primarily to describe or refer to the state and degree of structure of a system. The more "ordered" a system is, the greater its internal structure and the more the functions or purposes of the system can be realized. Entropy, disorder, or chaos refer to the breakdown of the structure of the system. In most instances, diseases or pathological conditions could be characterized as a breakdown of the order of the system and an increase of the disorder of the system. Order also implies a set of rules that govern the system's behavior. Many times these rules are known, and can be described, in the terms of David Bohm, as being of the "explicate order." Many times the rules are not apparent or are unknown, or hidden. These can be described, again following David Bohm, as being of the "implicate order." We have found, for example, that there are "hidden orders" in the body, hidden structures, which have functions that do not normally manifest, i.e., are not clearly apparent to us. In the octahedral structure model (see above), we have found just such a hidden order, a structure hidden in the body which seems to have important regulatory functions in the body (see chapters three and five for details).
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PARADIGM: A paradigm is a pattern or model. In the context of this work, the term "paradigm" refers to the system of world views which comprise the model of nature or the world held by a culture or group of people. The ancient Chinese system of world views is quite different from the world views underlying modem Western cultures. What lies behind these systems of world views are different sets of assumptions about how the world is. For example, since at least the seventeenth century, one of the Western assumptions about nature has been that the world, and all things in it, are reducible to their component parts. Understanding those things is a process of analyzing the parts and compiling the information to reproduce the thing. Typically, but not exclusively, the ancient Chinese made an opposite assumption: one cannot separate anything from the whole web of reactions in which it is immersed in the world, thus one cannot simply reduce an object to its component parts to understand it. Interestingly, with new findings in the field of physics, scientists are also seeing the world now as irreducible, creating what is called a "paradigm shift."ll
SAYOSHI: This term was first coined by Yasumasa Katsumata. In English it means something like "phantom function." When objects are placed close to the surface of a body, the body receives certain influences from those objects. In the living body, these influences are received without the involvement of any conscious or sensory mechanism. All objects have their own specific influences, the functions of which can be transmitted to one object and then from this to other objects. In the living body these functions are different from the known physiological functions. Katsumata has called these functional factors sayoshi. Sayoshi has the following characteristics:
1. It remains in a space after an object has been removed from that space. 2. It can be removed by moving any conducting substance (excluding insulators) over it. 3. It can be carried by one object to another object. This is called the "replication effect." 4. It can be propagated by electromagnetic waves (high frequency current inside the body.) Therefore it can be said that sayoshi is not material. Katsumata calls these electromagnetic waves which carry sayoshi "molecular waves." 5. In the living body, the sayoshi of an object acts on the sayoshi of the body and can produce physiological changes. Sayoshi is a kind of static quality in space, like an electromagnetic or gravitational field. However, electromagnetic and gravitational fields are very much dependent upon the substances that produced the fields, and will be moved with the substance, whereas the sayoshi effect can remain in the space once occupied by the substance that generated it, even after the substance has been removed. This is an essential difference between sayoshi and ordinary known fields. According to Einstein's theory, the already known fields are transmittable in light fields, where they have no stationary mass and do not have energy in a stationary condition. Substances with mass cannot be transmitted to remote places by means of electromagnetic waves. Sayoshi is transmittable by them, but has no mass; thus it cannot have substance. In modem science, all things are composed of either substances and, or fields, all phenomena occur along with these. Sayoshi is neither substance nor field. Consequently, sayoshi is not explicable by any known theories. Appendix 4 has further discussions and examples of the concept of sayoshi, with a mathematical analysis of the vector properties of sayoshi, especially with regards the properties of the acupuncture needle.
xxxvi
Glossary of Terminology
SYSTEMS THEORY - OPEN SYSTEM, CLOSED SYSTEM, SIGNAL SYSTEM: "Systems are integrated wholes whose properties cannot be reduced to those of smaller units. Instead of concentrating on basic building blocks or basic substances, the systems approach emphasizes basic principles of organization."12 Normally our senses lead us to perceive the world in discrete units. We tend to see objects as separate from each other, and from force of habit, we tend not to perceive how things interact with each other. The ancient Chinese world view included the idea that all things interact with each other all the time. The developing scientific world view is the same: all things interact with each other all the time. But our ordinary language is not really capable of describing the world and these interactions like this. Systems theory is a theoretical model that allows just such descriptions. Foss and Rothenberg, in their book, The Second Medical Revolution, have described this in some depth. The use and equivalency of systems theory to the ancient Chinese medical models is explored in the conclusion of Hara Diagnosis: Reflections on the Sea, by Matsumoto and Birch. An open system is a system which exchanges information (energy, matter,) with its environment. All living organisms (systems) are thus open systems. A closed system is a system which exchanges no information with its environment. (See the discussions of dissipative structures and entropy above.) The signal system is a term coined by Dr. Manaka. It refers to a model that he has developed of how things interact, typically at more subtle levels. Information passing between things and within things is generally referred to as a signal. Often the exact nature of such signals are unknown, especially in the field of acupuncture. Hence he has named this the "X-signal system," "X" because of the frequently unknown nature of the signals. This model is important because it has allowed the development of a theoretical model which is equivalent to the traditional Chinese model of acupuncture, and which is experimentally testable. Until considerably more is known of what the ancient Chinese were describing in their medical models, it is premature to limit the scientific description of any of those models to concepts and models available to us now. Typically the technology we use to make our measurements gives limited measurements, making it difficult to be certain that what is measured is the same as that to which the Chinese referred. Until the phenomena clearly associated with acupuncture theory and practice can be more comprehensively analyzed, it is perhaps wiser to use less specific language in describing them, by selecting terms such as "information" or "signals." This at least is reflective of the vagueness of the original Chinese descriptions and is able to resolve some of the paradigmatic differences between the traditional Chinese world views and the traditional (post-seventeenth century) Western world views. (See the introduction to this text for further discussion.) TOPOLOGY - HOMEOMORPH: Topology is the branch of mathematics dealing with three-dimensional geometric forms, both physical and imaginary. It deals with space - the topological space, the phase space - and the properties of solids. In particular it is useful for describing those properties of solids which remain unchanged through a series of different deformations of an object (see chapter 2 for discussions and examples of this). Some of these properties, such as connectedness, allow a description of how the whole system behaves. When an object is deformed by stretching, bending, etc., the old form and new form retain certain properties in common. The two forms are then homeomorphic to each other. Topology is also useful in modem physics in the analysis of complicated electrical networks, for example, and in the analysis of oscillating systems. This last use is important in the growth of studies in the nature of chaos and chaotic rhythms.
Glossary of Terminology
xxxvii
ENDNOTES 1 See for example, Paul Unschuld, Nan Ching: the Classic of Difficult Issues, p. 113; L. Gwei-Djen and J. Needham, Celestial Lancets, p. 51. For a discussion of this issue and Shibata's ideas, see Matsumoto, K. and S. Birch, Hara Diagnosis: Reflections on the Sea, p. 149. This is reinforced by Wiseman's note that he chose "sinew" to preserve the vagueness of jin in Chinese. In the medical literature the symptoms associated with the jing jin are mostly symptoms of muscle pain, muscle spasm, muscle cramps. To exclude the term muscle from the translation might lead the English-speaking practitioners away from the obvious clinical association . But, the jing jin not having been experimentally investigated by Dr. Manaka left me with no choice. The reality that we do not know what, if anything, is in these jing, or whether they may only represent projections of information, perhaps with the signatures described by Williamson and Kaufman, Biomagnetism (op.cit) makes the term "channel sinew" acceptable, since it is less rigidly material. 2 See for example Wiseman's immense work, Glossary of Terms in Chinese Medicine. For Paul Unschuld's contributions, see for example, his Nan Ching: The Classic of Difficult Issues, and the proceedings of the 1986 Symposium on translation methodologies and terminologies edited by Unschuld, in Approaches to Traditional Chinese Medical Literature, Dordrecht: Kluwer Academic Publishers, 1989. 3 Davies, P., The Cosmic Blueprint, New York, Simon and Schuster, 1988, p. 85. 4 Ibid., p. 84. For good discussions of this concept, see: Prigogine, Ilya and Isabelle Stengers, Order Out of Chaos, New York: Bantam Books, 1984. 5 For good discussions of these issues, see: James Gleick, Chaos, Making a New Science, New York: Viking Penguin, 1987. 6 See for example, Wilber, Ken, The Holographic Paradigm and Other Paradoxes, Boulder: Shambhala Publications, 1982. 7 See for example, David Bohm, Wholeness and the Implicate Order, London: Ark Paperbacks, 1980. 8 Cunningham, A.J., "Information and health in the many levels of man: Toward a more comprehensive theory of health and disease," Advances 3:1, pp. 32-45, 1986. 9 Carl Friedrich von Weizsacker, The Unity of Nature, 1980, quoted from Jahn, R.G. and B.J. Dunne, Margins of Reality, San Diego: Harcourt Brace Jovanovich, 1987, p. 298. 10 For good discussions of these issues in medicine, see: Lawrence Foss and Kenneth Rothenberg, The Second Medical Revolution, Boston: Shambhala Publications, 1987. For more general discussions of the applications and importance of the information theory model, see: Alastair Cunningham, "Information and health in the many levels of man: Toward a more comprehensive theory of health and disease," Advances 3:1, pp. 32-45, 1986. For more technical discussions and descriptions, see: Ernest Schoffeniels, Anti-Chance, New York: Pergammon Press, 1976. 11 For good discussions of these concepts, see Capra, F., The Turning Point, New York: Bantam Books, 1982; and Foss, L. and K. Rothenberg, The Second Medical Revolution. 12 Capra, F., The Turning Point, New York: Bantam Books, 1985, p. 266. In the systems model, what passes back and forth between each interacting system or level is information (see above). Like the use of information theory, systems theory allows descriptions of how a person, for example, interacts with all internal and external systems, i.e., it allows an holistic description of the person.
DESIGNATION
Paradigm Publications is a participant in the Council of Oriental Medical Publishers and supports their effort to encourage explict statement of the methods and sources used to produce Oriental medical texts in English. This text was originally composed in English but reports research performed by the authors and published in Japanese. The clinical and basic research methods employed are documented in the text. The definition of the technical terms used by Dr. Manaka are given in the Glossary. Those not noted in the glossary follow Wiseman, Glossary of
Chinese Medicine and Acupuncture Points.
SECTION ONE: SIGHTING THE DRAGON
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CHAPTER ONE
ACUPUNCTURE: TRADITION AND TRANSMISSION Acupuncture and moxibustion therapies are believed to have originated in China approximately two thousand years ago. As a traditional medical practice, they encompass several treatment methods. The main method is the use of needles to puncture the skin. Secondarily, moxibustion is used to warm or cauterize points on the skin. Bloodletting, cupping, scratching needle techniques, and fire needle techniques are supplementary methods. The enormous clinical value of acupuncture and moxibustion therapies is evidenced by their continued and extensive use in modern China, their spread centuries ago to other Asian countries, such as Japan, Korea, and Vietnam, and their more recent arrival in the West, where they have weathered even the rigorous scrutiny of Western science and medicine, revealing some of their secrets to scientific method. The tradition of acupuncture and moxibustion is rooted in, and based on, a few ancient medical texts, such as the uan Di ble" Jing SU-. Wen, Huang Di Nci Jing Ling Shu, and Nan Jing ( 'rca 300 BC to 100 AD, texts t at ave formed a ric intel1ectual radition through countless commentaries, developments, extensions, and explanations in numerous subsequent texts.I Throughout this long and venerable history, a complexity of theories and clinical systems have evolved. In some cases these have retained their original form, and in other cases, they have adapted to the passage of time, transforming under the scrutiny of clinicians and scholars.
TRANSMISSION In ancient times people did not have the mechanisms for storage and transmission of knowledge that we have today. Technology was not in the hands of a few specialists, but in the hands of " doers," craftsmen and artisans. These craftsmen and artisans practiced acupuncture and moxibustion and developed high levels of expertise without the formal education that is emphasized today. They amassed experiential knowledge and the know-how of important clinical methods, passing their knowledge on in the classical texts. Using right-brain pattern recognition more than left-brain analytic methods, they constructed sophisticated methods and systems that achieved clinical success without the appearance of the scholarly and coherent methodologies that are so important to us today.
4
Acupuncture: Tradition & Transmission
There are Western scholars who claim that no Western scientific methods were practiced in ancient China, that acupuncture and moxibustion are justified only as folk medicines with traces of shamanism. Methods such as applying simple, naturalistic philosophies, and using theories such as yin-yang and five phases to explain complex medical phenomena, are seen by such Westerners as thoroughly unscientific methodologies, inappropriate for the modern world. Yet the prevalence of this Western intellectual chauvinism is at odds with the facts. Many excellent therapeutic systems were developed in China; many excellent methodologies and technologies, among them the early use of magnets, compasses, gun powder, and astronomical instruments, had their nascence in ancient China.2 At the time of the European Middle Ages, at least twenty influential ideas and technologies had been imported from China to the West, but only two had been exported to China. Something of a paradox can be glimpsed between the historical facts and the claims of some scholars. We would hope that such evidence might encourage us to set aside haste in judging the cultural legacies of others and in adapting them too abruptly to our own cultures. We might discover that taking the theories and language of acupuncture and moxibustion out of clinical context, and solely at face value, is not highly useful. We might discover that without a broader appreciation of the rich background and legacy of these medicines, it is all too easy to misinterpret them. We must at least acknowledge the continued survival and success of these medicines in the modern world.3 Not only has the practice of acupuncture and moxibustion gained acceptance at the professional level, but these traditional therapies have also made considerable gains in the medical delivery system.4 As acupuncture as a medical delivery system is transmitted from its ancient Eastern origins to modern Western cultures, it is essential that we recognize and understand the difficulties inherent in such transmission. For it is only by so doing that we may be able to grasp the nature of acupuncture and moxibustion and develop consistent and powerful clinical methods. By first recognizing these difficulties and then developing strategies to address them, we may find that we are not only able to clarify and verify many of the classical theories, we are - with good research methodology - able to encounter phenomena not yet described and develop new, more comprehensive theories and powerful clinical procedures that are potentially more suitable to the modem world. By raising questions in a framework broader than most other researchers use, and suggesting research methods, we may be able to point the way to a more thoughtful approach to the study of acupuncture and moxibustion.s UNCLEAR TERMINOLOGY
Such a diversity and wealth of literature exist in the native languages of China and Japan that sifting through the traditional ideas and clinical applications requires the skills of scholars as much as the clinical insight of practitioners. Archaic and classical Chinese create particular translational problems that require specialized philological work. The classical texts described people, health, and disease using different terms than those familiar to us today. To compound this obstacle, the general concepts described in these early texts are often rooted in clinical experience and thus do not lend themselves to interpretation by intellectual endeavor alone. Careful coordination and cooperative methods of translation are required. Even given such coordination, perhaps we can never really know what was meant by terms two thousand years old. Perhaps our modem languages and experiences simply do not entertain equivalent concepts.
Acupuncture: Tradition and Transmission
5
Many use the arcane jargon of the old texts without really understanding its meaning. This is particularly true because of the predominance of left-brain thinking and cognition in the modern world, and its broad application to all things. However, we should recognize that the terms of these arcane jargons are often keys that are essential to a deep understanding of acupuncture and moxibustion. They require appropriate and reasonable methods of examination, analysis, and testing, before they can be understood accurately and coherently. One day, as when Champollion deciphered the Rosetta stone, a genius will decipher and explain these key terms. When this happens many will be surprised by the immensity and importance of this cultural legacy. A good example of this conceptual and translational difficulty is the term qi, The Huang Di Nei Jing Su Wen is generally acknowledged to be the primary extant text in the field of acupuncture and moxibustion. Of the more than fifty thousand characters comprising this text, over eleven hundred (about one in fifty characters) are the term qi. It is obvious that this term has considerable significance. According to tradition, everything is composed of qi in one form or another; all movement involves qi. There have been many translations of the term by scholars and practitioners alike, all of which pose difficulties. We commonly find translations such as "vital force," "vital energy," "life force," "energy," "breath," "spirits," "air," "pneuma," "influences," all of which represent some specific aspect of the term, or a generalization of its concept, but rarely both.
#\, in Japanese ki.
In a modern Chinese dictionary, we can see that the term qi is given quite a wide variety of meanings: "gas; air; breath; smell, odor; weather; airs, manner; spirit, morale; to make angry, to get angry; bully, insult; [in Chinese medicine] vital energy, energy of life." Obviously, the term is used in many different senses in everyday language. Characterizing all these different meanings and nuances with a single term or translation is difficult. Qi is expressed in personality and in emotional context. In Japan, we greet people by asking how is their yuan qi: "0 genki desu ka?" As practitioners, we treat people with our qi. Certain techniques of breathing and gymnastics such as qi gong and tai ji build and master the qi. The classical literatures of China and other East Asian countries provide many examples of simple expressions of the universal and encompassing nature of qi: Heaven and Earth have correct qi; its form is flexible and fluid. In the lower parts it is in the rivers and mountains on earth; In the upper parts it is in the sun and stars in the sky; The human being is said to be overwhelmingly and universally soaked in it. - The zheng qi song of the Wen Tian Xiang, before 200 BC. Life is the follower of death and death is the predecessor of life, but who knows their cycles? Man's life is due to the conglomeration of the qi, and when they are dispersed, death occurs. - Zhuang Zhou, in Science and Civilization in China II p.76. In everyday language and context, the term qi in China and Japan has multiple shades of meaning and uses, from classical to modern times. When a child inherits characteristics of his or her parents, this is traditionally said to be the xian tian qi, the "before heaven qi," or "prenatal qi." It is recognized that some form of qi passes from parents to their offspring. In the twentieth century, we understand this as details of the DNA, chromosomes, genes, etc. Likewise, when someone catches a cold or flu, it was traditionally said to be an external pathogen, a xie qi, such as cold, wind, damp, dryness, summerheat, or heat. Today we use theories of bacteria and viruses. In ancient times, and still in the modern literature, these
6
Acupuncture: Tradition & Transmission
and related phenomena all come under the general heading of qi in some adverse form. It is evident that we cannot define clearly the term qi, but, as we will see, it may be possible to suggest an understanding of its nature based on numerous clinical experiences and researches. What is important in our attempts to clarify and understand such terms is the nature and consistency of the research methodology we use. Qi poses particularly complex difficulties because it is essentially a qualitative rather than quantitative concept. It is thus not open to simple quantitative methodology. But what of quantitative terms? Are they more readily resolved? The term cun for example, loosely translated as "body division" or "body inch," is clearly a quantitative term. Yet similar problems arise with this term. According to the traditional literature, the term cun refers to some distance on the body surface that is different in each body area, and different according to each individual. But in the descriptions of each acupoint, the needle depths for insertion are also given in cun. Little or no indication is given as to which length of cun is meant for each point. It appears that there must be some acceptable standard length for this cun. For Westerners and Asians, the actual length of the cun will vary, because, for the most part, Westerners are taller and of larger body build. Should there be one standard for Asians and another for Westerners? Researchers who have tried to answer this and related questions come to quite different answers. The standard distance of one cun in Japan is now 3.3 em, but other estimates vary from 2 em to 3 cm.6 In China, attempts at standardization of the cun have also been made. One study states, for example, that one cun is 22.3 +/- 0.14 mm? These ranges in length are quite different. How do we resolve this problem? Perhaps the relative definition is best, because it depends on the body area and individual differences. But to the scientific mind, this is not a happy solution. A quantifiable standard is much more acceptable. Translation of the "organs," the zang fu, is also particularly difficult. The original terms and their modem English equivalents can be seen in the following table: Zang Organs xin gan pi fei shen xin zhu (xin bao luo)
heart liver spleen lung kidney heart governor I master (pericardium)
FuOrgans
Western Equivalent Organs
xiao chang dan we dachang pang guang san jiao
small intestine gallbladder stomach large intestine bladder triple burner (triple warmer)
Western Equivalent Organs
We all know that the traditional Chinese terms refer only partly to the physical organs and their physiological functions, those described by Western anatomical labeling. The traditional terms also refer to functions not described by Western science. This translational problem is particularly difficult for the xin zhu/xin bao luo, the san jiao, and pi. It is far from clear that there is even a functional equivalent
Acupuncture: Tradition and Transmission
7
for the san jiao in the Western literature. The xin zhu/xin baa Iuo is not always seen as the.~ericardium, as_H has other functions clearly not related to the pericardium. The _Pt. mvolves what m Western terms may be described as pancreatic functions, but 1t 1s commonly seen as the spleen, which has none of the digestive functions of the pi. There are approximate functional equivalents for the other organs, but for these three, it is hard to see such near equivalence. What is the best way to translate these terms? To a Western-trained doctor, rendering the standard anatomical references can be misleading. But the terms must be translated and those seen in the preceding table, which are in common use, can be at best only approximations, carrying with them many cultural biases. Such problems must of necessity be recognized as unresolvable, at least until some creative individual invents a reasonable methodology for comprehensive understanding. INCONSISTENT TERMINOLOGY
A particularly difficult problem with which we must contend when dealing with the literature of acupuncture, and more broadly East Asian or Oriental medicine, is the inconsistent use of the same terms by different authors, in different books, in different periods. Often the same terms are used by different authors at different times to mean different things. This has created great confusion and considerable difficulty for translators. For example, the terms shao yang, tai yang, yang ming, tai yin, shao yin, and jue yin, when found in the classical acupuncture texts (the Su Wen, Ling Shu, Nan Jing), primarily referred to the pairs of arm and leg yang or yin channels, being a sixfold pairing of the twelve channels. In the herbal literature, especially in the Shang Han Lun, the terms referred more to the stages of progression of disease and the degree of penetration into the body of pathogens. In even earlier pre-medical texts, the terms referred to six periods of the year of sixty days each.s These multiple uses have created considerable difficulty and confusion. Other examples abound. For instance, the use of the terms bu (supplementation or tonification) and xie (drainage or dispersion) raise many interesting questions and difficulties. The term bu generally is understood to mean the supplementation or replenishment of vacancies or insufficiencies, where xie means the ridding, draining, or breaking down of repletions or fullnesses. But there are a greater number of ideas about how these goals should be achieved, some of which are obviously unclear. In massage therapy, massaging with the flow of the channel is said to be supplementing, while massaging against the flow of the channel is said to be draining. Yet, if KI-ll- a reflex point for the bladder channel- is sore, applying a light, stroking massage, following the directional flow of the bladder channel down the legs, will eliminate the pressure pain on this point. By stroking in the opposite direction, we can cause the pressure pain to return. Thinking in terms of supplementation or drainage in a case like this might be inappropriate. These same phenomena would occur regardless of whether the pressure pain on KI-ll is a sign of bladder repletion or vacuity. Instead, we need to redefine the terms clearly, or perhaps to not use them at all in this context. The herbal tradition describes the use of supplementation (bu) and drainage (xie), but sometimes with opposite meaning to their use in acupuncture and moxibustion. For instance, earlier this century, the Japanese herbalist Yumoto Kyushin defined pulmonary tuberculosis as a febrile disease and prohibited the use of moxa to treat it- because of the supplementing and warming effects of moxa. Yet,
8
Acupuncture: Tradition & Transmission
famous moxibustionists such as Takeshi Sawada and Bunshi Shiroda took great exception to this idea. They had unusually go?d results treatin? ~ulmonary ~ber culosis using only moxa. How do we recone1le these contradictions? Cons1stent research methodologies might help to resolve these difficulties. In the classical texts the following techniques were all seen to be important methods of supplementation and drainage: 1. The use of inhalations and exhalations 2. Needling against or following the flow of the channel. 3. The selection of specific points. 4. The use of finger pressure. 5. The use of slow and quick techniques. 6. The choice of moxa or needles. 7. The depth of insertion of needle. 8. Blowing or not blowing on the burning moxa. Many contradictions and problems can be discovered when using these various techniques. For example, the classic notion of the supplementing point and draining point can be contradicted. In our research, we have found that these points can produce the same effects depending on how we stimulate or influence them. We have devised powerful clinical methods based on their simultaneous use. Another interesting example of textual inconsistencies can be found in the numerous interpretations of radial pulse diagnosis. In the following table, while it can be seen that most texts share a general agreement over the guan or "bar" position and the cun or "inch" position, it is equally evident that the chi or "foot" position of the radial pulse is different in virtually all cases. This poses considerable difficulty in diagnostic consistency and is one reason why numerous other diagnostic techniques have arisen to help confirm, or deny, what is felt in the pulse. If we study the table on the following page, we can see various interpretations of the three positions of the radial pulses on the left (L) and right (R) arms in the superficial (yang) and deep (yin) positions.9 Many interpretations other than these eight can be found, as can different translations of the same passages, but we can clearly see differences in these samples. There are many more examples of confusion or inconsistency in the literature. Some may have stemmed from the widespread use of simple mnemonic rhymes. When they were written, they may have served as useful learning devices for students who were almost always clinical apprentices as well. Today these rhymes are often confusing and difficult to understand, and have contributed to irregular translation. Other unclarities may have arisen through attempts to simplify the literature, especially the introduction of simple formulary approaches. Such approaches were likely invaluable for the study of acupuncture, particularly for beginning students who could thereby obtain reasonable results quickly. However, as diminishing attention was given to the more traditional concepts of restoring balance and harmonizing the whole body (a concept, as we will see, that is essential to the practice of acupuncture), more information became lost. Further, many such formularies were given simplified explanations. Over generations, this approach lead to the creation of treatment strategies based on reduced information; understanding became more difficult.
Acupuncture: Tradition and Transmission
Comparison of radial pulse diagnoses Text
Position
SuWen
cun cun guan guan chi chi
Side R L R L R L
Yang level LU HT 5T diaphragm KI KI
Yin level chest CV-17 5P LR abdomen abdomen
Nanling
cun cun guan guan chi chi
R L R L R L
LI 51 5T GB TB BL
LU HT 5P LR PC KI
Nan ling Ben Yi
cun cun guan guan chi chi
R L R L R L
LI 51 5T GB TB
LU HT 5P LR PC KI/BL
cun cun guan guan chi chi
R L R L L R
LI 51 5T GB (?)TB KI/BL
LU HT 5P LR
Mailing
cun cun guan guan chi chi
R L R L R L
LI 51 5T GB child door/TB/KI/BL left Kl
LU HT 5P LR BL
Mailing Tu Shuo
cun cun guan guan chi chi
R L R L R L
LI 51 5T GB TB BL
LU HT 5P LR
cun cun guan guan chi chi
R L R L R L
-
LI/TB
LU HT 5P LR Original yang/KI/BL Original yin
cun cun guan guan chi chi
R L R L R L
chest CV-17 5T diaphragm/GB LI 51/BL
LU HT 5P LR Kl TB
Qian lin Yao Fang
Lei ling
Yi Zong lin lian
mingmen
PC 5T GB
51/mingmen
??
mingmen KI
9
10
Acupuncture: Tradition & Transmission
EXPERIENTIAL ADAPTATIONS
In both historical and modem times, the practice of acupuncture has involved employment of differing treatment levels or differing treatment targets. Some focus only on the patient's symptoms and apply needles with the intention of alleviating or ameliorating those symptoms. (A common form of this therapy is shi?~ ki ryoho or stimulation therapy.) Others focus on the state of the flow of the qt m the meridians or channels, and apply needles to correct the flow of qi. (A common form of this therapy is keiraku chiryo or channel therapy.) Still others adopt some middle ground between these two and combine both aspects in treatment. Significant variations in approach and teaching methods are the result of these different focuses. As a result, studying acupuncture and moxibustion can be difficult and confusing for the beginner. Recognizing this, many translations, schools, and traditions within the field of acupuncture and moxibustion simplified the techniques for study and for teaching so that the student might learn more easily. (A good example of this process is the barefoot doctor training in China.) These simplifications tried to reduce and rationalize major parts of the field into a· single coherent system. Though helpful at face value, over time many useful concepts were ignored or simplified to the point of inaccuracy. This is clearly seen in the T.C.M. system most popular today, the bagang bianzheng, where essential components of channel theory, as well as structural, five-phase, and biorhythmic concepts are ignored or simplified to mere aphorisms. It is fine to do this; within the delivery system established in China it is effective and useful. For the beginner, or those whose place in the system will be essentially paramedical, the approach is satisfactory. Yet when examined in detail this system creates basic problems. For example, the popular notion that an acupoint has specific, defined effects, a key concept in this system, disintegrates quickly when we raise the question as to how specific effects were defined and what tests determined their validity. We must also address the fact that the functions of acupoints can vary from patient to patient. Changes occur in the points based on daily biorhythms, biological changes, changes following infection,lO surgery, etc. If we ask what points are good for asthma we may be able to list a few that will produce a 50-60% success rate with asthmatic patients. But what of the other 40-50%? These same acupoints do not have the same characteristics. This may be an easy way for students to study acupuncture and moxibustion, but in a clinical setting it rapidly becomes limiting and overly complicated. When there are many points said to be good for a given condition, how do we select the ones to use? What parameters are used in the decision process? The more parameters, the more complex and difficult the decision becomes. Yet, the more simplistic the criteria, the lower the rate of treatment success. The clinician with many years experience can decide with ease which points to use, but how does the beginner decide? Many years ago I treated a patient who had a twenty-year history of asthma. I treated her asthma by burning moxa at CV-22 (at the center of the jugular fossa). This completely eliminated her symptoms. It was more than twenty years before I heard from this patient again. She was only beginning to experience a return of her asthma; apparently, that single treatment had eliminated her chronic asthma completely! Because of this experience should I conclude that burning moxa on CV-22 is effective for asthma? Likewise, many years ago I was treating a difficult and stubborn case of trigeminal neuralgia. Various forms of therapy had so far been helpful, but only with short-lived success. Since I was researching and studying the eight extraordinary vessels at the time, I decided to try the extraordinary vessel confluence-jiaohui
Acupuncture: Tradition and Transmission
11
points, SI-3 and BL-62, with TB-5 and GB-41, using silver and gold needles shallowly inserted on the side of the body opposite to the pain. This completely eliminated the pain! Should I then have concluded that this was the treatment of choice for trigeminal neuralgia? The interesting questions about these case studies are more to do with methodology. The problems exist at three basic levels. First, at what level of use and experience should an observed clinical effect be incorporated into the body of clinical literature? That is, at what point can we say that moxa at CV-22 is good for asthma, or that gold and silver needles at the yang wei mai and yang qiao mai effectively treat trigeminal neuralgia? Second, how are such effects differentiated within the corpus of clinical literature and when is it acceptable for such observations to submit to experiential adaptation? That is, how do we determine when and how to use these treatments? Third, who is qualified to make such decisions and what is th~ appropriate methodology for making them? This last question is bound to be culturally and historically dependent. The way such findings may be interpreted in modem China or modem Japan will be quite different, depending on the theoretical perspectives of the interpreter. Let us imagine that it is nearly four hundred years ago in China and I am a good friend of Yang Ji-Zhou, the author of the Zhen Jiu Da Cheng. Because of this, he might have included these treatments in his text of 1601, despite the limited experience of my two cases. Today, almost four hundred years later, practitioners and students reading his text will place enormous trust in my results because they were included in this great and revered text, and because my friend's reputation in later centuries is excellent. Is this a sufficient criteria for making general proclamations about the treatment of asthma and trigeminal neuralgia? What if these treatments were to go through the mill of heuristic adaptation and later authors transmitted my results by saying only that CV-22 is good for asthma, or TB-5 is good for trigeminal neuralgia, without including the method I used (moxa) or the theory of the extraordinary vessels? What if translators then simplified the terms with which I diagnosed these conditions? Would these points reliably produce the desired results or would there be only a statistical percentage of patients who were helped? These are particularly difficult questions because methodology is something remarkably lacking in traditional literature. Simplifying the accretion of therapeutic effects observed over the centuries into a list of functions is useful for the beginner. But who sifted through the literature? What standards and models did they apply to interpret it? What assumptions did the compilers and translators bring to their work? We have no simple answers to these questions, but we have at least tried to address them by devising methodologies appropriate to the ideas. Because of the great diversity of information that has developed over the centuries, we have found that generally it is better to have a more flexible model and method. Even within the lifetime of a single practitioner, many changes of theory and practice can occur. Imagine how much more complex this is with thousands of practitioners. In modem practice we often see such changes; a particular practitioner may develop a specific methodology that yields a model changing over time. Dr. Paul Nogier, the founder of auriculotherapy, first defined very specific points and areas in the ear with specific point recipes for each disease. But now, after many years of practice, he has found that there are three overlaying maps which may be active simultaneously.ll He has a rather complex method for using these findings, but for the beginner and general clinician he simply recommends
12
Acupuncture: Tradition & Transmission
auriculotherapy using pressure pain points in the ears. This initial approach is easy for the student to learn because of a clear methodology and systematization. However, as the clinical findings and theories become more complex, they are more difficult for the beginning student to grasp. The second approach, the approach of auriculomedicine, is difficult for the student to learn, and is perhaps only really comprehensible to clinicians, as it is more experiential and less intellectual. As clinical practitioners develop more expertise, their techniques and strategies often evolve, leading to quite different approaches. This is necessary for both individual and general growth, but is typically not within the grasp of students. Hence students are generally exposed to a systematized approach that tries to sidestep these issues. But, just as in a game of chess or in a fencing match, the players must modify their techniques based on their opponent's reaction, in medicine, the practitioner must do the same based on the response of the patient. Often the simplified systematic approaches that beginners learn are not sufficiently flexible to allow for such modifications. What is important is the need for, and utilization of, a creative and consistent research methodology and methods of assessing the effects of treatment. We can take nothing at face value because without clinical tests and confirmation, we have no real idea of what these simplifications mean. RESEARCH DIFFICULTIES
In recent years much scientific research has been done on the nature and mechanisms of acupuncture and moxibustion. While this is laudable, it often leaves unanswered questions as to what the classical acupuncturists were doing. A major focus of this research has been the neurological effects of acupuncture, but this is really only one part of what happens during therapy. The effects of treatment are complex and entwined. Some are hidden and hard to measure. Yet as we hope to demonstrate, these minute signals and responses are probably the most important occurrences and the ones most closely allied to classical theory and practice. Many scientific researchers in acupuncture tend to take a narrow perspective in their research, unfortunately neglecting the larger picture and losing sight of the general significance and effects of acupuncture. Such a perspective also creates poor clinical research and practice. This was evidenced in a recent symposium of the Society of Japanese Acupuncturists and Moxibustionists on the systematization of the diagnosis and treatment of lumbar problems. Instead of looking systemically at lumbar problems, it focused only on the diagnosis and treatment of the lumbar region. While this may be a good "scientific" approach, this simplistic, reductionist approach can only fail to achieve a complete understanding. This method ignores the simple clinical reality that we are frequently able to treat lumbar problems without touching the lumbar region. Unfortunately, modem scientific researchers and acupuncturists scorn traditional theories (channel theory, five-phase theory, etc.). This may be simply the result of their inability to devise suitable tests or to develop equipment sensitive enough to research these theories. Whatever their reasons, this mental bias in their approach biases their results. Scientific research is further hampered by its own unattainable concept of rigor. The double blind study is the supposed pinnacle of clinical research, yet in acupuncture research, it is impossible to perform a true double blind study. Some of the effects involved in acupuncture and moxibustion are so subtle that they are impossible to block or eliminate. These effects are more than the placebo effect,
Acupuncture: Tradition and Transmission
13
which is a thorn in the side of any medical researcher. They manifest at more subtle levels, such as the simple touch of the patient by the therapist. We can show how touch can have a series of effects, two clearly demonstrable ones being the touch of the thumb versus the touch of the little finger. Both these techniques produce notably different effects depending on where the touch occurs. Even the best designed double blind studies involve touching the subject in some manner, if only to insert the needles. How are we to account for the potential effects of touching contact? Further, in certain styles of acupuncture practice, the success of treatment depends in part on the practitioner's qi for its efficacy. How can these effects be eliminated and leave a viable form of treatment to be studied? Another related problem in the scientific analysis of acupuncture arises at a more basic level. The premises that comprise the foundations of acupuncture and East Asian medicine are quite different from the premises that support Western science and medicine. As a consequence, applying Western premises to the analysis of acupuncture and East Asian medicine may, at times, be like trying to slice a loaf of bread with a chain saw: it is possible, but very little of the bread remains. The following passage from the Tang dynasty medical sage, Sun Si-Mo, expresses some of these differences: There are diseases whose interiors are the same, but whose exteriors are different, and vice versa. Therefore the repletion and vacuity of the zang and fu, the smoothness and blockages of the blood vessels, ying, and wei cannot be observed [solely] by the ears and eyes, [instead they] can be elucidated by pulse diagnosis. There are floating, sinking, wiry, and tight [categories] of pulse in the blood vessels. There are high, low, shallow, and deep flows in the different inductive [acu]points. There are differences in the thickness, thinness, hardness, and softness of the skin, muscles, and bones. Only a person who uses his heart [/mind] delicately can tell these differences.12
Western medical analysis needs objective signs and indications before diagnosis and treatment are determined. Here, traditional Chinese medicine is seen as relying primarily on subjective assessments, in particular, intuitive observations and decisions. This is a significant difference between Western methodology and Chinese or Japanese traditional medical methodology. While scientific research is important for mapping some of the effects of therapy, it rarely addresses the important questions regarding what it was that the classical texts tried to describe. It is self-limiting in a field such as acupuncture, where it is impossible to rule out or describe the subtle effects - which are possibly the more important effects - and is thus not very helpful in achieving the goal of a consistent research methodology. This does not, however, rule out the use of scientific knowledge and technology for achieving this goal. The current attitudes toward the research and the teaching of acupuncture and East Asian medicine in Japan arose during the Meiji era. The government was desperately and hastily trying to modernize Japan. The medical systems of that time, including acupuncture, moxibustion, anma (massage), and herbal medicine were Westernized, both in their theoretical descriptions and the manner in which they were allowed to be taught. The traditional theories were completely thrown out, and, with the exception of the blind practitioners of acupuncture, moxibustion, and anma, who were allowed to continue as part of the government's social policy towards the blind, all other practitioners were banned from practice. The Ministry of Education set the curriculum for the education of the blind. The committee that decided this curriculum submitted the following plan:
14
Acupuncture: Tradition & Transmission
Since the channel is a concept not considered by Western mediciJ!e, it shall be omitted and instead of talking about the jing xue, channel acupomts, the term kong xue, acuholes, will be used. The kong xue will be taught solely by their anatomical locations and their effects [main indications]. Treatments for particular diseases will be given simply by listing combinations of kong xue for each disease.
The principles in this plan still seem to be in operation in most schools of acupuncture in Japan. The scientific study of acupuncture typically takes these Meiji-era modernizations as fundamental to research protocols. As a consequence, most research ignores the basic principles and premises of acupuncture. This problem is not limited to Japan. Also in China, for example, following the political changes of the late 1940's and the cultural revolution of the 1960's, acceptable methodology for the study of acupuncture underwent enormous revision. Political, social, and cultural influences play important roles in the determination of methodology and protocol. Modem politics usually has had little patience for the ancient and traditional theories of China. If we are truly to appreciate and understand acupuncture and moxibustion, we must take an open-minded approach. We must contend with the difficulties of transmission of knowledge posed by the differences of culture and language, and acknowledge that much of the information described has been derived from clinical experience and thus may not be amenable to a strict Western analytical, academic method. Who in the modem world, where scientists are making fundamental discoveries so rapidly that they need constantly to redefine principles, would want to state that a particular body of "scientific knowledge" and the methodologies on which it is based, represents a fixed, immutable constant of universal application? If the standards and methodologies of traditional Western science are inappropriate for modem Western medicine, how much more is this true for East Asian medicine?l3
TOWARDS A MEDICAL EVOLUTION The interaction and evolution of different medical systems is a phenomenon dependent on many factors. Paul Unschuld describes the integration of East Asian and Western medicines in three stages: coexistence, cooperation, and integration. These stages appear on three fronts: the methods or means, the personnel, and the systems used. The progression through these three stages is already underway, particularly in China where East Asian and Western medical systems have evolved through coexistence and cooperation toward an integrated approach. But, in general, the evolution of personnel and systems will take more time. In China, personnel coexist and are beginning to cooperate, but have not come close to an integrated approach. The systems, however, are neither cooperating nor integrating, merely coexisting. This is a complex issue; there are many methodological considerations that must be resolved before further evolution can occur. It is our hope that the theories, methods, and clinical procedures that we have developed and that we present here will point the direction for others to follow. Perhaps the models we describe in this text will help this evolution through cooperation and integration of the medical systems. To be honest and fair to these theories and clinical medicines, we should approach them with unbiased minds; we should not prejudge based on current standards. Throughout the long history of acupuncture and moxibustion many
Acupuncture: Tradition and Transmission
15
geniuses devised and described powerful theoretical models and clinical techniques. Some of these have survived to modem times, but many have sunk into obscurity to await rediscovery. We should never dismiss something because we are unable to understand it, or because it does not fit clearly into our current model of how things are. As clinicians, researchers, or scholars, we can only make progress in unravelling the Rosetta stone of East Asian medicine with open minds and willingness to participate in this research adventure. It is our purpose in this book to give examples of how one can begin to approach the Rosetta stone, to hold up a beacon to light the way. Throughout the theoretical sections we will discuss classical theories, raise questions as to their meanings, and describe clinical research methods by which these theories can be confirmed and described. We think that the research methods and clinical tests we have devised and the good clinical results we have obtained will justify our theoretical conclusions. But, probably more than anyone, we recognize the inherent limitations and possible contradictions of all these ideas. It is in this light that we would like to clarify our purposes and methods with a simple yet profound saying that arose in the tradition of the tea ceremony and has continued as a traditional teaching method: In Japanese, -;r li8i ~ is termed shu ha ri; in Chinese, it is termed shou po li. Simply put, this means what we absorb and obey, we must eventually break away from (so as to begin our own new tradition). To merely follow our teacher's tradition is not sufficient, but it is a necessary starting point. If we take the wisdom of shu ha ri, we can develop a suitably flexible mind and approach, and begin to make real progress.
CHAPTER ENDNOTES 1 Paul Unschuld lists more than 130 commentaries in Chinese and Japanese on the Nan Jing alone. See: Medicine in China: Nan Ching, the Classic of Difficult Issues, 653-669. 2 Joseph Needham's multi-volume work, Science and Civilization in China, gives an exhaustive and enlightening recital of such discoveries. See especially volumes III, IV and V. 3 In Japan, for example, acupuncture, moxibustion, and herbal medicine have attained a level of clinical success that compares well with Western medicine. These therapies are often found integrated with allopathy. Research is often government-sponsored and conducted at prestigious universities and medical schools. In China in the last twenty years, considerable government-sponsored research has been conducted. In France, acupuncture training is conducted as a post-graduate specialization for medical doctors. Numerous other countries use and recognize acupuncture and moxibustion to varying degrees. 4 In Japan, for instance, such therapy is favorably viewed by the populace. In a study conducted from 1975 to 1976 by researchers at the Chiba University Oriental Medicine Research Association, the researchers found that acupuncture, moxibustion, and herbal medicine were favorably judged by those who participated in the study. Questionnaires were sent to more than 2200 patients who came for therapy. With nearly half responding, the statistics clearly showed that most patients had tried Western medical therapy (75%) before coming for acupuncture, moxibustion, or herbal therapy. Most gained improvement or abatement of their symptoms (approximately 70%) following therapy using one of these three methods. Most patients reported that they would use or recommend these therapies in the future (approximately 60%) and most felt that both modem (Western) and traditional (East Asian) medical systems were necessary (80%). Clearly, in Japan, the existence of diverse medical systems is seen as favorable and complementary. 5 S.B.: Some serious attempts have been made to broach the problems of translation and transmission. Among the best descriptions are in the work of Nigel Wiseman. His introduction to Glossary of Chinese Medical Terms is a thorough analysis of the topic, and the work itself is notable for the inclusion of Asian clinicians in the process of term selection and definition. 6 For instance, Dr. Yoshio Nagahama defined one cun as three centimeters (see Shinkyu Chiryo no Shinkenkyu p. 21). Dr. Haruto Kinoshita defines it as two centimeters (see Illustration of Acupoints p. 12). 7 Chen Weichang et al., "The determination of the depth of puncture for the development of needling sensation," National Symposia of Acupuncture and Moxibustion and Acupuncture Anesthesia, June 1-5, 1979, pp. 113-114.
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Acupuncture: Tradition & Transmission
8 This is also seen in the medical literature. See for example, Nan Jing 7 (Paul Unschuld, Medicine in China: Nan Ching, the Classic of Difficult Issues, p. 122). 9 From Y. Manaka, Ilea no Tameno Shinjutsu Nyumon Kuoza p. 135, Yokosuka: Ido no Nippon Sha 1958, 3rd edition. The books referenced come from the following approximate dates: Su Wen, 300 BC; Nan Jing, 100 BC- 100 AD; Nan Jing Ben Yi, 1361 AD; Qian fin Yao Fang, 652 AD; Mai Jing, 300 AD; Mai Jing Tu Shuo, circa 290 AD; Lei Jing, 1624 AD; Yi Zong fin Jian, 1742 AD. For a more complete discussion of the interpretation of the six pulse positions, see Birch, S., "An historical study of radial pulse six position diagnosis: Naming the unnameable," Journal of the Acupuncture Society of New York 1:324, 19-32, 1994. 10 As is evidenced in trigger points; see: Travel J. and S.H. Rinzler, "The myofascial genesis of pain," Postgrad. Med. 11 (1952), p. 425-434. See also, Melzack, R. et ai.,"Trigger points and acupuncture points for pain; correlations and implications," Pain 3:3-23 (1977). 11 P. Nogier, From Auriculotherapy to Auriculomedicine, Saint-Ruffine: Maisonneuve, 1983. 12 Y. Manaka, quoting from the Qian fin Yao Fang in "The treatment of several diseases of the neck, shoulders, and arms by acupuncture and moxibustion," Modern Oriental Medicine 3:4, 1982. 13 S.B.: There have been many publications on the problems of research methodologies in Western medicine, a number of which are referenced in the introduction.
CHAPTER
Two
THE X-SIGNAL SYSTEM
What cannot be seen is called evanescent; What cannot be heard is called rarified; What cannot be touched is called minute. These three cannot be fathomed And so they are confused and looked upon as one. Its upper part is not dazzling; Its lower part is not obscure. Dimly visible, it cannot be named And returns to that which is without substance. This is called the shape that has no shape, The image that is without substance. This is called indistinct and shadowy. Go up to it and you will not see its head; Follow behind it and you will not see its rear. -D.C. Lau, tr, Lao Tzu: Tao Te Ching XIV:70.
In a way, the whole idea of the tao was the idea of a field offorce. All things oriented themselves according to it without having to be instructed to do so, and without the application of mechanical compulsion.
- J. Needham, Science and Civilization in China II:293. Most living systems exhibit multilevel patterns of organization characterized by many intricate and nonlinear pathways along which signals of information and transaction propagate between all levels, ascending as well as descending. - Fritjof Capra, The Turning Point, p.282.
In our years of practice and research, we have unravelled many stories. In so doing we have found a story of our own that draws on both classical Chinese theories and modem scientific research. This fusion we have named the "X-signal system." We think that this is an apt name because what we are describing is something hidden, virtually unknown, but something essential to the practice of acupuncture and moxibustion. We can only paint a picture in broad brush strokes, leaving the work of filling in the details to others. This, too, is one of the goals of this book, to stimulate more good clinical research.
18
The X-Signal System
From this research, and from the perspective of the signal system, we have developed a systematic and comprehensive treatment plan with many alternative treatment methods. In our presentation of this material, we hope that you will be able, by example, to devise your own treatment style. We feel that this is important, not only for your own growth and development, but for the continued growth of acupuncture and moxibustion. If we appear at any time to be making fixed and absolute statements, you are well advised to review the text. When I begin to lecture an audience, regardless of who they are, I often begin by saying, "Don't believe what I'm going to tell you." It is our purpose only to show by example how you, the reader, can mold your own practice and perform your own clinical tests and research.
As we present the X-signal system at its current state of evolution, we will explain how we see it as related to various theories and practices of acupuncture and moxibustion. We will elaborate some classical theories and the tests, researches, and methods of verification that we have developed and implemented to explicate them. These theories include channel theory; the unidirectionality of channel flow; the closed circuits of the channel flow; yin-yang theory and its relationship to body structure, topology, and thus the extraordinary vessels through octahedral theory; the five-phase theory and its relationships to isophasality as a branch of topology, and the five-phase engendering ("creative") and restraining ("destructive") cycles. Our simple, demonstrable tests that confirm these theories also use simple statistical research methods such as the meridian imbalance diagram (M.I.D.),l and simple technological tools that influence the body without stimulating the nervous system. Tools including various polarity agents such as the thumb and little finger, the north and south magnetic poles, the positive and negative polarities of different metals, and the ion-pumping cords, have been particularly useful for mapping characteristics of the X-signal system. We believe these characteristics lie at the heart of the classical theories.
THE THEORY OF THE X-SIGNAL SYSTEM The theory of the X-signal system as the biological system that lies at the heart of acupuncture and moxibustion theory and practice can be stated as follows: There is a primitive signal (information) system in the body that has embryological roots, but is masked by the more advanced and complex control (regulation) systems. Thus, the original signal system is hard to find or see. This primitive system is able to detect and discriminate internal and external changes and plays a role in regulating the body by transmitting this information. This system serves as the modus operandi of acupuncture. We have been able to make the following observations about the X-signal systern: - We cannot explain it with neurophysiology because it manifests and is manipulated clinically with minute stimuli or influences that cannot be clearly said to affect the nervous system. - The agents of therapy and their biological actions cannot be explained by current neurophysiology. - As part of the signal system, the vertical relationships - the channel systems - can be used very successfully.
The X-Signal System
19
- It manifests in and through certain acupoints that are topologically related, structurally, functionally, and biorhythmically.
- The octahedral theory, as a general theory of the relationships between structure and function, is an essential component of the signal system. - It appears to fit well with and provide a model of explanation for many classical acupuncture theories and concepts.
- Holographic principles appear to play some part in the signal system. We feel that this signal system is a biological system as yet undiscovered by biologists and anatomists. This is why we have called it the X-signal system. The nature of the signals transmitted throughout the body, the nature of the information flow, is not yet clearly defined. It appears to operate at a more primitive and deeper level than many of the flows of biological information- neural, hormonal, biochemical - that have been clearly defined by modem science. Many parts of this system can be described generally and rationalized using general information theory and the abstract mathematics of geometry and topology. Since it does not manifest through commonly known biological laws, its biological effects and significance need to be carefully distinguished from the known effects of the anatomophysiological systems. This is particularly important because many of the biological effects of acupuncture and moxibustion are the result of direct stimulation of the anatomophysiological systems, especially the neurological system, which tends to mask the effects of the signal system. Having recognized this, we have devised many clinical experiments and invented many clinically useful polarity agents, such as the ion-pumping cords, the ion beam device, and the electrostatic adsorbers. These devices provide minute stimuli or influences so that only the signal system is stimulated. Insertion of needles with stimulation activates both the signal system and the anatomophysiological system, with an array of physiological responses. The clinical rules of the five phases, for example, are difficult to explain by anatomophysiology, as are ideas that materialize the qi and the channels. But, when taking advantage of the signal system, we can see the operation of these rules clearly. With careful examination and use of the correct devices, we have been able to isolate and map specific characteristics of the signal system. As well, we have found that there are great therapeutic benefits to be gained by deliberately influencing the signal system. Mention here of the concept of appropriate scale is pertinent. To look at a particular phenomenon, we must use glasses that are suited to the scale of the phenomenon. If we want to examine the general anatomical structure of an organ, we can examine it with the naked eye. If we want to understand the cellular structure, we must use a microscope. If we want to understand the molecular structure of each cell, we must use the scanning electron microscope or an equivalent scanning instrument. Without appropriate modelling and tools for each scale, we can determine nothing about the phenomenon studied. This is as true in the study of acupuncture as in anything else. If the nature of what we are dealing with in acupuncture is very subtle and, to most people, unobservable and imperceptible to the naked eye, we must devise appropriate methods and tools of observation coupled with appropriate models. The appearance of the dragon we are chasing is elusive. It is so well masked by the clouds of rationalism and dogmatism that we can only glimpse it at specific times in specific conditions.
20
The X-Signal System
BIOLOGICAL EXAMPLES OF THE SIGNAL SYSTEM The Acrasiales amoeba is a slime mold inhabiting the Wand woodlands and forests. Under normal conditions, it is a single-celled organism that lives an independent existence. Yet, when unfavorable conditions arise, the single-celled organisms aggregate to form a multi-celled organism. This larger organism forms a stem and spores, which are released into the environment, where on contact with a favorable medium, they grow and live independently again. This phenomenon is an unusual biological cycle. In spite of the fact that the organism does not have the anatomophysiological systems of higher organisms such as the nervous and hormonal systems, it is able to perform this complex multicellular function. Obviously it has a signal system, parts of which have been recently mapped, but we still do not have a clear understanding of its operation. Even harder to understand is the mechanism of insect communication, as it seemingly violates the laws of chemistry. It has the added difficulty of minuteness of scale. For example, the pheromone, which is a kind of sex hormone, is secreted in very small amounts by females to attract male partners. It has been shown to have powerful effects over relatively huge distances. The concentration of the pheromone in the air must be beyond Avogadro's number, since known amounts of pheromone that are released into the air at a fixed site are able to attract males over sizable distances. Based on simple calculations we must conclude that the pheromone molecule is having an effect at a dilution that leaves no original molecule of the pheromone present. This is a well-documented phenomenon that has even found commercial application in insect control, but has as yet defied rational explanation. It is not yet known how a substance can have an effect in the absence of molecules of that substance. This phenomenon is also seen in the field of homeopathy, where commercial and medical applications have been used for more than a century. Homeopathy is a form of therapy where small amounts of very dilute solutions are taken as medicine. Preparation involves soaking the chosen object (plant, mineral, etc.) in pure water and then adding one part of this solute to nine parts alcohol. This is mixed and then diluted in water to a 1 in 10 concentration, called "01'" This is then diluted, again to a one in ten concentration of the 01 solute, now called "02." This process of dilution continues to a "010" dilution. At each stage of dilution the solution is vigorously shaken. At stage 010, the solution is ready for use, being one of low potentization. With a continued dilution to 030 (a relatively highly potentized dilution), there are no molecules of the original substance left in the solution, since the dilution has passed Avogadro's number. In a single mole of a substance there are roughly 6 x 1026 molecules of that substance present (1026 = 100,000,000,000,000,000,000,000,000.) Very potentized dilutions can go as far as 0100. At these levels of dilution there can be no probability that any molecule of the original substance is present. When solutions such as these are used, they defy the rational understanding of chemistry and pharmacology. Yet the therapeutic effects of homeopathy are too well known to dismiss.2 Experimenters in Russia and Scotland have shown that solutions diluted beyond Avogadro's number do have effects that can be measured. In 1933 in St. Petersburg, Perusson examined the effects of solutions diluted to 10-120. He examined the effects of a super-diluted solution of mercuric chloride on the action of the salivary enzyme ptyalin, which converts starch to sugar. Even at a dilution of 10-120 the mercuric chloride solution was able to affect the rate of starch to sugar conversion.3
The X-Signal System
21
From 1946-1952, William Boyd of Edinburgh performed thorough experiments to verify Perusson's findings. His research seems to be quite legitimate. He used solutions of mercuric chloride at a concentration of I0-61 and found that this dilution of solute was also able to affect the rate of starch to sugar conversion.4 These results raise fundamental questions about our assumptions and presumptions in chemistry and biochemistry.s More recently, researchers in France caused quite a stir when they published the results of a study that showed similar superdiluted effects (antiserum diluted to I0-120). Attempts were made to disprove this recent study; at best, the skeptics have been able claim only that there must be an unknown error. 6 Some modern homeopathic researchers have speculated that the original molecules of the substance, prior to dilution, actually imprint or stencil themselves permanently into the original solute, spatially rearranging the molecules in some way. After many dilutions, this original stenciling survives, even though molecules of the original substance are not present. This stenciling is as yet unproven. How does it work? Is it something electrical? No one clearly knows. The authors of the recent antiserum study in France speculated that "transmission of the information depended on vigorous agitation, possibly inducing a submolecular organization of water or closely related liquids ... Water could act as a template for the molecule, for example by an infinite hydrogen-bonded network, or electric and magnetic fields."7 A similar, perhaps stranger, phenomenon was recently observed by Yasumasa Katsumata, a Japanese physicist and acupuncturist. He has found that any substance that has occupied a certain space will leave some of its properties in that space after the substance has been removed. He has called this sayoshi, "phantom function."8 Mr. Katsumata suggested that the phenomenon is related to the rotation of the earth towards the west, and the rotational gravitational vector. This phenomenon can be seen in other instances and defies clear explanation or refutation. That the body responds to super-dilute solutions of a substance and to phantom functions, suggests that there are systems at work other than the anatomophysiological systems with which science is familiar. We believe that these phenomena occur at the signal level. There are numerous examples of such phenomena in nature, as our daily experiences can confirm. At a wine-tasting competition, a skilled wine taster can sip a small amount of wine and distinguish, from among the minute amounts of hundreds of different chemicals present in the sample, which wine it is and even where the grape was grown and where the wine was bottled. Here, a refined development of the olfactory and gustatory senses can discriminate unbelievably tiny differences. This is difficult to explain with neurological principles, it is too complex and the discriminations are made too quickly. Surely there must be other mechanisms at work! A professional baseball player can hit a ball accurately when it is travelling so fast that it exceeds the reaction time of the nervous system. How is this possible? We can speculate that the strength of the stimulation, the amount of energy (signal) necessary to produce the desired effects, is dependent on the total field in which the energy is received/perceived. At night a car headlight can be blinding, but at midday, it may even be difficult to see. The pheromone released in a field can have profound effects, but if many similar chemicals are released at once, are the effects as strong? Not only do these low-level effects need to be carefully observed, but they also need to be carefully discriminated from the myriad of other effects that
22
The X-Signal System
may be happening simultaneously. As we will see, this becomes significant when we try to examine the effects of certain stimuli on the body. If the n~rvous system is also stimulated, we cannot recognize the effects of the low-level stimulus. The structure, symmetry, and asymmetry of the body may also demonstrably participate in the signal system. For example, in experiments with limb b~d tr~ns plantation in salamanders, it is possible, if the bud is transplanted at the nght hme in the right place, to cause a symmetrically opposing bud to form spontaneously, balancing the asymmetry of the transplantation. The salamander, a relatively primitive organism, can be said to have a latent tendency to keep its symmetry.
Figure 2.1: Symmetrical limb bud growth in salamanders
Likewise in the fiddler crab, which has one large claw and one small claw; if the large claw is removed, the small claw will develop to become the large claw and the severed stump will grow a small claw.
Figure 2.2: Asymmetric claw regrowth in the fiddler crab
There is an original asymmetry in this crab that is naturally restored if it is disrupted. In this case, regrowth of the claws is an example of regeneration. Regeneration tends to be limited to certain structures in lower order animals. For instance, a frog or salamander can regenerate a severed limb, while a lizard can regenerate a severed tail. But in higher organisms, where the biological systems are more complex, this form of regeneration does not usually occur except in limited cases, in very specific conditions, with specific stimuli applied.9 We can generalize that the ability to restore normal structure, to return to an original symmetry or asymmetry, is higher in lower-order organisms but decreases as we ascend the evolutionary scale. In biological organisms, this can be seen at the level of organismic allocation of energy to different functions in the body. Specializations that benefit the organism in some respects- greater mobility, greater adaptabilityrequire the sacrifice of other functions - decreased regenerative abilities. Great gains in one area are often offset by losses in other areas. What are the mechanisms and signals responsible for these growths? The latent tendencies towards symmetry in the salamander and asymmetry in the crab are clear but not explicable. In these cases we can say that the signal system is responsible for the phenomena observed, but this too needs further clarification.
The X-Signal System
23
ORIGINS OF THE SIGNAL SYSTEM Professor Ernest Schoffeniels of the University of Liege has helped considerably to develop the use of information theory in biology, particularly with his discussions of "generalizing information theory to open systems." His book L'anti Hasard (Anti-chance) is particularly interesting and useful. He applies thermodynamic theory and information theory to the process of biological evolution, and in so doing casts new light on the nature of biological systems. In a 1984 lecture in Tokyo he summarized his conclusions thus: In recognizing that biological systems are cybernetic networks, the conclusion is reached that there are two main languages in biology: molecular and electrical. Since a molecule can be an information, operations befalling it in a metabolic sequence are informational and enzyme catalysis is the executor of these operations. The problem of information transmission can now be introduced: generator of information, encoder of information, information channel, receptor of information. Additionally, one has to define the properties of the transducer whose effect is to transform one language into another thus allowing for tuning of the generator and receptor. Two fundamental problems only partially answered are those of conservation and combination of biological information. Application of classical information theory to the calculation of the information content of biological systems is beset with contradictions. To understand the cause of these setbacks, it is useful to review the most important points of information theory, establishing relations so derived with classical thermodynamics. Then one must consider the problem from the angle of information accumulation in the course of time within the DNA, a true integration of different information received by biological structures and therefore, derived from Prigogine' s and Eigen 's theories, to consider the evolution of biological structures in relation to a changing environment. This leads to a deterministic mechanism of evolution. Thus it is on the background of genetic information that systems develop which allow interaction of an informational nature with the environment. Herein lies the importance of the generalization, epitomized in the feedback organism-environment, that in an evolving environment, an organism can only evolve.
His theories are quite complex and very powerful. What is of importance to us here is his idea that the DNA, the biochemical memory of the cell, contains enfolded layers of information that are derived from the most primitive of organisms at the earliest stages of evolution. Much of this information is biochemical, some may be structural. It is well known that the structures of biological molecules can encode information beyond the atomic sequencing of the molecules. With the right influence, stimulus, or circumstance, this stored information can be made to manifest as a particular sequence of events or actions even in more advanced organisms. Thus, it may be that just as the salamander and fiddler crab have stored in their genetic memory a certain tendency towards symmetry or asymmetry, the slime mold has the information required to cause its pluricellular state to arise and govern its return to the unicellular state. With the right stimulus this information is released from within the layers of DNA so that the resulting activities and changes ensue. While we agree in principle with Schoffeniels' thesis, we should add that the complexity and diversity of bioinformational effects make it unlikely that DNA is the sole repository of this information. There are probably other systems capable of storing biological information. We can observe the natural order of each event that occurs and measure the phenomena at each stage. There is an unobservable higher order of organization
24
The X-Signal System
that governs these activities and changes. This can come from organismic and even global levels of organization. If, for example, the Gaia hypothesis is correct, all living organisms would be functional parts of a larger organism.lO In this case the higher order of organization would be literally global and hidden levels of functional organization would exist everywhere around us. The ability to see this higher order is entirely dependent on the scope of the method we choose to search for it. Mathematicians, physicists, astronomers, meteorologists, and researchers in many disciplines have begun to uncover even more general, and probably universal, higher orders in nature. There are organizing principles and levels of organization that appear only when the correct method of analysis, commonly computer-enhanced mathematical analysis, is used. For example, one astronomer discovered that simple geometric organizing principles were capable of explaining complex, apparently random, celestial orbits. The key, he believed, was the repeated stretching and folding of phase space in the manner of a pastry chef who rolls the dough, folds it, rolls it out arin, folds it; creating a structure that will eventually be a sheaf of thin layers. 1
There are unobservable orders of organization in nature, like the multilayering of phase space or French pastry. These are important to the behavior of objects in nature, and can only be discovered with the appropriate analysis. These hidden higher orders describe rules that govern the flow of information, only the effects of which can be observed. Observable, unobservable, lower and higher orders of organization are not too dissimilar to the notion of the conscious and unconscious mental realms. The unconscious realm lies hidden beneath the conscious, and by all accounts appears to be much deeper and larger than the conscious. This concept is similar to David Bohm's idea of an explicate order behind which lies an implicate order. The implicate order is enfolded or hidden within the explicate, but is neither observable nor measurable; it is only knowable through the existence of certain phenomena, because sometimes we are able to roll time backwards and perceive its manifestations. This implicate order is likewise much deeper and vaster than the explicate order. As Bohm himself states: It is being suggested here, then, that what we perceive through the senses as empty space is actually the plenum, which is the ground for the existence of everything, including ourselves. The things that appear to our senses are derivative forms and their true meaning can be seen only when we consider the plenum, in which they are generated and sustained, and into which they must ultimately vanish. This plenum is, however, no longer to be conceived through the idea of a simple material medium, such as an ether, wnich would be regarded as existing and moving only in a three dimensional space. Rather, one is to begin with the holomovement in which there is the immense "sea" of energy. . .. This sea is to be understood in terms of a multidimensional implicate order ... while the entire universe of matter as we generally observe it is to be treated as a comparatively small pattern of excitation.12
The notion of holomovement is a specific extension of the idea of a hologram. As we will see later, the holographic paradigm also has its place within acupuncture theory and practice, and may be an important component of the signal system. Homo sapiens are as much a part of this holomovement as all else. We are equally subject to the flow, storage, and transmission of biological information as are other organisms and are equally capable of manifesting expressions of this hidden order, of the latent tendencies enfolded into our genetic background. We can see numerous examples of this, many of which are described in the next two chapters.
The X-Signal System
25
CLINICAL EXAMPLES OF THE X-SIGNAL SYSTEM In acupuncture therapy, we can apply a very tiny influence (too small to be called a stimulus) to an acupoint and produce changes in an area of the body that is unrelated via neurophysiology. For example, we can place a north-facing magnet on the large intestine point in the auricle and the reaction at the large intestine source point, LI-4, on the same side decreases. Reversing the magnet in the auricle, so that the south pole faces the point, increases the reaction at the same LI-4. On the opposite auricle, placing the south-facing pole on the large intestine point reduces reaction at the original LI-4, while the north pole increases the reaction. The polarities reverse if we stimulate the opposite side. This phenomenon is essential to an understanding of acupuncture, as it demonstrates right-left, north-south antagonisms. We can cite many examples of hidden relationships in the body and of the action of the signal system. The next two examples are derived strictly from the clinical practice of renowned practitioners, medical doctors who, as practicing acupuncturists, have devised new methods of diagnosis. Dr. Reinhold Vall measures the DC electrical resistance at the jing points of the channels, next to the nails of the fingers and toes. He diagnoses channel and organ dysfunctions by their variations in electrical resistance. He uses homeopathic remedies as his treatments. This is his original method for selecting the appropriate remedy and quantity of remedy. He calls it "Medikamententestung." If this test describes some channel abnormality or organ dysfunction, he selects an appropriate remedy sample that the patient holds in one hand while the physician remeasures the points. If the numerical values are restored to normal, then this remedy is seen as appropriate for that patient's problem. His theory is that the remedy is able to affect the electrical resistance in the channels through the sample. This is not explicable through normal pharmacological action, but somehow the sample sends a signal through a glass ampule to bring about a measurable biological change. The second example is similar, although not quite so mysterious. Dr. Yoshiaki Omura has advanced the hi-digital 0-ring test, a type of kinesiological test, and reports similar phenomena. The patient tested makes a ring with the forefinger and thumb. The therapist tries to pull the digits apart, while the patient tries to resist. The degree of resistance is assessed by the therapist. If the patient has an organic disease, he is asked to place his other forefinger on the skin of a region affected by the disease, e.g., over the liver in liver problems. The patient exhibits little power of resistance. The therapist then retests the patient, while the patient holds a sample medication. If the medication is correct, the power of resistance will increase. If the dosage is too high, the patient will not have the power to resist. The signals involved somehow affect the power of grip. They must be stimulating the nervous system to change the grip, but what signals the nervous system is unclear. It is evident from these examples that these effects are not transmitted through anatomophysiological systems. Some other signal system is involved, part of what we have called the X-signal system.
TOPOLOGICAL COMPONENTS OF THE X-SIGNAL SYSTEM Our research and work have shown that the signal system is also related to more gross structural properties of the body. That is, some behaviors and functions of the body are closely tied to the three-dimensional structure or symmetry
26
The X-Signal System
of the body. For example, the body can be described by three-dimensional halves - upper-lower, left-right, front-back - as an octahedron, which can be shown to affect the behavior or functions of the body. As an example, we might examine the "pressure perspiration reflex" discovered by Professor Kentaro Takagi. He found that if pressure is applied to one side of the body, maximally at the nipple level, perspiration will occur only on the opposite side of the body. The dividing line will be at the exact center of the body. If pressure is applied, for instance, to the upper right side and the lower left side, perspiration will occur only in the upper left and lower right portions of the body. If the pressure is reversed, the perspiration is reversed, again with the dividing lines at exactly the center lines of the left-right, inferior-superior sections.
Figure 2.3: Pressure perspiration reflex on opposite quadrants of the body.
Similarly, if pressure is applied to a point on both sides of the upper body, perspiration will occur only on the lower portions of the body. These quadrantal relationships appear on both the anterior and posterior portions of the body and are not at all explicable by neurophysiology. Instead, they seem to be manifestations of a certain octahedral symmetrical tendency. This octahedral symmetry is enfolded or hidden within the body, manifesting only in specific conditions. We propose that this symmetry is an essential part of acupuncture theory, as well as of the signal system. Biological, clinical, and medical examples of this model can be found throughout this text. The general theory of the octahedral model can be summarized as follows: Prior to the current stages of evolution, organisms did not possess the complex information systems that now exist. Organisms had a primitive signal system, the X-signal system, which is now retained as a rudimentary biological information system. The reason some of the more subtle techniques employed in acupuncture can be so remarkably effective is that the X-signal system is accessed in some fashion.
The X-Signal System
27
The octahedral system is part of the hidden order. The signal system functions to access biological information derived from the structure and function of our primitive ancestors and our earliest stages of embryogenesis. This idea is essentially topological. Applying topological theory to biology we are able to explain the signal system in greater detail and trace its origins in evolution and embryology. More than this, taking a generalized topological view of the body as our starting point allows us to more clearly understand the relationships of structure and function, pathological deviations and normal variations (biases). From this, we have been able to devise simple but powerful treatment procedures and reliable diagnostic assessments. We may use a limited definition of topology: The study of those properties retained by an object under deformation such as stretching, bending, squeezing, but not breaking or tearing. One immediate consequence is that injury or surgery on the body with the formation of scars will disrupt the normal flow of information. This occurs not only as an "energy blockage," but as a distortion or disruption of the information flows associated with the properties describable by topology. A lump of modelling clay molded first into a sphere, then a cube and then some other random shape retains certain properties:
Figure 2.4: Modelling clay in sphere, cube, etc
Examples of these properties are: connectedness, separability, regularity, compactness. A donut-shaped ring of clay molded into a cup with a handle has the same properties as the cup, even though their appearance is different.
Figure 2.5: Donut
These shapes are homeomorphic. Similarly, a double-holed donut shape can yield a double handled cup, both of which retain the same properties.
Figure 2.6: Double handled cup
The size and shape of the object is not important in topological descriptions. By examining it from this perspective, we can propose descriptions of biological
28
The X-Signal System
systems and their properties that otherwise might not be made. Topological reasoning allows us to describe how octahedral symmetry, with its inherent properties, may have arisen through the course of evolutionary and embryological development. This may seem extremely abstract; however, the implications of this idea for biology are enormous. As with information theory, these properties do not need to be defined clearly. We can propose that this topological theory is a subset of information theory that pertains to certain aspects of information transmission and storage. It allows us, for example, to describe how phenomena occurring in the body can produce manifestations elsewhere. Just as we can define the flow of electrons, ions, and chemicals as information, so, too, can the transmitted effects described by the language and concepts of topology be classified as an (undefined) information flow. Recent studies in the geometry of nature describe properties that belong to the whole system being analyzed which are not describable with reference to the component parts of the system. Many of these studies have revolved around the investigation and description of chaos. It has been found that chaotic systems can spontaneously give rise to order. Underlying the seemingly chaotic systems are what appear to be universal layers of order, describable geometrically and mathematically: In the 1980s, chaos brought to life a new kind of physiology built on the idea that mathematical tools could help scientists understand global complex systems independent of local detai/.13
Interestingly, the use of this method is very effective for describing the hidden order contained within an object. Some, like Benoit Mandelbrot, believe that these geometric properties- in his words "fractal orders" -are universal in nature and require only a few rules to decode.l4 Perhaps the theories of yin-yang and the five phases are such rules. We can see more than structural relationships by the use of topology theory. The changes of an object through space and time come under the purview of topology; thus the normal timing of physiological events, of biorhythms, also falls within its realm.15 We can use this to reexamine the classical Chinese descriptions of biorhythms where the flow and interrelationships of the channels, the numerous five-phase relationships, can be viewed from an isophasal perspective. "Isophasality" refers to the synchronous harmonic effects, or resonances, pertaining to the various phase shifts of bioenergetic and biorhythmic occurrences.l6 For example, in clinical practice, if we find a pattern of synchronous occurrences in the body- areas of tenderness, tension, pulse qualities, and symptom complexesthat correlate to the earth phase, then the earth points of each of the channels are therapeutically available, especially those of the more biorhythmically active channels. By whatever means, these acupoints resonate with or are in harmony with that specific pattern of phase energetics and can have profound effects upon it. All earth points are isophasal, having in common some properties not shared with other points. The same commonality can be found to hold true for other classes of points. With delicate experimentation and examination we have been able to map some of these properties. We can also look at both evolution and normal development from a topological perspective. From the moment of conception to the moment of death, the organism retains essentially the same topological structure, the same homeomorphic properties, even though it has undergone numerous changes and transformations. Organisms thus retain certain properties that may or may not have manifested at
The X-Signal System
29
these various stages of development. Clinically, we can draw parallels between t~e first divisions of the fertilized ovum to the dividing lines of the left and right
sides of the body, the axis of the ren mai and du mai in classical theory, and the dividing lines of the superior and inferior parts of the body, the axis of the dai mai in classical theory.
@
r-------------~~--------------~
Single Cell
RenMa~ DuMai ~
~
RenMai, DuMa-i
TwoCells
11--J,Qt Four CeUs
DaiMai
9
II•
0
Figure 2.7: The first division gives rise to the ren mai-du mai axis. The second division gives rise to the dai mai axis.
Thus, we can see the possible embryological roots of octahedral theory, as the left-right, superior-inferior portions are clearly delineated in this development. The anterior-posterior portions may be delineated in the same manner. The physical body retains properties that were active and important at all stages of embryogenesis, many of which are now latent, awaiting the correct stimulus, circumstance, or bias, to manifest again. Evolution can be viewed as the progressive extension of topological principles and properties. If for example, we take a simple donut-shaped structure, we can imagine the hole on one side representing a mouth and the other as the anus:
I§ Figure 2.8: Donut shape
As this donut shape is flattened, we can derive a tubular structure, somewhat similar to primitive organisms, such as a worm, with a mouth, gut tube and anus:
Figure 2.9: Tubular structure
Manipulation of various areas of this tubular organism yields elementary limb formations, as are found in fish fins:
Figure 2.10: Fish limb formation
30
The X-Signal System
Further development of these structures yields the arms and legs. Finally we arrive at structures like those of mammals and indeed people:
Figure 2.11: Structural outline of mammalian and human forms
Because there is continuity in the reproductive cycles of successive generations, where development occurs against the background of genetic information, we can argue that organisms alive today, such as mammals, fish, and people, all retain those same properties that were present in the earliest and throughout all later stages of evolution. Schoffeniels states this point quite clearly: The content of a biological system increases in the course of its development since it represents an integration of all the modifications which it has undergone and which it has imposed on the environment/?
Within the body many such systems exist, each of which are subsystems and have subsystems within them. Properties that developed early on in the evolution of these systems will have been integrated into the total biological system. Whether or not these properties manifest depends mostly on need and response. If they are not needed for survival, they may not manifest since that would represent an unnecessary expression of information, a waste of energy. Their manifestation would be obviated as well by the evolutionary development of more efficient information systems, such as the neurological system, having specific targets, hormones and other molecules with specific on-off activation sites. These supercede, but do not eradicate, the more primitive properties that belong to the signal system. The more primitive systems may be made to manifest in response to the correct stimulus. We can give numerous examples to demonstrate these ideas. We propose that some theories and techniques of acupuncture either describe certain of these properties or use them to obtain therapeutic effects. Yin-yang, channel, and fivephase theories have proven successful tools for exploring and taking advantage of the signal system. ExPERIMENTS WITH THE BIOELECfRICAL NATURE OF THE X-SIGNAL
The information flow of the signal system can be viewed as molecular and/ or electrical in nature, though some of the preceding examples suggest that there are other mechanisms at work. While certain molecular and electrically mediated effects of acupuncture and moxibustion have been documented in various researches on the anatomophysiologic system effects, the subtle effects pertaining to the signal system have not been clearly defined. From our own research we can suggest that some are electrical or electromagnetic in nature. Our main reasons for saying this are as follows:
The X-Signal System
31
1. With the correct application of polarity agents to the body, we are able to bring about almost instantaneous changes, such as decrease or increase of pressure pain and tension at specific acupoints. These rapid changes occur too quickly for them to be molecular. As we have already stated, stimulus from polarity agents is too minute to affect the nervous system, so neither are the effects neurological.
2. The various polarity agents that we can use for testing and treating operate essentially from an electrically positive and negative polarity, and thus we can reason that their effects are at least in part electrically mediated. Examples of these polarities are as follows:
Polarity agent two-metal contact bi-polar magnet contact* digital contact ion-pumping cords ion-beam apparatus electrostatic adsorbers * See
Positive
~~fger north pole thumb red clip red electrode positive stick
Negative zinc silver south pole little finger black clip black electrode negative stick
the glossary for magnetic pole definitions
These various polarity agents produce repeatable results and effects. Reversing polarities will reverse the effects. For example, ST-27 is the Manaka diagnostic point for the large intestine. If right ST-27 has pressure pain, placing a north-facing magnet on right Ll-4 will decrease the ST-27 pressure pain. Reversing the magnet so that the south pole faces to right Ll-4 will cause the ST-27 reaction to return. This reversibility eliminates the possibility of a placebo effect or another psychological phenomenon, and demonstrates that a genuine response is occurring. Although these tests cannot be repeated indefinitely, this type of procedure can be applied on a specific point several times, after which the reactive points will become insensitive regardless of the polarities applied. This may occur because of overstimulation, with the flip-flop effects of polarity reversal. When the two-metal contact technique is used, the electrical effects are similar to, but differ from, a metal battery. These two metals do not make contact as in a metal battery because they are not inserted into the body fluids, but are placed on the body surface. A metal battery has two metals inserted into a conducting medium. We know from experiments, clinical results, and observations, that each of these agents produces some electrical polarity so that minute electrical currents flow, but these are very difficult to measure; often they are simply too small to measure. We can further suggest that the mechanisms of these minute currents are probably one or more of the following: 1. The semi-conductor network of the interconnected large molecules throughout the body described by Szent-Gyorgyi and Oschman.18 2. The ionic currents that flow through the cardiovascular system from various local microscopic areas to other local microscopic areas, described by Nordenstrom.19 3. The DC electrical current system said to flow through the perineural cells, described by Becker.20 4. Other currents as yet not clearly mapped and other systems as yet undescribed.
32
The X-Signal System
Many of these effects and mechanisms are denied or ignored by researchers because they are hard to measure. Anatomophysiologic system effects, the effects of acupuncture and moxibustion on the neurological, neurohumoral, hormonal and cardiovascular systems, are easier to measure and document. The essential problem is that both the anatomophysiological system and signal system are activated when the body is stimulated using needles and moxa. Since the anatomophysiological effects are clearer and more easily measured, these tend to obscure the subtler signal system effects. But using polarity agents, applying very small biases to the body, we can bypass the anatomophysiological system effects and thus more clearly observe the signal system at work.
BIASOLOGY The concept of bias is useful for describing very subtle influences in the body. We might go so far as to say that the concept of bias is an important idea for handling the hidden aspects of the body, as they pertain to the functions of the signal system and thus the theories of acupuncture and moxibustion. A bias can be described with examples such as the following: 1. In bowling, the lopsidedness of a ball causing its curved path.
2. A mental inclination or leaning. 3. A slanting or diagonal line cut or sewn in cloth. 4. In engineering, a steady force, voltage, magnetic field, applied to a device to establish a reference level or determine a range of operation. In the medical field we can find examples of biases, such as the methods of Drs. Vall and Omura which utilize the bias effects of substances brought in close contact with the body surface. In psychoanalysis the concept of the Freudian complex can be seen as a bias. A small incident in a patient's childhood biases that person throughout their life until they confront the incident and relieve the bias it creates. Similarly, an irrational fear of spiders or monsters can be a hidden bias. In our own practice we once had a nurse come for treatment of shoulder pain. She had a scar on her lower limb from an osteomyelitic problem that had occurred many years before. Injection of one cc. of novocaine subcutaneously into this scar eliminated the shoulder pain. In this case we can describe the old scar as biasing the body and causing secondary problems. This can happen with any scar and has been reported as a common problem with scars from abdominal and other surgeries. Similarly, a patient who came for treatment of chronic shoulder and low back pain felt that she had nowhere else to tum and was depressed about her condition. After good results had been obtained, it was necessary to relieve the mental bias she had concerning the condition, which had predisposed her to perpetuate the condition. To prevent its returning, an anti-bias was given by simply telling her that the Western disease name she had been given was no longer accurate. Since simple treatment of her liver channel was able to cure the condition, it was only a liver channel problem. She was told that she should stop worrying about it, a tactic that proved successful. After the war, I had a distraught male patient who was depressed, anxious, and worried that he was dying. His family was concerned as he was slowly wasting away and seemed very sick. Recognizing that the man had nothing organically wrong with him, yet might well eventually die because of the emotional bias, I told him that as an experienced doctor I was always able to predict when a patient was soon to die and that I would tell the patient when this was about to happen, but that in his case it was not going to happen now. Of course, because the patient trusted
The X-Signal System
33
me, I was able to counterbias the negative bias and the man recovered soon thereafter. Only recently did I hear from the man's family that he had passed away, some forty years after he was "dying." Other examples of bias might include a patient with a toothache, who creates a secondary distortion and bias by chewing only on the side that does not hurt, so as not to irritate the toothache. This causes other problems later. Any repeated imbalance movement can trigger a bias. Someone who writes extensively with only the right hand, or who plays tennis only with the right arm, will bias the body and eventually may have problems. We can see that in each case we need an anti-bias or a suitable counter-bias for the particular problem at hand. This requires a simple means for finding the bias and a simple means for testing the applicability of a particular counter-bias. A successful counter-bias will release the bias and allow both the secondary bias effects and the original functional problems to change. The use of polarity agents to achieve this is extremely helpful, especially because the polarity agent itself generates a tiny electrical/magnetic bias. When applied to the appropriate points, this can be a very potent counterbias. Thus we can use the study of biases, biasology, as a useful means for examining our diagnostic and therapeutic approaches, since it allows us a multi-disciplinary synthesis and rationalization of our understanding of the body's hidden signal system, the X-signal system. We can use the concept of the bias outside of the medical realm to examine other facets of the signal system. For instance, in the practice of Zen Buddhism, there is the concept of satori. This refers to a particular conscious state that is achieved at a particular moment in time. Usually satori occurs when some small phenomenon occurs, such as the sound of a bamboo shoot falling in a bamboo grove, or the light tap of the zen monk's staff on the subject's shoulders. These are clear examples of bias, a tiny stimulus given at a critical moment. In the realm of biometeorology the tiny but significant effects of the geomagnetic field are seen as a favorable bias to the organism, as they are essential to the correct timing and integration of physiological events. In all cases, the bias refers to some minute or subtle influence, analogous to the minute signals of the X-signal system. When we apply such a minute stimulus or bias, we are able to observe the topological nature of acupuncture and moxibustion theory and practice. We can also observe some of the complex relationships between structure and function, symmetry and asymmetry. Using these observations, we have derived new clinical laws, rules, and methods of treatment. For instance, looking at some of the body's natural asymmetries, such as the position of the liver and gallbladder on the right, and the stomach, spleen, and heart on the left, we might expect to find particular asymmetrical patterns, if any of these organs or their associated function sets develop problems. We would expect these asymmetries to bias the body in particular patterns. This is what we actually find. The liver, being in the upper right abdominal quadrant, will produce a particular pattern of tension and pressure pain in the body. The right-sided subcostal tension that develops as a result of a functional liver problem in fact biases a whole set of muscle groups, producing a range of other problems. Reactions often will be found on the left sartorius, left internal oblique, right external oblique, right serratus anterior, right rhomboideus major, and the right rhomboideus minor muscles when liver problems occur. This particular spiral of muscle bands is a functional set, as can be demonstrated using kinesiological
34
The X-Signal System
techniques. It is associated with the liver, because the liver is in the upper right abdominal quadrant and tends to bias this muscle set.
Figure 2.12: Functional muscle group
A simple procedure such as placing the right hand palm down on a magnet heater, or the left foot sole down on a magnet heater, will generally release these tensions and tendernesses throughout the functional muscle set. In releasing the pattern of muscle reactions, the body structure is subtly altered and liver function improved. Any number of procedures can be used to achieve the same effects, their goals generally being to relieve reactions of the upper right and lower left body areas. Ideas such as bias can be useful in this context. A bias can be an unbelievably small event that radically changes the behavior of a whole system. It can change the system in a favorable direction or an unfavorable direction. In this sense it is similar to the low-level signals which we have postulated lie at the heart of acupuncture practice. Small, seemingly insignificant changes in the body develop; these bias the body and cause functional changes to occur. Development of tension throughout the spiral band of muscles that cross over the liver slowly causes functional changes in the liver. Application of a small dose stimulation bias - can push - bias - the body so that it tends towards a more healthy or normal functional state. Disease may begin at a sub-cellular level and then spread, biasing the rest of the system. Treatment can similarly start at a very minute but strategically powerful level, and counter-bias the system. Using the meridian imbalance diagram (M.I.D.), we are able to confirm these observations objectively and track a patient's progress before, during, and after treatment. The M.I.D. procedure was specifically designed as a means of observing and statistically demonstrating structure-function relationships, particularly octahedral relationships. It provides simple, objective statistical measures of a patient's overall energetic state, described in classical theory as yin-yang balance. When we consider the effects of acupuncture and moxibustion therapies as occurring primarily through the X-signal system and secondarily through the anatomophysiological systems, we can also gain insight into the possible mechanisms of action that infuse both classical and modern clinical observations and systems. For instance, why is it that one point on the body surface can be observed to affect one area or part of the body and yet a point close to it, in the same dermatome, can affect a totally different area or part of the body? It seems clear that these effects cannot be neurological. Further, how can we understand the various simple and complex systems of reflexology? We can find modern descriptions of how all parts of the body reflect
The X-Signal System
35
somewhere on the feet, hands, nose, eyes or auricles. (Of these, the hand reflexology of Tae Woo Yoo and the auricular reflexology of Nogier and the Chinese are particularly useful.) As we have already suggested, if we consider the theories of the holographic paradigm, where all aspects of the whole reflect or contain all other parts of the whole, as descriptive of part of the signal system, we can begin to see how such systems may work. These reflex points and areas are able to receive and send very specific information to specific areas of the body.
THE X-SIGNAL SYSTEM IN ACUPUNCTURE &
MOXIBUSTION THERAPY
It is important that we do not confuse the neurological and humoral effects of acupuncture, so thoroughly researched and described in needle analgesia and anesthesia research, with the signal system effects. The analgesic and anesthetic effects are seen to a lesser degree in normal acupuncture and moxibustion than when deliberately applying acupuncture analgesic and anesthetic techniques. Likewise the signal system effects are seen to a lesser degree in normal practice and more clearly in the subtle practices of the traditional keiraku chiryo, or channel (meridian) treatment schools, when very tiny influences are given in treatment. Acupuncture anesthesia uses strong stimulation and counter irritation to produce anesthetic and analgesic effects. In the American movies, when a cowboy was shot, his friend would feed him whisky and then apply an upper cut to the jaw. Then the friend could remove the bullet lodged in his body. Acupuncture anesthesia is like this. With a strong stimulation, people become faint; if the stimulus is strong enough, the operation is easy. But we should not think of using acupuncture anesthetic methods for treatment of general or subtle problems! While admittedly it is difficult to discriminate the clearer neurological and humoral effects of acupuncture from the subtler effects of the signal system, if we consciously try to use the signal system, we can produce remarkable results. This is because this system participates in the therapy regardless of whether we think about it or not. Our research suggests that the clinical effects of channel therapybased acupuncture that we describe in this text occur primarily at the signal system level. The signal system either regulates the informational systems in the body, which in turn regulate the energy systems, or it directly regulates the energy systems. Either way, if we can learn to control the signal system, which requires only the tiniest energy or signal input, we can produce dramatic effects throughout the information and energy systems. If there is an error signal in the information system and we learn how to correct this signal, many problems in the energy systems can be corrected. Because the observations of these error signals require only simple diagnostic checks and are corrected by tiny influences or energy inputs, simple diagnostic and therapeutic systems can be developed. Indeed, because the input required is so small, we are often able to stimulate or influence the body with only a simple touch or non-invasive application. Since needles may not be used or needed, the risks are greatly reduced and safety greatly enhanced. Before finishing these discussions of the signal system, let us briefly return to our earlier question of how it relates to the theories of acupuncture and how, for instance, might we understand the rather difficult concept of qi. In the last chapter we looked at the problems involved in accurately translating the term qi. We can now state more clearly that the term is untranslatable into a specific Western word. Rather, it should be rendered as vague and wider term, such as "information." Qi has uses that imply physiological process. In this sense information
36
The X-Signal System
refers to the whole sequence of events in the process and may involve all the known equivalent biochemical and physiological components. Qi also has uses and functions that imply less tangible processes, transformations, and exchanges. The term "information" is equally vague, referring only to the fact that something is transmitted, transformed, or produces change. Qi does work, is the result of work done, and is the medium of regulation. Yin-yang and the five phases have the same difficulty of translation. In the medical literature, many of these functions can be clearly described in the terms we use to explain the information and energy systems: the neurological, biochemical, storing, dissipating, or assimilating functions of modem biomedicine. Yet, many of the functions and ideas described by the ancient Chinese cannot be rationalized in that way. All we have are descriptions of various qi functions, movements, interfaces and transformations. The Chinese descriptions are like a qi signal system, parts of a larger system, the X-signal system in our words. Relative to their uses in classical medical literature, we can now explain these terms with reference to the signal system model that we have developed. The terms "yin-yang" and "five phases" are used to categorize and describe interrelationships. In signal system terms, they describe the characteristics of components of the whole body and how they interact and regulate, at a primitive biological level, through information/ signal exchange (qi). The twelve channels represent pathways of information/signal transmission and sites of information/ signal reception. Thus, they have yin-yang and five-phasal characteristics and acupoints. The eight extraordinary vessels represent what are probably the remnants of a primitive biological structure that functions to globally regulate the body, through distribution of qi, both in the sense of what does work and what regulates activities - information/ signals. One final question we should raise: what is it that prompted the ancient Chinese to describe these things? How were they able to observe and discern things that are virtually undistinguishable to us in modem times? We have proposed already that perhaps they were using more right-brain pattern recognition and observation. In the West and in modem times, the tendency is to use left-brain patterning. If this is true, then we can say that the ancient Chinese had a finer, more developed sense of intuition. Perhaps because of their simpler, more natural life styles, they may have been more attuned to natural phenomena and could perceive aspects of nature that are difficult for us to see. This would be true of all simpler, more natural cultures, not just the ancient Chinese. We can cite the Micronesian natives who had the ability to navigate thousands of miles over open waters in small sailing boats without maps or compasses. While it is harder for us to see these aspects of nature that are now hidden for us, we can use the same rules that the ancient Chinese described. With careful application, we may discern and observe these rules and devise methods of using them with powerful clinical effects. We can now examine more thoroughly some traditional acupuncture theories and show with simple experimentation (that you may repeat for yourself) how the signal system rests at the heart of acupuncture as its modus operandi.
CHAPTER ENDNOTES 1 S.B.: The term "Meridian Imbalance Diagram" has been retained because of the number of papers already published which refer to it as such. 2 S.B.: Even the queen and royal family of Britain have an homeopathic doctor as their primary care physician. 3 See The American Homeopathic Association Bulletin. 4 English Homeopathic Journal, 1954.
The X-Signal System
37
5 S.B.: For an interesting discussion of scientific research into the effects and mechanisms of homeopathy, see: Manning, C.A. and L.J. Vanrenen, Bioenergetic Medicine East and West, Berkeley: North Atlantic Books, 1988, pp. 65-89. 6 Davenas, E. eta!., "Human basophil degranulation triggered by very dilute antiserum against IgE," Nature 333:816-818, 30 June, 1988. For the disclaimers of this study, see pages 787 and 818 of the same issue of Nature. 7 Ibid. 8 In acupuncture, this is relatively easy to demonstrate. Normally, placing a small, north-facing magnet at LU-10 will reduce the tension and pressure pain of LI-4 on the same hand. If instead the magnet is held anywhere from a few centimeters to several meters away from LU-10, while pointing the magnet at LU-10, the same effects can be observed as when placing the magnet directly on LU-10. However, this occurs only when the magnet is held east of the acupoint. If the magnet is held to the north, west or south, the effect disappears and the pressure pain at LI-4 is unchanged. This effect can be observed using other tools and other points. See Appendix 4 for further presentation of sayoshi. 9 S.B.: See for example studies on the partial regeneration of fingertips accidentally severed in children, where regeneration only occurs under special conditions. Illingworth, C.M. and A.T. Barker, "Measurement of electrical currents emerging during the regeneration of amputated fingertips in children," Clin. Phys. Physiol. Meas. 1:1,p.87-89, 1980. 10 Lovelock, J., Gaia: A New Look at Life on Earth. 11 Gleick, J., Chaos, p. 149. 12 Bohm, D., Wholeness and the Implicate Order, pp. 191-192. 13 Gleick, J., Chaos, p.280. 14 Ibid., p.238. 15 See for example Winfree, A.T., The Geometry of Biological Time, New York: Springer-Verlag, 1980. 16 Amore clinically based definition of the term "isophasal" can be found in chapter six. 17 Schoffeniels, E., Anti-Chance, p.103. 18 Oschman, J.L., "The connective tissue and myofascial system," Rolfing 1981 conference, unpublished paper. 19 Nordenstrom, B., "Biologically closed electric circuits: clinical, experimental and theoretical evidence for an additional circulatory system," Stockholm: Nordic Medical Publications, 1983. Taubes, G., "An electrifying possibility," Discover, April1986, p.23-37. 20 Becker, R.O. and G. Selden, The Body Electric.; Becker, R.O. and A.A. Marino, Electromagnetic Fields and Life.
SECTION
Two
IN PURSUIT OF THE DRAGON
RESEARCHING AND EXAMINING TRADITIONAL THEORIES AND CONCEPTS
the universe is a vast organism with now one and now another component taking the lead - spontaneous and uncreated it is, with all the parts of it cooperating in a mutual service which is perfect freedom, the larger and the smaller playing their parts according to their degree.''
J. Needham, Science and Civilization in China II p.288.
CHAPTER THREE
YIN-YANG THEORY The concepts of yin and yang are central to the theories of East Asian medicine. Explication of these terms in the professional literature depends on context, author, and era; their meaning carries as many subtleties, nuances, and facets as the term qi. The multiplicity of their correspondences make it difficult to design an encompassing and coherent definition. Even the use of terms like "positive" and "negative" to express their polar nature is inadequate. There is clearly no scientific definition available. For the purposes of our research, we propose to use clinical procedures and tests to focus and clarify our understanding of these concepts. Many conceive of yin and yang as fixed entities or ideas, sometimes almost palpable entities. Our perceptions and methods of analysis always define the polarities with various syntagonistic and antagonistic tendencies. It is difficult to see the underlying, indivisible unity of which yin and yang polarities are but appearances. Realistically, they are just relative ideas, simultaneously syntagonistic and antagonistic, complementary and opposite. In some sense they are like a moebius strip. First examination shows two surfaces, and we can say that one side appears yang, and the other yin; but with closer inspection we find that there is only one surface: its duality is just a relative appearance. We can further imagine that the relative balance of yin and yang surfaces in the body form a large, complex mobile:
Figure 3.1: The balance of a mobile
42
Yin-Yang Theory
Here many pendants balance antagonistically against one another, often with one against many at the various fulcra. Total balance and harmonization consists of all the partial balances throughout the mobile. Left-right balance is not free from the superior-inferior or anterior-posterior balance. All facets are organically related. Different parts can become unbalanced, but generally the whole remains relatively balanced. The concept of balance is not a rigid, strictly defined idea. In dynamic systems such as the human body, or nature in general, rigidity is not possible. Balance is always an oscillation around a reference point. For example, a pendulum always appears to swing back and forth over the same point, but its real motion is much more complex. When analyzed statistically it appears to be balanced; but at any particular time, its motion may not be balanced at all. When standing upright, the center of gravity always sways back and forth over some reference point that lies directly below the center of the body. Blood pressure, body temperature, and probably all physiological processes oscillate through some normal range. This homeostatic process is vital in dynamic and living systems. Without it, order likely could not prevail. The concept of balance is thus flexible and not rigid. Yin and yang balancing or harmonization is something similar; it is always relative and moving. Such are the dynamic balances of life. Historically, in Chinese medical tradition, yin and yang were viewed as opposite polarity concepts used to assess disease and to design treatments to restore balance. We think that there are two ideas basic to this concept. First, there are concepts relating to changes within the environment: terrestrial, celestial, bodily, seasonal, and the changing condition of the disease. Yin increases, peaks, and gives rise to yang. Yang increases, peaks, and gives rise to yin. This concept has been described extensively, and many familiar examples can be cited. For example, during the course of a year the relative state and flux of yin and yang is quite complex. At the summer solstice, in June, yang energy is said to be already peaking, after which it begins to decline, while yin ascends. But in actuality, the warmest days come in July and August, after the actual peak of yang, during the time yang is declining and yin ascending (yang gives rise to yin.) There is a lag between reality and appearance. This same phenomenon occurs during the winter: yin peaks at the winter solstice in December, but the coldest days come in January and February. In this context, yin and yang are not absolute and separate. In yin there is yang and in yang there is yin, as is graphically portrayed in the yinyang taiji symbol.
Figure 3.2: The tai ji symbol
YIN-YANG IN TOPOLOGY The second perspective views the yin-yang components of the physical body as a system of syntagonistic-antagonistic relationships. We say that these are topological relationships. This differs from the first concept of yin and yang within and
Yin-Yang Theory
43
engendering one another. Now we consider yin and yang as separate: in yin there is no yang, in yang there is no yin, and there are relatively clear yin-yang boundaries. This second concept has been given little attention in the field, yet it is a perspective that we have found particularly useful because it correlates to the channel system, and the flow and regulation of qi. The classical yin and yang correspondences, such as those referring to the structural, topological relationships of the body, have notable clinical utility. Body portions superior posterior inferior anterior
yang yin
left right
If we take these three structural, functional yin-yang divisions and draw "dividing lines" as polar axes of the body, we can define eight areas of the body, eight octants. Together these illustrate octahedral theory, the concept of a structural symmetry enfolded into the body. left-right posterior dividing line
left-right anterior dividing line
Yang
superior-inferior dividing line
Yin Figure 3.3: Structural octahedral body symmetry
Research abounds which corroborates octahedral theory. The pressure perspiration reflex tests of Professor Takagi are one example, mentioned earlier. Takagi demonstrated that these perspiration effects could be elicited with needle stimulation to single acupoints. Interestingly, he found that shallowly and deeply inserted needles elicited different responses. Stimulation that clearly produced strong nervous system reactions (deeper needling) did not manifest this octahedral symmetry. Needling with little (or no) nervous stimulation was able to manifest the symmetry. Our theory of the signal system, responding to tiny electrical bias or stimulation, predicts such differences. Other biological and medical examples of octahedral symmetry can be referenced.1 The non-pathological harlequin flushing of the newborn clearly manifests left-right asymmetries.2 The familial condition, painful harlequin flushing, manifests clear left-right, anterior-posterior, and superior-inferior asymmetries.3 Some researchers have noted left-right, superior-inferior asymmetries in the distribution of biopotentials.4 Superficial lymph drainage is clearly quadrantaJ.S Opioid peptides have shown left-right, inferior-superior, medial-lateral limb specificity in acupuncture analgesia.6 We have devised simple tests to demonstrate and validate the octahedral model. The use of north and south magnets on the large intestine points of the a uri-
44
Yin-Yang Theory
de to relieve pressure pain at LI-4 is one example. If right LI-4 has pressure pain, north (+) at the right large intestine point of the auricle will reduce the reaction, while south(-) will increase it. South(-) to the left large intestine auricle point will reduce reaction, while north (+) will increase it. We can take this simple experiment further. First, we can compare left and right LI-4 points after each application of the magnets. Second, we can also place the north and south magnets on the points directly behind the large intestine points on the posterior surface of each auricle. When doing this we obtain the following results: Magnet
Auricle point
RightLI-4
Left Ll-4
north(+) south(-) south(-) north(+) south(-) north(+) north(+) south(-)
right LI point right Ll point behind right LI pt. behind right LI pt. left LI point left LI point behind left LI pt. behind left LI pt.
decrease increase decrease increase decrease increase decrease increase
increase decrease increase decrease increase decrease increase decrease
We can see that it is difficult to reduce the reaction on one side without increasing the discomfort on the other side. A north magnet syntagonistically affects one side, the same side, and in so doing it antagonistically affects the other side. In this relationship the magnetic polarity has relative effects on LI-4 of one side of the body that are dependent on left-right, posterior-anterior antagonisms. This pressure-pain relief method causes relief on one side, but creates an antagonistic pain on the other, further demonstrating the structural symmetrical properties enfolded into the body which we postulate are the product of evolutionary and embryological development, and part of the X-signal system. This same type of test can be applied to other auricle points to elicit the same pattern of changes. For instance, for a subject experiencing pressure pain at LR-14, we can place north and south magnets on the left and right auricle liver points and on the points directly behind them on the posterior surface of each auricle. This gives the following results: Magnet
Auricle point
Right LR-14
Left LR-14
north(+) south(-) south(-) north(+) south(-) north(+) north(+) south(-)
right liver point right liver point behind right liver pt. behind right liver pt. left liver point left liver point behind left liver pt. behind left liver pt.
decrease increase decrease increase decrease increase decrease increase
increase decrease increase decrease increase decrease increase decrease
The same pattern of responses- right-left, anterior-posterior polarities- again occurs. These examples also indicate that the auricle points manifest on the posterior portion of the auricle, directly posterior to the same point on the anterior portion, where most of the auricular points are located. These points seem to show antagonistic tendencies. In the physical octahedral body, applying north and south magnetic poles to points on one side of the body will cause reduction of pressure pain on a point on the same or opposite side. We can demonstrate not only the right-left, anterior-posterior antagonisms, but also the inferior-superior antagonisms. If we place two strong magnets (over three thousand gauss) with north and south contacting either side of the anterior and posterior midlines, we can produce reductions in pressure
Yin-Yang Theory
45
pain in specific areas of the abdomen. These areas vary according to where we place the magnets:
~~
~~ J, ! ------+-------
® !@,J.
------+-------
~
~
Figure 3.4 (i)
Figure 3.4 (ii)
(i) - If we place a north magnet to the left and a south magnet to the right of the midline above the navel on the abdomen, pressure pain on the left side of the abdomen reduces (ii) - If we place the two magnets below the navel line, north on the left and south on the right, the right side of the abdomen shows pressure pain reduction.
This procedure compares the right-left dividing lines. If we then try the same experiments with the anterior-posterior dividing lines, we find the following:
~~ J.
!
------+-------
~ Figure 3.4 (iii)
(iii)- Placement of the magnets on the back again reverses the effects. Above the navel line, north on the left and south on the right produces reduction on the right side of the abdomen .
~~ !J,
------+-------
~ Figure 3.4 (iv)
(iv)- Below the navel line, north on the left and south on the right produces reduction on the left side of the abdomen .
N = north magnet S = south magnet
.U. =reduction of pressure pain
1t = increase of pressure pain
46
Yin-Yang Theory
~~~ J
('(\
~
./
! \_ t! ------+-------
(~k-kl
(~\ Figure 3.4 (vi)
Figure 3.4 (v)
(v)- Placing south on the left lateral side of the chest on the anterior portion and north on the left lateral side of the chest on the posterior portion will cause a reduction in the upper right quadrant (URQ) and lower left quadrant (LLQ) reactions . (vi)- Reversing the positions of the north and south magnets causes the URQ and LLQ reactions to return.
(backside!
t
!
------+-------
(-kside)
(~}_
~ ! ------+-------
1~\
Figure 3.4 (vii)
Figure 3.4 (viii)
(vii)- Repeating the same test procedure on the right side will cause the phenomena to reverse. South on the right anterior and north on the right posterior lateral portions of the chest will cause the URQ and LLQ reactions to increase. (viii)- North on the right anterior and south on the right posterior portions of the lateral chest will cause the URQ and LLQ reactions to decrease.
~~ ~~ t! ------+------- "' ® t® ,......... {~\ Figure 3.4 (ix)
! !
®
------t------® I J, / ~\
AT(""'
tbachideJ
Figure 3.4 (x)
(ix) - Placing south on the LLQ and north on the lower left lumbar region causes the URQ and LLQ reactions to increase. (x) - Placing south on the RLQ and north on the right lower lumbar region causes the URQ and LLQ reactions to decrease.
N = north magnet S = south magnet
.U. = reduction of pressure pain
1t = increase of pressure pain
Yin-Yang Theory
47
If we use this method to examine the boundary lines that pass through the navel to delineate superior and inferior regions, similar reversals of reactive areas occur depending on the polarity of the magnets. These simple tests clearly demonstrate all three sets of antagonisms and polarities that compose the octahedral model. What is significant here is not just the particular mechanisms that underlie each expression of octahedral antagonism, but also the general rules behind all these mechanisms. The fact that the body manifests a set of antagonisms is most important. We must ask: what are the biological functions of such a structure? We have speculated on the role such a system may play in the management and distribution of energy. In primitive organisms this would be a very significant aspect of regulation. In higher organisms its significance may be reduced by the multiplicity of other mechanisms that have evolved, but it may still play a biological role similar to the role it plays in more primitive organisms. In terms of acupuncture and the regulation of energy (qi), the octahedral antagonism is significant. The boundary lines of this octahedral symmetry are all yin-yang antagonisms: inferior-superior, anterior-posterior, right-left. As we shall see in later chapters, we can devise powerful treatment procedures based on octahedral theory, which is an essential part of the overall picture, the signal system.
CHAPTER ENDNOTES 1 In chapter two we also referenced our development and use of the M.I.D. as an objective, statistical means for demonstrating the octahedral model. See also, Matsumoto, K. and S. Birch, Hara Diagnosis: Reflections on the Sea, pp. 228-231. 2 See for example: Mortensen, 0. and A. P. Stougard, "Harlequin colour change in the newborn"' Acta Obst. et. Gynec. Scandinav. 36, 352-359, 1959. 3 See Hayden, R. and M. Grossman, "Rectal, ocular and submaxillary pain," Amer.Jour.Diseases Childhood 197:479-482, 1959. Dugan, R. E., "Familial Rectal Pain," Lancet, April1972, p. 854; Mann, T.P. and J. E. Gee, "Familial rectal pain," Lancet, May 1972, pp. 106-107; Diggle, J. H., "Familial proctalgia with painful harlequin flushing," unpublished manuscript. 4 Hori, S. et al., "Objective consideration of the correspondence between pulse diagnosis and quadridemarkation of the body," abstract, Amer. Jour. Acup. 13:1, p. 80, 1985. From Jour. Jap. Soc. Acup. 33:4, p.420-426, 1984. 5 See for example Kapit, W. and L. Elson, Anatomy Coloring Book, p. 69, New York: Harper & Row, 1977. 6 Edisen et al., "Regional and lateral specificity of acupuncture-induced action of blood-factor effects inhibiting flexor reflex in the rabbit'" Physiol. Chern & Phys. & Med. NMR 15, p. 189-199, 1983.
),1'.\~
Y~~~
~
CHAPTER FOUR
THE CHANNEL SYSTEM: /ING LUO THEORY Like yin-yang, the concepts of the jing luo, the channels or meridians, and their xue, the acupoints, are central to the traditional theories of acupuncture and moxibustion. Along the course of the channels were said to flow the qi, blood, ying, and wei. Each channel was described as having a direction of flow and as being connected in a continuous circuit. On this circuit the more than 360 acupoints were described by their locations, categories, and general use. The term jing luo refers generally to the channel system, but this involves more than the vertical trajectories, the jing mai, and includes the connecting horizontal trajectories, the luo mai. Other channel systems in the body describe different functional sets. Each category has different associated functions, with overlappings among all categories. Type No. Function jing mai (primary channels) 12 connecting to internal organs & external luo mai (connecting vessels) qi jing mai (extraordinary vessels) jing jin (channel sinews) jing bie (channel divergences) jing shui (water channels)
15 8 12 12 ??
limbs & joints interconnect the organ-channel system regulate the channel system connect with body musculature branching & leading back to the channels referenced only briefly and obscurely
The acupoints are found only on the shi si jing (fourteen channels): the twelve jing mai (primary channels) and two of the qi jing mai, the ren mai and du mai. All other channels intersect acupoints on these fourteen channels and have no acupoints of their own. According to our model, use of the twelve primary channels, the channel sinews, and the extraordinary vessels are usually sufficient to regulate the body through the octahedral and (iso)phasal components of the signal system. If we examine aspects of their nature, origins, and functions, and apply it to our model of the signal system, we can discover how the twelve primary channels, the channel sinews and the extraordinary vessels regulate the body through the octahedral and phasal components of the signal system. Few attempts have been made to clarify the nature of the channels and acupoints or to confirm the various theories related to them. If we examine the difficulties associated with studying these phenomena, we may be able to describe a
50
The Channel System: Jing Luo Theory
variety of tests, experiments, and theories that both demonstrate and clarify their nature. We have already stated that the channels and acupoints seem to be an essential component of the X-signal system. In demonstrating this we can not only demonstrate traditional theories, but describe new clinical rules and devise useful clinical procedures.
PATHWAYS OF THE TWELVE PRIMARY CHANNELS In chapter ten of the Ling Shu we find simple, concise, and very abbreviated descriptions of the pathways of the twelve primary channels. These descriptions form the basis of most later descriptions. There have always been difficulties understanding these ideas. As with many other classical discussions through the long history of Chinese medicine, numerous inconsistencies and variations arose as different ideas about their pathways, natures, and functions were added by different authors. Perhaps the most commonly cited descriptions can be found in the Shi Si Jing Fa Hui of the fourteenth century, which gives detailed, relatively clear descriptions of each channel. But if we examine modern acupuncture texts from around the world, we find variations for each of the twelve channels and many of their acupoints. Many books describe the bladder channel as having two parallel trajectories, the first one and one half cun (divisions) and the second three cun lateral to the spine. Other books describe three parallel trajectories, the third being half a cun lateral to the spine. Still other texts describe the third trajectory as being down the spine itself. There are also variations in location and order of specific acupoints. Some believe that the order of the bladder channel and its acupoints passes from the line one and one half divisions lateral to the spine (BL-11 to BL-35 at the base of the spine), to the top of the line three divisions lateral to the spine (BL-36), then down the back and the leg to BL-50. Others believe that the medial line first descends the leg to the popliteal crease then rises to the top of the lateral line on the back. How do we approach these differences to determine if one is right, or more correct, than the other? Proponents of each theory claim clinical results to support their theory. But what does this mean and how are we to evaluate these claims? In some German 1 and English2 texts we find descriptions of the abdominal pathways of the stomach and kidney channels that are more lateral than those most other texts describe. When questioning some of these authors, we found that this theory derived from a literal interpretation of some sketches from sixteenth century and early seventeenth century acupuncture texts. The Zhen Jiu Da Cheng is often cited. This text presents somewhat primitive and exaggerated representations of the pathways of these two channels. Again, the proponents of these interpretations lay claim to clinical results as support for the acceptance of their sources. We can see in the following illustrations from the Zhen Jiu Ju Ying of 1529 that the stomach channel trajectory is not shown as moving closer to the midline of the abdomen as is described by most sources. Instead, it remains more lateral, roughly on a line that passes through the nipple. Likewise, the kidney channel is shown much further lateral to the midline than is typical. Again, these pictorial trajectories have their proponents, despite the written descriptions in the same texts. The textual discussions of point location do not match the illustrations in the same book. The written descriptions place the channel trajectories closer to the midline than the representative diagrams.
The Channel System: Jing Luo Theory
51
Figure 4.1: Ancient channel trajectories of the stomach and kidney
In addition to variations of actual channel trajectories from school to school, there are many variations of acupoint location. Two illustrative examples show the scope of this problem. In China today, LU-7 is located in the small hollow on the radius, one and one half divisions proximal to the wrist crease. In Japan, it is usually located one and one half divisions proximal to the wrist crease on an imaginary line between LU-9 and LU-5, that is, between the radius and radial artery.3 Similarly, LI-2 is usually said to lie on the large intestine channel distal to the metacarpophalangeal joint. Yet others place it at the middle phalangeal joint. Again, good clinical results are claimed for either location.
Figure 4.2: Alternate locations of LU-7 & LI-2 Anyone familiar with more than one traditional view of acupuncture and moxibustion can recount similar examples. Many questions exist regarding which theory or interpretation is correct. These differences and unresolved contradictions fuel the fires of skepticism in the scientific community. Those who believe that acupuncture and East Asian medicine are simply nonsense point to these inconsistencies with glee. Such inconsistencies also have had a negative impact in the
52
The Channel System: Jing-Luo Theory
acupuncture community, where many who study acupuncture and moxibustion do not believe in the existence of the channels. They consider only the acupoints, and often not even the classical acupoints. The problem is large and difficult to resolve. We saw earlier how the requirements of scientific rigor often force the researcher to ignore precisely those ideas to which their attention should be given. These philosophical and methodological problems are exacerbated when acupuncturists posit that the channels are just a conceptual idea, perhaps only a heuristic device. The various interpretations and variations of pathways and locations are used as evidence of this. Thus, in both the West and East Asia, there is controversy as to the existence, nature, and usefulness of the channels and their acupoints. Essentially the problem becomes one of verification and research. How does one demonstrate that one theory or interpretation is valid, or that it is more valid than another? Is it possible to resolve the textual inconsistencies? This is made even more difficult because each school and tradition claims that clinical success validates its particular viewpoint. Clinical success does not guarantee the validity of a theory. It requires that we address the equally difficult problem of defining what we mean by " success." When different traditions claim success in their treatments, what independent standards do we use? The problem is further compounded by the difficulties inherent in actually measuring the channels and acupoints, of mapping them scientifically. If the channels and acupoints are indeed real, then they should have some material basis in the body. My friend the late Dr. Yoshio Nakatani of Japan, the founder of the Ryodoraku school, measured and used the electrical characteristics of the channels and acupoints, especially the source-yuan points.4 Dr. Reinhold Voll of Germany mapped the channels and acupoints electrically and diagnosed by measuring electrical properties at the terminal or jing points.5 Dr. Robert Becker of the United States has measured the electrical characteristics of the channels and acupoints.6 Dr. Li Ding Zhong of China has presented dramatic evidence for the existence of the channels through his study of dermatological diseases? He also presents evidence for the channels derived from the phenomenon of propagated sensations, a phenomenon first described in Japan in the 1950s, occurring in a small percentage of people.S In this last category, with insertion of a needle into a specific acupoint, sensitive persons can describe the trajectories of the channels based on the sensations that they experience. Many practitioners have had patients who have at least some ability to describe these propagating sensations. r--"\"W. . ......-:-r---,
Figure 4.3a: Map of propagating sensations on patient's shoulder and back.
The Channel System: Jing-Luo Theory
53
The preceding figure shows the pathways described by a blind channel-sensitive person after needling GV-14. Drs. Rokuro Fujita, Masao Maruyama, and Yoshio Manaka examined this patient. Notice the various lines over which he would consistently feel the propagating sensations. This was a particularly interesting case. GV-14 is located below C7 (cervical seven) according to one theory, below C6 (cervical six) according to another, and below T1 (thoracic one) according to yet another. The examiners took advantage of this sensitive patient's descriptions to investigate these different locations. It was found that needling any of the three locations produced the same propagations. Each was felt in three directions. However, when a large magnet was placed on the patient's shoulder close to GV-14, the different locations produced different radiations when the point was needled. The C6 location radiated only to the bladder channel; the C7 location only to the gallbladder channel; and the Tllocation only to the small intestine channel, each point producing a different directional effect.
Figure 4.3b: Differing propagating sensations following magnet placement.
When thinking about this phenomenon and these different directional effects, we reasoned that they might be related to the electromagnetic fields of the body, that small changes in the fields would change the pathways of propagation. We think that this is probably a better way to understand the phenomenon. This example makes obvious the difficulty of drawing any concrete conclusions about exact channel pathways or acupoint locations. If we study every researcher's tests and studies, we find that each researcher describes different pathways and different acupoint locations. Often these pathways and point locations are quite different from the classical descriptions. As with the classical and modern acupuncture literature, there is little consensus regarding exact trajectories, pathways, and locations. These findings only seem to add to the controversy. How can we understand these seemingly contradictory ideas and descriptions? We think it is possible to reach some acceptable understanding by considering the following: - The roles or functions of the channel system. - The probable evolution of the channel system concepts. - The probable mechanisms of observation used by the ancients who first described the channel systems. If we are able to imagine ourselves living at the time when the channel system was first being described and systematized, we may be able to gain some insight
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The Channel System: Jing-Luo Theory
into what the channels were thought to be. What were the likely observations that inspired the ancient Chinese to speculate and then develop channel system theory? Perhaps coupling these speculations with simple clinical tests and demonstrations using "polarity agents," that is, working from the demonstrable channel phenomena themselves, we may be able to resolve some of the contradictions and difficulties. For staunch skeptics who question what the channels "really" are, our methodology will be unacceptable. There likely will never be a satisfactory answer for such questions, at least until the advent of an as yet unconceived measuring method. Perhaps such questions of reality are far too problematic, as they are rarely (if ever) resolved. The hidden assumptions, the manner in which the question is asked, and the methods chosen to find the answer, always color or preselect the research findings. Even the most ardent objectivists recognize that purely objective research is theoretically and practically impossible. Thus, questions of reality are rarely the terrain of the scientist.9 Often the ability to ask the correct question is as important as finding an answer.
CHANNEL SOFTWARE VERSUS HARDWARE Many authors have taken an analogy from computer science to distinguish the software of a system from its hardware. For example, Davies has suggested that there are software laws that cannot be logically derived from the underlying hardware: We are therefore led to entertain the possibility that there exist "software laws" in nature, which govern the behavior of organization, information and complexity. These laws are fundamental, in the sense that they cannot logically be derived from the underlying "hardware laws" that are the traditional subject matter of fundamental physics, but they are also compatible with those underlying laws . .. The software laws apply to emergent phenomena, inducing their appearance and controlling their form and behavior.lO
Perhaps the channels operate as software, as emergent properties of the body's hardware. A few years ago, on a trip to Paris, we had the good fortune to visit the Sorbonne museum. There, an historical collection of scientific hardware, scientific equipment and curiosities, was displayed. It was interesting to see so many different hardware devices, practically all of which are now out of date or have failed to survive. The software, the theories behind such a diversity of hardware, are neither so numerous nor so complex, but the physical outcome is sufficiently vast to fill a museum with their skeletons. Perhaps there is some similarity between this and the channels. One could see in this museum that the software has remained practically unchanged, while the hardware rapidly comes and goes. Perhaps it is not critically important to know the hardware of the channels, since treatments can be devised without that information. We can report many clinical cases where the significance of the channel software is clearly the most important information. For example, at the Kitasato Institute, Ms. Itaya treated a patient for amenorrhea. This patient had received numerous hormonal treatments that were ineffective. Physical exams showed her in good health except for the amenorrhea. She had tried various Western medical treatments during the last three years without success and was finally told by the physicians that her case was hopeless. However, we could find a very clear East Asian medical diagnosis for her condition. In this case, the channels were an essential key to successful diagnosis and treatment.
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While the hardware or mechanisms of these imbalances remain unclear, we are able to make diagnoses and perform successful treatments using just the software, the theories that are based on the unknown hardware. Such is often the case in the practical application of systems or methodologies. For example, an expert river fisherman can almost intuitively judge the best weather and river conditions and select the part of the river that will yield the best catch. Despite there being little hardware or physical evidence to support the methodology of expertise in river fishing, such expertise truly exists. Similarly, a professional baseball player is able to hit a ball that is travelling at very high speeds with incredible precision. The rate at which the ball travels is on the order of ten times faster than the speed of the nerve signals that must occur for the player to strike the ball. The hardware for such expertise is thus difficult, if not impossible, to describe. A high level of technology can be developed without any scientific foundation, as long as one has the ability to perform the appropriate input-output analysis of the observable phenomena. Expertise or knowledge of the channel software is a form of understanding the body's "blackbox."ll While we can offer no clear description of the body's hardware, we propose that it is better to examine and define the software first. This not only helps us in our quest to define the hardware, it helps us refine our clinical skills as we discover clinical rules and applications. To this end, the use of polarity agents is extremely useful for mapping operative characteristics and providing a practical body of knowledge based on simple, repeatable tests. For example, tradition teaches that channel flow begins with the lung channel at LU-1 on the pectoral muscle. It then flows down the arm to the thumb and returns from the index finger at Ll-1 as the large intestine channel, travels up the arm, shoulder and neck, to the side of the nostrils. Here it continues as the stomach channel, etc. We can take advantage of the electrical characteristics of the channels to investigate this. Using the polarity agents of zinc (-) and copper (+), we can demonstrate this circuit. If pressure pain appears on this part of the circuit, since the stream of the circuit is unidirectional, placing copper (+) upstream (close to the source/origin/beginning) and zinc(-) downstream (further from the origin), without joining the two metals, should cause any pressure pain located between the two metals to decrease or vanish. We propose this because of the addition of current flow in the direction of flow of the channels. If we reverse the zinc and copper, according to this same logic, the pressure pain should return. This is exactly what happens. This two-point contact works regardless of the distance between the points. The two metals can be placed only on the lung or large intestine channels, or as one metal on each. One metal can be on the shoulder and the other on the hand or both can be only a centimeter apart; all combinations work. The pressure pain on the circuit between the metals is increased or decreased depending only on polarity. However, pressure pain is unaffected when the metals are placed on points that are not on the channels or are on other channels.12 With this simple experiment we can begin to map the channel software.
EARLY OBSERVATIONS OF THE CHANNEL SYSTEMS When we read a classic description of the channels, we are reading the product of many years of research and practice. This is often forgotten. There was an evolution prior to the writing of the early texts, and an evolution of ideas through later and modem texts. Parts of this evolution will always remain unclear, lost in history, while other parts can be traced through reasonable conjecture, and archaeological and textual research.
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The earliest observations of the channel system were somewhat similar to the propagated sensations already described. Perhaps various ancient doctors found particularly sensitive patients, or were themselves exceptionally sensitive. They described sensations that propagated along specific routes when the body was stimulated. Wishing to document and teach their discoveries, these ancient doctors wrote books. Possibly, the readers of these books did not share the authors' sensitivity or experiences. They may have had difficulty understanding what was written because they did not share the direct observation that produced the descriptions. Thus, they understood the descriptions slightly differently, each according to their individual background and clinical experience. We can envision how diverse interpretations of a single phenomenon may have arisen. It is also worth noting that modem studies of propagated sensations reveal individual differences in the trajectories of propagation. It is likely that this was also a factor in ancient times. The phenomenon is clearly documented, but it does not provide the systematic theories we have now. It provides the foundations on which such a systematization could be constructed. This systematization probably occurred as the result of direct observations. It was, for example, commonly observed that treating a point on one part of the body produced changes at another part. The evolution of vertical or longitudinal relationships -later called the channels- probably included this variety of observation as well. Recently a manuscript titled Yin Yang Shi Yi Mai Jiu Jing (Yin yang eleven-vessel moxa treatise), dated prior to 168 BC, was excavated at the Mawangtui archeological site in China. In this text there is no mention of a twelfth channel corresponding to hand jue yin (pericardium); neither is there any reference to a three yin-three yang categorization of the channels, a five-phase categorization, or any specific acupoints. To date, this is the oldest extant written record that makes reference to the jingluo. It is believed by some to be the antecedent of the jingluo system described in the Nei Jing. The channel system used in that era was much simpler, referring more to body parts than to internal organs. Yet we cannot doubt that it was effective as a therapeutic system in its day. At least we can safely assume that its inclusion with other treasures indicates that the book was honored and revered. We cannot say conclusively that this system was the prototype of the channel systems described by later literature; however, we can imagine that at least the earliest channel system concept would include the ideas of inferior-superior, vertical body relationships, that are described by this early text. Another example of what is probably an early conceptual stage in the evolution of the channel system can be found in chapter 21 of the Su Wen. Here, only four categories are given for the channels. The back of the body is labeled as being controlled by tai yang, the front by yang ming, the lateral aspect by shao yang, and the medial aspect of the limbs by tai yin. Ling Shu chapters 10 and 15 describe the channels as a circuit: lung ~ large intestine ~
spleen <:::: stomach ~
heart ~ small intestine ~
kidney <:::: bladder ~
pericardium~
triple burner ~
liver <= gallbladder ~ lung~
etc
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The Ling Shu 17 and Nan ]ing 23 describe all the channels as running from the toes and fingers centripetally, not as a circuit. Similarly, Ling Shu chapter 5 describes the channel "root"' and "knots" all of which flow centripetally. It was not until much later texts, such as the Shi Si Jing Fa Hui (Elucidation of the fourteen channels) (1341 AD) that we see the now standard descriptions of the circuit first outlined in chapter 15 of the Ling Shu. These variations suggest that the channel categories and pathways were developed in stages. Among the various means of classifying the channels that survived to this day, only a few are used in clinical practice. This does not make the other descriptions wrong per se. Difficulty in comprehension and utilization is not proof of error. Some inventive practitioners and researchers are able to understand and utilize less common descriptions with good effects.13 In the theories of traditional acupuncture and moxibustion, there are two methods of treatment. In the first, problems such as headache and toothache are treated using specific local points. One can treat known reflex points without any thought of channel theory. The second method does not utilize these local reflex points. Based on probable empirical observation of inferior-superior relationships, and thus less reliant on the effectiveness of local points, this second method utilizes more distal points instead. For instance, for lumbago one can utilize inferior-superior correlations to select points or areas of the body for needle stimulation. Chapter 41 of the Su Wen describes over twenty different treatments for lumbago. Many point prescriptions are related to specific channel problems; for example, liver channel lumbago, kidney channel lumbago or extraordinary vessel lumbago, such as that of the yin wei mai and yang wei mai. These descriptions provide evidence for the systematization of vertical or longitudinal relationships through the concept of a channel system. The experience of placing a needle and obtaining a directional effect was also an important step in the development of channel theory. From these experiences the ancient Chinese, step by step, devised a system composed of twelve primary channels. We can imagine how the original practitioners of acupuncture and moxibustion used these methods of observation to research and select acupoints beneficial for specific conditions. They compiled an experiential knowledge of several hundred acupoints. The need for a systematic usage of these points in relatively simple treatment procedures that could be taught and recorded led to a systematization of vertical point relationships. From this and other research, they developed the concept of twelve primary channels each having a left and right pathway, and of two central channels. The acupoints were placed on these lines and named the jing xue, channel points. The twelve bilateral primary channels were categorized as six yin and six yang channels: Name
tai yang shao yang yangming tai yin shao yin jue yin
Arm/leg arm leg arm leg arm leg arm leg arm leg leg leg
Channel small intestine bladder triBle burner ga lbladder large intestine stomach lung spleen heart kidney tericardium ver
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The Channel System: Jing-Luo Theory
Further, since it is written in the old books that if the yin increases the yang decreases, someone then theorized that the yin channels were ascending streams of qi that ran from the toes to the torso and from the torso to the fingers. Based on the same idea, someone theorized that the yang channels were descending streams of qi that run from the fingers to the head and from the head to the toes. This style of thinking appears to be only theoretical. However, as we will see, it is possible to demonstrate the flow as well as the circuit. Further, it is possible that this flow may have been observed through the propagated sensation phenomena and the heightened sensitivities of certain people. When these ideas became coupled with the directional effects of stimulation, the concept developed further. The channels and their characteristics were the result of adding theoretical explanations, software, to the effects observed. Reviewing illustrations from texts such as the Shi Si Jing Fa Hui of 1341, the Zhen Jiu Ju Ying of 1529, and the Zhen Jiu Da Cheng of 1601, shows that the channels were not traced with great anatomical accuracy. One can also see slight variations even where it appears that one set of illustrations is based on another set. For example, the illustrations of at least the Ju Ying were based on the illustrations of the earlier Shi Si Jing Fa Hui. We can see interpretational differences, and these continue throughout history. We can demonstrate "channel-related phenomena" that support traditional descriptions, but we cannot prove that channels exist, or clearly state their nature. The traditional descriptions were of the channel software. It is to the uses and effects of this software that our attention should tum, for in this we can discover the secrets of the channels. We have found that channels are related to the signal system and are an important aspect of the regulation and overall operation of the body.
RESEARCHING THE CHANNEL SOFTWARE In modem textbooks, we find exact anatomical descriptions of the channels and their acupoints. They are illustrated with thin, precise lines and described by Western anatomical locations. How were these precise locations determined? Is there any evidence that these are valid? If the justification for a particular pathway or location is clinical experience, then we would do better to examine the different techniques of stimulation employed by each of the researchers - examine the software, rather than the hardware. We also need to examine the various techniques and instruments used to measure and observe the channels. The variations produced by each technique or device are the result of the difference between what they are measuring and the methods used to calibrate the instruments.14 Each electronic device contains a circuit that modifies the raw currents so that a reading may be produced. This too is software, a set of assumptions concerning the nature of what is measured. From these differences we must also extract the normal physiological variations that occur through individual differences and normal biorhythmic fluctuations. Until all these are measured and calibrated so that some concept of "normal variation" can be justified, no measurement or reading can be taken at face value. The channels may be considered as the systematization of the longitudinal relationships between acupuncture points. The channels (including the extraordinary vessels and the channel sinews) were viewed as parallel systems of energy transmission. Although the system of channels describes the longitudinal relationship between acupuncture points, it is not the only conceivable system. As lines or pathways of energy circulation, the channels were said to have unidirectional flow
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59
in continuous circuits. IS The major circuit begins on the lung channel, passing to the large intestine, stomach, spleen, heart, small intestine, bladder, kidney, pericardium, triple burner, gallbladder, liver, and then back to the lung. Within this major circuit are smaller circuits, comprised of the arm and leg, yin and yang pairs of the three yin, three yang categorization.
yin
yang
yin
yant?;
yin
yang
shao yin
tai yang
joe yin
shao yang
tai yin
yang ming
HTE
> SI
LR E
> GB
LU E
> LI
IXI IXI IXI
KIE
~
BL
PC
E
~
TB
SP
E
~
ST
Figure 4.4: Continuous circuits of paired meridians:
Shao yin-tai yang (heart-small intestine-bladder-kidney}, make a continuous circuit. Jue yin-shao yang (pericardium-triple burner-gallbladder-liver}, make a continuous circuit. Tai yin-yang ming (lung-large intestine-stomach-spleen), make a continuous circuit.
These circuits or sets are important components of channel software, as they form the basis of important clinical concepts and various treatment methods. Numerous simple clinical tests use this software to corroborate channel theory and to provide a clearer definition of other characteristics of the signal system. The use of pressure points is the key to this simple and repeatable validity. The simplest channel points are pressure pain locations.l6 These tender reflex points are real, but when we try to research the relationships between the locations of these points and the organ problems they reflect, we encounter great difficulty. As an example, consider the acupoint LI-4, located on the muscle between the thumb and forefinger. This point on one hand - usually the right - is often tender, while on the other hand it is not. If the left arm is extended outward to the side, while looking to the right, the pressure pain will shift from right to left LI-4 (and vice versa). Since the pressure pain can be exchanged by body movements that we cannot suppose instantly change an organ condition, we cannot safely say that this pressure pain is related to some disease. Rather, it is related to tension of the muscles, tendons, and body posture. From this and other examples, we can posit that it is questionable to always directly associate pressure pain with internal diseases. Pressure pain points indicate or signal pre-clinical functional changes that could be associated with either normal changes or pre-clinical pathologies. For example, after drinking water the stomach wall expands, producing tension and pressure pain in the subcostal region. This pressure pain is not pathological; it is a sign of functional change. However, in a patient who lives a stressful life, pressure pain and tension in the same area may be signs of a condition that will much later produce symptoms. When we consider the relationships of the pressure pain points to the channel points, we should consider these possibilities. Pressure pain is extremely useful in diagnosis, and it is particularly useful for clinical research. We can use the presence, relief, and return of pressure pain at an acupoint as a gauge by which to observe the effects of a procedure. In acupuncture, the application of needles or moxa mechanically stimulates the points. However, we can produce the same effects using minute amounts of stimulation from the positive
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The Channel System: Jing-Luo Theory
and negative polarity of polarity agents. By stimulating acupoints without stimulating the nervous system, we can observe the increase or decrease of pressure pain at these points and discover the relationships between points. CLINICAL EXPERIMENTS WITH POLARITY AND THE JINGLUO
The following discussions describe a number of simple clinical tests and experiments designed to study various traditional theories and concepts. Central to these tests are the finding of pressure pain at related acupoints and then either the relief or lessening of the pressure pain or a reversal, a worsening of the pressure pain. In each test we applied particular technique(s) to specific acupoint(s) and observed changes of the pressure pain response in related point(s). Knowing that the pressure pain response could change with changes of the body posture, all tests were done with the subject lying supine, in a relaxed state. Knowing that the pressure pain response could be associated with particular pathologies, relatively healthy subjects were tested. There were a few occasions where the tests and results did not match the findings described below. In our experience, this was usually due to the presence of some hidden or pre-clinical problem. In such cases, the simple tests, applied without a diagnosis and usually only briefly, were not enough to produce an observable response on their own. A more complete procedure, i.e., diagnosis and treatment, did produce the expected changes. Here we wish only to illustrate theoretical principles of diagnosis and treatment. Two common problems that can show no response, or different responses in the tests, are poor point location and repeated testing of the same points or palpation of the same points. In the pages that follow, we describe tests that were conducted over a number of years on a number of different subjects - often students and assistants. Each test was always done by first ascertaining the presence and degree of pressure pain and then reevaluating it after applying each technique being tested. If more than one variable factor was examined at the same time, only one factor was varied with each test. We think that the results of these tests allow us to investigate and make statements about traditional concepts with reasonable certainty. The pressure pain response is usually a sign of hidden or pre-clinical changes in the body. It is thus a direct sign of changes in the signal system itself. Tests that use very small amounts of stimulation, designed to look at changes in pressure pain responses, can give us specific information about the workings of the signal system. CIRCUIT FLOW: DIRECTIONAL POLARITIES OF THE CHANNELS
Earlier we described the polar effects of stroking with or against the bladder channel flow. This is a simple illustration of the directional qualities of a channel. Stroking lightly down the channel (in the direction of flow) with the thumb will relieve a KI-ll reaction; stroking up the channel (against the direction of flow) with the thumb will cause the reaction to return. Stroking down the channel (with the flow) with the little finger instead of the thumb will cause a return of the KI-ll reaction. Stroking up the channel (against the flow) with the little finger will relieve the KI-ll reaction. We have already demonstrated that the thumb is positive and the little finger negative, thus we can see that the directional effects of the channel are polarity-dependent as well. We also described supplementation (tonification) and drainage (dispersion) techniques and mentioned the technique of needling a point with or against the flow of the channel to supplement or drain. The phenomenon produced by
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61
angling the needle in a certain direction is another example of a directional property associated with channels. The following example demonstrates this. We have found that treating a point on one side of the body will generally relieve a reaction at a point on the same side of the body. When treating a point on the midline of the body, reactive points on either or both sides will be relieved. For example, if right LI-4 is reactive, an intradermal needle (hinaishin) inserted to a depth of 1 to 2 millimeters at GV-14 in a downward direction will reduce the LI-4 reaction. Removal of the needle followed by reinsertion in the same point, but in an upward direction, will restore the original LI-4 reaction. Needling CV-6 at a depth of 1 to 2 millimeters in an upward direction will reduce the reaction. Needling CV6 in a downward direction will restore the LI-4 reaction. While this test does not specifically demonstrate the direction of "flow" at GV14 or CV-6, it does demonstrate that the direction of needle insertion is important and also that the effect is not neurophysiological. Since the same point produces an opposite effect, the nervous system, as it is described by science, cannot be the arbiter of that effect. This is again another polarity related to the directional qualities of channels. In modem China the angle of insertion is usually viewed with some disdain. Most needles are inserted perpendicularly and deeply. With deep insertion, the nervous system is stimulated and different effects are produced. When needles are inserted shallowly, as with the hinaishin, and as was the practice in classical times (since they claimed to obtain opposite effects using needle direction polarities), we can clearly demonstrate the polar effects of opposite needle directions.l7 Aside from the notion of needling with and against channel flow to produce supplementation or drainage, a second interpretation of the classics exists. To produce supplementation when needling more than one point on a channel, first needle closer to the origin of channel flow, then needle consecutively further down the channel stream. To achieve drainage, the opposite is true: needle further down the channel stream, then consecutively closer to the origin of channel flow. For example, for right LI-4 reaction, one might first needle LI-11 shallowly, then LI-8, then LI6, LI-2, to drain the channel and reduce the LI-4 pain. If the order of stimulation is reversed, starting at LI-2, the LI-4 reaction would be restored. Thus, it seems that both interpretations of the classical idea are workable, further confirming the notion of needle direction polarity. This too is demonstrating the directional qualities of the channel. We can see how a conceptual definition or characteristic can be tested for validity, even where "reality" cannot be approached. Thus, we can subject more traditional ideas to methodologically specific scrutiny. IS The next few examples utilize the polarity agents of copper (+) and zinc (-), north and south magnetic poles. These agents are extremely useful, because the body responds in specific ways according to where the metals or magnets are placed. We frequently utilize them for mapping and defining specific characteristics inherent to the channel system. We have already described a simple use of zinc and copper on the lung and large intestine channels to relieve, or cause the return of, pressure pain on the channel pathway between the metals. We described our findings that copper (+) upstream (closer to the channel's beginning) and zinc (-) downstream, will cause pressure pain to reduce. Zinc upstream and copper downstream will cause it to return. This is true in almost all cases on the primary channels. It is not so clear (and may actually reverse) with the extraordinary vessels. For certain specific acupoints the concept does not apply. All these findings describe a characteristic of the channel software.
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The same phenomenon can be seen with the use of magnets. If we place a north-facing magnet(+) upstream and a south facing magnet(-) downstream, the pressure pain of points between the magnets will decrease or disappear. If we reverse the polarity, the pressure pain will increase or reappear. Thus, taking as a specific example pressure pain on right LI-4, we choose a random distal point on the large intestine channel and place a north magnet at this point. At a proximal point we place the south magnet and the LI-4 reaction will decrease or disappear. Reversing the position of the magnets will cause the LI-4 reaction to return. The distance between the points is irrelevant to the strength of the effect.
N+
pressure pain decreases
s -
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
channel stream
s -
pressure pain increases
N+
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
channel stream Figure 4.5: Polarity experiments on LI-4 with cu and zn
If we use random points on the lung channel, placing zinc (-) distally and copper (+) proximally, it will reduce reaction at the same LI-4 point (provided the points are on the same side of the body). Using copper distally and zinc proximally on the lung channel will cause the LI-4 reaction to return. The polarity reverses because the lung channel flows distally (away from the center of the body) and the large intestine channel flows proximally (toward the center of the body). The continuity of this channel stream can be seen in the next example.
We can also use the tai yin-yang ming circuit (the four-channel set, lung-large intestine-stomach-spleen) to demonstrate this continuity and establish the directional qualities of each channel. If we place copper (+) randomly upstream on one channel in this circuit and zinc(-) randomly on a point on the next channel in the circuit, we obtain the expected effect. Thus, for example, copper on a point on the large intestine channel, and zinc on a point on the stomach channel, will decrease the LI-4 pressure pain regardless of the distance between the two points. Reversing the polarity, zinc on the large intestine and copper on the stomach channel, will cause the reaction to return. On the arms, legs, arms and legs, or only one centimeter apart, all combinations reduce or increase the pressure pain, depending only on the polarity of application. Direction of flow is demonstrable and the demonstration is repeatable. Examining further qualities of the four-channel sets, we can use polarity agents to reduce distal pressure pain points and points that may not be located on the channel at all. For instance, using the large intestine channel (a proximally flowing channel), we can place copper (+) distally or upstream on the right channel and zinc(-) proximally or downstream on the same side. This placement of polarities will reduce pressure pain on ST-27, a large intestine diagnostic point. Reversing the position of the two metals will cause the pressure pain to return. Using the kidney channel (a proximally flowing channel), we can place copper (+) distally on the left channel and zinc (-) proximally on the same side. This placement of polarities will reduce pressure pain on left KI-16, a diagnostic point of the kidney channel. Reversing the position of the polarity agents, placing the zinc (-) distally and the copper (+) proximally, will cause a return of the reaction.
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These two examples offer even greater significance than previous examples because the results of testing on the arm or leg are observable on the abdominal reflex points. Polarity and directional properties are clearly demonstrated, and the likelihood of their non-neurological nature is corroborated. Positioning the north pole (+) distal to the south pole (-) on a proximally flowing channel will vanquish the pressure pain reaction found on a diagnostic point of that channel. Reversing the polarity placement will cause the reaction to return. We see a regularly occurring pattern here, related to polarity properties and correlating with the directional properties (direction of flow) that are described in classical texts. In particular, these last two examples have further clinical significance because the main diagnostic area used is the abdomen. We can evaluate the efficacy of our treatments by assessing the reduction of pressure pain or tightness at points on the abdomen that were found to be reactive before treatment. With the correct selection of polarity agents, applied in the correct order, on carefully selected points, the abdominal reactions can be reduced easily. As we will see, this accomplishes the first stage of treatment. There are other directional qualities associated with the channel and their acupoints, as can be seen in the following two examples. Both use the effects of magnetic polarity. The first demonstrates some left-right, surface properties associated with the acupoints. These too are polarity dependent. The second demonstrates properties of the acupoints that are tied to rotational vectors and that are created with rotating magnets; these effects and properties are also polarity dependent. We can select a point "A'' on any of the channels of the four limbs. If we place a north magnet close to, but not touching a south magnet, and place both magnets on a horizontal plane to the left and right of point "A," the effects observed will reverse when the two magnets are switched. One alignment will decrease pressure pain at a point related to "A," while the other alignment will increase pressure pain at the same point. For example, if we apply the magnets to the left and right of TB-4, the source-yuan point of the triple burner channel, and palpate for a reaction at ST-25 on the same side of the body, a triple burner diagnostic point, we can observe this reversal. One application will reduce the ST-25 reaction, while the reverse alignment will increase the reaction. Similarly, we can place magnets either side of LI-4 and check the reaction at ST-27, the large intestine diagnostic point. Magnets placed either side of SI-4 will influence the reaction found at ST-26, a small intestine diagnostic point. In further research, we have found that rotating a plastic disc with a two centimeter diameter over an acupoint (without touching the surface of the skin) will stimulate the point. Clockwise and counterclockwise rotations have reverse effects, one positive and the other negative. For example, rotating the disc clockwise, then counterclockwise, over the draining point (LI-2) and the supplementation point (LI-11) of the channel has the following effects on pressure pain at Ll-4 on the same arm: point LI-2 LI-11
clockwise LI-4 increases Ll-4 decreases
counterclockwise LI-4 decreases LI-4 increases
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If we place four magnets at the corners of a centimeter square on the plastic disk, the procedure can be repeated to check rotational magnetic polarity effects. With all four magnets placed so that the north poles (+) face the acupoint, we obtain the following results:
point LI-2 LI-11
clockwise LI-4 increases LI-4 decreases
counterclockwise LI-4 decreases LI-4 increases
In this case, we can say that north-facing magnets are positive when rotated clockwise and when rotated counterclockwise they are negative. Using south-facing magnets, the rotational polarities reverse: point LI-2 LI-11
clockwise LI-4 decreases LI-4 increases
counterclockwise LI-4 increases LI-4 decreases
This phenomenon shows clearly the use of the supplementation (LI-11) and drainage (LI-2) points, relative to the five-phase supplementation (tonification) and drainage (dispersion) techniques. Polarity agent stimulation and tests of fivephase points are described in greater detail in chapter six. This technique also works on almost all the acupoints on the body. However, there are specific acupoints where this polarity produces the same effect with either rotation. These are the intersection-jiaohui points (in Japanese, koe ketsu). SP-6, san yin jiao, is the three leg yin intersection-jiaohui point. TB-8, san yang luo, is the three arm yang intersection-jiaohui point. GB-35, yang jiao, is the three leg yang intersection-jiaohui point. GB-31, feng shi, is also a three leg yang intersection-jiaohui point. A point on the pericardium channel, roughly halfway between PC-3 and PC-7, around PC-4, is the Manaka three arm yin intersection-jiaohui point. A point roughly two divisions above SP-10 is the Manaka leg three yin intersection-jiaohui point. It is important to note that these points are all on the gallbladder, triple burner, spleen, or pericardium channels. This is significant because octahedral interpretations of yin-yang predict this discovery, since the gallbladder, triple burner, spleen and pericardium channels define the lateral dividing lines of the octahedron; see the discussion below. Rotating either north or south magnets, clockwise or counterclockwise, over these points will reduce pressure pain reactions at relevant diagnostic points (e.g., GB-26 the spleen diagnostic point, KI-16, the kidney diagnostic point, LR-14, the liver diagnostic point, when SP-6 is tested without regard to polarity). In other acupoints, polarity effects are the rule. Thus, we can say that these intersection-jiaohui points are special points that are outside the realm of normal acupoint characteristics. We feel that this anomaly is explained by octahedral theory. These points occur on the octahedral dividing lines of the body (such as the ren mai and du mai). We call this phenomenon the "san yin jiao characteristic." These intersection-jiaohui points have unique characteristics, being receptive to either positive or negative stimulation. Further, according to other tests we have performed, they are able to receive information and transmit it to the opposite side of the body. Normal acupoints tend to transmit only to the same side of the body. Thus, these points are extremely useful.
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GB-31
GB-35
Figure 4.6: The intersection-jiaohui points.
With the preceding experiments and countless other clinical examples, we have been able to deduce that there is a specific circuit flow in the channels similar to what is described by the classical texts. On the yin channels the flow ascends from toes to torso, torso to fingers. On the yang channels the flow descends from fingers to face, and face to toes. While the classical texts do describe the flow of qi, blood, ying, and wei through the channels, we cannot provide a clear verification of this idea. However, our demonstrations do show that something is flowing, that it flows in a particular direction, and in a particular circuit. Part of its nature is related to the signal system. It readily manifests using the tiny stimulation effects of the polarity agents. Our research and demonstration of the systemic microcirculatory changes that result from acupuncture (see appendix 2) allow us to say that we have some idea of what the ancient Chinese observed when they postulated a flow of qi, blood, ying, and wei. In this context, some original, interesting, and thought-provoking research conducted by Professor Furukawa, an electrical engineer at Kagoshima University, may prove to be enlightening. His research gives us hints as to the nature and function of channels and acupoints. Acupoints are said to receive stimulation from needles and moxibustion and through this stimulation to help regulate the flow of qi, blood, ying, and wei. But, as we have demonstrated, the acupoints can also receive very small stimulation or influences from the use of, for instance, polarity agents. Perhaps the acupoints, as active sites on the channel trajectories, also have biological functions like those of the channels. These function would also be part of the signal system and play important operational and self-regulatory roles. Professor Furukawa examined what happens when a subject holds his breath for fifteen seconds. He measured the magnetic and electrical fields and the pH value of points on the hands and feet, some of which were acupoints, and recorded the changes in these variables before, during, and after the period in which the breath was held. These variations are due to changes of the oxygenation level in body tissues. Based on the results of his measurements, Dr. Furukawa conjectured that the acupoints may be sensors that are sensitive to blood circulation, responding
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to minute changes in the environment local to the point, and communicating information that regulates circulation. Since we have seen that acupoints can detect and discriminate very small signals, smaller than we can imagine, his ideas are not difficult to accept. If Professor Furukawa's conjectures are correct, we can speculate that this observation may be only a modem interpretation of what the authors of the Chinese medical classics called qi, blood, ying, and wei. This additional signal function allows us to speculate more generally that the function of the acupoints, and by extension the channels, is one of transduction. Clearly, this idea is worth further investigation. CIRCUIT FLOW: CIRCADIAN RHYTHMS
The clinical software of the channels is most clearly described by the various categorization and relationship labels applied to the channels. One particularly useful discussion from the classics describes the circuit of the twelve primary channels through the period of a single day, that is, a circadian rhythm. For each two hour period of the day, one of the twelve primary channels is said to reach a peak of energy level and activity. This biorhythm follows the overall circulation of the channels with the heart channel peaking at noon and the gallbladder channel peaking at midnight. This circuit is as follows:
12
Figure 4.7: The channel clock
The origins of this circuit concept are lost in the depths of Chinese calendrical and medical science. Tracing the historical course of the concept is a task we will leave to others, as we concentrate our attention on the theoretical implications and clinical applications of the circuit. We have been able to apply the relationships inherent in this circuit to validate further our signal system concept and to extrapolate treatment techniques of great clinical value.
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The relationships described by this circuit are available at any time of day. At 6 pm (kidney channel peak). if we diagnose a fire imbalance, we can treat the fire point of the kidney channel, KI-2. If we diagnose a problem of the large intestine channel by finding pressure pain on ST-27 (reflex point for the large intestine), we can treat the metal point of the kidney channel, KI -7. (The metal point is selected because the large intestine is a metal phase channel). At 2 pm, if we find pressure pain on KI-16. reflecting the kidney channel, we can treat the water point of the small intestine channel, SI-2. In clinical practice, this provides excellent utility. At the Kitasato Institute, we once had a 64 year-old man come to us for therapy. He suffered a violent fever at nearly the same time every night. This fever was of unknown Western etiology and physicians had been unable to find an effective therapy for his problem. Using an electrical measuring device. the "Neurometer," we measured in microamps the electrical current at the skin at the left and right source-yuan points of the twelve channels.19 The following chart shows the first set of readings we obtained: Channel hand tai yin lung foot tai yin spleen handjue yin pericardium foot jue yin liver hand shao yin heart foot shao yin kidney hand yang ming large intestine foot yang ming stomach hand shao yang triple burner foot shao yang gallbladder hand tai yang small intestine foot tai yang bladder
Left 35 31 25 39 35 29 46 25 54 20 36 36
Right 41 24 23 28 28 28 39 21 50 24 36 22
We compared these readings with the values for the source-yuan points as obtained by averaging the scores from measurements of the same values in fifty healthy athletes. These average values are shown in the following table. Channel hand tai yin lung foot tai yin spleen hand jue yin pericardium foot jue yin liver hand shao yin heart foot shao yin kidney hand yang ming large intestine foot yang ming stomach hand yang ming triple burner foot yang ming gallbladder hand tai yang small intestine foot tai yang bladder
Left 36.9 43.4 31.8 39.2 32.9 38.0 42.1 31.0 38.6 31.0 39.8 33.8
Right 36.8 42.9 31.4 38.2 34.2 35.8 40.0 30.6 38.2 31.0 39.2 34.1
Comparing thes.e readings to the patient's readings, we found his results showed an abnormal tendency. Instead of the source-yuan points of the foot yin channels showing the normal higher readings, which appears to be a healthy "imbalance," the hand yin lung and hand yin heart channels showed higher readings than the foot yin spleen and foot yin kidney channels. When compared to the leg yang channels, the arm yang channels showed the typically higher values.
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Since we saw the patient's problem as essentially biorhythmic, we took further measurements at 4 pm and again at 10 pm on the same day. 10 pm was the time of maximal fever. The differences can be clearly seen in the two sets of readings below, where at 10 pm, the triple burner channel clearly had high readings. Side hand tai yin LU foot tai yin SP hand jue yin PC foot jue yin LR hand shao yin HT foot shao yin KI hand yang ming LI foot yang ming ST hand shao yang TB foot shao yang GB hand tai yang SI foot tai yang BL
4pm readings left right 35 26 45 47 25 39 14 20 25 34 31 44 40 35 12 10 43 40 22 33 14 25 45 61
lOpm readings left right 34 34 41 38 21 34 21 20 20 20 34 40 42 38 14 17 81 85 34 30 21 12 41 24
There was a clear imbalance of the triple burner channel. We theorized that he had a biorhythm problem which only manifested at the normal peak of triple burner activity, thus causing an abnormal tendency. We treated him at this time using the ion-pumping technique on the confluence-jiaohui points of the yang wei mai and dai mai, TB-5 and GB-41. These points were selected because treatment occurred at the time corresponding to a triple burner peak and because the triple burner showed abnormal activity at this time. (Confluence-jiaohui points_ are discussed further in the next chapter.) Treatment was simple and effective. After one treatment the patient's fever reduced. Usually this fever was most violent late at night when it produced sweating, but after treatment it was dramatically reduced. We treated him three more times, after which the fever completely stopped and he appeared to be in good health. We followed this case for five years, and noted no recurrence of the fever. During this period we checked the values for the source-yuan points, as with the original baseline test, and found that the antagonistic tendency had returned to normal. Channel hand tai yin lung foot tai yin spleen hand jue yin pericardium foot jue yin liver hand shao yin heart foot shao yin kidney hand yang ming large intestine foot yang ming stomach hand shao yang triple burner foot shao yang gallbladder hand tai yang small intestine foot tai yang bladder
Left side 45 50 21 45 30 40 42 14 38 21 22 39
Right side 35 43 24 26 25 31 32 12 45 24 18 22
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Now only the tai yang channels showed an opposite tendency. The relative balance of the other channels was good. It appears that our body always strives to maintain balance. If a negative inclination occurs in one place, a positive inclination will occur to maintain balance. This new state is a balanced state, but a balance that includes an abnormal inclination. Besides this type of clinical example, there is much more evidence for the existence of a channel biorhythm. Using several subjects, we tried to determine which channels peaked at what times, taking measurements hi-hourly through a twentyfour hour period. These efforts yielded results like those following which show an average set of readings for the individuals tested: %
20%
r
20%
+1
PC
-1
I
LU
TB
j_
j_
j_
j_
j_
j_
j_
12
12
16
20
0
4
8
HT
j_
12
Figure 4.8: Average of bihourly readings of upper channels in a 24-hour period %
% Kidney
+1
+1
-1
-1
Figure 4.9: Average of bihourly readings of lower channels in a 24-hour period
Looking at these findings, we can see that nine of the twelve channels peaked at the time predicted by the traditional literature. Three channels did not correlate. Perhaps our modem lifestyles play a role that cannot be ignored. We no longer rise with the sun and retire with the sunset as did the people of ancient times, and as is still the custom in parts of China, and in primitive cultures. It is possible that measurements of large populations that were socio-economically and geographically disparate would produce some evidence of predictable biorhythmic patterns. 0CTAHEDRALITY
Besides these temporal relationships in the channel circuit, and the pattern of ying qi circulation moving fifty times a day through this circuit, there are other important relationships. Of particular note are the opposite polarity relationships of the circuit, traditionally the zi wu. For example, the heart channel is in opposition to the gallbladder channel, the small intestine to the liver, etc. These opposite polarities, while described in the traditional literature as temporal or biorhythmic, also
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manifest structurally independent of the time of day. They are based on the yinyang relationships we find in the octahedral model. The six pairs are sometimes called the yin-yang, six phase pairs. Each pair is composed of either a leg yin-arm yang pair or a leg yang-arm yin pair. They manifest the octahedral yin-yang, superior-inferior, anterior-posterior relationships, and, depending on how we use them, also manifest a left-right polarity. leg shao yang gallbladder leg yang ming stomach leg tai yang bladder leg jue yin liver leg tai yin spleen leg shao yin kidney
==> ==> ==> ==> ==> ==>
arm shao yin heart arm jue yin pericardium arm tai yin lung arm tai yang small intestine arm shao yang triple burner arm yang ming large intestine
Aside from the clinical results we obtain using these opposite polarity relationships, there is other evidence for the existence of these relationships. Once, I had a fifteen-year old patient who suffered a hematuria that was difficult to diagnose and was finally discovered to be due to the presence of a cancerous growth on the right kidney. We examined the urine of this patient every two hours during each twenty four hour period until we discovered the cycle governing the presence of blood in the urine. It peaked around 6:00 am, when there was also a tendency towards decreased urine output.
......
Figure 4.10: Variation of patient's urine samples in a 24-hour period What is interesting to note is that the hematuria peaked at 6:00am, opposite to the kidney channel peak at 6:00 pm. In a statistical study of the occurrence of heart disease and the rhythms associated with the incidence of problems, we discovered that most heart attacks, and aggravation of heart problems, occur close to either noon or midnight. Generally these are seen as two distinct groups. The heart channel peaks at noon, but perhaps each channel has two peaks, one positive and the other negative. The cycle described by the classic texts describes the peak, the maximal level of activity, but as can be seen in the preceding case, there is also a nadir, a minimal level of activity. If this is so, the opposite polarity relationships between pairs of channels could also be a biological phenomenon. While not clearly understood, we are able to take advantage of it in the clinic where it is very useful.
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At the physical organ level, we can suggest possible functional correlations with these pairings. For example, the hepatic portal system links the small intestine and liver. Both the kidney and large intestine play an integral role in the regulation of water excretion and reabsorption. In certain cases, heart problems have been cured by removal ofthe gallbladder, the cholecystic heart.20 If, as some have suggested, the triple burner relates to the lymphatic system, then the spleen and triple burner, at opposite points of the circadian channel clock, should have some strong functional relationships. CHANNEL FREQUENCIES
Since the channels demonstrated certain characteristics, such as being electrically measurable, we further investigated the relationship between the channels and different frequencies. Using an oscilloscope with headphones, we found that playing sounds to a subject in the low frequency range (50 Hz) reduced pressure pain and tension located along the abdominal midline. Sounds in the higher frequency range (1000Hz) reduced pressure pain and tension at the lateral edges of the abdomen, even in subjects who evidenced very stubborn reactions. Curiously, in schizophrenics, the reverse was true. Low frequency reduced lateral reactions and high frequency reduced midline reactions. While this is an interesting phenomenon that is hard to explain, it does suggest that channels lying more medially on the body - the kidney or stomach for example - respond to lower frequency stimulation that those lying more laterally on the body - the spleen or gallbladder for example. To explore this idea further, we subjected different acupoints on the limbs (channel points, five-phase points, intersection:Jiaohui points) to low and high frequency pulsed electromagnetic fields. Again the same frequency correspondences were found. Low frequency affected the midline of the body; higher frequency affected the lateral edges of the body. However, there were certain exceptions. The intersection:Jiaohui points (again) showed opposite effects. For instance, subjecting the Manaka three yin intersection-jiaohui point (above SP-10) to low frequency fields released tension from the lateral edges. High frequency fields released tension from the midline. The effect reversed from that of non-intersection:Jiaohui acupoints. This seemed to be another curious phenomenon, demonstrating once more that the intersection-jiaohui points appear to have unique properties which set them apart from other acupoints. In other clinical tests, low frequency stimulation applied to CV-1 released pressure pain and tension on the head of a subject (between GV-24 and GV-20). Low frequency stimulation applied to left SP-6, the three leg yin intersection:}iaohui point, released tension from the gallbladder channel on the right side on the neck, focusing around GB-20. With suitable application this simple technique might be a useful form of therapy. In order to investigate frequency relationships for each of the channels, we adopted another approach. Using a SEIKO quartz metronome, which emits regular clicks at a rate of 40 to 208 clicks per minute, we recorded the frequency that appeared to affect each of the twelve main channels and the ren mai and du mai by reducing pressure pain and tightness at related reflex points and areas. Initially we used the presence of pressure pain on these reflex points as our measure of a specific channel problem. Then, we set the metronome at different rates, letting the subject listen to the clicks while we repalpated the reactive acupoints. We then determined the frequency that reduced the reaction. The metronome frequencies that reduced the reactive acupoints thus studied were then projected to be indicative of that corresponding channel.
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For instance, we found that pressure pain on KI-16, a reflex point for the kidney channel, was reduced by listening to the metronome when it was set at a rate of 120 clicks per minute. Pressure pain at ST-25, a reflex point for triple burner problems, was relieved by a rhythm of 152 clicks per minute. Pressure pain found at BL18, corresponding to the liver channel, was reduced at a rate of 108 clicks per minute. The corresponding reflex points on the abdomen and chest and along the ren mai and du mai were primarily used in this study. (See chapter 8 for further description of reflex points.) Using this method of investigation on many subjects, we came up with the following frequency-channel correspondences: Yang
gallbladder small intestine stomach large intestine bladder triple burner
du mai
Rate
Yin
Rate
120 120 132 108 112 152 104
liver heart spleen lung kidney pericardium
108 126 132 126 120 176 104
ren mai
Once these correspondences were established, we tested them clinically. These tests involved having the patient listen to the metronome, or tapping specific acupoints at the frequency we found effective for that channel. For this we used the Manaka wooden hammer and needle. (See chapters ten and eleven for detailed descriptions of this therapy.) For example, for a reaction at KI-16, the reflex point for the kidney, tapping Kl-3 randomly produced little change. Tapping at a rate of 108 beats per minute also produced little change. However, tapping at a rate of 120 beats per minute produced a decrease of the reactivity found at KI-16. For ST-25 reactions, tapping TB-4 at a rate of 152 beats per minute caused a reduction of reactions. Kl-3 and TB-4 were selected in these examples because they are the sourceyuan points and tend to affect the channel on which they lie more than other channels. We used this method on a patient with pain in the left leg, difficulty walking, and pressure pain and tension along the stomach, gallbladder, and bladder channels of the left leg below the knee. Tapping GV-14, the intersection-jiaohui point for all the yang channels, alternately at a rate of 132 beats (stomach), then 120 beats (gallbladder), then 112 beats (bladder) per minute, for twenty taps per rate, consecutively reduced the pressure pain and tension along the stomach, gallbladder, and bladder channels. The patient's pain was much reduced and the patient experienced greater ease when walking. These and numerous other clinical examples provide confirmation of these channel-frequency correspondences. Another interesting and useful application of these frequencies involves thread-size moxa applied to certain acupoints. We found that when moxa is burned on an acupoint on a specific channel, setting the metronome at the corresponding frequency for that channel, and having the subject listen to the metronome, can have the effect of tranquilizing the channel. For instance, when we burned moxa on GV-20, one subject displayed strong sensitivity to the heat of the direct moxa. When listening to the metronome at 104 beats per minute (the frequency corresponding to the du mai), the same subject reported heat but no discomfort. When using the metronome at 120 beats per minute, the same subject again reported discomfort. Similarly, when moxa was burned at GB-17 or GB-20, setting the metronome at 120 made the moxa procedure
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more comfortable, but at a setting of 112, the moxa procedure became uncomfortable again. This exemplifies the specificity of channel reaction to metronome frequency. While these channel-frequency relationships clearly require further research, we can suggest that these simple frequency relationships are specific signals that are sensed and transmitted by the signal system. The difference in signal between 108 and 112 clicks of the metronome, or beats of the wooden hammer and needle, is very small. Yet, specific systems in the body appear to be finely tuned to a difference of that magnitude. A frequency of 108 will reduce reactions along the large intestine channel and at points associated with it, but not the bladder channel nor its assoqated points. A frequency of 112 will reduce reactions in the bladder channel and the" associated points, but not the large intestine channel. This fine-tuning ability of the channels and acupoints is, we think, characteristic of the signal system. The signal input is very small and the differences between the signals smaller still, yet the channels and their acupoints can sense these differences and respond with remarkable, obvious, and distinct reactions. The channel frequency relationships are useful for clinical application as well as for conducting research. They aptly characterize the biological signal system associated with acupuncture and moxibustion. When we treat and stimulate the channel points, it is not only stimulation that occurs, the channel points also receive minute signals and discriminate between these signals. Other practitioners and researchers have described frequency characteristics for the channels, certain acupoints, and even body areas. My friend, the late Mr. Naomoto from Kyoto, found the following frequency relationships. These too can be used clinically with good effect: Naomoto's Channel Frequencies Channels Frequency per second kidney-bladder 2 lung-large intestine 5 pericardium-triple burner 10 heart-small intestine 20 liver-gallbladder 50 spleen-stomach 100 We leave it to later works or creative readers to describe these frequency relationships further. Dr. Paul Nogier, the originator of auriculotherapy, describes frequency relationships that correlate to an area of the ear, a set of tissues, organs or functional relationships, and a class of acupoint.21 Our frequency relationships are simple and easily demonstrated; Nogier's frequency relationships are more complex. We can say that all these relationships relate to the signal system. Further, we think that the original acupuncture treatment techniques described in the classical medical literature were also intricately related to this delicate signal system. THE CHANNEL SINEWS
Dr. Rokuro Fujita of Kanazawa, Japan, proposed that the vertical relationships in the body, the channels, are related to the vertical longitudinal muscles of the body, those muscles that traverse from the top of the head downward to the
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The Channel System: Jing-Luo Theory
toes in a cooperative interlocking system like the channels. He theorized that the channels constituted a projection of the muscle system. This is an interesting idea, but it does not take account of the many slanting and cross relationships in the muscle system. For example, if the weight is placed on the toes of the left foot, or on the left lumbar region, the upper right side of the body compensates to maintain balance. The body is able to compensate in this manner because there are interlocking muscle groups running from the left leg upward to the right side of the neck. Further, the channels are usually described as thin lines, even with their variations in trajectories. The interlocking tendino-muscular systems are sometimes broad, sometimes narrow bands. The relationship of the channels to the longitudinal muscles is not as clear as Dr. Fujita proposes. Yet, there does seem to be some relationship as is demonstrated by the example of pressure pain at Ll-4. If right LI4 evidences pressure pain, extending the left hand outward (to the left side), while looking to the right side (by turning the head), will cause the pressure pain to leave right LI-4 and appear in left LI-4. If the right hand is then extended outward while looking to the left side, the tenderness leaves left LI-4 and returns to right LI-4. Repeating this for several iterations will eventually eliminate the pressure from both right and left Ll-4. Thus, we might say that pressure pain in an acupoint is at least partly related to muscle and tendon tension and body posture. The channels and acupoints themselves have some general relationship to the muscle systems and posture of the body. THE MU POINTS
This relationship is again evidenced when we examine the classic mu points. These specific diagnostic points on the anterior of the body correspond to each of the twelve channels or organs. The mu points are seen in the following diagram:
LU-1
LR-14 GB-24
CV-14 CV-12
LR-13 GB-25 ST-25
CV-5 CV-4 CV-3 Figure 4.11: Mu points
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Some of these correspondences are paradoxical. Why is the kidney reflex point, GB-25, the only point on the posterior of the body? Why are the pericardium, heart, stomach, triple burner, small intestine, and bladder reflex points on the midline, and not bilateral? Center-line tenderness does not help us understand whether we should treat the corresponding channel on the left or right side of the body. This determination is often a key to the success of treatment. Because of these questions, we examined these mu points to determine which were accurate correspondences and which were not. We also tried to find if there were more accurate reflex points. Using north and south magnets placed at either side of channel source-yuan points (as described earlier), we checked which abdominal points became less or more reactive. We also used a simple channel stretching technique to help confirm the reflex point correspondences. We found that in a supine, relaxed position other acupoints were better reflex points for the channels than the traditional mu points. This we confirmed by treating the source-yuan points of the corresponding channel and finding that the tenderness of the point on the abdomen decreased or vanished. Thus, we determined a series of new mu points (see chapter eight). We also found that if tenderness were present in one of these reflex points, ST25 for instance, reflective of the triple burner, but not CV-5, the classic mu point of the triple burner, stretching the triple burner channel on the same side as the tender ST-25, would cause the tenderness to disappear from ST-25 and to reappear at CV5. Similarly, tenderness at ST-27, the new large intestine reflex point, would disappear and reappear at ST-25, the classic mu point of the large intestine. when the large intestine channel was stretched. Using these and other tests, we confirmed that in the relaxed, supine position a new series of mu points are reflective.22 This, like the LI-4 example, tends to indicate some interesting relationships between the channels, acupoints, and muscle systems. We think that the mu points may have arisen from observations made in conjunction with the practice of some exercise system such as daoyin, qigong, or taiji. Whatever the origin, it seems clear that body posture is important for understanding the functional state of each channel as well as the nature of the channels. THE CHANNEL SINEWS AND FUNCTIONAL MUSCLE GROUPS
Dr. Fujita's idea may have more relevance in an examination of the channel sinews. The classical texts describe this idea and some of its uses. As with many classical descriptions, the details are not clear. The system of the vertical channel sinews was described in Ling Shu chapter 13. Their trajectories tend to intersect acupoints on the channel pathways and can be seen to have the following characteristics: - The channel sinew trajectories tend to follow the normal channel trajectories. This can be clearly seen in the first two trajectories. the leg tai yang and leg shao yang channel sinews. These look very much like the trajectories of the bladder and gallbladder channels. - They always run from distal points on the limbs toward the center of the body. - There are, like the primary channels, twelve bilateral trajectories, six on each arm and six on each leg. - Unlike the primary channels, they are independent of each other. They do not form a circuit and there are no descriptions of interchannel relationships. Perhaps, like the arm and leg tai yang channels, the arm and leg tai yang channel
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sinews have some relationship, but this is not described; it is only surmised because of the similarity of their names.
Figure 4.12: Leg tai yang channel sinew
Figure 4.13: Leg shao yang channel sinew
-Unlike the channels, there are no relationships to the internal organs. Because of this they are called just the leg tai yang channel sinew or arm tai yin channel sinew. (The leg tai yang channel is also the bladder channel and the arm tai yin channel is also the lung channel.) -Treatment procedures for the channel sinews were described. The method uses fa zhen, the "burnt" or "hot" needle technique (described in chapters ten and eleven). Rotating the head to the left while standing straight with the weight evenly distributed, will cause a thin band of tension to occur on the right side of the body at the back of the neck. This band will pass from there, down the back, around the right side of the body from below the axilla, to the upper right quadrant of the abdomen, cross the abdomen down to the lower left quadrant, down the sartorius muscle, and finally down to the left foot. This functional muscle group can be seen in the illustrations on the following page. This band of tension is the result of a specific movement and occurs as a compensatory mechanism that allows the body to maintain its posture. Since the fibers of each muscle in this group are controlled by different nerves of the central nervous system, we can speculate that there is a central nervous system pattern that relates these nerves to each other through the corresponding movement. There are many similar functional muscle groups, but little evidence to suggest that they are of neurological origin. This particular group is important because tension and pressure pain tend to occur along it when there are functional liver problems. Reactions will be found at left LR-3, the Manaka leg three yin intersection-jiaohui point, and the lower left and upper right abdominal quadrants.
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Figure 4.13: Functional Muscle Groups
A slanting and crossing muscle group of great clinical significance is formed by the crossing of the internal oblique to the external oblique, then to the anterior serratus, rhomboideus major, and rhomboideus minor muscles. (See also chapter two.) Since the classical texts do not describe these groups, or at least do not clearly describe them, more research is required before we can adapt the classical descriptions to incorporate these relationships. Because the channel sinews have trajectories that often follow the channels and intersect with channel acupoints, it is difficult to discriminate clearly those properties that belong solely to the channels and those that belong solely to the channel sinews. These overlapping properties may be the source of the muscle-posture-channel relationships we demonstrate with the LI-4 and mu point examples. It is clear that the position and posture of the body is important for understanding the channels and channel sinews. This is further evidenced in the classical texts. Often, when an acupoint was described with indications of how to treat it, and for what it should be used, there were also descriptions of what position the patient should be instructed to assume during treatment. Our research has verified that this makes a significant clinical difference in many cases. A good example of this can be found when treating LR-3 or LR-2 with moxa. The therapy is more effective when the patient is upright with their feet flat on the floor. Another quite different method of interpreting muscle-channel sinew relationships can be found in the work of Tada Kono. He has found that specific deep and superficial muscles correspond to particular channels. If a problem occurs in a channel, its corresponding muscles may develop functional changes of tonus. The opposite is also true. He has also found specific abdominal reflex points that have a worsening or improving effect on the tonus of the associated muscles when north or south magnets are applied. (Similar associations of muscles and channels from
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The Channel System: ling Luo Theory
kinesiological sources are discussed in appendix 1). The findings of Kono and others considerably expand and complicate any theory of channel sinew relationships. Kono's findings and correlations are summarized in the following tables.23 Acupoints CV-12 CV-10 ST-23 CV-9 ST-25 left medial ST-26 right medial ST-26 CV-8 CV-7 CV-6 CV-5 CV-4 CV-3 CV-2
Channels stomach heart gallbladder large intestine large intestine liver lung spleen pericardium kidney triple burner small intestine bladder gallbladder
Channel Lung
Muscles Serratus Anterior: Pectoralis Minor: Coracobrachialis Triceps Brachi: Latissimus Dorsi; Spleen Vastus Medialis: clavicular region of Pectoralis Major Heart Subscapularis Kidney Iliopsoas: Piriformis: Iliacus; Psoas Major: Scalenus Posterior Pericardium Gluteus Medius: Gluteus Maximus; Adductor Longus: Biceps Brachi Liver Rhomboideus: costal region of Pectoralis Major Large intestine Tensor Fascia Latae: Biceps Femoris Levator Scapulae: Vastus Lateralis Stomach Small intestine superior portion of Rectus Abdominis: Rectus Femoris Fibularis Longus: Lateral Gastrocnemius; Bladder Tibialis Anterior; Erector Spinae Teres Minor: Gracilis: · Triple burner Medial Gastrocnemius Sartorius; inferior portion of Rectus Abdominus Gallbladder Popliteus: Deltoideus Anterior
Perhaps classic descriptions of the channel sinews were part of a larger tradition: daoyin, qigong, taiji, etc. Parts of their nature and function may have remained hidden or been kept secret. Only their general pathways, indications. and simple treatment procedures were given in the Ling Shu. To acquire a deeper understanding. study of the muscle bands and functional groups. movement and body posture, qigong, taiji, and other related movement disciplines would be required; but these are beyond the scope of our current text.
The Channel System: Jing Luo Theory
79
CHAPTER ENDNOTES 1 See for example: Johannes Bischko, An Introduction to Acupuncture, Heidelberg: Haug publishers, 1985. 2 See for example: J.R. Worsley, Traditional Chinese Acupuncture: Volume 1, Meridians and Points, Tisbury, UK: Element Books, 1982. 3 See Matsumoto, K. and S. Birch, Extraordinary Vessels, p.121, for discussion of these variations in location of LU-7. 4 See for example: Nakatani, Y. and K. Yamashita, Ryodoraku Acupuncture, Tokyo: Ryodoraku Research Institute, 1977. 5 See for example: Vol!, R., "Twenty years of electroacupuncture diagnosis in Germany: A progress report," Amer. Jour. Acup. 3:7-17, 1975. 6 See for example: Becker, R.O. and G. Selden, The Body Electric, New York: William Morrow Company, 1985. 7 Li Ding Zhong, The Jing Luo Phenomena, Volume I, Tokyo: Yukonsha Publishing Co., 1983. 8 Li Ding Zhong, The Jing Luo Phenomena, Volume II, Tokyo: Yukonsha Publishing Co., 1985. 9 S.B.: Most research into acupuncture and East Asian medicine is seriously flawed. This would require more than the brief summary of the subject that has been provided. A study-by-study analysis of research in acupuncture needs to be done. In the Introduction some of these issues were addressed. We are not alone in suggesting this view; respected members of the research community also concur. 10 Davies, P., The Cosmic Blueprint, New York: Simon and Schuster, 1988, pp. 144-145. 11 S.B.: "Blackbox" is scientific slang for a piece of hardware of unknown description. Computer users, for example, often treat their computer as a "blackbox" a cybernetic appliance the operation of which is unknown to them, and of no value to their work. 12 S.B.: Pressure pain is sometimes reduced or increased if the metals are not on the channel; however, non-channel placement produces irregular, unrepeatable effects. Placement on the channel produces regular, predictable results. 13 For example, Mr. Oda has researched the "root and knot" chapter of the Ling Shu. See: "Chiryo no Jisai," Nihon Shinkyu Topology Gakkujutsu Taikai, July 1988, pp. 55-60. 14 S.B.: A good review of the electrodermal instruments and their differences in measurement can be found in Tiller, W.A., "On the evolution of electrodermal diagnostic instruments," Journal of Advancement in Medicine 1:1, Spring 1988. 15 See Ling Shu chapter 15 and the Shi Si Jing Fa Hui. 16 There are many pressure pain points related to different diseases. For example, McBurney's point, Lanz's point, Morris's point, Munro's point, Kummel's point, Crado's point, Lenzmann's point, Onodera's points. (See appendix 1 for details of pressure pain points from Western sources.) These come from Western medical practice; they are understood to be reflex points for internal diseases. 17 S.B.: An interesting study of the electrical properties of needle angle can be found in IonescuC. Tirgoviste and E. Papa, "Tonification and dispersion effect of an acupuncture needle obliquely introduced into an electric field," American Journal of Acupuncture 144:4, 1986, pp. 339-343. 18 S.B.: Keep in mind Dr. Manaka's admonition that such clinical demonstrations "prove" nothing in any absolute sense, but do raise the specificity of the measurement and the concept. Usually, supplementation and drainage are judged on theoretical criteria. Often the clinical validity of these ideas is determined by the viewpoint of the researcher, translator, or practitioner. Sometimes concepts such as these are dismissed for political reasons; sometimes they are simply dropped from translations. The importance of these clinical demonstrations is that they evidence a specific condition (pressure pain), with a specific method (shallow needling), and provide repeatable evidence (pressure pain changes) of a channel "software" characteristic. 19 This is the technique described by my friend Dr. Nakatani in his Ryodoraku system. 20 Our thanks to Dr. John Diamond for this last example. See: Harding Rains, A.J. eta!., Bailey and Love's Short Practice of Surgery, London: H.K. Lewis and Co. Ltd., 1971. 21 See his work with the VAS method, From Auriculotherapy to Auriculomedicine. See also Bourdiol, R.J., Auriculosomatology, Paris: Maisonneuve, 1983, in particular pages 95 and following. 22 For further discussions of this, see Matsumoto, K. and S. Birch, Hara Diagnosis: Reflections on the Sea, pp. 350-352. 23 Taken from Kono, T., Kin Shin Dan Ho, Tokyo: JICC Publishing Company, 1986, p. 251.
~
~
CHAPTER fiVE
THE EIGHT EXTRAORDINARY VESSELS
(QI /ING BA MAl) AND THE OCTAHEDRAL MODEL Like the twelve channels, but at a simpler and possibly deeper level, the eight extraordinary vessels (qi jing ba mai) also serve to regulate and distribute the body's qi. If we examine the pathways and points of these eight vessels, we can see that they have treatment points evenly distributed among the twelve channels along the boundary lines of the octahedral structure. The qi jing bai mai can thus profoundly and easily affect the octahedral structure and its role in the regulation and distribution of qi. Earlier we saw how the octahedron relates to yin-yang theory and we described the left-right dividing lines as the ren mai on the anterior portion and the du mai on the posterior portion. We noted that the superior-inferior dividing line was the dai mai. We proposed that these dividing lines are generated during embryological development and are retained as energetic entities, three of the extraordinary vessels, throughout life. We can further postulate that the anterior-posterior dividing lines are related to the extraordinary vessels. However, this is not as easy to see. On the yang portion of the body, at the lateral edges, the triple burner and gallbladder channels separate the anterior and posterior portions. On the yin portion of the body, at the lateral edges, the spleen and pericardium channels divide the anterior and posterior portions: Yang Triple Burner, GaDbladder
J
ren mai, du mai triple burner, pericardium, gaUbladder, spleen
Pericardium, Spleen
dai mai
Yin
Figure 5.1: Structural octahedral body symmetry
82
The Eight Extraordinary Vessels & the Octahedral Model
In other words, the octahedral structure is physically defined by the pathways of the dai mai or girdling vessel (as the superior-inferior dividing line), the ren mai or conception vessel (as the anterior portion of the left-right dividing lines), the du mai or governing vessel (as the posterior portion of the left-right dividing lines), the triple burner and gallbladder channels (as the anterior and posterior dividing lines at the lateral edges of the yang portion of the body), and the pericardium and spleen channels (as the anterior and posterior dividing lines at the lateral edges of the yin portion of the body). Hence these four laterally placed channels have important relationships to the extraordinary vessels. Four of the extraordinary vessel treatment or confluence-jiaohui points lie on these channels: TB-5, GB-41, SP-4, PC-6. It is perhaps because these treatment points lie on channels comprising some of the dividing lines of the octahedral structure, that they function as confluence points for the extraordinary vessels. These dividing lines have special significance. In ancient times physicians knew this and thus called the extraordinary vessels the "ocean of yin," the "ocean of yang," the "ocean of the blood, the channels, the organs." Because the eight extraordinary vessels intersect with the regular channels, often at points along these midline trajectories (ren mai and du mai), there is reason to conjecture that there are special functions relative to these dividing lines. When we treat these confluencejiaohui points on the regular channels, we are able to affect the dividing lines and thus the channels that intersect with them on either side of the intersecting point. This is what happens when we say that we are treating the extraordinary vessels. Clinical practice based on this octahedral proposal is extremely effective. While the concepts and tools required to explain the octahedral model are themselves complex and difficult to wield, requiring, at least, the mathematics of three dimensional, solid structures (topology), our conjectures allow us to devise a simple diagnostic and treatment approach. We can apply treatment to the extraordinary vessel points and reduce reactions found in these eight body areas. As these reactions change, the body structure changes, and the functional events that caused these reactions also change, producing powerful therapeutic effects. A minimal number of points produces a maximal effect. Looking at yin-yang and the extraordinary vessels in this manner greatly simplifies the general theory and allows us to develop procedures for further testing and demonstrating yin and yang concepts. We saw in the last chapter that with simple tests we could demonstrate the classical ideas that describe the yin channels as streams of energy (qi) flowing from toes to torso and from torso to fingers, while the yang channels are descending streams of energy flowing from fingers to head and head to toes. This too is a simple yin-yang polarity demonstration, but when we try to look at the extraordinary vessels and the octahedral model in the same way, we encounter many difficulties and differences. For example, the extraordinary vessels do not have jing points, source points, or five-phase points. Neither do the extraordinary vessels have a deep, close relationship to the internal organs nor biao-li (surface-interior) relationships. They generally pass from feet to head and have no acupoints on the arms, and their treatment points are not usually on the pathways of the extraordinary vessels themselves. There are three other important differences. First, the extraordinary vessels were not described as composing a circuit, like the channels. Second, extraordinary vessel descriptions by different authors have much greater variety than descriptions of the twelve channels.! Third, while the channels were said to be responsible for circulating qi, blood, ying, and wei as energy streams, the extraordinary vessels were not clearly described as having a similar
The Eight Extraordinary Vessels and the Octahedral Model
83
function, or even as being energy streams. They were, as already described, often called "oceans" instead of "streams" or "rivers" like the channels. When we apply the same polarity tests to the extraordinary vessels that we applied to the twelve channels, these differences become apparent. We also find that conclusions concerning extraordinary vessel trajectories are less clear than with the twelve channels. It is partly due to these difficulties that we find it easier and more useful to consider the eight extraordinary vessels as dividing lines capable of affecting structural changes and thus as related to the octahedral topological model. In general, we theorize that extraordinary vessel functions have older embryological and evolutionary roots than the twelve channels. Since they regulate the body at a deeper, more primitive level of symmetric-asymmetric regulation, their structure-function balance is more difficult to examine.2 In relation to the octahedral model, we can say that they probably have a much broader regulatory effect on the movement of qi (primitive signals) than do the regular channels, which serve as specific information pathways (signal communication). However, combining particular yin-yang pairs of channels, such as the polar channel pairs, we are able to elicit similar, broad changes of qi flow that can be explained through the octahedral model. In various experiments using two-metal contact on the channels, we found that placement of copper or gold (+) upstream, closer to the beginning of the channel, and zinc or silver(-) downstream, closer to the anastomosis, generally reduced pressure pain on the channel, or on a point related to the channel (see the last chapter. However, there were occasions where a polarity opposite to what we would expect reduced the reactions. When we discovered this, we thought that this reversal might be the result of an extraordinary vessel function. Even though the extraordinary vessels were described as having a direction, and thus by extension, a possible flow, we postulated that there might be another energy flow in the opposite direction, a counter-current. When testing these theories with experiments using gold (+) and silver (-) contact procedures, we treated pressure pain on left KI-16, placing gold (+) upstream, distally on the kidney channel, and silver (-) downstream, proximally on the kidney channel, to reduce the KI-16 reaction. Reversing the gold and silver contacts caused the reaction to return. Then we thought about the classical descriptions of the origins and pathways of the chong mai. According to the classical literature, the chong mai passes through KI-16 as does the kidney channel. One theory posits that it begins at CV-1, another that it begins at ST-30. In the first theory, it passes from CV1 to the kidney channel and ascends the abdomen. In the second theory, it emerges at ST-30, a branch ascends the abdomen, and another branch descends the leg to emerge near LR-3 and KI-1. Next we tried placing gold (+)on ST-30 and silver(-) on KI-1 or LR-3. This alignment decreased the KI-16 reaction. The reverse alignment of metals caused the reaction to reappear. Gold on ST-30 and silver on ST-11 (on the ascending pathway of the chong mai) reduced the KI-16 reaction, while reversing the gold and silver caused the reaction to reappear. These responses seemed somewhat paradoxical in comparison to the normal channels. Though we had thought these results to be indicative of some extraordinary vessel flow, how could a flow in the extraordinary vessels account for the horizontal dai mai pathway around the midline? Despite these difficulties, our understanding became much clearer through the following tests. Placing gold on CV-1 and silver on CV-24 did not reduce the left KI-16 pressure pain; however, moving the silver one centimeter to the left of CV-24, did reduce
84
The Eight Extraordinary Vessels and the Octahedral Model
the KI-16 reaction. Placing gold on CV-1 and silver on KI-1 or LR-3 also reduced the KI-16 reaction. But, placing the silver on SP-6 did not reduce the reaction. According to tradition, SP-6 is supposed to be on the descending branch of the chong mai. Rather than a flow of energy in the extraordinary vessels (the direction of which is unclear), we think that these examples demonstrate relationships between specific acupoints that are described as being on the pathway of the extraordinary vessel; that is, they demonstrate topological relationships between the acupoints rather than a flow of qi between the points. Thinking of the extraordinary vessels as related to the octahedral dividing lines of the body is very useful. Treatments addressing these dividing lines can affect wide areas because they can affect the areas to both sides. This is evidenced in the frequency stimulation examples described earlier. Generally, low frequencies affect the midline of the body and high frequencies affect the lateral edges. This too is indicative of specific topological relationships. At the intersection-jiaohui points, which are points that lie on the octahedral dividing lines where two or more channels intersect (GB-31, GB-35 on the gallbladder channel, TB-8 on the triple burner channel, SP-6 and the Manaka point two finger-widths proximal to SP-10 on the spleen channel, and the Manaka point halfway between PC-3 and PC-7 on the pericardium channel), the effects reverse. Similarly, either positive or negative stimulation of these intersection-jiaohui points cause similar changes in reaction, where other non-intersection points elicit reversible effects with positive and negative stimulation. This too is because these special points lie on the octahedral dividing lines. Other channel acupoints on the pathways of the extraordinary vessels were also described as intersection-jiaohui or "meeting" points. Treatment of these eight special points likely activates the extraordinary vessels by first stimulating the octahedral dividing lines and thus the intersection-jiaohui points which are on them, and then the extraordinary vessels that pass through these intersection points. In this manner profound changes of structure and function can be brought about by using very few points. This may be why the eight extraordinary vessels were each described as having a broadly diverse range of effects, sometimes affecting several major systems in the body. For instance, the chong mai-yin wei mai pair were said to affect the chest, lungs, heart, spleen, stomach, liver, gallbladder, intestines, and reproductive system. Clinically, this pair is selected for a wide range of symptoms within this spectrum. Few, if any, of the twelve channels can be said to have such diverse effects. The table on the following page summarizes the intersection-jiaohui points of the extraordinary vessel pathways.3 The octahedral model of the body and its relationship to the extraordinary vessels is clinically useful. It allows us to clearly map asymmetries of body structure. There are tendencies towards certain yin-yang imbalances that are the result of certain bodily asymmetries. For instance, simple left-right differences relative to each of the organs create asymmetrical tendencies. The heart, spleen, and stomach are all situated on the left, the liver and gallbladder on the right; the right lung has three lobes where the left has two. Asymmetrical muscle tension will develop from biases produced by functional changes in the organs. Both palpatory tenderness, and the appropriate treatment it indicates, will predominate on one side rather than another. This is what we observe clinically: asymmetric patterns of reaction that typically occur can often be seen in relation to the octahedral model.
The Eight Extraordinary Vessels and'the Octahedral Model
Extraordinary vessel
Intersection-jiaohui points
ren mai du mai chong mai
CV-1 to CV-24 GV-1 to GV-28, BL-12 KI-ll to KI-21, ST-30, SP-6, KI-1 (possibly LR-3, KI-3) GB-26, GB-27, GB-28, LR-13 KI-2, KI-6, KI-8, ST-12, ST-9, BL-1
dai mai yin qiao mai yang qiao mai yin wei mai yang wei mai
85
BL-59, BL-61, BL-62, GB-29, SI-10, LI-15, LI-16, ST-1, ST-2, ST-3, ST-4, ST-5, ST-9, BL-1 KI-9, SP-13, SP-15, SP-16, LR-14, CV-22, CV-23 BL-63, GB-29, GB-35, LI-14, TB-13, TB-15, SI-10, GV-15, GV-16, GB-13 to GB-21
As well as the asymmetries of left-right, we can also see superior-inferior asymmetries. This is evidenced in the menstrual cycle. Women lose blood every month through menstruating and are thus biased towards certain lower burner problems more than are men. This is not only a superior-inferior asymmetry, but also a male-female asymmetry, both of which are viewed in Chinese terms as yinyang imbalances. Many other asymmetries arise from daily life: most people use their hands with greater agility than their feet. Intricate work is hand work because the hands are closer to the organs of sense, the eyes. People develop a more pronounced sensitivity in the hands and fingers than in the feet and toes. We have measured this repeatedly with M.I.D. diagnosis. This represents an obvious superior-inferior asymmetry. Such simple asymmetries that result from normal daily activities can have a significant influence on health. Using the simple yin-yang theories of the octahedral model, it is possible to understand many components of the disease process. Several healing modalities, notably the sotai exercise system developed by Dr. Keizo Hashimoto, have focused on the functional changes and pathologies that can stem from postural and structural imbalance. For example, lessened attention to, or decreased awareness of the feet and toes, has more profound implications than might be expected. Through evolution our movement has become dependent primarily on the feet and toes; our lessened awareness of their relative position, movement and balance affects the body's structure through repeated daily movements and habits. If we are not using our feet and toes in a balanced manner, our posture and structure slowly become imbalanced. This, in turn, biases us toward functional changes and pathologies. Finally, on a more theoretical note, it is possible to diagram the twelve channels in quadrantal and yin-yang relationships to each other and to visualize the distribution of the eight treatment points of the extraordinary vessels within these relationships. Though we can construct many such diagrams, we think that the diagram on the following page is sufficiently thought-provoking:
86
The Eight Extraordinary Vessels and the Octahedral Model
LU
PC HT
SI
LR ST
Figure 5.2: Quadrantality of 8 cardinal points of the extraordinary vessels
CHAPTER ENDNOTES 1 See Matsumoto and Birch, Extraordinary Vessels, for a compilation of these various descriptions. 2 S.B.: It is interesting to note that Li Shi Zhen, the only classical author to have written a treatise on the extraordinary vessels, the Qi Jing Ba Mai Kao, also speculated on their primacy both developmentally and relative to the twelve channels. See: Qi Jing Ba Mai Kao, vol. 1, p. 7, from the Tu Zhu Nan Jing Mai Jue, Taipei: Shui Cheng Shu Ju Publishing Company, 1970. 3 This table was taken from Matsumoto, K. and S. Birch, Extraordinary Vessels p. 25-67. See this work for more complete descriptions of the pathways of the extraordinary vessels.
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CHAPTER SIX
THE FIVE PHASES For once a system of categorizations such as the five element system is established, then anything can by no means be the cause of anything else . ... [It is designed] ... to systematise the universe of things and events into a pattern of structure by which all the mutual influences of its parts were coordinated.
- J. Needham, Science and Civilization in China II:284-5. In traditional theories, five-phase concepts are central to the theory and practice of acupuncture and moxibustion. As with yin-yang, many descriptions of the five-phase theories exist, notably those most traceable to the Nan Jing. There are two components to the five-phase theories. The first ascribes numerous correspondences to each of the phases; these are found scattered throughout the classical literature and are not confined to the medical classics. Almost everything in the universe, between heaven and earth, was so classified, including the various phases of different cycles observed in nature and in the body. The basic correspondences associated with the five phases are summarized in the table following. It is noteworthy that these correspondences are often cyclical and biorhythmic. Phase Season Direction Activity Zang Organ (Yin) Fu Organ (Yang) Emotion Color Sound/Voice Taste Sense Organ Body Part
Wood spring east growth LR GB anger blue/green shouting sour eyes muscles I tendons
Fire summer south maturation HT/PC SI/TB joy red laughing bitter tongue blood vessels
Earth long summer* center transformation SP ST overthinking yellow singing sweet mouth flesh
Metal fall west gathering LU LI grief white wailing spicy nose skin,body hair
Water winter north storing KI
BL fear blue/black groaning salty ears bones,head hair
• sometimes seen as the equivalent of "Indian summer" at the end of summer and beginning of fall. More often seen as the last eighteen days (the last one-fifth) of each of the four seasons.
It is very likely that the original channel concept was very simple and was refined and described in greater detail through further clinical use. The five-phase organ categorizations, for example, were further developed and refined so that specific acupoints on each channel trajectory were assigned a five-phase representation
88
The Five Phases
(the transporting-shu points, elsewhere the "antique" or "command" points). In succeeding centuries, there were further classifications and correspondences that produced the current, complex channel system descriptions. The five phases are important in the signal system. The clinical tests that allow us to demonstrate and validate the theory and function of the five phases focus on the five-phase acupoints that lie on each of the twelve channels. The second component of five-phase theory describes various relationships between the phases. For instance, they are described as engendering each other in sequence. Wood engenders fire; fire engenders earth; earth engenders metal; metal engenders water; water engenders wood. They are also described as interacting mutually in a regulatory or restraining sequence. Wood restrains earth; earth restrains water; water restrains fire; fire restrains metal; metal restrains wood. These mutually interacting engendering and restraining cycles allow each phase to interact with and regulate each other phase. The phases are usually pictured thus:
Figure 6.1: The engendering cycle of the five phases
8 Figure 6.2: The restraining cycle of the five phases
The twelve channels are also classified according to the five phases. Each channel includes a sequence of five transporting-shu points, each point corresponding to a phase. These points always run in sequence from the digital extremities towards the elbows and knees. On the yin and yang channels, the sequences are different, as follows:
The Five Phases
Phase gallbladder small intestine triple burner stomach large intestine bladder
Phase liver heart pericardium spleen lung kidney
Yang channel transporting-shu points Water Wood Fire Metal
Earth
jing
ying
shu
jing
he
GB-44 SI-1 TB-1 ST-45 Ll-1 BL-67
GB-43 SI-2 TB-2 ST-44 LI-2 BL-66
GB-41 SI-3 TB-3 ST-43 Ll-3 BL-65
GB-38 SI-5 TB-6 ST-41 LI-5 BL-60
GB-34 Sl-8 TB-10 ST-36 LI-11 BL-40
Yin channel transporting-shu points Earth Metal Wood Fire
Water
jing
ying
shu
jing
he
LR-1 HT-9 PC-9 SP-1 LU-ll KI-1
LR-2 HT-8 PC-8 SP-2 LU-10 Kl-2
LR-3 HT-7 PC-7 SP-3 LU-9 KI-3
LR-4 HT-4 PC-5 SP-5 LU-8 Kl-7
LR-8 HT-3 PC-3 SP-9 LU-5 KI-10
89
Diagnosis of channel pathology is based on radial pulse palpation, abdominal palpation, and channel palpation. The diagnosis is partially based on the corresponding phase. Treatments frequently involve the use of these five-phase points through channel and phase interactions. Many different treatment styles and uses have evolved, some simple and some complex; most trace their source to the Nan Jing. These classical theories form the basis of Japan's Keiraku Chiryo schools, or channel treatment ("meridian therapy") schools. As with yin-yang, the channels, the acupoints and the extraordinary vessels, we cannot yet clearly explain the mechanisms of the five-phase theory or the effects of the five-phase acupoints. However, we can demonstrate that they too belong to the signal system. For our purposes, we can devise simple, repeatable tests that demonstrate the existence of phasal characteristics and the interacting cycles and some of their correspondences, especially those associated with the five-phase points. There are also biorhythmic cycles that were based on, or classified by, five-phase theory. Some of these correspondences and cycles are mathematical, topological concepts, rather than abstract philosophical concepts. This notion of correspondences and cycles we term "isophasality."
ISOPHASALITY All things reject what is different [to themselves] and follow what is akin. Thus it is that if [two] chi [qi] are similar, they will coalesce, if notes correspond they resonate. - J. Needham, quoting the Chun Qiu Fa Lu circa 200 B.C., from Science and Civilization in China II:281.
Our term "isophasality" means that certain acupoints on the surface of the body have some similar property, or something functional in common with all other points on the body surface that belong to that phase. All earth points have something in common with all other earth points. We can liken this idea to inversions of a musical chord. The C Major chord can be:
90
The Five Phases
Figure 6.3: musical chord
Each chord has similarities with the others. Actually, any point on any channel will have isophasal correspondences on all other channels. We could, with repeated careful testing, probably find many isophasal sets. The concept of isophasality is essentially a mathematical concept, a property of any topological structure.l Another method of explaining the term "isophasal" might be to visualize it as equal energy states in two different points that are part of a continuous energy cycle. For example, in the Kreb's cycle at one side of the diagram, energy is poured into the cycle. At the other end, energy is extracted. At points X and Y the energy state is equal. Thus, X and Y are isophasal.
Figure 6.4: The Kreb's cycle
We might also hypothesize that the similarities common to each acupoint may be the result of a simple physical principle, vibrational properties such as a frequency or wavelength, or a microelectric property, such as resistance, capacitance, etc. We could, for example, suggest that the earth points of the tai yin-yang ming set have a simple numerical relationship to each other such as the following example, where X represents the properties common to the points in different numerical proportions: LU-9
LI-11
ST-36
SP-3
X
sx
lOX
15X
That the Chinese may have understood this idea and used it to identify the phase and source points is remarkable. That they selected five of these isophasal sets as clinically useful was probably due in part to the prevalence of five-phase theories at that time, and to the remarkably meticulous work of one or more practitioners who had learned to recognize very subtle differences. In modern acupuncture practice, the microsystems of reflexology, French auriculotherapy, Chinese auriculotherapy, and Korean hand acupuncture depend on the idea of isophasality. According to our experience, we can needle the large intestine point in the auricle to reduce reactions at the large intestine reflex point,
The Five Phases
91
ST-27. We can also needle the same point on the palm, or a point on the equivalent large intestine channel on the second or fourth fingers, to reduce the ST-27 reaction. We may therefore consider these systems of reflexology as describing points that are isophasal with body areas or other points. We have already suggested that the mechanism behind these microsystems may be holographic; if so, perhaps there is some relationship between the holographic paradigm and isophasality. This model of isophasality can be further developed and confirmed if we take advantage of traditional five-phase theory and change the nature of the signals that we use for testing and therapy. We should, however, remember that the signals we work with and affect are so subtle that it is extremely difficult to measure them. The following discussion describes clinical tests and their results, utilizing different agents to examine five-phase characteristics, especially the characteristics of the phase points. On their own, these tests may not be enough to convince the reader to experiment with them clinically, but our own clinical utilization of these ideas for the treatment of patients is more than convincing. Not only are we able to observe some phenomena that lead to powerful clinical procedures, we also can observe the various phase cycles and interactions. In the example of pain in right LI-4 where north and south magnets were placed on the left and right auricles at both the anterior and posterior surfaces, we found that we could only shift the pressure pain around. We could not eliminate it from LI-4 on both sides. (See the discussion in chapter three.) To eliminate the pressure pain from both sides we needed to apply isophasal theory and select a corresponding point in the four-channel functional set, yang ming-tai yin. Because LI-4 is a point on an arm yang channel we should select a leg yin channel point. Because it is sore on the right side, we should select a point on the left side. Because LI-4 is a source point, we should select another source point. In the four-channel set, the lower left yin channel source point is left SP-3. We find that applying a south magnet(-) to left SP-3 will rid the right LI-4 reaction without producing a left LI-4 pressure pain. Placing a north magnet (+) on the point will cause the reaction to return to LI-4. If we now test the five-phase points of the channels, we can demonstrate that even more complex responses are possible. This is because these points have secondary characteristics associated with their corresponding phases as well as characteristics associated with the channels on which they lie. The use of polarity agents on these points needs to be mapped differently. Using these points, we sometimes obtain decreases in pressure pain when the alignment of the polarity is opposite to what would be expected were the point not a member of this special group. The zinc may be upstream and the copper downstream, when working with non-phasal channel points; when working with the phase points, the polarity may be opposite. For pressure pain on right LI-4, placing zinc(-) on right LI-11 (the earth point) and copper (+) on right ST-36 (the earth point) will rid the LI-4 reaction. Reversing the zinc and copper, the reaction will still decrease. This occurs regardless of channel flow and polarity of application. The channel source points are all isophasal to each other. All earth points are isophasal; all other phase points are isophasal to all other corresponding phase points. Thus, for pressure pain on right ST-27, the large intestine reflex point, placing copper(+) on right LI-1 (the metal point) and zinc(-) on right ST-45 (the metal point) has the same effect as zinc(-) on LI-1 and copper(+) on ST-45; both decrease the ST-27 reaction. In context of the isophasal characteristics of the acupoints, we can explore other phasal correspondences and characteristics. For example, according to traditional theory, each phase has a corresponding color:
92
The Five Phases
Phase Color
wood blue/green
fire red
earth yellow
metal white
water blue/black
It is possible to investigate these correspondences by looking at the effects of these colors on the five-phase points. Our clinical investigations show very clearly that the acupoints respond to these different colors. To apply the colors, we have used colored pens, small pieces of colored paper, a light instrument capable of emitting small points of colored lights of low intensity, etc. Generally, we have found the following correspondences to hold: - blue or green corresponds to the wood points - red corresponds to the fire points - yellow corresponds to the earth points - white corresponds to the metal points - black corresponds to the water points - yellow and orange correspond to the source-yuan points According to tradition, each channel has a source-yuan point as well as a transporting-shu point. Each source point has a particular effect on its own channel. On the yin channels, the source points are also the earth points. These source points are:
Yang channels gallbladder small intestine triple burner stomach large intestine bladder
Source point GB-40 SI-4 TB-4 ST-42 LI-4 BL-64
Yin channels liver heart pericardium spleen lung kidney
Source point LR-3 HT-7 PC-7 SP-3 LU-9 KI-3
Overall these color-phase correspondences have proven so exact that we have been able to use them to explore many phasal characteristics. We have devised a simple testing procedure to confirm diagnostic and therapeutic point combinations. For example, for pressure pain at right LI-4, the large intestine (metal) source-yuan point, placing red at right LU-10 (the fire point) will reduce the LI-4 pressure pain. Here the color red on the fire point increases the action of fire; and fire restrains metal. Stimulating the five-phase point characteristics improves a metal channel problem (pressure pain at LI-4). If the red color is removed from LU-10 and replaced with black, the LI-4 pressure pain will return. In this case, black (corresponding to water) on the fire point decreases the action of fire (water restrains fire), and thus decreases the action of fire on metal. Here we can observe the action of a color on its own corresponding phasal point (red to fire) and the action of a color on a non-corresponding phasal point (black to fire). In this way we can explore both the isophasal effects of the colors (red to all fire points, yellow to all earth points) and the engendering and restraining cycle functional characteristics. For a subject with pressure pain at right LU-1 (the lung channel diagnostic point), placing yellow (the earth color) at LU-9, the earth point, reduces the LU-1 pressure pain. Likewise, for a subject with pressure pain at KI-16 (the kidney channel diagnostic point), placing yellow at KI-3, the earth point, reduces the KI-16 pressure pain. Generally, any color placed on its corresponding transporting-shu point will tend to have beneficial effects.
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Our initial observations suggest that this is the case, but more rigorous clinical testing on larger subject groups will be necessary to map any exceptions. For pressure pain at right LR-14 (the liver channel diagnostic point), we can put blue or green at LR-1, red at LR-2, yellow at LR-3, white at LR-4, or black at LR-8 and get a reliable reduction of the LR-14 pain. Clinical reality is more complex because of differences in the subject or patient's condition and because the different colors tend to have particular characteristics of their own. When applying colors to the phase points, the effects can vary from subject to subject. Generally in healthy, well balanced subjects, all wood points respond in the same manner - reduction of tension, pressure pain, reversal of 0-ring test- in related reflex points when blue or green is applied to the points. A similar response is noted with red for fire points, yellow for earth points, white for metal points, black for water points, yellow or orange for source points. However, as with most of the testing and clinical experiments we do in subjects with clear or strong imbalances, especially in the channel under investigation, such simple tiny stimulation is sometimes not enough to elicit the same responses clearly. Particular combinations of points and colors give stronger effects. We have found that red and white tend to be somewhat "exciting," blue, green, and black tend to be "sedating," while yellow and orange tend to be "neutral." For example, in a patient with right subcostal tension, a positive 0-ring response at right LR-14, and a weak liver pulse, placement of yellow at LR-3, the earth point, produced slight changes in each of these signs. Adding red to LR-2, the fire point, immediately changed the 0-ring response and improved the subcostal reaction and the pulse. It is possible to devise different treatment strategies for different patients using these properties. Generally, the source points are useful points to begin. In simple cases, applying yellow to the source points alone is sufficient. In more complex cases, adding red to the fire points, or white to the metal points, will usually produce a sufficient response. It is remarkable that particular points on the body surface, which have no known light receptors, are not only able to detect and respond to color, but are able to discriminate between different colors and even combinations of colors (see below). By this method we can state with confidence that the descriptions in the classics of the location of the five-phase acupoints and the source points are verifiable, and that these points do have properties that correlate with various aspects of five-phase theories. Clearly, there are isophasal points for each channel. The classical descriptions of the various interactions of the phases, the engendering and restraining cycles, also seem to be accurate and verifiable. Next, let us recall our earlier question regarding the bladder channel as it traverses the back. We have also noticed isophasal correspondences active there. There have been a multiplicity of descriptions. Are there two or three pathways? Does the pathway one and one half cun lateral to the spine, return to the top of the pathway three cun lateral to the spine, before passing to the buttocks and down the legs? Or does it first pass down the legs, then back to the pathway three cun lateral to the spine? Or, are these pathways different? In searching for answers to these questions, we applied gold-plated (+) and silver-plated(-) pellets to a variety of points on the back and legs, from points on one pathway to another, and up and down each pathway. Our logic was that we would observe the same(+) to(-) correlation to channel flow described in previous experiments. Again, we recorded pressure pain response at corresponding reflex points. Without question, to be entirely conclusive our results would need more rigorous repetition. Based on our pilot research, however, it would appear that the
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bladder channel path runs as one broad stream down the spine, encompassing all the "distinct" pathways at either side of the spine At each vertebral level there are usually one or two acupoints. On the line one and a half cun lateral to the spine are the back shu points that correlate to each channel-organ system. On the line three cun lateral are a series of acupoints whose names imply similar correlations. It appears that these acupoints are isophasal with one another. For example, BL-13, the lung shu point, is isophasal with pohu, BL-42. These points lie at the same vertebral level. Likewise, BL-23, the kidney shu point, is isophasal with zhishi, BL-52, and lies at the same vertebral level. Clinically this means that it is sufficient to palpate and choose the more reactive point at the vertebral level corresponding to the target channel. Hence, the argument about correct sequencing and numbering of the points may be theoretically unanswerable, because the points seem to be isophasal parts of a broad stream. Trying to argue such questions without a research methodology is silliness arguing with nonsense.
PHASE CYCLES According to five-phase theory, in the engendering cycle each phase is the mother of the next phase and the child of the preceding phase (see Figure 6.1). Wood is the mother of fire and the child of water. Fire is the mother of earth and the child of wood. Earth is the mother of metal and the child of fire. Metal is the mother of water and the child of earth. Water is the mother of wood and the child of metal. Within each set of five transporting-shu points on each channel, one point is described as the supplementing or "mother" point and another as the draining or "child" point. The selection of these points is based on the phase correspondences of the channel, and follows the dictum of the Nan Jing: "When vacuous supplement the mother, when replete drain the child." Thus, on the large intestine channel, corresponding to the metal phase, LI-2 (the water point) is the drainage point and LI-11 (the earth point), is the supplementation point. For the kidney channel (water), Kl-1 (wood) is the drainage point and KI-7 (metal) is the supplementation point. For the twelve channels, the supplementation and drainage points are as follows: Channel lung large intestine stomach spleen heart small intestine bladder kidney pericardium triple burner gallbladder liver
Supplementation LU-9 LI-11 ST-41 SP-2 HT-9 Sl-3 BL-67 Kl-7 PC-9 TB-3 GB-43 LR-8
Drainage LU-5 LI-2 ST-45 SP-5 HT-7 Sl-8 BL-65 KI-1 PC-7 TB-10 GB-38 LR-2
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If the idea of an engendering cycle is correct, then these points should have some special properties and effects on the channels. Traditionally, one would use supplementing or draining needle techniques to obtain the required effects. Our tests show not only that these points are capable of being supplementation and drainage points, but that in responding to polarity agent influences, there is a polarity between these pairs of points that has profound clinical effects and applications. This is a new discovery and one which we believe sheds considerable light on the nature of the five-phase acupoints. Using a small 1.5 volt (AA) battery we can test the polarity effects of the supplementation and drainage points. As with the other polarity agents the current flowing when we use a battery of this potential will be very small, probably around one milliampere - not enough to stimulate the nervous system. If, for example, right Ll-4 is reactive, holding the battery and touching the positive pole to right LI11 (mother, earth point) will reduce the LI-4 reaction. Reversing the battery and touching the negative pole to LI-11 will increase the LI-4 reaction. Likewise, touching the negative end to right LI-2 (child, water point) will decrease the Ll-4 reaction, while the positive end increases the reaction. This demonstrates the effects of small electric polarities on the body, and further, something of the nature of the supplementation (mother) and drainage (child) points. Any positive polarity applied on the supplementation point will reduce reactions, while negative polarity increases reactions. Any negative polarity on the drainage point reduces reaction, while positive polarity increases the reactions tested. This occurs regardless of the direction of channel flow. Furthermore, we can repeat this procedure and produce consistent results using any of the polarity agents we have described: north magnet(+), south magnet(-), thumb(+), little finger(-), red clip (+) or black clip (-) of ion beam or ion pumping cord. This is an important finding. It raises complex and interesting questions about the nature of supplementation and drainage. Using magnets we obtain the following results. However, with magnets the effects are not always consistent; some subjects show exceptional responses. It is not yet clear why.
Polarity North(+) South(-)
Reaction on LI-4 to magnet placement LI-11 (mother) LI-2 (child) increases decreases decreases increases
Using an ion beam apparatus we obtain the same results: Reaction on LI-4 to ion-beam polarity placement Polarity LI-11 (mother) LI-2 (child) Red (+) decreases increases Black (-) increases decreases
Having defined these characteristics we can further define the polarity of other tools, such as the thumb and little finger. Using the polarity of the thumb and little finger (held lightly on the points) again yields the same results: Reaction on LI-4 to finger placement LI-11 (mother) LI-2 (child) Digit Thumb(+) decreases increases Little Finger (-) increases decreases
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Another example would be pressure pain of left KI-16, the kidney channel diagnostic point. Using the same variety of polarity agents (ion beam, magnet, thumb and finger) on left KI-7 (supplementing point) and left KI-1 (draining point) yields the following results: Reaction on KI-16 to Polarity Agent ion beam (+) (-) ion beam thumb (+) (-) little finger north magnet (+) (-) south magnet
polarity placement KI-7 (mother) decreases increases decreases increases decreases increases
KI-1 (child) increases decreases increases decreases increases decreases
These points, the supplementation and drainage points, appear to be receptors for different information, different signals. The points are capable of detecting very tiny polarity influences and are able to discriminate and respond clearly to positive and negative influences. This might be due to the polarities of the points themselves -certainly this is implied in the traditional nomenclature of "supplementation" and "drainage." Based on these clear results, we were led to formulate a model which described the interaction of the minute electrical currents of the applied polarity agents with the signal system, at the level of the channels where the influences are filtered and differentiated. Knowing these effects, we can formulate individual treatments based on the channel(s) that are imbalanced. We can intentionally affect the signal system. When we apply this information methodically, we can obtain very controlled and precise clinical effects (as we will describe in later chapters). Our further research and experimentation has shown that if we apply only a negative polarity to the drainage point, or only a positive polarity to the supplementation point, the effect - decrease in pressure pain and or tension - generally is sustainable for only a short time. But, if we simultaneously apply positive polarity to the supplementation points and negative polarity to the drainage points, the effect is greatly amplified and longer lasting. According to tradition this technique is paradoxical. Stimulation of the supplementation and drainage points on the same channel is thought to produce a neutralizing effect. Perhaps these traditional concepts are misunderstood or inadequate; perhaps the nature of the supplementation and drainage points, indeed, perhaps the concept of supplementation and drainage itself, is different than the current understanding.2 Perhaps these supplementation and drainage points work by activation and suppression. Positive polarity applied to the supplementation points and negative polarity applied to the drainage points may function to activate the channel or flow of qi/information in the channel. Negative polarity applied to the supplementation points and positive polarity applied to the drainage points may function to suppress the channel or flow of qi/information in the channel. Activation will address conditions of xu (vacuity); suppression will address conditions of shi (repletion). Perhaps the activation or suppression functions are homeostatically balanced. The above tests and results also confirm the description of the phase points as a fixed sequence according to the engendering cycle. The choice of drainage and supplementation points is based on the engendering cycle, though it is a concept
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that developed many centuries after the original correspondence of these points to the phases had been made. That is, these points were not selected as supplementation and drainage points because of their polar nature, rather as a development of five-phase theory. PHASE-TONE CORRESPONDENCE
Another useful phasal correspondence is the phase/tone correspondence. In qigong, six monosyllabic phonemes phonetically representative of six written characters were selected as capable of affecting the phases. This is the liu zi jue, the six character method. We have done research with these tones and have used them clinically. We found that the phase-phoneme-character correspondences are mysteriously accurate. These correspondences are seen in the following table: Character 1¥1 Pilf Pif-
"~ P)\
lli
Phase-phoneme-character correspondences Organ Transliteration Pronounciation xu sshuu liver ke slightly guttural ke heart hu whooo spleen si like 'sir' with soft r lung chui like choooway kidney xi shee triple burner
Phase wood fire earth metal water (fire)
As an example of the tests we have conducted with these characters, consider again pressure pain and tension on right LI-4. Hold the thumb or little finger over the point to be stimulated and chant the tone corresponding to that point. Then, check LI-4 to see if the reaction is decreased. The results we obtain in this case are as follows (on the right arm):
Tone chui hu chui hu
Reaction on right-side LI-4 to tone & polarity agent Agent LI-11 (mother) LI-2 (child) thumb increases thumb decreases little finger decreases increases little finger
In spite of using the thumb, a positive polarity, for both chui (water) and hu (earth), the point responses are tempered solely by the phonemes. The earth sound at the earth point produces a favorable response at LI-4, reduction of pressure pain. The water sound at the earth point has an unfavorable response. Earth restrains water; in this case, stimulating water at the earth point is antagonistic. Similarly, in spite of the use of the little finger at LI-2, the use of chui or hu seems to be what tempers the effects on LI-4. The earth sound at the water point antagonizes the channel - here earth restrains water. In another subject, we measured the electrical current in milliamperes on the bladder channel phase points using the vital meter, an electrodermal measuring device manufactured and sold by AsAHI. We determined the following current values in rnA (milliamperes): Point BL-67 BL-66 BL-65 BL-60 BL-40
Left 0.5 1.3 0.5 0.6 8.0
Right 1.0 0.5 0.7 1.0 8.0
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In this case, BL-40, the earth point, gave abnormally high readings. We tested/treated points on the spleen and stomach channels using the chanted characters, metronome, and thumb. We theorized that reducing earth should release the antagonistic constriction on water via the restraining cycle. Holding the thumbs over SP5, the drainage point, chanting chui with the metronome set at 120 (chui and 120 belong to kidney-water), we found the BL-40 point readings reduced to 2.6 on the left and 5.2. on the right. To reverse this trend, since earth antagonizes water, holding the thumbs over both ST-36, chanting hu with the metronome set at 132 (hu and 132 belong to stomach-earth), caused both right and left BL-40 readings to rise to 7.0. This example demonstrated the water-earth antagonism: earth restrains water. We wondered if these tests were simply the product of the thumb-little finger polarity. We suspect that someone expert in qigong could simply hold their thumb or little finger over the point and use their breath and concentration to achieve the same effects. However, those not versed in qigong usually need the chanted character to produce the effect. We also wondered if these effects were channeled through the nervous system as an auditory response. Our results do not clarify if it is the nervous system of the subject, of the tester, or both, that is affected. If the tester chants the words "water," "earth," "fire," in place of the corresponding characters in various languages we get the same changes only if the subject knows the language. Yet, if the tester says the character quietly (so that the subject cannot hear), the same effects are found. These tests are rather peculiar, but do produce functional changes. While we cannot explain them satisfactorily, we cite these tests as evidence for the existence of a restraining cycle among the phase points. Another example is provided by the following case. For pressure pain on left KI-16, placing the little finger(-) on left KI-1 (child) and the thumb(+) on left Kl-7 (mother), decreases the Kl-16 reaction. If we then hold the thumb over Kl-3, the earth point (restraining water), generally no change occurs at KI-16 unless one applies a qigong ability. This can be explained primarily by noting that KI-3 is not the supplementation or drainage point, and thus is not tuned to the(+)(-) polarities as are these points. But, when hu is chanted the Kl-16 tenderness reappears. In this case, we stimulate earth, which restrains water, to produce an antagonistic effect on water, and the original Kl-16 reaction reappears. Based on these and other tests and the numerous clinical results that we have obtained using these ideas, we think that the five-phase points have characteristics of their own, as well as the characteristics of their channel. Depending on how one stimulates them, the points manifest some characteristics more than others. The problem of the five phases is essentially one of topological geometry. By examining the observed facts first, we can begin to decipher the theory described by the ancient Chinese. Diagrammatically, we can envision the five-phase points on the four-channel sets as a topological unit:
Figure 6.5: mutual exchange of information
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There is a mutual exchange of information between the points, especially the isophasal points. In a sense, this is like an energy cycle, a kind of functional cycle, like the Kreb's cycle. At certain points around the cycle, the energy content or state is the same, and certain information transmits between the isophasal points. In like manner, certain strings on stringed instruments will resonate when a particular note is played. To quote Dong Zhong Shu, writing from the second century B.C.: The kung note or the shang note struck upon one lute will be answered by the kung or the shang notes from other stringed instruments. They sound by themselves. [As I said] when the note kung is struck forth from a lute, other kung strings [nearby] reverberate of themselves in complementary [resonance]; a case of comparable things being affected according to the classes to which they belong.3
BIORHYTHMS AND THE FIVE PHASES The classical biorhythmic treatment methods that we describe are primarily based on five-phase logic, or on biorhythmic variations of the eight extraordinary vessel confluence-jiaohui points. DAILY CHANNEL BIORHYTHMS
Knowing the time of day and having reached some diagnostic conclusion about the channel and thus the phase that is imbalanced, we can select a point to correct this channel/phase problem. 12
211
I
19
':it'
31
I
ps
Figure 6.6: Channel Clock
In a liver-wood problem, treating the wood point of the channel that is peaking in the energy cycle will be effective. For instance, if it is 2 pm, the peaking time
of the small intestine channel, and we have diagnosed pressure pain around the liver and the Manaka san yin jiao point on the left leg (both indicative of liver-wood), we can select the wood point of the small intestine, Sl-3, for treatment. To check that this is the correct point, we can test with a simple tool like a north-facing magnet. We can also check other small intestine points and compare the decrease in reaction around the liver and on the left leg. Usually we find that the wood point produces the most change. Needling this point eliminates the pressure pain on the abdomen and left leg.
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If it is 6 pm, the peaking time of the kidney channel, and we have determined weakness in the kidney position of the radial pulse and pressure pain on KI-16 to indicate a kidney vacuity or depletion, we can check the water point of the kidney channel, KI-10, again using a north-facing magnet. Comparing with other kidney channel points we generally find that stimulus on KI-10 produces the most positive change in reaction. Thus, needling the water point of the kidney channel, KI-10, improves the kidney pulse and rids the KI-16 pressure pain. In these cases, we would not check the drainage points when comparing effectiveness of other points versus the phase point diagnosed. This is because, as we will see below, at the time a channel peaks, its drainage point can be particularly effective for therapy. Thus, these points have slightly different properties. These examples further demonstrate the characteristics of the phase points; they are also isophasal with certain body systems, and can be selected according to time of day. In the above example of a liver-wood problem, if it were 8 am, the wood point of the stomach, ST-43, would be chosen. At this time, the small intestine wood point would be ineffective for the same condition, since the small intestine channel is not peaking at that time. If it were twelve noon instead, the peaking time of the heart channel, we would choose the wood point of the heart channel, HT-9. The small intestine wood point would probably still be effective, as would the bladder and kidney wood points, BL-65 and KI-1. This is because within the four-channel set, in this case, shao yin-tai yang, if one isophasal point is active, the other three are also active to varying degrees.
At any time, treatment can be selected from among the four wood points. Since the heart channel peaks between 11 am and 1 pm, the small intestine channel from 1 pm to 3 pm, the bladder channel from 3 pm to 5 pm, and the kidney channel from 5 pm to 7 pm, then the wood points of any of these four channels can be used on a patient who is diagnosed with a wood problem, and who is available for treatment between 11 am and 7 pm. Thus, as an extension of the method described above, at 6 pm, if the spleen channel is the target channel, the earth points of the kidney, bladder, small intestine, and heart channels, KI-3, BL-40, SI-8, and HT-7, will be effective. In a case such as this, we can use simple diagnostic checks such as the application of a north magnet to each of the points while checking tender areas for signs of decreased discomfort. This method allows us to determine which of the four points produces the strongest change in abdominal reactions. In this manner, we can identify the isophasal properties of the points and the reliability of the daily channel biorhythms, determining the most effective phase point for treatment. We can test the logic of the restraining cycle with the circadian channel biorhythm to determine if it too is a viable method of utilizing the circadian cycle. For example, if we find pressure pain on left ST-27, the large intestine reflex point (see chapter eight for the full list of correspondences), we should be able to decrease this reaction by supplementing the fire point of the peaking channel (fire restrains metal). At 11:30 am (heart channel peak), in a subject experiencing pressure pain on left ST-27, using a supplementing needle technique on left HT-8 (the fire point of the heart channel) should eliminate pressure pain on ST-27. Using a draining needle technique should cause it to return. In our trials, this is in fact what we found. In this case, we used the traditional methods of supplementing (inserting on exhalation in the direction of channel flow) and draining (inserting on inhalation against the direction of channel flow). In a subject with pressure pain on right ST-26, the small intestine reflex point, at 10 am (spleen channel peak), we decided that instead of needling or applying the plus-minus polarities, we would use the wooden hammer and needle, with the
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metronome. Since the small intestine frequency is 120 beats per minute, we tapped at this rate. Because the small intestine corresponds to fire, we tapped at the spleen fire point, SP-2. As a comparison, we also tapped at the water point, SP-9, to see if the action of "water restrains fire" would antagonize the results. We obtained the following results: Point tapped right SP-2 right SP-9
Phase fire water
Frequency 120 120
Reaction on ST-26 decrease increase
In this case, the fire point, SP-2, produced the desired results of reducing the ST-26 reaction. SP-9, the water point, antagonized the results (water restrains fire), and the ST-26 reaction returned. Notice that the metronome setting and rate of tapping was the same, the only variable was the acupoint. Thus it appears possible to take advantage of the phase points along with the circadian cycle to produce specific results. DAILY BRANCH METHODS
There is a more general and traditional method of treatment based on an interpretation of the classical concept of the nai zhi fa, the daily branch method. In the last chapter we referred to the use of the drainage point of the channel at peak, or the supplementation point of the channel that had peaked in the previous time cycle, as biorhythmic "open" points. At any time of the day this option is available, regardless of the diagnosis. The following points are available at the times indicated: Time 3am-5am 5am-7am 7am-9am 9am-llam llam-1pm 1pm-3pm 3pm-5pm 5pm-7pm 7pm-9pm 9pm-llpm llpm-1am 1am-3am
Channel Lung Large Intestine Stomach Spleen Heart Small Intestine Bladder Kidney Pericardium Triple Burner Gallbladder Liver
Supplementation Drainage LR-8 LU-5 LU-9 Ll-2 ST-45 LI-11 SP-5 ST-41 HT-7 SP-2 HT-9 SI-8 BL-65 SI-3 BL-67 KI-1 KI-7 PC-7 TB-10 PC-9 TB-3 GB-38 GB-43 LR-2
When we test these points at the designated times, we find not only a further demonstration of the circadian channel biorhythm, and the nature of supplementation and drainage points, but also further evidence for the existence of phase relationships. More importantly, we have another powerful and useful therapeutic option. Traditionally, supplementation points in the nai zhi fa method were recommended for any condition of vacuity or general vacuity, regardless of which channel was vacuous or most vacuous. The drainage points were recommended for any condition of repletion or generally replete conditions, again regardless of the particular channel. We have found that these points can be therapeutically useful regardless of whether the condition is replete or vacuous.
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For example, when we examined a patient at 8 am (stomach peak) who showed reactions in the right subcostal region of the abdomen with a weakness in the liver position of the radial pulse, we chose LI-11 (mother point of the previously peaking channel) as the available supplementation point and ST-45 (child point of the stomach channel) as the available drainage point. Using the logic where positive polarity applied to the supplementation point produces a reduction in reactions, while negative polarity increases the reactions, and vice versa for the drainage point, we tested the traditional logic. The results we obtained were as follows: Point treated LI-11 (r) ST-45 (r) LI-11 (r) ST-45 (r)
Polarity applied
+ +
Reaction no change no change decrease decrease
We treated with the positive electrode at right LI-11 and the negative electrode to right ST-45 for a duration of twenty seconds. This eliminated the subcostal reactions and strengthened the radial pulse. On another day at the same time, a different patient showed weakness in the heart position of the radial pulse, and pain around CV-15/CV-14, a heart channel diagnostic area. In this case, we used a polarity agent device similar to the ion pumping cords, termed electrostatic adsorbers,4 and applied the same logic to treat the same points. We placed the positive pole at right LI-11 and the negative pole to left ST-45, for roughly 40 seconds. Treating contralaterally in this fashion can be useful for midline reactions (i.e., around CV-15/CV-14). This greatly reduced the abdominal reaction and improved the pulse. This combination takes advantage of the left-right polarity component in the octahedron. We can use any polarity agent to test these open points and confirm treatment strategy. These tests demonstrate that points do become open or active at the times indicated by the traditional texts. Treating the same points at 2 pm, with the same polarities, on another subject with right subcostal tension, was not effective. However, when positive polarity was applied to right HT-9 (the supplementation point for that hour) and negative polarity to right SI-8 (the drainage point for that hour), the reactions did decrease. Since these points respond to the minute influences of polarity agents, we can clearly state that these open points represent some aspect of the signal system. POLAR CHANNEL PAIRS
The maximum-minimum energy relationships of the daily channel rhythms, termed here the polar channel pairs, offer another treatment option: Polar channel pairs
large intestine triple burner small intestine heart pericardium lung
kidney spleen liver gallbladder stomach bladder
While these pairs are used clinically as yin-yang sets with a clear structural basis, an understanding of their underlying function can be found in the concept of
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the daily channel rhythms. We have found this polar channel set of relationships particularly useful. Treating a leg yin-arm yang channel pair, such as kidney-large intestine, immediately activates inferior-superior, yin-yang relationships as well as yin-yang channel relationships (anterior/medial-posterior/lateral). Using points on these two channels according to left-right strategies essentially activates all the yin-yang antagonisms of the octahedral model. Treatments so based can produce effects that extend well beyond the two treated channels to regulate the whole body. TEN-DAY CHANNEL BIORHYTHMS
The workings of the signal system are clearly evidenced by the biorhythmic phase treatment method known as the nai jia fa, or ten-day stem method. The ten-day stem method of treatment uses the five-phase and source points on all twelve channels in a complex phase sequence. The sequence passes from jing to ying, to shu, to jing, to he acupoints of the five yang channels in the engendering order of the phases. It then alternates the same point sequence through the five yin channels, again in the engendering order of the phases. The sequence then returns to the yang channels. In other words, in ten days the sequence alternately passes from a yang channel sequence of points in engendering order then to a sequence of yin channel points, also in engendering sequence, then back to a yang sequence. On the eleventh day the whole cycle begins again. The Ten-Day Cycle
Jing
Ying
Shu
Jing
He
TB/PC
GB-44 wood LR-1
51-2 fire HT-8
5T-43 earth 5P-3
LI-5 metal LU-8
BL-40 water KI-10
TB-2
51-1 fire HT-9
5T-44 earth 5P-2
LI-3 metal LU-9
BL-60 water KI-7
GB-34 wood LR-8
TB-3
5T-45 earth 5P-1
LI-2 metal LU-10
BL-65 water KI-3
GB-38 wood LR-4
51-8 fire HT-3
TB-6
Ll-1 metal LU-ll
BL-66 water KI-2
GB-41 wood LR-3
51-5 fire HT-4
5T-36 earth 5P-9
TB-10
BL-67 water Kl-1
GB-43 wood LR-2
51-3 fire HT-7
5T-41 earth 5P-5
LI-11 metal LU-5
TB-1
PC-8
PC-7
PC-5
PC-3
PC-9
Chapter 9 gives the full sequence, with corresponding open times and discussions of how to calculate which point is open according to the day and time of day. This method is clearly based on five-phase sequences and logic. It is almost too fantastic to believe, except that the points produce profound clinical results that can be clinically researched and verified using the polarity agents. For example, in a subject with pressure pain on left KI-16, application of the negative electrostatic adsorber to left PC-9, the open point according to the ten-day stem method, reduced the Kl-16 reaction. Exactly one week later, the same application of the electrostatic adsorber, to the same point, in the same subject, had no effect
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on the same Kl-16 reaction. When the adsorber was applied to left SP-3, the open point at that time according to the ten-day stem method, the KI-16 reaction decreased. In a group of six subjects with monolateral pressure pain at LI-4, we selected the open point according to the ten-day stem method, stimulating it using the wooden hammer and needle with a metronome. At this time HT-4 was the ten-day stem open point. On each subject we tapped a point roughly one centimeter proximal to HT-4 for 10 beats at a rate of 126 beats per minute (the heart frequency rate). We then tapped HT-4 (river-jing metal point) for the same number of beats at the same rate. We found that after tapping the point proximal to HT-4 in all subjects, the LI-4 pressure pain was unchanged. After tapping HT-4, the pressure pain reduced in all subjects. This tends to indicate that the open points are very specific and very sensitive. We have repeated these simple tests many times. Sometimes the use of the open point not only rids the reactions tested, it also eliminates the subject's symptoms. Sometimes open points respond antagonistically to the use of a negative or positive polarity agent. For example, in the case above, the negative adsorber when applied to left PC-9 reduced the KI-16 reaction, while the positive pole caused the reaction to return. This is particularly interesting, since PC-9, the supplementation point, is usually antagonized by negative application and benefitted by positive application. Here, the effects must have been due to the biorhythmic properties associated with being "open," and not just the phasal characteristic of the point. Because open points can respond to polarity agents with a corresponding increase or decrease in abdominal signs and radial pulse strength, then they too must be related to the signal system. The ten-day stem method of biorhythmic treatments is easily demonstrable and of enormous clinical significance. It is possible that the sequence of open points is the product of the body's physiological response to normal variations in the geomagnetic field. However, any theory substantiating the open points will require large-scale data gathering and investigation. Many characteristics of these open points have yet to be mapped; for instance, the pattern of positive, negative, or neutral influences that cause each point to most effectively respond, remains to be discovered. What frequency of stimulation is best for each point? The biorhythmically open point is like an entry into the signal system. We have found that when using the wooden hammer and needle to tap the open point, by varying the frequency of tapping, we can target the responses (release of pressure pain) to specific channels in an almost exact manner. In the following example, remember that the same open point, GB-43, was stimulated with different frequencies with specific responses of each frequency. On a subject with pressure pain on KI-ll, the bladder channel diagnostic point, and on LU-1, the kidney channel diagnostic point, varying the frequency of tapping gave the following results: Frequency 120 ll2 126
Correspondence Kl, GB, SI BL LU,HT
KI-ll reaction unchanged decreased unchanged
LU-1 reaction unchanged unchanged decreased
Here, when we tapped GB-43 at 120 beats, no change was observed at KI-ll or LU-1. When GB-43 was tapped at ll2 beats, the bladder channel frequency, the KIll pressure pain decreased, but not the LU-1 pressure pain. Likewise, when GB-43 was tapped at 126 beats, the lung channel frequency, the LU-1 pressure pain
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decreased, but not the KI-ll pressure pain. This suggests the specificity of response of the ten-day stem method open points. Hence it appears we are able to target specific channels with open points depending on how we affect the points. Based on these results, we can see that the open points can be used for general treatments, regardless of the condition of the patient, as well as for specific imbalances. In the context of five-phase theory, the ten-day stem method is significant because the sequencing of points is heavily based on five-phase theory. Its clinical effectiveness helps validate the five-phase model. SIXTY-DAY LING GUI BA FA RHYTHM
The last biorhythmic treatment method we will discuss is the ling gui ba fa, literally the "spiritual turtle eight methods." This technique exclusively uses the eight extraordinary vessel confluence-jiaohui points in a complex sixty-day sequence. The order of acupoints in this sequence is derived by numerical or numerological methods. Some of the numerical correspondences lend further credence to five-phase theory, because they are based on, or derived from, five-phase ideas, correspondences and philosophies. The basis of the sequence is the eight trigrams of the later heaven sequence from the Yi Jing, or Book of Changes. (For the complete set of charts of the sixty-day cycle, see chapter 9.) Like the points on the ten-day stem method, these points respond antagonistically to polarity agent effects and are also sensitive to frequency stimulation selected according to the subject's problem. In a subject with pressure pain on the left medial side of the left gastrocnemius muscle (the kidney-large intestine reflex point), the wooden hammer and needle with metronome were used to stimulate the extraordinary vessel point that was the open point according the the 60-day ling gui ba fa cycle, GB-41. Tapping left GB-41 at a rate of ll2 (bladder) beats per minute had no effect on this reflex point, but at a rate of 120 beats per minute (kidney, gallbladder, small intestine), the pressure pain disappeared. From this example, we reason that the 60day open point, here GB-41, has a specificity of action like the ten-day stem cycle described above. Only when GB-41 was tapped at the kidney channel frequency (120 beats), did the kidney reflex pressure pain reduce. In another subject with pressure pain on the left gastrocnemius in the spleentriple burner reflex area, the same phenomenon was seen. Tapping left GB-41 at a rate of 120 beats per minute reduced the pressure pain a little, but at a rate of 132 beats per minute (spleen, stomach), the pressure pain disappeared. In a third subject having pressure pain at the same point on the gastrocnemius, tapping right GB42 (a non-open point, local to the open point, GB-41) at a rate of 132 beats per minute had no effect, but right GB-41 at the same rate reduced the pressure pain. In this case we observed not only the same phenomenon, but the specificity of the point action. In a subject with pressure pain on both KI-16 (the kidney channel diagnostic point), both KI-ll (the bladder channel diagnostic point), and CV-15 (a heart channel diagnostic point), we used the ion beam apparatus to test and treat the open extraordinary vessel point. At that time, KI-6 was the open point. Applying the negative electrode to right KI-6 had little effect on the abdominal reactions; applying the positive electrode to left KI-6 reduced the reactions a little. Applying the positive electrode to right KI-6 also had little effect as did applying the negative electrode to left KI-6. We then applied the positive electrode to left KI-6 and the negative electrode to right LU-7, the confluence-jiaohui point coupled with Kl-6. This eliminated all the abdominal reactions.
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Using these simple clinical tests to compile clinical results, we find that the extraordinary vessel open points appear to be also related to the signal system. It is our theory that open points are like temporal windows that give direct access to the signal system, and can thus have broad effects. We can see from the examples described in this chapter, and from the many other cases we have experienced in our practice, that with the exception of a few cases where treatment must be absolutely tailored to the patient's condition, these treatments work regardless of the patient's condition. This suggests that biorhythmic treatments must work, at least in part, by activating a homeostatic mechanism, process, or chain of responses. We can state that part of the signal system must be homeostasis; otherwise individual normalcy would be unachievable. Theoretically, the five-phase cycles and interactions are inherently ideas of homeostasis. The various cycles - the engendering, restraining, etc. - keep each other in check at some optimal or healthy level. The biorhythmic treatments, for the most part rooted in five phase logic, work homeostatically. The clinical results correspond to the theoretical descriptions. While the exact nature of these biorhythmic processes is not clear, their evidences may be rationalized by the general theory we have developed. Natural biorhythmic fluctuations are an integral part of the signal system. The ability of an organism to respond to subtle changes in the environment is essential to its ability to adapt and survive, which would appear to be an integral component of signal system function.
THEORETICAL SUMMARY In the context of our model of the signal system, which we have seen operating in nature and possibly in early evolution, these traditional Chinese descriptions of the organismic undercurrents in nature and the human body are perfectly rational and coherent. Using polarity agents we have arrived at a general description of the signal system and have begun to re-examine and re-theorize the channel, acupoint, and body structure relationships. We have seen some of the properties of yin-yang, the channel system, and the five phases. The five phases can be observed through the five-phase points on each of the twelve channels, through the phase correspondence of each channel, and to some extent through the study of open point biorhythmic cycles. The channel points are inseparable from the channels, but the channel surface contains non-channel points along its trajectory. The channel trajectories go superiorly and inferiorly, left and right, controlling the yin-yang oppositions in the body. In topology, a point can transform to a line, from a line to a surface, and from a surface to a solid object, the physical structure. The entirety and its parts are generally equivalent and inseparable. The body's signal system we have described conforms to these properties. We can use the language and concepts of topology to explain some of its functions. In particular, the information transmitted in topological transformations, and mirrored in the topological properties of a body, appears to be similar to some of the information handled by the signal system. In informational and signal system terms, we believe that in the body, at least, the descriptions of yin-yang and the five phases correspond not to mere abstractions but to general descriptions of physiological interregulation. We have found that five-phase theory is exact and mathematical. It is not recognized by physiologists because it is a signal system function and is not an effect that results from physiological stimulation.s In acupuncture and moxibustion, the signal effect and stimulation effect occur simultaneously and are difficult, if not
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impossible, to distinguish absolutely. However, by avoiding the stimulation effect, using minute polarity agents that activate only the signal system, it is possible to see the exact mathematical relations of the five phases, their correspondences and clinical rules. Observing, understanding, and utilizing these properties and characteristics requires an appropriate theoretical and methodological approach. In the future, mathematicians may be able to formulate these ideas and provide clear schematizations of these ideas, which first arose in the classical texts. For now, we must take advantage of them as the ancient Chinese have taught us by applying them clinically. Combining the phasal characteristics and properties with the yin-yang, octahedral properties, we are able to design and implement powerful yet simple diagnostic and treatment procedures.
CHAPTER ENDNOTES 1A simple functional explication of the term "isophasal" is: placement of agent X at acupoint A and agent Y at acupoint B can increase or decrease pressure pain at another acupoint, C. If we reverse X and Y, so that X is on B and Y on A, the reaction at C will reverse. However, if either placement of X at A with Y at B or X at B with Y at A gives the same response at C, then we can say that A and B are isophasal points. This is clearly seen in the example of copper and zinc placements at ST-36 and LI-11, or LI-1 and ST-45. 2 S.B.: These findings are explored mathematically in appendix 5 where a model capable of explaining these findings and reconciling them with the traditional descriptions is developed. 3 From J. Needham, Science & Civilization in China II:281-2 4 See the next chapter for discussion of these (and other) therapeutic devices. 5 For a discussion of this in the context of mathematical modeling of the five phases, see appendix 5.
SECTION THREE: REACHING FOR THE TAIL
TRADITIONAL CONCEPTS IN MODERN PRACTICE
CHAPTER SEVEN
SYNTHESIZING DIAGNOSIS AND TREATMENT FORMULATING A CLINICAL PICTURE The various theories of acupuncture and moxibustion can be seen against the background of the signal system as topological theories relating to structure, function and rhythm. Our experimentation has clearly established and verified the following postulates, based on and derived from classical theory: - The twelve channels have a direction of flow. The yin channels flow from feet to body and body to hands; the yang channels flow from hands to head and head to feet. - The twelve channels compose a continuous circuit. - Within this circuit there are three smaller circuits each composed of two yin and two yang channels - the four-channel sets. - The twelve-channel circuit evidences a circadian rhythm that is both a temporal cycle of maximum and minimum energies and a set of structural relationships (yin-yang, syntagonistic-antagonistic relationships). These structural relationships exist between the pairs opposite each other on the channel clock, (e.g., heart-gallbladder, bladder-lung). - There is a set of acupoints on each channel that coincides with the so-called five-phase acupoints. The same-phase points exhibit properties common to other same-phase points, that is, they are isophasal with each other. - The twelve channels also exhibit phase properties according to traditional teachings. - The channels and five phase points (the transporting-shu points) exhibit interphase relationships described by traditional teaching as aspects of the fivephase cycles, the engendering or "creative," "mother-child" cycle, and the restraining or "controlling," "husband-wife" cycle. - The supplementation and drainage points, two characteristic sets of phase points, exhibit polarity-dependent properties. - The eight extraordinary vessels directly relate to body structure and symmetry. That is, they relate to the octahedral dividing lines of the body; they cross the
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regular twelve channels at certain intersection points, through which they effect broad functional changes in the body. Generally, the eight confluence-jiaohui points of the extraordinary vessels are polarity dependent. - The channels also coincide with each other at intersection-jiaohui points that exhibit unique, polarity-independent properties, what we have termed the san yin jiao characteristic. - There are characteristic biorhythmically active points based on circadian, ten-day, and sixty-day cycles. Some of these are polarity dependent and some polarity independent, but all produce general effects throughout the body. The results of our experimentations have led us to formulate a model of an Xsignal system that is essentially bio-informational with a primary regulatory function. Our model proposes that this information system has primarily homeostatic functions, regulating the overall energetic condition and the overall physiological condition. The evidence we have gathered suggests that acupuncture, in particular the channels, qi, yin-yang and the five phases, participate in this signalling system. Treatment that takes advantage of, and activates changes in this system, can produce diverse effects because potentially the whole biological system can be affected. If the function of the information system approaches the ideal, then the body will function optimally. It will tend to resist disease and, should a disease condition arise as a result of any of a variety of causes, so long as it does not reach a stage of organic degeneration, a timely recovery will occur. Should a derangement of the information system arise such that part of its overall control is lost and the body ceases to function properly, a small intervention from the outside can nudge the body's internal regulatory system back in the right direction and restore proper function. This X-signal system is essentially not anatomical (though in microscopic structures it may have some physical expression), just as the various theories of the channels, yin-yang, and the five phases are not clearly anatomical. The system is described by what are essentially hidden or enfolded, primitive biological properties which we believe arose through various stages of evolution and were then masked by the development of the more efficient automation systems such as the nervous and endocrine systems. This process of enfoldment probably involves their being absorbed into the body of information stored, for example, in the genetic information carried by the DNA. As such, the information now represents a reserve of potential information that is unfolded only with the correct stimulus, influence, or condition. In the process of unfoldment, we can see manifestations of the clinical laws of acupuncture that were classically formulated as channel, yin-yang, extraordinary vessel, five phase, and biorhythmic theories. The techniques we have designed and used to elicit these manifestations employ polarity agents, the nature of which produce effects so small that they do not primarily elicit neurohumoral or other clear biological responses, many of which are involved in the effects of acupuncture and moxibustion when stronger stimulation is applied. Instead, these polarity agents stimulate at the signal system level. By developing systematic methods of testing and utilizing these agents, we are not only able to confirm the biological existence of the various theories of acupuncture and moxibustion, and related clinical laws, but we also are able to formulate new clinical rules and systematic, reliable treatment methods that synthesize traditional methods and modem ideas. This new system, composed of many subsystems, is not a closed system. With careful research, testing, and observation, it is possible to interface the methods and concepts of other systems with those presented here.
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Since the information system operates with tiny amounts of energy, it can be affected and regulated with equally minute amounts of energy. An advantage of using this intervention as a method of treatment is that there is little danger of causing any damage in the form of side effects. This intervention in, or interference with, the information system, is carried out with the following principal aims: Activation: increase of function with an appropriate amount of stimulation, both in the sense of addressing hypofunction and in the traditional sense of correcting conditions of xu, vacuity.
Suppression: reduction of excess activity, both in the sense of addressing hyperfunction and in the traditional sense of correcting conditions of shi, repletion. Rebalancing: activation of homeostatic mechanisms using appropriate methods and amounts of stimulation. Induction: modification of the directions or locations of the body's reactions, both in the structural sense and in the sense of creating a kind of energetic symmetry. Transformation: alteration of processes that have biphasic patterns, for example, taking advantage of biorhythmic fluctuations. Stimulation: the use of stronger stimulation to correct imbalances, used primarily in difficult, stubborn cases. Using this approach we are able to perform simple, systematic, highly effective treatments. Following the theories we have proposed, the systematic, step-by-step use of the signal system can be formulated as a "root" or general treatment approach. Based on our octahedral, yin-yang model, we can target different yinyang surfaces one step at a time to effect a rebalancing of the body's yin-yang system. Thus we might term this approach a "yin-yang treatment style." This style has the following purposes and merits: - Regardless of the nature and complexity of the patient's condition, we are able to equilibrate total body imbalances. This is particularly important and useful in many kinds of functional diseases that are otherwise difficult to diagnose, and equally difficult to treat. - We are able to economize on the number of points used and the doses of stimulation given to these points. As a result, even if incorrect treatment is given, no serious harm is done and side effects are few. - We are able to minimize the symptom control treatments. - For each step in the general yin-yang treatment procedure, we are able to obtain feedback as to the relative success and effects. This gives us the immediate possibility of modifying our technique or selection of points according to need~ - We can utilize the repeatable and demonstrable effects of polarity agents to great advantage. These polarity agents include ion-pumping cords, the ion beam device, and the electrostatic adsorbers. North and south pole magnets and zinc and copper pellets can be used, though our own experience dictates a preference for the first three devices. It is important to note as well that the efficacy of treatment depends on the functional makeup of the information system, which is complex and stratified. Because of this complexity and stratification, a uniform pattern of intervention cannot be expected to produce a constant and uniform set of effects. Thus, treatments must be tailored to suit the individual.
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Further, patterns of treatment will differ and produce different results depending on the range within which the intervention is introduced. For example, if a symptom such as pain is considered simply a local problem, the treatment will be administered locally as a symptomatic treatment. If the pain is considered an expression of an imbalance of the entire body, then the treatment will be holistic and general. Classical channel treatment according to the five-phase theory of acupuncture or the eight extraordinary vessels exemplifies this approach. Finally, the degree to which the concept of patterns of treatment plays a role in the effectiveness of the therapy depends on the abilities of the therapist. For example, if the therapist is able to take both external and internal origins into account, and is able to consider the ecology of the individual's environment, the possible treatments will become more numerous and more effective. His or her attitude toward the execution and focus of treatment will be more universal. In effect, the broader and deeper the therapist's education, and the less prejudiced their view, the greater the range of therapy. We have found that the most interesting aspect of channel therapy is not dealing with each one separately, but taking their various relationships into account. Point combinations that are derived from relationships are able to work with synergistic effects, and absolute, though not indefinite, properties. The best treatment system is one that treats the channels flexibly by using combinations of points on the right and left, superior and inferior, anterior and posterior portions of the body. Diagnosis and treatment must be designed with the primary goal to correct imbalances and asymmetries, and only secondarily to address specific symptoms. Hence all of the practitioner's senses and sensitivity must be trained to discriminate delicate and subtle differences in the patient's condition. Within the field of traditional medicine, a wide variety of diagnostic methods exists. These medical procedures, invented in ancient times, depended on the use of simple, unsophisticated techniques of inspection and palpation. However, for diagnoses directly related to the information system, a specialized, functional system of diagnosis, based on palpation, is required. In the signal system model, the concept of diagnosis, the zheng (akilshi in Japanese), differs from Western biomedical diagnosis in several important respects. A Western diagnosis arrives at a disease name, which is an expression of functional and organic changes. Akilshi is a collection or pattern of signs and symptoms that center on a treatment adaptation or method. Thus, depending on what treatment method is selected, the akilshi will be different, where in Western biomedical terms, several cases might all be the same disease entity, regardless of treatment possibilities. For example, "gastric ulcer" is a Western diagnosis that remains the same regardless of the therapy to be used. Akilshi can be said to depend on the intentional consciousness with which we observe the patient. This is, again, the software that plays a significant role in acupuncture and East Asian or Oriental medicine. However, this makes the akilshi dependent on the style, experience, sensitivity, and ability of each practitioner. Provided that diligence is maintained, and each patient's case is studied with care, the development of this kind of flexible approach to diagnosis, treatment, and assessment is a great benefit to patients. Patients with complaints that are undiagnosible by Western medicine, complaints that have been accurately diagnosed, but for whom allopathic treatment has not succeeded, or patients with multiple complaints, often benefit from this akashi-based approach, because the less rigid diagnostic concept permits a therapeutically tailored diagnosis.
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ROOT TREATMENT AND SYMPTOM CONTROL TREATMENT In the traditional practice of acupuncture and Oriental medicine, therapy consisted of a root or general treatment (ben zhi fa in Chinese, hon chi ho in Japanese), followed by a symptom control or local treatment (biao zhi fa in Chinese, hyo chi ho in Japanese). The root treatment was intended to equilibrate basic energetic problems, to balance and restore harmony to the body. The symptom control treatment was intended to address specific symptoms. Because it was also understood that symptoms could cause general, whole body imbalances, the distinction between symptom control and general treatments was given credence in treatment structure and approach.
With a root treatment, diagnosis and effective therapy can be administered for complex conditions that may not have clear symptomatic relationships to patterns, to diseases, or to indications for standard treatment methods. Complaints having no clinical or established etiology or progression in Western medicine can also be treated. For example, symptoms such as dysmenorrhea, fatigue, or pain are often subclinical. These conditions are identified with disease names, but without clear treatment strategies. Yet such conditions are easily treatable when we adopt an approach that looks for whole body imbalances and uses alteration of the informational and regulatory system for correction. Symptoms, local conditions, can be seen as resulting from broader whole body imbalances. Correction of the overall imbalance often will relieve even quite diverse symptoms. Further, the same diagnosis and treatment patterns can be useful for different patients with diverse symptoms. Local problems, such as trauma, may also be sources of whole body imbalances that can be treated at the source level with the root treatment method. In conditions such as lesions or degenerations, where organic changes have already occurred, root treatment accelerates the healing and repairing processes. Since root treatments are aimed at nudging the body's homeostatic mechanisms so that the body heals itself, these treatments are usually very simple. This simplicity is quite different than treatments that remain only at the level of symptom control. Symptomatic treatment without information regulation treatment can be complex, for if a patient has a number of complaints, many points must be selected to address each complaint one by one. Symptom control treatment that follows an information regulation treatment can be much simpler. Because a root treatment affects the energies at a much deeper, primal level, it requires only a small amount of energy. Further, the symptom control treatment that follows a root treatment typically requires fewer points and only small amounts of energy. Today the channels seem to be used for symptomatic treatments. For example, many Japanese texts list symptoms that exist when the lung channel is replete and then recommend that certain points on the lung channel be drained when these symptoms are present. This is not so different from listing the indications of individual acupuncture points as is the practice with the ba gang bian zheng system. This information has value as a reference, but it does not give the clinician a systematic or reliable method f~r the selection of acupuncture points. Since diagnosis is often quite complex, requiring intricate patterns of points that are not experimentally investigated, but empirically justified, there is no idea of systematic validity. Since the treatments so justified are not staged, or even discussed in terms of imbalances, the effects of individual treatments are not assessed.
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FORMULATING A MODEL OF DIAGNOSIS AND TREATMENT
We propose a model of diagnosis and treatment that utilizes the techniques of classical acupuncture in combination with more modern systems. For our model, we consider it most important to divide the classical channel therapy into a few relatively simple subsystems or steps. This way treatments can be provided at each step and these treatments will have a direct relevance to the factors being examined. If a certain treatment is not effective in accomplishing the specific objectives of a particular step, then another technique or combination of points can be employed. Diagnostic assessment and treatment interweave; depending on the degree of success at each step, the next step or two may be skipped. This decision is based solely on individual assessment. Thus, each consideration is tested and retested, and a treatment assumption that fails never becomes the foundation of further misassumption. These treatment steps are as follows: Step One: Treatment to adjust the octahedral, isophasallevels on the front of the body Step Two: Treatment to adjust the octahedral, isophasallevels on the back of the body Step Three: Ttreatment to adjust musculo-skeletal functional and structural imbalances Step Four: Symptom Control Step Five: Recommendations to the patient In our model, treatment starts with the three steps of the classical channel treatment system (keiraku chiryo) and is followed by more symptomatic methods of treatment. If the root treatment is successful, it reduces the overall number of points we need to use. Sometimes we need to address patients' symptoms first because we must relieve their suffering. However, the practitioner might bear in mind that continuous effort should be made to perform therapy using the minimum number of acupuncture points possible - maximum benefit for minimal intervention. Although the number of acupuncture points and the amount of stimulation may be increased when the need arises, care must be taken not to exceed the individual's limit beyond which unnecessary side effects arise. We have found that combining classical treatment methods with more modern therapies will most often be effective for root treatment. Fortunately, as practitioners, we can access many healing paradigms practiced by many doctors over many years. Classical treatment methods that are still applied in clinical practice by different schools and practitioners, to varying degrees, include the following: - Jingluo channel therapy (keiraku chiryo), using the channels and their phase points - Jing jin channel sinew therapy - Jing bie channel divergence therapy - Qi jing ba mai extraordinary vessel therapy - Liu zhu zhen fa biorhythm treatment systems - Bloodletting therapy - Okyu, moxibustion therapy - Cupping therapy
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More recent treatment systems include the following: - Wrist and ankle acupuncture therapy of Zhang Xin Shu - Ryodoraku diagnosis and therapy - Voll's electrodermal diagnostic and therapeutic methods - Motoyama's A.M.I. diagnosis and therapy - Akabane imbalance methodology (heat sensitivity and intradermal needles) - Nogier auriculotherapy - Chinese auriculotherapy - Tae Woo Yoo's hand acupuncture therapy - The Ishikawa system (an electrodermal methodology) - Barefoot doctor acupuncture from China - Electroacupuncture -
Scalp acupuncture Regulation of autonomic nerve imbalances Stimulation according to the neural dermatomes Acupuncture analgesia and anesthesia
It is worth noting that the combined use of two completely different modalities can achieve rapid improvement in the efficacy of treatment. For example, using auricular points combined with reflex points on the hand can deliver rapid and successful results in therapy. At times there are many connections between two such systems; on other occasions there are none. For example, there are points of association between abdominal diagnosis and channel therapy. Particular points on the abdomen can reflect the condition of specific channels. However, the combination of the systems of abdominal diagnosis and auricular points can be an unfortunate one, since their correlation is not obvious or well demonstrated. In such cases, using a third system as an interface between the other two can produce a single coordinated system. For example, the five-phase point system and auricular points appear to have little in common. If five-phase correlations can be demonstrated relative to the acupuncture points of the auricle, the two systems can be combined, allowing a further logical interface between the diagnostic and therapeutic methods of abdominal diagnosis, five-phase points and auricular points. In our experience, for root treatment, selecting from classical channel therapy, channel sinew therapy, extraordinary vessel therapy, or biorhythmic treatments has provided the greatest effectiveness and utility. The symptom control methods we most frequently and successfully use are auriculotherapy and hand acupuncture therapy, moxibustion therapy, bloodletting and/ or cupping therapies, and occasionally barefoot doctor acupuncture or scalp acupuncture. Using these methods, we are able to perform effective and well-rounded treatments in almost all cases. This is our treatment approach, which we will describe in detail in the next few chapters. However, it is possible to design different treatment combinations. Our selections for root treatment are primarily based on the findings and experiences described in the preceding chapters, where we saw the channels, yin-yang, the five phases, the channel sinews, the extraordinary vessels, and biorhythms as all participating in the signal system, the body's information and regulation system. We have also found that the unvarying use of the same pattern of treatment will not necessarily bring about the fulfillment of a particular objective; several
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other systems may be more useful, depending on the individual. The practitioner must watch the patient's reactions and make timely selections and changes of treatments. Simplicity is the keynote in the root treatment method. Trying to combine too many of these systems is not helpful. We use the root treatment to alter the information control system, the signal system, so that overall body imbalances can be corrected. Many times, simply counter-biasing the information system, the regulation system, will additionally relieve symptoms. When the general imbalances are corrected, the symptoms are corrected. When such interference in the information system is not enough, then specific symptom control treatment is required. Sometimes symptom control operates at the signal level, but often it works with physical stimulation. The effectiveness of treatment will be determined by the choice of acupoints made. When a particular treatment system is followed, the problem is to know how to limit, or how to expand, the arena of treatment. Methods of assessment and reassessment are required for each treatment method used. The subdivision of the root treatment and symptom control methods is related to this principle. For example, if the symptom control treatment is carried out on the grounds that a symptom such as pain in a particular location is a disease phenomenon, a certain effectiveness is to be expected. However, from other perspectives, many questions arise. Should the pain be treated as referred pain? Should it be considered as associated with one or more channels and be dealt with by channel treatment? Should these channels be treated separately or with reference to the entire channel system? Should time considerations play any part? Many approaches are possible, and the most appropriate should be selected for each patient. Finally, forming new systems by combining those listed above, or altogether different systems, should involve at least an attempt to equilibrate total body imbalances. It should also use diagnostic methods that are easily repeatable and assessable so that the adequacy and efficacy of any treatment can be determined. Longterm criteria will be necessary to enable examination of the overall objectives of the whole logistical system, and the synthesis of subsystems, to determine if treatment goals have been fulfilled. Vigilant examination of the body structure, muscle forms and other visual signs also plays an important role. In addition, the M.I.D. technique can be used. Allopathic Western diagnostic tests such as tests to monitor blood chemistry and blood levels, may also be incorporated usefully for this purpose.
TOOLS OF THE TRADE Over the years, we have invented, tried, and tested numerous tools, devices, and gadgets. My own clinic closets appear similar to the museum in Paris that we visited. I have many different machines and devices that we tried and no longer use, many that we occasionally use, and a few that are routinely used. Typically, devices and machines that apply relatively strong stimulation, such as electroacupuncture machines, fall in the category of rarely if ever used. This is because through years of study and clinical trial of our signal system theory, we have come to realize that it is difficult to control or effect the signal system using strong stimulation. Since our basic approach has evolved into one of regulating the signal system, it has seemed generally unhelpful and unnecessary to use machines that give stronger stimulus. Thus it is that machines and devices which apply small or tiny stimulus have, for the opposite reasons, become the tools of our trade. Many modem schools of
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thought in acupuncture seem to prefer the "more is better" approach; hence few tools which deliver small, controlled stimuli have been widely available. Partly because of this, and partly because of my own inquisitive and inventive nature, I have designed and invented a range of treatment tools and devices capable of giving a controlled, small stimulus, thereby allowing us to effect and regulate the signal system. The various tools I have designed, or have had a hand in designing, and which are referred to throughout this book, include the ion-pumping cords, the ion-beam device, the electrostatic adsorbers, the Manaka wooden hammer and wooden needle, and LED light sources delivered through fiber optic arrangements. Other tools which we have used, particularly in our theoretical and clinical studies, include north and south facing magnets for bi-polar magnetic techniques, copper-zinc or gold-silver application for 2-metal contact techniques, thumb and little finger for polarity touch, and color application for polarity and phasal actions. A notable clinical advantage in the use of these polarity agents is the greater control gained over the therapeutic effects. This control circumvents excessive stimulation and adverse reactions. Because the signal system operates with low-intensity stimuli, the use of these polarity agents is well-suited to treatment of the signal system. An added advantage over use of strong stimulation, such as that given with deeply inserted and strongly manipulated needles, and especially with electroacupuncture, is that shorter, simpler stimuli give the practitioner more time to assess and regulate the extent of treatment. A
STIMULUS Stimulation
Figure 7.1: Graph of types of stimuli and response
Treatment A (using strong physical stimulation) can arrive at the desired condition quickly, but can also easily overshoot, producing symptoms of overdose such as extreme fatigue, nausea, or light-headedness. Treatment B (using polarity agents, low intensity stimuli), nudges the body to adjust slowly back to the desired condition. There is less chance of overshooting optimal stimulation and causing adverse reactions or effects. In the chapters following, we will describe various treatments where use of polarity agents is required. In these cases, the ion-pumping cords, the ion beam device, and the electrostatic adsorbers are most frequently used. The two-metal contact and bipolar magnetic contact techniques could be selected, but we use these primarily for research purposes. Unless otherwise stated, the three techniques can be used interchangeably.
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GENERAL GUIDELINES FOR CLINICAL APPLICATION OF POLARITY DEVICES
When using polarity devices in the clinical setting, the patient should be asked to remove all jewelry and nylon clothing touching the body surface, in order to avoid mixing electromagnetic signals. The principle is to eliminate electrically active, electrostatic, or conductive sources, while making the abdomen and other important palpatory areas available. Since some Western clothing fashions are rich in interfering materials, Western modesty can conflict with clinical utility. The best compromise may be to advise patients to wear loose, natural fabric clothing on treatment days, or to have cotton examination robes available. Be sure that the patient is comfortable and relaxed, in a supine position. The knees may be raised if necessary, to ease any low back discomfort. The surroundings should be comfortable, safe, sufficiently warm, and not too bright or too noisy. Furthermore, when using ion-pumping cords, ion beam, or electrostatic adsorbers, it is best not to needle any other points simultaneously. It has been our experience, for example, that needling points that lie above the dai mai, while treating SP-4 and PC-6 with ion pumping, can give unfavorable results. Before we delve further into the intricacies of diagnosis and treatment, it would be useful to examine the history, development, and construction of the three primary polarity devices we use, and as well offer some helpful guidelines as to their clinical uses. DEVELOPMENT AND GUIDELINES FOR USE OF THE ION-PUMPING CORDS
In the 1940's, I invented a treatment for burns using the ion-pumping technique.l With severe, painful burns, excessive numbers of positive potassium ions abound in the area of the burn. The disruption of the cell walls in the damaged area is the source of the potassium ions. Thinking that it would be helpful to move these positive ions to other areas of the body, I experimented with many ways to achieve this goal and found the following useful. With the patient reclined on an insulated table, I attached the negative lead of a Van de Graaff generator to an undamaged part of the body. I then covered the burn with a sterile, thin, metal foil, attaching a metal chain and a germanium diode with the opposite (positive) end attached distally on the body. I found that this produced excellent results treating burns. It eliminated or greatly reduced the pain of the burns and accelerated the healing process. After these initial experiments and findings, I then refined and developed the method to treat other diseases. I found that ion pumping (I.P.) techniques applied to the eight confluence-jiaohui points on the extraordinary vessels were particularly useful; I was able to eliminate the use of the Van de Graaff generator, and I devised systematic treatment methods using these eight points.
Figure 7.2: Photo of the Manaka Ion-Pumping Cords
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An ion-pumping cord is essentially a copper wire or silver chain with a germanium or silicone diode in it. This composition allows a unidirectional flow of electrical current through the wire, creating part of a circuit. Theoretically, attaching the positive and negative clips of an ion cord to two needles inserted shallowly will create a polarity between the two needles and electronic and ionic currents will begin to flow inside the body. In my early research and experimentation with this theory, I referred to it as "tiny electronic communication." The research difficulties posed by this treatment style were daunting, as the amount of electric current flowing is minute and difficult to measure. The devices that could measure the current would both become part of the circuit and introduce electrical potentials much larger than those supposedly measured. Realistically, it seemed that this phenomenon might be justified only from experience, in the same way that traditional acupuncture and moxibustion treatments have no scientific proofs, but substantial statistical evidence. The weight of the clinical and statistical evidence that accumulated demanded some theoretical model to explain the phenomenon, and eventually the ongoing research of this model gave rise to the signal system hypothesis. There is as yet no "hard science" proof of the I.P. model. The most favored explanation of the theoretical mechanism of the ion-pumping cords postulates a flow through the wire of a negative charge from the red to black clip and positive charge from black to red clip.
~ ------------------~
Figure 7.3: Positive-negative charge flow on the ion-pumping cords
Inside the body tiny electronic and ionic currents are difficult to describe. They must occur; otherwise, there would be no circuit. Any number of the following might be occurring:2 - Rapid electron currents across the skin surface between the needles. - Rapid and/ or slower electron currents through the superficial and deeper tissues between the needles.3 - Slower, positive and/ or negative ionic currents through the body fluids between the needles.4 - A relative electrolytic effect, where the tissues and fluids at the needle sites undergo slight electrolysis, acting as relative anode-cathode sites that produce electronic and/ or ionic currents for some time after the needles are withdrawn. Any or all of these mechanisms might occur, and other possibilities not yet mentioned. Whatever the mechanisms, the currents involved are, we believe, too minute to stimulate the nervous system directly, and are so small that we have not been able to measure them accurately. Further, there is a curious fact about the ion pumping technique. Because the ion-pumping cord is a wire with a diode in it, the cord can act as an antenna for electromagnetic fields, and converts these magnetic fields into a small current that flows in only one direction according to the orientation of the diode. In experiments where subjects were treated in an environment shielded from the normal background of environmental magnetic and electromagnetic fields (i.e., in the depths of a mine shaft beneath a mountain or in a Faraday cage), the cord technique did not produce results. Only when artificially produced
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fields were introduced to the vicinity of the cords did they begin to work. This suggests that part of the mechanism of the ion-pumping cords involves the production of minute electric currents in the wire from the transduction of external fields. The difficulties we experience in describing exactly what occurs when we use the ion-pumping technique hold true for the other polarity agents we use in research and treatment. The mechanisms involved in the use of the two-metal contact technique, the bipolar magnetic technique, the ion beam apparatus, and the electrostatic adsorbers may well show some slight variance from the ion-pumping technique, but all agents produce a minute positive-negative electrical polarity. When selecting the ion-pumping cords for clinical treatment, it is important to note that needle placement always precedes cord attachment. Correct point location is necessary for ion-pumping to be effective. Special attention must be given to locating the treatment points. Once the needles are inserted, the clips may be attached to the needles. Needles are always inserted shallowly (about 2 mm.). The insertion angle is either perpendicular to the surface at the point, or oblique (around a 45° angle) in the direction of channel flow. Since the needles are only shallowly inserted, special care is required when attaching the ion-pumping clips. If the weight of the clip pulls against the needle, it can be sufficient to pull out a properly inserted needle. Position the clip so that it does not dislodge the inserted needle. Number 2 gauge Japanese needles are ideal for use with the ion-pumping cords. Number 3 can also be used, if number 2 are not available. Number 1 gauge needles are often too thin and are pulled out too easily. Number 4 and thicker needles are too thick, and can be overly stimulating. With ion-pumping treatment, all the needles used should have the same gauge. Insertion should be painless and should give no stimulation. In Japan, they say that the practitioner's needle insertion technique should be so good that inserting a needle into a sleeping cat would not wake it! The needles with ion-pumping cords attached are retained for 10 to 20 minutes; generally 10 minutes is sufficient time. When proper treatment with the ion-pumping cords is administered, the patient will quickly become relaxed and the abdominal reactions should improve. Occasionally, the ion-pumping technique can be too strong. Rarely, it may irritate a condition. Care should be taken to check for any of the following: - patient agitation - discomfort - flushing - worsening of abdominal reactions If you have followed the testing procedures for determining a diagnosis, these problems will not occur. If any of these reactions do occur when treating the extraordinary vessel points, unclip the ion-pumping cords and reverse the attachments (red to black, black to red, not crossing). Usually this will correct the problem. However, if the reactions persist, or continue to worsen, remove the ion-pumping cords and the needles. Recheck your diagnosis. Likewise, if these reactions occur when treating the polar channel pairs, check the connections, then stop the treatment. Do not reverse polarity when treating the polar channel pairs. (There are only occasional exceptions; all concern the yang channels.) The ion pumping (or other polarity agent) treatment can be expected to decrease the abdominal reactions; thus it is important to recheck the palpable reactions to insure that the treatment is producing the expected results. Don't anticipate a "cure" with one treatment and don't expect all the abdominal reactions to disappear with one treatment. Generally it takes a course of treatments to create those changes.s
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During the ion-pumping treatment, it is not uncommon for the patient to complain of having a very itchy nose or itchiness to the sides of the nose. This may be difficult for the patient, but is actually a good sign that the treatment is working well. It is a good idea to check the electrical conductivity or the integrity of each cord periodically. This is easily achieved by hooking the cord up to a simple electrical meter to measure resistance. DEVELOPMENT OF AND GUIDELINES FOR USE OF THE ION BEAM APPARATUS
Recently, the Deutsche Gesellschaft Fur Akupunktur school won a prize for its research essay on the different effects of silver and gold needles. Stimulated by this, I did my own research and discovered that placing two different metals on the channels in different patterns produced certain effects according to how and where they were applied. I called this the "two-metal contact technique." The application of copper and zinc is believed to add a small voltage to the channel and to cause a small current to flow. While not yet accurately measured, this is believed to be similar to what is shown in the following diagram:
~ -
-------------------
+
Figure 7.4: Diagram of voltage causing small current to flow in channels
This technique proved extremely useful in researching the problems of tiny electronic communication stimulation of the body. Application of this technique and the bipolar magnetic technique is very easy because the points only need to be touched to produce the effects. Wishing to further refine clinical research into the tiny electronic communication techniques of stimulation, I then devised the ion beam apparatus, which has also proven extremely useful in both research and application.
Figure 7.5: Photo of the ion beam apparatus
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The ion beam apparatus utilizes cylindrical coaxial conductors with negatively and positively biased wave forms of electric current passing through the conductors so that they produce very weak negatively and positively charged electrical fields or "beams of energy." These can be applied to a small point on the skin surface, producing low levels of electrolysis, ionization, and current. We offer the following more detailed explanation of the ion beam device. In acupuncture anesthesia, there is a pulse transmitter intended to produce needle anesthesia. It has two polarized outlets.
Figure 7.6: Wave Form
The first (la) uses a wave form with positive bias. The second (lb) uses a wave form with negative bias. They both have sawtooth wave forms alternating with spike wave forms. Passing these wave forms through a cylindrical coaxial conductor generates polarity beams.
lb
()
la
+ (-)------------~---la
()
()
lb
Figure 7.7: The cylindrical coaxial conductor
In one conductor, wave form la is passed through the central axis, with lb
passed through the tubular axis. When these pulses pass at the same time through the coaxial conductor, a small beam field is generated at the other end. This beam has only a minute stimulatory effect. In the second conductor, we reverse the wave form polarities: lb is passed through the central axis and la through the tubular axis. This produces a beam field of opposite, but equally minute effect. Using the first beam is like using the north magnetic pole; this is the positive beam. Using the second beam is like using the south magnetic pole; this is the negative beam. The effects of the ion beam apparatus are localized field effects. Nothing is inserted into the body and nothing is actually placed on the skin surface. There are no sterilization problems, no fear of needles, and great simplicity of use, provided
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that a correct diagnostic assessment is made. These positive and negative beams are also useful for researching the signal system. They produce effects similar to acupuncture stimulation. We can thus examine yin-yang imbalances and their regulation with this device as well as the effects of various point combinations. When treating with the ion beam device, it is important to note that for higher frequencies the time limit should be shorter, for lower frequencies it can be longer. The minimum to maximum range is roughly 20 seconds to 1 minute. (Some practitioners think that even twenty seconds is too long.) The ion beam electrodes need only to be held lightly to the points. This is sufficient to obtain a therapeutic effect. DEVELOPMENT OF AND GUIDELINES FOR USE OF ELECTROSTATIC ADSORBERS
The electrostatic absorbers are entirely different in their construction. They are essentially metal rods with an extremely sensitive ceramic capacitance device built into them.
Figure 7.8: Photo of Electrostatic Adsorbers
This device actually withdraws the static electrical charges that are caught or stored in body tissues, adsorbing them as it were, when the rods are touched to the body surface. By placing oppositely directed diodes in each of a pair of these metal rods, they are given a very slight positive-negative polarity. The adsorbers have been developed only recently, and like the ion beam and ion-pumping cords have proven highly useful for both research and treatment. Not only are they free of sterilization problems, but their application is extremely simple, needing only to be touched to the relevant points. When treating with the electrostatic adsorbers, the relevant points may be touched with a slight pressure and contact retained for 20 seconds to 1 minute. This is usually long enough, though sometimes as long as two minutes may be required to obtain sufficient effect. The length of contact time should be determined by careful monitoring of the rate of change shown by the reactive points and indications selected as feedback. If you are not completely clear about the choice of points in a treatment, for instance whether KI-6 or LU-7 should be used with the ion-pumping technique, you can touch the electrostatic adsorber or ion beam to the point, selecting the polarity you want to test. Five to ten seconds is long enough. If the abdominal or other reactions improve, this confirms your diagnosis, choice of points, and polarity of treatment.
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CHAPTER ENDNOTES 1 More details of this can be found in Matsumoto, K. and S. Birch, Hara Diagnosis: Reflections on the Sea, pp. 254 passim. (Ed): Like many inventions, ion pumping was the result of extreme need, in this case, Dr. Manaka's efforts to treat masses of war-injured persons without conventional medical supplies. 2 See Matsumoto, K. and S. Birch, Hara Diagnosis: Reflections on the Sea, pp. 210-212, for discussions of possible current effects. 3 Hiroshi Motoyama claims to have measured electric currents moving through the dermal connective tissues. See Motoyama, H., "A biophysical elucidation of the meridian and ki energy; What is ki energy and how does it flow?" Research for Religion and Parapsychology 7, no.1 (Aug 1981). 4 Bjorn Nordenstrom has developed a model of such ionic currents. See Nordenstrom, B., "Biologically closed circuits: clinical, experimental and theoretical evidence for an additional circulatory system," private publication. See also: Taubes, G., "An electrifying possibility," Discover (April1986), pp. 22-37. 5 S.B.: We have noticed when teaching ion-pumping cord technique that very exact point location is crucial. The difference between a significant (greater than 50%) improvement in abdominal reactions and little or no improvement, may be only 1 or so millimeters difference in point location. Thus the first step to take, if little or no change in abdominal reaction is noted within 2-3 minutes of cord application, is to check point location. Often, re-locating and re-needling the point will produce the desired results.
~
~-
~~
CHAPTER EIGHT
DIAGNOSTIC ASSESSMENT FORMULATING A DIAGNOSIS DIAGNOSTIC METHODS INVOLVING THE BIOLOGICAL INFORMATION SYSTEM
Since traditional times, practitioners have performed a diagnosis based upon the gathering of information by the "four examinations" -looking (visual examination); listening/smelling (auditory and olfactory examination); asking (questioning the patient); and touching (tactile examination). Many systems of diagnosis which employ the four examinations have been proposed and passed down, each emphasizing different aspects of technique. In China for example, modern diagnostic emphasis rests strongly on asking diagnosis, whereas in Japan today, the emphasis rests strongly on touching diagnosis. Our own system of diagnostic data-gathering and decision making likewise calls upon the four examination methods. Based on our research and extensive clinical experiences, we have focused on certain diagnostic methods and have systematized them into a coherent and relatively simple system. In our system, the important steps in formulating a diagnosis are: - Visual examination (skin, muscle tonus, posture) - Tactile examination (palpation) Palpating the radial pulses Investigating the pattern of abdominal or mu point reactions Palpating areas on the gastrocnemius muscles Palpating various other areas of the body, such as the back, neck, arms, and legs Even when complaints or diseases vary, in diagnosis we seek a common pattern with the aim of balancing the body as a whole by providing treatments using standard point combinations. Thus, we need a simple procedure that helps us discover this common pattern. We also need techniques both to confirm the diagnosis of this pattern and the selection of the points to treat the pattern. It is here where simplicity and systematization are important. Palpation of the abdomen, chest, and various other parts of the body provides both the signs necessary to observe the pattern - via the detection of pressure pain, tension, tightness, etc.- and the medium required to test and confirm the diagnosis and treatment.
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After checking these, you should reach some diagnostic conclusions. These may be confirmed using either the Omura 0-ring test, or by testing reduction of point reactivity using a polarity agent. VISUAL EXAMINATION
In terms of assessing the overall condition of the patient's energy, visual examination is often helpful. Patients with a large, full frame have what is traditionally called a yang or replete (shi) constitution. Those with a thin, weak frame have a yin or vacuous (xu) constitution. Typically those with yang constitution recover from illness more quickly than those with a yin constitution. Inspection of the abdomen is particularly useful. If the abdomen is full and rounded with a wide costal arch, this is a yang patient. If the abdomen is thin, with thin, weak, flaccid muscles, a narrow costal arch, loose skin, and a sunken appearance, this is a yin constitution. Generally, if the lower ribs and costal border region are distended, with visible raised venules, or vascular spiders (in the subcostal and lower costal regions), this indicates the yin wei-chong mai extraordinary vessel pair, and therefore the potential of liver, spleen, stomach, gallbladder, and heart channel involvement (though especially the liver). If the abdomen is thin, depressed, and with poor tonus, this indicates the yin qiao-ren mai extraordinary vessel pair. In particular, if there is accompanying tightness in the muscles of the lumbar region, this indicates yin qiao mai-ren mai involvement. Inspection of the skin, to observe the color, hardness and elasticity, should be noted locally and over the body as a whole. This is particularly important for the diagnosis of blood stasis in the lower abdomen. The superficial layer of the skin is an important location for treatment with special acupuncture techniques, for example, subcutaneous (intradermal) and scratching needles. In the case of liver problems, visual examination of the skin is most helpful. In particular, you can look for areas of dark pigmentation along the lower border
of the chest or upper abdomen, in the regions below the eyes, and outward from the lower border of the nose:
-------------------------------:------- ------------::::.-----Figure 8.1: The Hirata Liver Zone
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Figure 8.2: Liver diagnosis area on the back Pigmentation, particularly in these areas, is often the key to a diagnosis of liver weakness. As well as being indicative of liver problems, such signs are more generally indicative of blood stasis problems. This is a term used in the traditional literature, but in this context we can assign it a specific technical meaning. Blood stasis is a condition where some obstruction has occurred in microcirculation. Typically it may manifest in the following situations: - as a byproduct of the natural breakdown of the cellular elements of blood; - from incomplete menstrual flow; - in association with local swelling, edema, and discoloration of an area due to trauma or bruising; - as a result of blood transfusion; - in conjunction with hemolysis occurring during a febrile disease; - as an inherited predisposition. Once blood stasis has manifested, it is difficult for the body to naturally eliminate; thus, it can remain permanently. Blood stasis can give rise to conditions such as bacterial infections, bruising easily, spontaneous bleeding, and blood coagulation leading to apoplexy, congestive heart failure, heart attack, hemiplegia, etc. Blood stasis is heavy and typically remains in the lower abdominal regions. Since the left common iliac vein is larger than the right, more blood stasis can be found on the left side, resulting in palpable reactions at the surface of the abdomen in the lower left abdominal quadrant. This can be accompanied by visible changes in the condition of the skin, such as dryness. Blood stasis can show with discoloration and pigmentation of the skin and mucous membranes. The skin can become rough and dry. Menstrual disorders manifest. Psychological and emotional problems arise. In serious or advanced cases, psychosis can occur. Spider veins, vascular spiders, or small blue-colored superficial veins can be seen at times. While this particular condition is typically related to problems of poor circulation, clearly so when seen on the legs, there is an obvious overlap between blood stasis and poor circulation. Bloodletting or venesection techniques at these sites can be applied to treat both blood stasis and poor circulation. Clearly, blood stasis is a significant and common occurrence. Traditionally in China it has been treated with herbal formulae that use blood-quickening, stasistransforming herbs, but acupuncture is also effective in its treatment. Bloodletting techniques can be used as can ion-pumping treatments aimed at releasing the abdominal patterns associated with blood stasis.l The fundamental significance of
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blood stasis, according to our concept, is that it sets off a progression of metabolic, functional, and organic changes. The blood cells and tissues all are connected at the microcirculatory level where metabolic functions occur. Biases from either internal or external sources create an acute or chronic impairment of microcirculation. The resulting metabolic changes create functional changes that, if not remedied, and if chronic and advancing, lead to organic changes. If the organic changes continue to progress they become irreversible. This is a complicated set of biochemical and tissue processes, but when simplified as above, we can observe a general picture that shows the stages of blood stasis and indicates an appropriate treatment protocol for each progressive stage. In the first stage, which is easily treatable by a variety of techniques, sites of skin pigmentation begin to appear (like freckles), as do small papules and pimples. These are commonly found on the trapezius muscle, in the right subcostal and costal regions, and along the cheek bones. In the second stage, where treatment becomes more difficult, the pigmentation becomes darker; venules dilate, as can be seen in the vascular spiders and blue colored varicosities often visible on the legs. Moles with a light brown or red coloration begin to appear. The skin surface becomes rough, often over broad areas. The supraclavicular and lower neck regions especially show rough skin pigmentation or moles. Calluses also appear on the bottom of the feet in the following regions:
Figure 8.3: Callus areas on bottom of feet.
Typically (1) is related to the liver channel, especially when found on the right foot; (2) is related to the spleen channel; and (3) to the kidney channel. Functional disorders appear, as do problems of pain, psychoemotive problems, biases, and functional changes of the digestive and other systems. Problems in the tonus of the musculature can be seen with structural and other imbalances. In women the basal body temperature can become irregular; ovulation and menstrual problems and irregularities can occur. When using Itaya's M.I.D. testing, conditions of hyposensitivity will be found when heating the jing points. By the third stage of blood stasis, the condition becomes irreversible. The pigmentation becomes dark; the moles become black; the whole face becomes dark; the whites of the eyes become red and congested; baldness and dandruff can be seen. More serious symptoms can occur, particularly of an organic nature: ulcers, tumors, cancer, degenerative problems. Careful observation of the level of blood stasis a patient presents is helpful in prognosis. Sometimes treatment focuses specifically on blood stasis, especially when associated with the liver, which is a common occurrence. More generally, regardless of the channels or extraordinary vessels treated, if stage one blood stasis signs appear, the overall prognosis is good. Treatment should progress quickly and easily. If stage two signs of blood stasis appear, you may expect slower progress and your prognosis should reflect this deeper condition. If stage three signs of blood stasis appear, you may expect slow progress and perhaps an incurable condition. At each stage the treatment strategies alter to counter the level of the problem found.
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If treatment is successful you should see improvement and eventual disappearance of areas of pigmentation, skin roughness, and calluses. Sometimes moles disappear as well. In the first and second stages these changes are reliable feedback of the progress of treatment. By stage three, not much change can be expected, but those changes that do occur are generally very good signs. Thus we see how visual examination can allow us to determine the severity, extent, and prognosis of the patient's condition- even before palpating. Often, visual examination can help determine a diagnosis of which channels to treat, especially when the liver is involved. The actual diagnosis will depend on the radial pulses, on abdominal and palpatory findings, as well as on symptom patterns. Sometimes observation of areas of discoloration, papules, etc., will coincide with one of the Hirata zones.2 When this is the case, they often fit the overall pattern of diagnosis.
Figure 8.4: The Hirata zones
TACTILE INSPECTION
Palpating the radial pulses
Acupuncture can utilize examination of both the three bilateral radial pulses, the carotid pulses, and a variety of pulses at various body sites. Generally, the radial pulses are used only as they involve comparison of the strengths and qualities sensed at each different location. Our diagnoses are based on the traditional theory that the pulse positions reflect the states of the channels and the function of the related internal organs. There are many interpretations of radial pulse diagnosis. In chapter one we listed a few historical variations. The pattern that most clearly correlates with the channels, and is well confirmed in clinical practice, is that described by the Nan Jing:
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Position
cun guan chi
Right pulse deep superficial lung large intestine stomach spleen pericardium triple burner
Left pulse deep superficial heart small intestine liver gallbladder bladder kidney Small • Intestine /Heart
e
•
Large Intestine I Lung Stomach I Spleen
Gallbladder /Liver Bladder /Kidney
I
• •
1Triple Burner I Master of the Heart I Pericardium
•
Figure 8.5: Nan ]ing radial pulse positions
An experienced practitioner can use these pulses with reasonable reliability. However, complete mastery of radial pulse diagnosis takes considerable time and practice. We recommend the use of radial pulse diagnosis as only a confirmatory procedure. Using it in this manner allows two important cognitive steps. First, it serves as a means of diagnostic confirmation. Second, with repeated practice the feedback obtained permits safe, continued development of skill in interpreting the pulses. In the case noted earlier where there was a right subcostal tension and pressure pain, if the radial pulse showed weakness at the liver and small intestine positions, then the pulse would be one more sign confirming treatment of this pair of channels. On occasion, we can palpate the radial pulse and find many positions that feel weak, or find that the whole pulse feels weak. In these cases it is difficult to differentiate what is m:ost significant. There is a simple procedure that can be used to strengthen the whole pulse and thus make the significantly weaker aspects more obvious. This is accomplished by using the thumbs to lightly touch the bihourly supplementation points, which are receptive to the application of positive polarity. Since there is a supplementation point available at any time, we use the positive polarity available in the light touch of a thumb, applied to that bihourly point to strengthen general weaknesses. For example, if it is 10 am, the supplementation point available to us is ST-41. If the patient has weak, faint pulses, lightly touch both ST-41 with your thumbs for about fifteen seconds, to introduce a positive polarity bias. Then re-examine the radial pulses; you will find a clarified condition. For example, perhaps now only the liver pulse may be weak, and the other pulses more easily discernible. You can see that this subtle polarity stimulus at the bihourly supplementation points provides an extremely useful clinical technique, not only as a beneficial therapeutic procedure, but as a means of clarifying one of the more difficult aspects of Oriental medical diagnosis, radial pulse palpation. Of course, any positive polarity agent can be used instead of the thumb. The north magnetic pole, the positive electrostatic adsorber, the positive electrode of the ion beam device, etc., are all equally useful.
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One limitation of radial pulse diagnosis is that while we can discern weakness in a particular channel, it does not tell us whether we should treat the left or right branch of that channel. As we have explained, discrimination of left-right imbalances is often important clinically. These distinctions tend to be found with abdominal and body palpation, which with careful practice we can use to further refine our pulse diagnosis.
Palpation of abdominal or mu point patterns In the history of the use of abdominal palpation for diagnosis, there have been many methods and interpretations) As well as the mu points described earlier, there have been uses according to the five phases derived from the Nan Jing:
Figure 8.6: Abdominal five phase assignments from the Nan Jing
There have also been applications according to the organs (from the sixteenth century court acupuncturist, Isai Misonou:)
Figure 8.7: Mubunryu hara diagnosis
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Many practitioners use these and other applications to varying degrees. However, for our purposes we have developed patterns of interpretation that are based on simple, objective palpatory findings: pressure pain, poor muscle tonus, tension, tightness, flaccidity. Unlike the abdominal palpation of Western medicine, which seeks to reveal lesions of the internal organs (see appendix 1), we use abdominal diagnosis to evaluate the state of the channels from the condition of the skin of the abdomen, the tone of the muscles, the degree of tenderness and induration at various points. Specific and general patterns of reaction are taken into account to determine the diagnosis. In other important systems, emphasis is sometimes placed on palpable or visible palpitations or pulsings in the abdomen; slight temperature differences are also considered significant. Finding slight temperature differences requires considerable diagnostic skill and is a technique not easily attainable by a less experienced acupuncturist.4 Once skill using the techniques presented in this book is developed, you can use these more easily learned techniques as feedback confirmation for the development of other skills. Dr. Matsui of the Matsue Seyko Hospital wrote a paper in Japanese Medical News,(# 3075, April1982), describing pressure pain relationships on the abdominal aorta. She observed these signs clinically over an extended period of time, on a large patient population. Excluding the findings of patients with stomach or pancreatic diseases, she found that 50% of men and 67% of women have this pressure pain, an average of 60% of all persons tested. In warmer weather, this percentage rises by about 10% compared with cold weather. Arteriosclerosis occurs in 10-20% of the population over sixty, yet pressure pain for this age group was still 60%. In men and women below the age of twenty, the same 60% occurrence is found. Thus, there is no substantive relationship between these figures and the occurrence of arteriosclerosis. These observations are useful but only descriptive. When we find pressure pain around the aorta, we also find pressure pain in the lateral chest and abdominal regions; thus we cannot conclude that pressure pain around the aorta is only aortic pressure pain. It also reflects functional changes of other body points. The classical mu points, specific diagnostic points on the front of the body, can be palpated for reaction, but some mu points are not overly useful. As was mentioned in chapter four, the traditional mu points do not always show clear correspondences to the channels with pressure diagnosis,S but often show correspondence when using tests like the bidigital 0-ring test. Traditional Mu Points Yang channels
Yin channels
lung kidney liver heart pericardium spleen
LU-1 GB-25 LR-14 CV-14 CV-17 LR-13
large intestine bladder gallbladder small intestine triple burner stomach
ST-25 CV-3 GB-24 CV-4 CV-5 CV-12
For diagnostic palpation of a patient who is lying supine, we recommend the following new mu points. Based on our research and experience, they have proven to be more reliable than the traditional mu points.
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Manaka Mu Points Region LU-1 to LU-2 PC-1 (lateral and superior to the nipple) CV-17 Kl-23 at the sides of CV-14 LR-14 to GB-26 (usually right subcostal region) GB-24 to GB-29 region (often one or both points) both sides of CV-12 (including ST-21) GB-26 to SP-21 region (often one or both points) KI-16 (occasionally GB-25) ST-25 (sometimes slightly lateral to ST-25) CV-17 CV-12 CV-5 ST-26 (sometimes slightly medial to ST-26) ST-27 (sometimes slightly lateral to ST-27) KI-ll
Correspondence lungs pericardium heart, pericardium heart heart liver gallbladder stomach spleen kidneys triple burner upper burner middle burner lower burner small intestine large intestine bladder
Finding reaction in one of my mu points or reflex areas may indicate a problem of the associated channel. This reaction needs to be checked against the overall pattern of reactions. Often the pattern of reactions is more important and more useful than a single channel reaction. The selection of a reactive point or area as indicative of the patient's general imbalance usually needs to be confirmed. Reaction may not clearly show with the traditional mu points, but if the 0-ring test shows a positive reaction in the presence of pressure pain at the Manaka mu point, this correspondence is significant. For example, pressure pain at ST-26 and a positive 0-ring response at CV-4 reliably indicates a problem of the small intestine channel.
Figure 8-8: Manaka Mu Points
136
Diagnostic Assessment
The signal system can be assessed through observing the following reactions in the abdominal area: 1. Observing skin condition: thickness, brightness, hardness, color and pigmentation.
2. Observing the condition of the muscles: softness, hardness, lumpiness, pressure pain, etc. 3. Observing the condition of subcutaneous tissues: fattiness, puffiness, and what one feels when lightly pinching the skin. 4. Comparison of the abdominal quadrants. The healthy abdomen is neither hard nor soft; it is like mochi.6 It is elastic with no pain even on deep palpation. The abdomen can be difficult to diagnose in the following cases: - Particularly fat or thin people. - People who are using tranquilizers, hypertensive medications, analgesics, or neurological medications. These substances tend to dull the patient's sensitivity to pressure pain. - When the clinician is too well electrically grounded, there will be difficulty finding pressure pain. These problems are most obvious when examining pressure pain in the superior, inferior, left and right quadrants of the abdomen. Other cases that are difficult to diagnose by palpation are post-surgical patients and patients who are psychologically stressed. People who have had surgery often evidence changes in the position of internal organs. Patients with psychological problems often have reactions that are misleading. These problems can be overcome. First, you must not be overconfident in diagnosis. Second, you must pay special attention to differentiating and confirming the diagnosis. There are simple procedures you can apply to some difficult diagnostic cases. These often clarify and simplify diagnosis, especially with a patient having psychological problems that generate misleading signs. Typically, these patients show an oversensitivity in the abdominal region. When you begin to palpate, everything will hurt, or the abdomen will tense so that it is hard to ascertain the tonus or reaction of the muscles. The whole abdomen can also become extremely ticklish. In such cases, applying direct, thread-size moxa (usually three repetitions on GV-20), will reduce the overall reactivity of the abdomen, making it possible to continue diagnosis and treatment. This seems to work by settling the patient's qi. In traditional literature, GV-20 is indicated for nervous or psychological problems. If moxa, or the thought of moxa, upsets the patient, try holding the negative electrode of the electrostatic adsorber to GV-20 for approximately 20 seconds. This usually has the same or similar effect. Ticklishness is often misleading because the patient may attempt to dismiss the reactions experienced by saying that it tickles. A simple trick will usually clarify this, both for diagnosis and the patient. Compare left and right areas that are ticklish. Often where the left ASIS is described as extremely ticklish, the right ASIS is not at all ticklish. Also after treatment the ticklishness will greatly reduce; if not directly after treatment, then at least throughout the course of treatments. Patterns of reaction on the abdomen tend to fall into three overlapping groups. The first is a class of single channel problems; the second is the pairing of
Diagnostic Assessment
137
opposite-polarity, yin-yang channels, for instance, liver-small intestine. The third class involves the extraordinary vessels. The first group of patterns does not occur with great frequency. When patterns of this type do occur, they are often treated using the treatment points of one of the other two patterns, especially those of the extraordinary vessels. For example, we would consider pressure pain and tension on right LR-14 and along the right subcostal region, with general tenderness and tension to the left of the navel, along the stomach channel and at the left ASIS, indicative of a problem of the liver. However, if we look for an extraordinary vessel pattern, we can use the yin wei mai and yang wei mai connections, since the right subcostal reaction indicates a connection to the yin wei mai, and the lower left quadrant reaction indicates a connection to the yang wei mai. In this case the observation of this single channel problem would suggest an extraordinary vessel treatment as the first stage of general or root treatment. In the next stage of treatment, which involves treating the back of the body, our focus would shift back to the liver through the selection of the liver backshu point, BL-18, or an area of right-sided tension on the back. For the second group of abdominal reaction patterns, the opposite polarity, yin-yang pairing of channels, pain, tension, tenderness on palpation of the corresponding Manaka mu points for each channel pair might show as follows, and might correlate to the indicated patterns of disharmony. right LR-14, right subcostal region + ST-26 I KI-16 + ST-27 SP-21 to GB-26 + ST-25 GB-24, GB-29 + KI-23, around CV-14 KI-ll+ LU-1 to LU-2 around CV-12 + PC-1 or CV-17
= = = =
liver-small intestine kidney-large intestine spleen-triple burner gallbladder-heart bladder-lung stomach-pericardium
These findings generally must be confirmed by palpating the gastrocnemius muscles and the radial pulses. The third group of abdominal reaction patterns, those of the extraordinary vessels, will show in the following most commonly occurring patterns? These patterns each have target reflex areas on the abdomen, with corresponding Manaka mu point tenderness. For example, since the yin qiao mai-ren mai is treated using LU-7 and KI-6, should the lung and kidney channel Manaka mu points, LU-1-LU2 and KI-16, show tenderness, this would confirm the yin qiao mai-ren mai connection. The patterns are as follows: along the ren mai, LU-1, KI-16 subcostal tension (usually right), CV-17, PC-1, SP-21- GB-26 ASIS (usually left), or the belt line, ST-25, GB-24 ASIS, KI-11, ST-26
= yin qiao-ren mai = yin wei-chong mai = yang wei-dai mai = yang qiao-du mai
Upper-right quadrant reactions, especially in the subcostal region, with lower-left quadrant reactions, especially in the ASIS region, are signs of what we refer to as the "cross syndrome." This condition is treated through the yin wei mai connection on the right and the yang wei mai connection on the left, and is related to the liver and to blood stasis.
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Diagnostic Assessment
For each pattern of reactions from among these groups there is a simple formula of points that can be used. These formulae are based on the clinical experience and clinical rules described above and use polarity agents to obtain the therapeutic effect. The clearest corresponding reflex body areas, developed by my associate, Kazuko Itaya, are those associated with the extraordinary vessels. The general patterns of reflex areas are seen in the following illustrations:
Figure 8.12a: Yang Wei-Dai Mai
Figure 8.12c: Yin Qiao-Ren Mai
Figure 8.12e: Cross Syndrome
Figure 8.12b: Yang Qiao-Du Mai
Figure 8.12d: Yin Wei-Chong Mai
Figure 8.12£: Cross Syndrome
Taking into account these reflex areas, the Manaka mu points that correspond to the channels on which the relevant confluence-jiaohui points lie and the pathway points, we can complete the picture as follows:
Diagnostic Assessment
yin qiao-ren mai
along ren mai, LU-1 to LU-2 area, Kl-16 + ASIS, KI-ll to ST-30 area ST-12 area, ST-9 area, LU-3 to LU-4 area
yin wei-chong mai
subcostal region, especially on the right, CV-17, PC-1, GB-26 to SP-21 + LR-14, GB-24- especially on the right SP-13, SP-15, SP-16
yang wei-dai mai
ASIS - especially on the left, ST-25, GB-24 + along dai mai line from navel to the lateral edge of the abdomen (including KI-16, SP-15) around to BL-23 area, around ST-32
yang qiao-du mai
ASIS, KI-11, ST-26 + posterior superior iliac spine (PSIS), posterior axilla region - especially SI-9 to SI-10 region, along the sides of the cervical vertebrae
cross-syndrome
right subcostal, lower left quadrant + CV-17, PC-1, SP-21 to GB-26,left ST-25, GB-24
139
Palpating the gastrocnemius muscles In chapter four we provided evidence for opposite polarity relationships among the channels: gallbladder-heart, small intestine-liver, etc. There is an interesting system of palpation that correlates to these opposite polarity relationships. Mr. Osamu Honda of Asahikawa, Hokkaido, stimulated by our theories, was the first to note correlations between these six yin-yang pairs and reflex areas on the calf. These six areas are located on the posterior calf, the gastrocnemius muscles:
~~
® _}) ® ®
Pericardium
O
Bladder- LLg
0
GallbladderHeart
'
0 0 0 0 O O
Stomach- @ Pericardium
l
Bladder- Lung
I
GallbladderHeart
Figure 8.9: Reflex areas on the calf
@
®
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Diagnostic Assessment
Each area corresponds to one set of arm and leg yin and yang channels, in an innovative new systematization: A B
c
spleen-triple burner kidney-large intestine liver-small intestine
D
E F
stomach-pericardium bladder-lung gallbladder-heart
The areas are located as follows: A and D are between lines passing through BL-56 and BL-57; B and E are located between lines passing through BL-57 and BL58; C and Fare located between lines that pass through BL-58 and GB-37. Usually, Band E are at the widest portion of the calf, with A and D about two finger-widths above, and C and F about two finger-widths below. The upper and lower areas thus begin roughly one finger-width either side of the widest part of the calf and each area is about two finger-widths wide. The patient should lie supine with the knees raised to about a ninety-degree angle and feet flat on the treatment surface. Palpate these points with a gentle pressure, comparing left and right.
Figure 8.10: Gastrocnemius palpation
Initially, look for tight, hard bands of muscle. Once you have found this band, apply slightly firmer pressure to confirm and differentiate the reactions. Then select the most painful or clearly tight area to confirm the diagnosis. The treatment principle is to treat the side of the body opposite to the reactive area. It is important to note that in order to achieve appropriate treatment, it is crucial to differentiate left from right. Thus if left liver-small intestine, (C), is reactive, we would treat the liver and small intestine channels on the right side at the supplementation ("mother") and drainage ("child") points, using ion-pumping cords or other polarity tools. We have determined that the gastrocnemius diagnostic areas correspond to the abdominal findings as well as the radial pulse with considerable accuracy. They are particularly useful for confirming the relationships described by the second group of abdominal reaction patterns. For example, if we find C, the liversmall intestine area, reactive, we often find reaction on LR-14 (the liver channel diagnostic point), in the subcostal region, and ST-26 (the small intestine channel diagnostic point). In this instance, the radial pulse will show weakness in the liver position and sometimes a difference at the small intestine position as well.
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141
. This simple treatment m~thod can improve reactions found on the gastrocnemms and abdomen as well as Improve weaknesses found in the pulse. Sometimes symptomatic conditions are also eliminated. As another example, if we find reactions on left Kl-16 and ST-27, the kidney and large intestine reflex points, finding a reaction on the left or right gastrocnemius muscles in area B strongly confirms the abdominal findings. This diagnosis can be further supported with evidence from the radial pulses, the 0-ring test and point tests. It is important to differentiate the significance of reactions in particular points. While there is a functional overlap between the channels and extraordinary vessels, the extent of this overlap is rarely clear. Sometimes the treatment of right subcostal pressure pain and tension with accompanying lower left quadrant reactions can be achieved with an ion-cord treatment of the left yang wei and right yin wei mai connections. Sometimes it may require a liver-small intestine channel treatment. Careful attention is required to differentiate the exact pattern of reactions and the degree of the reactions, so that the most appropriate treatment can be determined. For example, Kl-16 pressure pain, if accompanied by clear ST-27 pressure pain and a reaction on the calf muscles in the kidney-large intestine reflex area, should be treated through the kidney-large intestine pair. However, if the ST-27 and calf muscle reactions are not clear, but there is clear pressure pain and tension at LU-1 and along the ren mai, then the yin qiao-ren mai connection is indicated.
Palpating the back and other areas of the body Each channel has a representative point on the surface of the back. Changes in the segments of the spinal cord, indicating morbid changes in the various visceral organs, can be inferred from the condition of the skin and muscles of the back. At the same time, the corresponding points can be used as treatment points. Premorbid changes, functional changes, can also be assessed by examination of the skin, the muscle tonus, and the degree of tenderness and induration found at these corresponding points. Palpation is useful for finding functional changes in muscles, i.e., hypersensitivity or tension. These indications can be clinical or preclinical. The mechanisms by which pressure pain, hypersensitivity, and other indications appear at the body surface are very complicated and far from clear. Different researchers have different explanations; these explanations are often contradictory. In Western medicine, hypersensitivity sometimes appears at McBurney's point and is associated with appendicitis. However, on occasion this hypersensitivity occurs with kidney stones, cholecystitis, diverticulitis, intestinal invaginations, intestinal TB, and intestinal cancer. It is difficult to explain this diverse range of associations.S Points and areas of hypersensitivity, tension, etc., are sometimes subject to external influences. Palpating the abdomen of a subject in an electromagnetically shielded room, while standing on an insulation mat, the practitioner will find certain points and areas of reaction. As soon as the practitioner steps off the mat and becomes "grounded," different points and areas of the patient's abdomen become reactive. Distinguishing functional hypersensitivity from a lack of functional change in sensitivity is also difficult. The following diagram shows the development of functional hyperesthesia or hypersensitivity in the earlier stages of a disharmony. As the disharmony becomes chronic and/ or more severe with an accompanying vacuity, it transforms to functional hypoesthesia or hyposensitivity. Notice also that development of functional hyper- and hypotonia is out of phase with the occurrence of hypoesthesia:
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HYPERESTHESIA
Figure 8.11: Functional hyperesthesia in early stages of disharmony
Finding hyposensitivity and hypotonia together is generally a sign of an advanced disorder. Correct treatment of a condition with functional hyposensitivity will usually cause a flare-up of hypersensitivity as the condition transforms from a more extreme vacuity to a less extreme vacuity. However, diagnosing the functional hyposensitivity can be difficult, as a lack of pressure pain can also be a sign of normal health. Hypoesthesia often occurs when patients are taking medications, especially antidepressants, hypertensive medications, tranquilizers such as valium, insulin, or pain killers. In cases where medications are being taken and pressure pain cannot be clearly or reliably elicited, diagnosis can become difficult. Reliance on what one feels (e.g. tension, tightness) becomes more important, as do the confirmatory tests. Because of these factors, when using palpation as the key diagnostic process, we need to be careful and consistent. We must eliminate all unnecessary variations. We also need other simple diagnostic checks to confirm our diagnosis in difficult cases, such as those involving functional hyposensitivity. Some experienced practitioners use the "pinching" technique. We like to use the Omura bi-digital 0ring technique, which has proven useful in these and many other cases. To confirm single or paired channel problems we can look for palpable reactions along the trajectories of the channels that show reflex sensitivity on the abdomen. For instance, in a liver channel problem we find reaction on or around the left Manaka three-yin meeting point (two divisions above SP-10, and slightly anterior to the liver channel), or on LR-3. To confirm extraordinary vessel treatments we can look for palpable reactions at key reflex points, such as pathway points. For instance, for yin wei mai-chong mai, we would look at CV-22 and ST-30; for yin qiao mai-ren mai, we would look at ST-12 and ST-9. Reactions will also tend to show on the back shu points. In a liver channel problem, BL-18, or the point lateral to it, BL-47, will be tight and/ or sore. Classically these back-shu points are: Shu
Lateral
Channel
BL-13 ifei shu) BL-14 (jue yin shu) BL-15 (xin shu) BL-18 (gan shu) BL-19 (dan shu) BL-20 (pi shu) BL-21 (wei shu) BL-22 (san jiao shu) BL-23 (shen shu) BL-25 (da chang shu) BL-27 (xiao chang shu) BL-28 (pang guang shu)
BL-42 (po hu) BL-43 (gao huang shu) BL-44 (shen tang) BL-47 (hun men) BL-48 (yang gang) BL-49 (yi she) BL-50 (wei cang) BL-51 (huang men) BL-52 (zhi shi)
lung pericardium heart liver gallbladder spleen stomach triple burner kidney large intestine small intestine bladder
BL-53 (bao huang)
Diagnostic Assessment
143
These point correspondences have no clear correlation to the nervous system, or to dermatome maps. There is possibly some correlation of these points and the Hirata zones (see Figure 8.3) discovered in the 1930's; however, this is not very clear either. Clinically however, these point correspondences seem to be significant. There is not always an exact, one-to-one correspondence between these points and the mu points or abdominal reflex points. While these points can be treated as part of the second step in the general or root treatment, they can also provide some diagnostic confirmation for other findings. Diagnosis for the second step of treatment involves both palpation of the back-shu points and areas, and the areas viewed in the following drawing. These are areas where fat deposits and edema most easily develop (shown in the illustrations on the following page). Thus palpable reactions, especially those found using the skin-pinching technique, should be sought. Puffy, fatty, or edematous areas, particularly on the shoulders and back, should receive special attention. Generally, they indicate areas where qi flow and blood flow are poor. Treatment can be administered using fire needle, hot needle, or moxa (see chapter 10 for details).
Figure 8.13: body areas where fat and edema accumulate most easily
Another useful palpation technique that provides a general assessment of the patient's overall condition and the progression of treatment is checking the tension, tightness, and pressure pain of the sternocleidomastoid muscles. A number of practitioners use this technique to assess the overall condition of the patient.9 Generally, we use it to determine the success of treatment. Palpate the muscles by' lightly pinching them between the thumbs and forefingers, and note the degree of tightness or pressure pain. As treatment progresses, repalpate the muscles. If the treatment is working, the muscles will be softer and less painful. This is a useful indication of the effectiveness of treatment.
STEPS FOR CONFIRMING A DIAGNOSIS Visual examination, palpating the radial pulse, palpating points and areas of the abdomen, mapping particular patterns of reactive points and areas, palpating the gastrocnemius muscles, areas on the back, neck, limbs - all these techniques will lead to a clear selection of the patterns described earlier.
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Diagnostic Assessment
If there are clear confirmations for one pattern, the following tests may be unnecessary, as they are used to double check and reconfirm a diagnosis. However, in any case where the confirmations are not clear, or appear to indicate more than one pattern, these tests help differentiate and confirm a particular diagnosis and an associated treatment. OMURA'S BI-DIGITAL 0-RING TEST
In chapter two we mentioned Dr. Omura's hi-digital 0-ring test as an example of a signal system function. This is a specialized kinesiological test that is particularly useful clinically because it allows us to assess the diagnostic relevance, or therapeutic usefulness, of any point more objectively. It bypasses subjective responses by the patient. Sometimes when we palpate the abdomen, we find that a number of points and areas have pressure pain or tension. It may be difficult to discriminate which of these points or areas are most significant. The 0-ring test gives very clear indications of significance. The relevant points or areas will show a weakened response.
The test involves having the patient touch the pads of the thumb and forefinger of one hand and holding them together while the therapist tries to pull them apart. This occurs while the patient lightly touches the extended forefinger of the other hand to the point being tested. The degree of resistance in the finger and thumb holding the '0' shape is assessed by the therapist both before touching the tested point, and while touching the tested point. When significant points are tested, the patient will lose the power of resistance. In recent years, Dr. Omura has further refined the hi-digital 0-ring test. He now uses a thin conducting medium such as a small metal rod that is held by the subject tested and touched to the point investigated instead of the extended forefinger. This simple test can be used to discriminate significant reaction from among a number of reactive points, thereby fine tuning the diagnosis. It also may be used to confirm a diagnosis, to demonstrate the efficacy of a treatment, or to check the efficacy of a projected treatment. After testing the relevant treatment points, or treating those points, the points or areas that showed both palpable reactions and a weakened response during the 0-ring test, should not only show less reaction when repalpated, but an increased strength of resistance when retested with the 0ring test. If not, the treatment or test was not appropriate. Omura's hi-digital 0-ring test is a valuable clinical tool because it is extremely easy to apply. In cases where a patient is unable, for one reason or another, to accomplish this test (e.g: a child, points of the back, or a patient with arthritis, etc.), a third person may be used. This person should make the 0-ring with one hand and touch the relevant point with the extended forefinger or metal rod. Thus, you test the patient through the third person; the process is exactly the same.IO TESTING POINTS WITH POLARITY AGENTS
This is another simple diagnostic test. Once you have determined a particular diagnosis, you can test the points to be treated to ensure that they reduce the reactions you have found on which your diagnosis is based. Since polarity agents are used to treat these points, we also use them for testing. The ion cord, ion beam, or electrostatic adsorber can be applied to the relevant point for five to ten seconds, while the point is repalpated. For example, having found reactions on both KI-16, both LU-1, and at both ASIS, and a weakened response with the 0-ring test, you are able to diagnose the yin qiao-ren mai connection. In this case, you can test KI-6 and LU-7. Based on our experience, when treating Kl-6 and LU-7 wi.th the ionpumping cords, KI-6 takes the negative pole (black clip).
Diagnostic Assessment
145
To test using the ion-pumping cord, ion beam or electrostatic adsorber, touch the negative pole to one of the reactive KI-6 points. Touch the positive pole to LU7 on the same side for five to ten seconds. Then repalpate the ASIS, KI-16 and LU1 areas on the side tested. If they feel less painful or tense, even only slightly, check further with the 0-ring test. If the 0-ring test reveals a stronger response, your diagnosis and treatment selection are confirmed. You have confirmed through several steps and procedures the diagnosis and treatment selection of the yin qiao mai-ren mai using the ion-pumping cords and can feel more confident that you will achieve the desired effects during the first step of general treatment. Finding pressure pain on left ST-25, GB-26 and SP-21 (the triple burner and spleen channel reflex points), and the right spleen-triple burner gastrocnemius area, a weakened response to the 0-ring test on the abdominal points, and a weakness of the spleen pulse allows you to diagnose a spleen and triple burner channel problem. Before treating the spleen and triple burner channels, test, for example, left SP-2, the supplementation point, with the positive pole of the ion-pumping cord, ion beam, or electrostatic adsorber and left SP-5, the drainage point, with the negative pole. Touch the points for five seconds. If this reduces the pressure pain at ST-25, GB-26 and SP-21, and increases the resistance in the 0-ring test, then you have clear confirmation to treat the spleen-triple burner channel. This simple systematic approach, with its constant feedback from the patient, pressure response of the points, radial pulses, and the 0-ring test, allows the development of a simple, reliable and testable treatment methodology that will achieve the first and most important step of the general treatment. This methodology also allows a considerable flexibility of treatment selection, since on the spot assessments of the projected efficacy of a particular treatment allow quick adaptation. This is beneficial not only to your patients, but also your learning and practice. Working with a safe, simple and reliable heuristic methodology allows you the important privilege of learning from your patients.
USING SYMPTOMS IN CONFIRMING DIAGNOSIS & TREATMENT Presenting symptoms can be important and helpful in diagnosis; they can also be irrelevant and misleading. Trust palpation. Generally, the procedures described above are sufficient for diagnosis. Sometimes a very complex pattern of signs and reactions can be simplified by considering the patient's symptom. Usually, you already know the symptoms prior to diagnosis. To varying degrees symptoms can guide and focus your diagnosis. Very complex symptom patterns may prove confusing and thus worthless. Very simple symptom patterns may prove helpful. Whether you use symptom assessment will depend on your skill as a practitioner, your comfort with the material and your ability to rationalize the complexity of a patient's condition. The following are simple symptom patterns associated with the eight extraordinary vessels, the twelve channels, and the channel sinews. The symptomology of the extraordinary vessels and channels is based on clinical observations and practice, the channel sinew symptomology has been translated from the Ling Shu chapter 13. EXTRAORDINARY VESSEL SYMPTOMOLOGY
- Ren mai: gynecological problems; hemorrhoids; asthma; bronchitis; lung problems; neurosis; toothache; ear, nose, and throat problems. - Yin qiao mai: urination problems; gynecological problems; cold feet; intestinal problems.
146
Diagnostic Assessment
- Chong mai: heart problems; neurosis; stomach problems; gynecological problems; cold feet; liver and gallbladder problems; problems of the anus. - Yin wei mai: nervousness; heart problems; palpitations; psychological problems; insomnia; stomach problems. - Du mai: epilepsy; fatigue; problems of the spine and neck; neurosis; insomnia; superficial invasion of cold or external qi; early stages of catching cold (Shang Han Lun, tai yang disease). - Yang qiao mai: whiplash; epilepsy; speech disorders; shoulder pain; lumbar pain; unusual sweating; trigeminal neuralgia. - Dai mai: a feeling of coldness or achiness in the lower back; gynecological problems; menstrual problems; problems in the lower abdomen. - Yang wei mai: dizziness; headache; whiplash; sweating problems; trigeminal neuralgia; tiredness; ear and eye problems. - Cross-syndrome: gynecological problems; digestive problems (especially intestinal problems); sciatica (especially of the left leg); liver problems; shoulder problems; low-back problems, HEENT problems, especially on the left. CHANNEL SYMPTOMOLOGY
The following symptom patterns, general relationships and uses are derived from Shinkyu Rinsho Iten (Clinical medical dictionary of acupuncture and moxibustion), page 85. The channel "triplets" are the arm-leg yin-yang groupings. For instance, the arm yin triplet is comprised of the lung, heart, and pericardium channels. Arm channels
Used for problems of
Comparison of yinyang triplets
Tai yin-lung
throat, chest,
lung area
lungs ~ue yin-pericardium
chest, heart, stomach, nervous problems
mainly heart/stomach area
Shao yin-heart
chest, heart, nervous disease
mainly heart and nervous disease
Tai yang-small intestine
head, occiput, mainly for face eyes, ears, and occipital nasopharynx, regions nervous diseases, febrile diseases, secretion problems
Shao yang-triple burner
Yang ming-large intestine
head, face, eyes throat, chest, and flanks, febrile diseases problems of head, face, eyes, ears, nose, mouth, teeth, throat, febrile diseases
mainly for regions of face and front of head
Characteristics of yin-yang triplets
3 yin for chest and chest region dysfunctions or problems of organs in upper abdomen (psychological)
head, face, occipital, neck regions, febrile diseases (five senses)
Diagnostic Assessment
Leg channels
Mainly suitable for problems of
Tai yin-spleen
gastrointestinal mainly for disease, genital, stomach and urogenital, and intestines pancreatic problems genital and urogenital mainly for liver, problems, chest and genital, and flank problems urogenital problems genital, urogenital, intestine and throat problems
ue yin-liver
Shao yin-kidney
Tai yang-bladder
Shao yang-gallbladder
Yang ming-stomach
eyes, nose, head, ears, occipital region, lumbar region, anus, nervous disease, febrile disease
Comparison of yin-yang triplets
147
Characteristics of yin-yang triplets
abdomen region and visceral organ dysfunctions, esp. lower abdominal; representing the energy of the lower half of the body
mainly for back problems; using back-shu points can treat internal organ problems
head, ears, eyes, sides of the body nose, throat, chest, and flanks, febrile diseases, gallbladder problems head, tace, nose, front of the body mouth, teeth, throat, nervous disease, febrile diseases, gastro-intestinal problems
integrate the upper and lower areas: head, face, five senses, can be cured by treating the three leg yang channels. If problem is in organs of the body, points below the knees should be used
We can add to this list of symptoms the following observations that are associated with problems of particular motions of the spine and joints: - Problems with extension of the spine are typically related to the bladder or stomach channels, as are problems of flexion of the spine. - Problems that come when standing from a sitting position are typically associated with the kidney or gallbladder channels. - Problems that come when sitting from a lying position are usually associated with the stomach or gallbladder channels. Focusing attention on these channels whenever motion problems are evident often helps redress the problem. If a patient pre·sents with a febrile condition, due to either some acute infectious disease, such as a flu or cold, or from some deeper infection, for example a pelvic inflammatory disease, special attention must be paid to these problems. If the fever is not systemic, but limited to an inflamed joint, as might be found in a patient with rheumatoid arthritis, one can generally deal with this with the procedures described in the symptom control section of chapter 11. The local inflammation is
148
Diagnostic Assessment
addressed in the final steps of treatment. If the fever is systemic, and clearly due to cold or flu, this must be dealt with directly. Some symptoms listed earlier, for example, symptoms associated with the du mai and ren mai, are the result of viral infections. As step one treatments they might be helpful. But, at a later stage in the same treatment, something more direct, such as direct moxa, bloodletting, or cupping, will be necessary. Generally, if a patient presents with such a problem, it is better to focus on that problem. Acute febrile conditions are delicate and can progress rapidly. Thus, it is better not to upset the body's already struggling defenses with too much therapy. If the fever is from a deeper infection, such as a P.I.D., acupuncture can be very helpful, but it is generally not a good idea to treat such a condition without having consulted an allopathic physician. Antibiotics are not perfect, but they do work faster than acupuncture in such conditions. If improperly treated, or even if too slowly treated, these conditions can become dangerous. In chronic conditions, which have shown no change for some time and which have been unresponsive to Western pharmaceutical and antibiotic therapy, the application of the treatments described in chapters 9 through 11 can be very advantageous. CHANNEL SINEW SYMPTOMOLOGIES
The following descriptions of the channel sinew symptomologies are derived from Ling Shu chapter 13.11 They are introductory at best because of the need for further research and clarification. These are basically symptoms of muscle cramps, spasms and tightness. A general or root treatment approach for channel sinew associated symptoms, or more generally, musculoskeletal problems, is given in chapter 10, under the descriptions of steps two and three of the root treatment approach.
Diseases of the leg tai yang channel sinew : -
Swelling and pain of the fifth toe and heel. Cramping in the knee region. Curvature of the spinal vertebrae (probably including scoliosis, lordosis). Stiffness in the back of the neck. Inability to raise the shoulder. Pain in the axilla and on top of the shoulder joint with difficulty moving the shoulder to the left and right.
Diseases of the leg shao yang channel sinew: -
Severe stiffness of the fourth toe (like cramping). Cramping of the lateral knee muscles. Difficulty bending and straightening the knee. Tetany of the muscles anterior to the femoral bone. Tetany of the posterior gluteal muscles. Pain in the axilla. Tetany of the muscles in the pectoral and anterior neck regions (pectoral and probably sternocleidomastoid and scalene muscles). - The left channel sinew affects the right channel sinew; hence a problem of the channel on the left may cause paralysis of the right foot. This is described as "the binding channel sinews are reciprocally crossed."
Diagnostic Assessment
149
Diseases of foot yang ming channel sinew: - Spasming of the muscles of the third toe and of the anterior tibialis muscle. - Shaking of the leg. - Spasming of the muscles around ST-32. - Swelling of the anterior portions of the thigh. - Testicular pain. - Cramping of the abdominal muscles. - Cramping between ST-12 and the cheek. - Sudden deformity at the side of the mouth (like Bell's palsy). - Acute inability to close the eyes. If heat is present, the muscle tonus decreases and it becomes difficult to open the eyes. - If cold in the cheek muscles, cramping and lateral displacement of the mouth. If cheek is hot, muscle tonus decreases and the mouth deforms.
Diseases of leg tai yin channel sinew: - Cramping on top of the big toe with pain at the medial malleolus and leg pain. - Pain on the tibia in the knee region. - Cramping on the medial side of the thigh. - Cramping and pain of the sexual organs. - Pain in the navel region with cramping below the navel which causes pulling pain at the lateral edges of the chest. - Cramping in the chest with pain at both sides of the vertebrae.
Diseases of the leg jue yin channel sinew: - Cramping at the top of the big toe with pain. - Pain in the medial portions of the thigh. - Pain and cramping in the inguinal joint. - Impotence. - Pain in the penis and inability to have an erection. - If cold, the sexual organ is stiff. If hot, the sexual organ is flaccid.
Diseases of leg shao yin channel sinew: - Spasming of the sole of the foot with pain along the whole trajectory of the channel sinew. - Cramping and epilepsy. - (If pathogenic qi lodges in) the external part of the leg shao yin channel sinew in the intrascapular region, the patient cannot tilt the head forward. - (If pathogenic qi lodges in) the internal part of the leg shao yin channel sinew in the intrascapular region, patient cannot tilt the head backwards. - If yang disease (is in the shao yin channel sinew), the lumbar region will lock and the patient cannot bend forward. - If the disease is on the inside, the patient cannot bend backwards.
150
Diagnostic Assessment
Diseases of arm tai yang channel sinew: -
Cramping at the little finger and pain in the region of the olecranon process. Pain from the olecranon process region to the axilla region. Pain at the back of the axilla. Pain from the scapular region to the neck. Tinnitus, ear pain, pain to the chin; the patient must close the eyes for a short while to be able to see clearly again. - Cramping in the neck muscles, overcontraction and swelling of the neck from heat or cold. - Pain along the whole trajectory of the channel sinew.
Diseases of arm shao yang channel sinew: - Cramping along the trajectory. - Stiffness and difficulty moving the tongue.
Diseases of arm yang ming channel sinew: - Pain and cramping along the trajectory. - Inability to raise the shoulders. - Difficulty turning the head to right and left.
Diseases of arm tai yin channel sinew: - Cramping along the trajectory, which if very severe will cause pain and cramping of the abdomen with difficulty breathing (like asthma), with light cramping in the chest and vomiting blood.
Diseases of arm jue yin channel sinew: - Cramping along the trajectory, pain in the anterior side of the chest with cramping and difficulty breathing (like asthma).
Diseases of arm shao yin channel sinew: - Contracted feeling in the center of the chest which affects the heart (like heart attack).
FLOW CHART FOR DIAGNOSTIC ASSESSMENT The flow chart that follows describes basic components of diagnosis and assessment, and various treatment strategies and their alternatives, with the reassessments that accompany each step. Note that the question and answer method is typical of the treatment methodology used. Reassessment always follows each step. Pressure pain, tension, radial pulses, pain levels, range of motion, flexibility, are always assessed when appropriate to the patient's condition. Note also that (1) generally gives a long-term assessment; how the skin texture and color, muscle tone, and imbalances progress is an indication of future condition; (2), (3), and (4) are important throughout diagnosis and treatment; (5) is particularly important when deciding the limit of treatment and what points will control symptoms. Remember that this flow chart represents a typical flow of diagnosis and selection of treatment approach. Assessment of individual cases may require altering this flow on occasion.
Diagnostic Assessment
151
DIAGNOSIS FLOW CHART
(1) ~ visual examination
(2)
~
radial pulse palpation
Observation (3) ~ abdominal and chest palpation
(4) ~ body and channel palpations
(5)
~
questioning diagnosis: symptoms
~ Confirmation (3) if very weak use 0-ring test use biorhythms (2)
Testing After arriving at a general diagnosis we can test the treatment points associated with that diagnosis using various tools (e.g. magnets, ion beam, etc.)
Assessment If diagnosis is clear and response If diagnosis is complex or unclear and the testing procedures produce to testing procedure is clear, i.e., improvements are seen in pulse, unclear responses, either retest the abdomen, body, 0-ring responses same points with different polaritief and possibly symptoms, go to: test a different pattern of points, or go to:
step one treatment using I.P., etc.
Decisions Reassessment of diagnostic signs and responses
Step one treatment using secondary approaches or alternative strategies
152
Diagnostic Assessment
CASE STUDIES OF THE AKASHI-BASED DIAGNOSIS The following case studies are illustrative of the diagnostic procedures described earlier, and the treatment steps subsequently presented:
Main complaint:
Female, Age 27 Sterility
Pulse:
Liver weak, kidney little weak
Abdominal findings:
Right subcostal and left ASIS pressure pain and tension, left ST-26 pressure pain. Left liver-small intestine area LI-4 and Manaka three-leg yin meeting pressure pain The upper right and lower left quadrant reactions with the leg yin meeting point indicate the cross syndrome and a problem of the liver, the gastrocnemius and left ST-26 reactions confirm this and in particular the liver-small intestine connection. This condition could thus be treated via the liversmall intestine connections or the right yin weileft yang wei connections. Differentiation could be made by 0-ring testing and/ or treatment point testing.
Patient 1:
Gastrocnemius muscles: Other points: Diagnosis:
Treatment:
This patient was treated via the cross syndrome pattern, since testing confirmed this as the dominant pattern.
Patient 2: Main complaint: Pulse:
Female, age 56 Hypertension The pulse was too weak to discern so the thumbs were applied to ST-41 for fifteen seconds (since it was 10 am). The kidney pulse then showed clear weakness. Both KI-16 and left ST-27 had pressure pain. Left LU-1 had pressure pain. Slight tenderness of the left kidney-large intestine area. Kidney vacuity treatable through the kidneylarge intestine connection or the yin qiao-ren mai connection. This patient was successfully treated using the kidney-large intestine connection.
Abdominal findings: Gastrocnemius muscles: Diagnosis:
Treatment:
Diagnostic Assessment
153
Patient 3: Main complaints:
Female, age 50 Eyes very itchy especially around 8 pm; gastritis; cold hands and feet Abdominal findings: Left PC-1 very sore; CV-17 sore and with positive bi-digital 0-ring test; CV-10 sore and with positive bi-digital 0-ring test Gastrocnemius muscles: left stomach-pericardium area Diagnosis: 8 pm is the pericardium channel time. Stomach problems can sometimes reflect at CV-10. Therefore diagnosis was the stomachpericardium channel connection. Treatment: This patient was successfully treated via the stomach-pericardium channels. It would have been possible to treat the yin wei-chong mai instead, because of the CV-17 and PC-1 reactions, gastritis, and time of flare up, but usually one would also see subcostal reactions and spleen reactions that would differentiate the yin wei mai-
chong mai. CHAPTER ENDNOTES 1 In chapters 9 and 11 we describe a number of treatment techniques. Importantly, Itaya's research on the microcirculatory effects of acupuncture show that the insertion of a single needle can have a general effect on problems of blood stasis (see appendix 2). 2 The Hirata zone system of correspondences was developed in the 1930's in Japan by Dr. Kurakichi Hirata. 3 See Manaka, Y. eta/., "Abdominal diagnosis and indications in traditional Chinese medicine"; Amer. Jour. Acup., July - Sept. 13: 3, 223-234; and, Hara Diagnosis, chapters 2 and 11, for discussions of this. 4 For a thorough review of palpatory diagnostic findings and their interpretations, see Matsumoto, K. and S. Birch, Hara Diagnosis: Reflections on the Sea, especially chapter 11 passim. 5 See Hara Diagnosis, pp. 350-352 for discussions of this. 6 Mochi is a traditional Japanese food made by pounding boiled, glutinous "sweet" rice until it acquires an even, sticky, elastic consistency. There are few Western foods that are similar; a sticky bread dough or a very soft taffy have some tactile correlations. 7 See chapter 16 of Hara Diagnosis for more details of differential diagnosis. 8 A recent study published in China describes key points that tend to become reactive when specific diseases are present. This method of diagnosis compares to Western medical palpatory diagnosis and contrasts with the palpatory diagnostic systems we describe. The specific point reactions provide a useful frame of reference for diagnosis but are not so useful for composing a general treatment (see appendix 1). 9 Ms. Tokito uses this technique to determine efficacy of treatment. See Matsumoto, K. and S. Birch, Extraordinary Vessels, pp. 150 passim. Mr. Oda uses it as part of his overall system of diagnosis. 10 Dr. Omura has published many papers on the use of the hi-digital 0-ring test. For some discussions of this test and speculations on its mechanism see: Omura, Y., "The hi-digital 0-ring test: Critical evaluation of its abnormal responses with laboratory tests including 'blood pressure and blood flow method,' 'blood chemistry,' etc., and neurological method," Acup. & Electro-Therapeutics Res. Int. Jour.8:37-43, 1983. See also, Omura, Y., " 'Bi-digital 0-ring test molecular identification and localization method' and its application in imaging of internal organs and malignant tumors as well as identification and localization of neurotransmitters and microorganisms - Part I," Acup. & Electro-Therapeutics Res. Int. Jour 11:65-100, 1986. See also, Omura, Y., "Electromagnetic resonance phenomenon as a possible mechanism related to the 'Bi-digital 0-ring test' molecular identification and localization method." Acup. & Electro-Therapeutics Res. Int. Jour 11:127-145, 1986. , 11 Editor's note: These symptom patterns have been translated from Dr. Manaka's book, Ika no Tameno Shinjutsu Nyumon Kuoza (Introductory lectures on acupuncture for medical doctors), second edition, 1980, pages 242-253.
~
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CHAPTER NINE
CLINICAL TREATMENT: STEP ONE Our attitude and our approach to treatment are fundamental to healing. Since we are administering qi therapy, procedures to restore the balance of qi, we must be aware that our own qi is integral to diagnosis and treatment. It is impossible to separate the practitioner from the therapy. The effects of acupuncture do not arise merely from the points treated and the procedure used to stimulate those points; they also depend on the practitioner. Decision-making and performance are affected by condition. As a practitioner, you must pay attention to your own health; treat yourself, or receive treatment, whenever necessary. Stay strong and healthy. Neither is the attitude of the patient separable from the healing process. The patient must be as thoroughly involved as is possible in their own therapy. Those patients who become involved in their own healing usually do better than those who just expect to be healed. This is not only because involved patients are more likely to change negative dietary or work habits, and thus acquire the benefits that derive from such positive steps, but also because they attend to home treatment whenever possible. In Japan for example, it is typical that patients go home with instructions to treat themselves in some way, using techniques of therapeutic exercise, self-massage, moxa therapy, or other treatments guided by the practitioner. Ideally a patient should be seen on a weekly treatment schedule. For acute conditions or for cases of extreme weakness, two or three times a week is often a superior schedule. When patients are unable to come for therapy as often as you suggest, simple home treatment procedures have greater importance. However, even patients who are able to come for frequent treatment can benefit from home therapies, especially in chronic or severe cases. When you first treat a patient, it is a good idea to not overdo the therapy, and to avoid strong stimulation. Sometimes there are unexpected reactions or overreactions to treatment. Minimal stimulation doses will reduce the possibility of an overreaction. As treatment progresses, gradually increase the stimulation as required by the condition. Common treatment patterns and a few unusual patterns are detailed later in the text. If you want to try a new form of therapy, or a new therapeutic pattern, follow this rule of thumb: always try the new procedure on yourself first. If the treatment goes well, then try it on your associates, assistants, family members, friends, and other healthy individuals. If you find no unexpected effects, then, and
156
Clinical Treatment: Step One
only then, is it appropriate to use your new treatment approach with your patients. Developing new treatments and procedures should always be done with great care.
TRADITIONAL CHANNEL THERAPY: FIVE STEP TREATMENT Traditional channel therapy has two distinct levels, the root or general treatment and the symptom control treatment. The root treatment is intended to adjust overall imbalances. The symptom control treatment is intended to alleviate the patient's complaints. Treatments that take advantage of the signal system are considered root treatments. Treatments utilizing channel characteristics, five-phase points, and the extraordinary vessels are root treatments. Procedures that harmonize yin and yang are also root treatments. Based on our premise that the signal system has topological characteristics, and thus relates to the body's structure, we view treatments that take advantage of the signal system as typifying what was classically considered root treatment. Our approach to root treatment is a three-step method, and symptom control treatment follows as a two-step method: Step One: harmonization of the front (yin) side of the body: reduction of abdominal and other anterior reactions, gastrocnemius muscle reactions, and balancing of the radial pulses Step Two: harmonization of the back (yang) side of the body: reduction of tension, tightness of the yang channels, especially on the back muscles, the shu points Step Three: adjustment of any remaining structural imbalances Step Four: clinical symptom control methods Step Five: home therapy for symptom abatement The first treatment step is usually the most significant. It is here where the use of the clinical rules and polarity agents is most developed. Steps one, two, and three usually accomplish the overall adjustment of the octahedral and isophasal levels of the signal system. If step one is very successful, the second and third steps may not be necessary, though as a general rule step two is always performed to some degree. Root treatment is aimed at correcting and regulating problems through the signal system. Ideally, were the perfect root treatment rendered, complaints such as pain would disappear without a symptom control treatment to address each symptom. Occasionally this does happen and the symptom control treatments are not required. But in practice, both treatment levels are generally necessary, like two wheels on an axle. At the first stage, different alternatives are able to address diverse sets of symptoms. Sometimes these symptoms are associated with the particular treatment combination, but at other times the symptoms are diverse and may seem unrelated. As root treatment progresses through steps two and three, addressing the back of body and musculoskeletal balance, many symptoms will already improve. For cases where the symptoms have not improved, therapy progresses to symptom control treatment. At this stage, specific points are selected to control and ameliorate specific symptoms.
Clinical Treatment: Step One
157
Frequently, symptoms in parts of the body without any special connection to tender points on the abdomen or gastrocnemius muscles are alleviated along with the reactions on the point associated with these diagnostic areas. It is also common to find that patients who are in an extremely xu (vacuous) or emaciated condition will have many complaints, but often their abdomen is soft and no place is especially sensitive. In such cases, there is usually hypersensitivity or muscular tension in the back. We also have regularly observed that even if the tenderness or differences in sensitivity on each side are initially reduced in the first step of treatment, after some time the same pattern will reappear. However, this pattern will change with repeated therapy through an appropriate course of treatments. Typically, the use of points for symptom control shows strong correlations to specific symptoms. These correlations are correspondences (e.g., isophasal relations, channel pathway relationships, yin-yang) or time-tested clinical uses. A number of possibilities can be chosen for the fifth step. Should poor lifestyle, or physical, mental, and dietary habits have clearly interfered with the patient's health, or should home therapy be necessitated by the severity or chronic nature of the complaints, some recommendations may be required. Where home therapy is given, specific symptoms can be addressed, as can the general condition. Other recommendations may be directed at the elimination of deleterious habits that bias the patient unfavorably or that indirectly worsen the symptoms and general condition. There are many possibilities for steps one and four. There is a more limited selection for steps two and three. Based on the research and the experiments described earlier, we have devised a set of clinical rules and guidelines with simple sets of treatments that can be used with reliable results for step one. We have also outlined a few supplementary and alternative treatment methods for confusing or complex cases. For steps two and three, there are some simple strategies and techniques based in the octahedral and isophasal theories that we have distilled from our clinical experience. For step four we describe several basic approaches for controlling symptoms and several secondary methods that can be used when confronted with very complex conditions or when the previous treatment stages have proven insufficient. For step five, a diverse range of possibilities can be selected from areas where the practitioner may be expert: psychological counselling, confrontation or support; recommendations and guidelines for changing mental, physical, or dietary habits; or suggestions for home exercise, home moxa therapy, and other home therapies. The flow chart on the following page summarizes these steps. The total adjustment obtained through combining steps one, two, and three involves an adjustment of the overall octahedral and isophasal levels. Each step adjusts specific imbalances at these levels. The combined effect of adjusting anterior (step one), posterior (step two), left, right, superior, and inferior portions (steps one through three), and combining isophasal effects with octahedral effects, has further regulatory consequences. The sequence of diagnosis and treatment is very simple. The number of factors examined are kept to a few basic ones. In most cases the overall effect is quite profound.
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Clinical Treatment: Step One
Treatment Flow Chart Step One: Regulate the Signal System Primary Approaches Secondary Approaches Adjust at level Adjust at level of of octants isophasal properties (a) Ion pumping, etc., (b) Colors to polar to extraordinary channel pairs vessels (c) ion pumping, etc., to polar channel pairs
Activate homeostatic type responses (d) open points (e) taiji moxa treatment
Address stubborn or unusual cases (f) alternative strategies: magnet heater, midline moxa
Reassess patient by rechecking palpable responses. If sufficiently improved, go to:
Step Two: Regulate the Signal System Adjust at musculoskeletal function level Treat back-shu points (a)
and/ or
(b) Adjust at level of isophasal properties Treat related channel points
and/or
(c) Adjust condition of yang channels
Step Three: Adjust at Musculo-Skeletal Function Level (a) sotai exercise to release (b) same with indirect or direct or muscle tension
moxa
Step Four: Symptom Control (a) intradermals to auricles and/ or hands and/ or body moxa to body points (formulary or to specific channels) (c) needle body points (various treatment formulae) (d) bloodletting, venesection
(b)
Step Five: Lifestyle Regulation (b)
(a) dietary recommendations lifestyle (mental, emotional, physical) recommendations (c) home therapy
STEP ONE OF THE ROOT OR GENERAL TREATMENT The first and most important step of a root treatment is restoration of harmony on the yin (front) side of the body. The procedures taken in this step are determined by the palpable reactions found on the abdomen, chest, and gastrocnemius region, and confirmed by the radial pulse. Correct treatment addresses reactions and imbalances found on the anterior portions of the body, on the gastrocnemius muscles, and in the radial pulses. By altering the octahedral and isophasal structures of the body, treatment reduces or eliminates palpable reactions in these regions and normalizes the pulse. Thus the first step of treatment has the following advantages: - As the procedure performed first, it serves to clear the way for the procedures that follow. When successful it can be sufficient in itself, and at the very least, it simplifies the rest of the treatment.
Clinical Treatment: Step One
159
- Specific factors, such as individual and constitutional differences, can be taken into consideration. - It requires some simple, verifiable diagnostic confirmation.
- Such checks allow selection of points for patients who are otherwise difficult to diagnose by other means. - The method of treatment can be decided for incipient diseases that are beyond detection by means that depend on symptoms. - Major physical imbalances can be treated in cases where a patient has more than one disease and there are a variety of symptoms. - Problems and imbalances can be detected and treated at preclinical or functional stages before a pathology becomes evident. In ancient China, there was a tradition that the superior physician treated diseases before they occurred. Because of the need to provide uniform, constant conditions for diagnosis, we recommend the following procedure: The patient should lie supine with their whole body relaxed, legs outstretched and relaxed, arms relaxed. All rings, watches, necklaces, pendants, socks and shoes, nylon tights or hosiery, etc. should be removed. Clothes should be loosened to allow access to the abdominal region, so that the practitioner may carefully examine and palpate the surface of the abdomen, first with lighter, then with firmer pressure. PRINCIPAL TREATMENT PATTERNS FOR STEP ONE
Working with the basic treatment patterns, we can correct many of the general imbalances, harmonizing the yin (front) side of the body. The most common patterns of disharmony involve the extraordinary vessel confluence-jiaohui points and the supplementation and drainage points of the polar channel pairs. These treatments are accomplished with polarity agents, primarily the ion-pumping cords, secondarily the ion beam and the electrostatic adsorbers. Open point biorhythmic treatments are also useful for achieving these treatment goals. Taiji or whole-body moxa therapy can also be useful as a general treatment. Other curious and useful techniques can be used for unusual or stubborn cases. We use a variety of techniques to address the patterns we discover because no single system is perfect nor always applicable; it is important to have backup methods at hand. The following treatment patterns are the nexus of a reliable treatment format for step one. You can develop your own treatment style based on these patterns. The most commonly used step one treatments use the confluence-jiaohui points of the extraordinary vessels, or the transporting, five phase, source and luo points of the twelve channels. These points are listed in the tables that follow. Vessel
Confluence-jiaohui point
ren mai yin qiao mai chong mai yin wei mai du mai yang qiao mai dai mai yang wei mai
LU-7
KI-6 SP-4 PC-6 SI-3 BL-62 GB-41 TB-5
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Clinical Treatment: Step One
PC-6, TB-5, GB-41, and SI-3 have the standard locations given in most acupoint books. In our experience SP-4 is on a muscle knot located at the proximal head of the first metatarsal. This is a little more proximal and inferior than some books describe. KI-6 and BL-62 are both slightly posterior to their usual locations, inferior to the center of the malleoli. LU-7 is located on the lung channel between the radius and the radial artery. Transporting points of the yang channels Channel well- springying jing metal water
GB
44 1 1 45 1 67
51
TB ST LI
BL
43 2 2 44
2 66
streamshu wood
riverjing fire
unitinghe earth
source yuan
connecting luo
cleft xi
41 3 3 43 3 65
38 5 6 41 5 60
34 8 10 36
40 4 4 42 4 64
37 7 5 40 6 58
36 6 7 34 7 63
11
40
Transporting points of the yin channels Channel well- springjing ying wood fire
LR HT PC SP LU KI
1 9 9 1 11
1
2 8 8 2 10 2
streamshu earth
riverjing metal
unitinghe water
source yuan
connecting luo
cleft xi
3 7 7 3 9 3
4 4 5 5 8 7
8 3 3 9 5 10
3 7 7 3 9 3
5 5 6 4 7 4
6 6 4 8 6 5
The locations of these points are described in many acupuncture books.l Following are the traditional uses of some of these points as described by the Nan Jing. On occasion these ideas prove useful, especially the idea of a source point having strong effects on its own channel: Source-yuan points - treatment of organ-channel system on which the point lies Connecting-luo points - treatment of internally-externally coupled organs or channels and connecting vessel symptoms Cleft-xi points - treatment of stubborn or acute conditions of organ or channel. Well-jing points - fullness below the heart Spring-ying points -body fever Stream-shu points- heavy body and joint pain River-jing points - panting, coughing, alternating hot and cold Uniting-he points - counterflow qi, diarrhea When using polarity agents, not all of these points are treated. As we have seen, the supplementation and drainage points have polarity-dependent properties
Clinical Treatment: Step One
161
that can be used advantageously. When using colors on the points, more points can be used, but still not the whole range. Open point treatments use all but the luo and xi points. Following the descriptions of treatment methods there are a series of case studies. These show the use of the polarity agents (ion pumping, electrostatic adsorbers, ion beam device) for the confluence-jiaohui pairs and supplementationdrainage pairs. These are anecdotal, selected recently from a busy practice. STEP ONE TREATMENT USING THE EXTRAORDINARY VESSEL PAIRS Step one treatment may typically begin with the selection of an extraordinary vessel confluence-jiaohui point pair. The methodology for determining their application is simple, and the scope of their use is broad. For the novice or practitioner inexperienced with the feedback - diagnose and reassess - method of treatment that is afforded by utilizing palpatory diagnosis, we strongly recommend beginning with these treatments. For the more advanced practitioner, or when diagnosis clearly matches, we further recommend treatments from the other methods presented here (polar channel pairs, etc.). According to the diagnostic schedule described in the last chapter, ion pumping can be applied to the confluence-jiaohui points of the extraordinary vessels in the following patterns: Diagnosis Treatment Confirmation Points & ion pumping Side treated Principal signs along ren mai ASIS, KI-11-ST-30 KI-6 black(-) usually bilateral LU-1-LU-2, Kl-16 ST-12, ST-9, LU-3-LU-4 LU-7red (+) subcostal region, PC-1 LR-14, GB-24 PC-6 black(-) usually right CV-17, SP-21-GB-26 CV-22, ST-11 SP-4 red(+) ASIS, ST-25 TB-5 black(-) usually left along dai mai from navel GB-41 red(+) GB-24 around to BL-23 ASIS, KI-11 PSIS, SI-9-SI-10 BL-62 black(-) usually bilateral ST-26 sides of cervical vertebrae SI-3 red(+) right right subcostal "cross syndrome" PC-6 black(-), SP-4 red(+) left left ASIS, left side navel rt PC-1, SP-21- TB-5 black(-), GB-41 red(+) (ST-25-ST-27) GB-26,left ST-25 Usually, the orientation of the ion-pumping cords follows the notations in the preceding table. Occasionally, unusual patterns or circumstances, which require different polarity hookup, may be noted. The following are examples of unusual patterns:2 - For treatments which require bilateral cord application using the the yin qiao mai and yang qiao mai connections, you should find abdominal reactions on both sides. However, if you find reactions only on one side, you can focus treatment on the affected side only. - In the same fashion, the typically one-sided yin wei mai and yang wei mai connections may be oriented bilaterally if the abdominal reactions are clearly evidenced on both sides. In our experience, if a patient presents with upper right quadrant and lower right quadrant reactions, e.g., right subcostal and right ASIS reactions, this often responds well to the treatment using ion pumping with placement of the black(-) cord on left TB-5, and the red(+) on left GB-41. If the unilateral abdominal pattern of reactions is on the left, the treatment is done on the right.
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Clinical Treatment: Step One
The testing procedures described in the last chapter can help determine whether or not to use this treatment. - When palpating the abdominal area, subcostal tension and pressure pain is a common finding. Relative to the extraordinary vessels, it is treated through the yin wei mai-chong mai. Most often this abdominal reaction occurs on the right side, being typically associated with the liver. If untreated, it can, over time, spread to the left side as well. In these cases the bilateral tension and pressure pain in the subcostal regions can be treated with bilateral utilization of the yin wei mai-chong mai. To do this, it is better to treat just the right side first and reassess the reactions. If the left side has not changed or has changed only slightly, then add the ion pumping to the left side. This bilateral subcostal reaction is a sign of a slightly more advanced condition and indicates that it will take more time to treat. We have also noticed that if there is tension or tightness in these regions, it is more easily treated when the pressure pain is still present, than when there is no longer pressure pain sensitivity. The lack of pressure pain is often a sign of a more advanced, or more serious condition. - If there is reactiveness only on the left subcostal region, or if there is greater reaction on the left side than the right side, it is often indicative of a much more advanced and possibly serious condition. This is more difficult to treat. Typically such a reaction is better treated through bilateral utilization of the yin wei mai-chong mai connection, rather than just treating the reactive left side. We have also found that left-sided reactions respond relatively well to bilateral use of the yin wei maichong mai before 4 pm. If treating this condition after 4 pm, it is often better to use the yin qiao mai-ren mai connection on the left side only. Test to determine which pattern will work better at what time. This left-sided reaction is often associated with problems of the heart and high blood pressure. - If you find this left-sided reaction and a hard pulse in the deep level of the second position of the right pulse (spleen), check the blood pressure of the patient. Such patients usually evidence an elevated blood pressure. This can be a relatively dangerous condition and should be treated with great caution. If the reaction found is more centrally located, yet still in this region of the abdomen, in particular in the substernal region, you can determine the seriousness of the condition based on the presence of pressure pain. If this region is hard and without pressure pain, it is more serious than if pressure pain is still present.3 This reaction (closer to the substernal region) can also be treated successfully with the yin wei mai-chong mai pair. On some occasions the yin qiao mai-ren mai pair will work better. The general pattern of reactions and the use of the testing procedures will help you decide which treatment to use. - Almost invariably, if the patient has poor muscle tonus and lack of strength in the abdominal muscles (general flaccidity), with corresponding tightness of the muscles in the lumbar region, it is best to automatically treat KI-6 (-)and LU-7 (+) bilaterally. Patients with this kind of abdomen are in a more advanced state of xu (vacuity), and treating KI-6-LU-7 provides a notable level of improvement. These variations of subcostal and substernal reactions are not particularly common, depending on your patient population, but it is important to pay attention to these variations, their significance, and treatment. STEP ONE TREATMENT WITH POLAR CHANNEL PAIRS
The polar channel pairs can be tested and/ or treated with colors, ion-pumping cords, electrostatic adsorbers, and the ion beam device. You will find these
Clinical Treatment: Step One
163
channel pairs to be clinically effective. If the ion-pumping cords or other polar agents are used with the polar channel pairs, they are not used simultaneously with the treatment of the extraordinary vessels, and vice versa. However, it is possible to use colors on the polar channel pairs first and then treat the extraordinary vessels with polar agents, and vice versa. STEP ONE TREATMENTS USING SUPPLEMENTATION AND DRAINAGE POINTS
According to the diagnostic schedule described in the last chapter and the observed polarity effects discussed in earlier chapters, ion-pumping cords, the ion beam device, or the electrostatic adsorbers can be used on the supplementing ("mother") points and draining ("child") points with good effect. These supplementation and drainage points may be depicted as in the following traditional illustration:
POSTERIOR
ANTERIOR
TB-10
Figure 9.1: Manaka's drawing of supplementation/drainage points
164
Clinical Treatment: Step One
These points are also listed in the following table: Channel lung large intestine stomach spleen heart small intestine bladder kidney pericardium triple burner gallbladder liver
Supplementing point LU-9 Ll-11
ST-41 SP-2 HT-9 SI-3 BL-67 KI-7 PC-9 TB-3 GB-43 LR-8
Draining point LU-5 LI-2 ST-45 SP-5 HT-7 SI-8 BL-65 KI-1 PC-7 TB-10 GB-38 LR-2
Utilization of these points is as follows: (+) indicates the red clip of the ionpumping cord, the positive electrode of the ion beam device, or the positive electrostatic adsorber; (-) indicates the black clip of the ion-pumping cord, the negative electrode of the ion beam device, or the negative electrostatic adsorber. Diagnosis Gastrocnemius Abdomen
Treatment Points and polarity applications
left A
ST-25, SP-21 to GB-26
right A
ST-25, SP-21 to GB-26
(+)to left SP-2, (-)to SP-5; (+)to TB-3; (-)to TB-10
left B
KI-16, 5T-27
(-)to right KI-1, (+)to KI-7; (-)to LI-2, (+)to LI-11 (-)to left KI-1, (+)to Kl-7; (-)to LI-2, (+)to LI-11
(+)to right SP-2, (-)to 5P-5; (+)to TB-3, (-)to TB-10
right B
Kl-16, ST-27
left C
LR-14*, ST-26
(-) to right LR-2, (+) to LR-8; (+) to 51-3, (-) to Sl-8
rightC
LR-14*, 5T-26
(-)to left LR-2, (+)to LR-8; (+)to 51-3, (-)to 51-8
left D
ST-21,CV-12,CV-17,PC-1
(+)to right PC-9, (-)to PC-7; (-)to ST-45, (+)to 5T-41
right D
5T-21,CV-12,CV-17,PC-1
(+)to left PC-9, (-)to PC-7; (-)to ST-45, (+)to ST-41
left E
Kl-11, LU-1-LU-2
(+)to right LU-9, (-)to LU-5; (+)to BL-67, (-)to BL-65
right£
Kl-11, LU-1-LU-2
(+)to left LU-9, (-)to LU-5; (+)to BL-67, (-)to BL-65
left F
CV-14,KI-23,GB-24,GB-29
(+)to right HT-9, (-)to HT-7; (+)to GB-43, (-)to GB-38
right F
CV-14,KI-23,GB-24,GB-29
(+)to left HT-9, (-)to HT-7; (+)to GB-43, (-)to GB-38
* As well as LR-14, the subcostal region itself can be reactive, especially the right side, over the liver. Kl-1 is located and treated on the sole of the foot, not the medial corner of the fifth toenail. PC-9 is located and treated at the radial corner of the third fingernail, not at the tip of the third finger. Because BL-67, ST-45, PC-9, HT-9, SP-2, LI-2, KI-1, SI-3 are often painful to needle, it is easier, just as effective, and more comfortable for the patient if you use the electrostatic adsorbers or ion beam device for these points. If you have the choice of a treatment tool, begin by testing the diagnosed channels with one tool, for example, the electrostatic adsorbers. If the changes of abdominal reaction are dramatic, the tool may only need to be reapplied for a short period to achieve the goals of step one. For example, if testing with the electrostatic adsorbers achieves the treatment goal for step one, then the ion pumping with
Clinical Treatment: Step One
165
needles would be unnecessary. However, if the test produces only a slight change, or if only the ion-pumping device is available, then proceed with needles and ion pumping. Remember that when needling these more sensitive points, it would be better to use thinner needles at all points and a quicker insertion method. In the preceding table, the most common treatment pattern utilizes points on the channels which are located on the side of the body that is opposite to the sore gastrocnemius reactions. For example, if left B, the kidney-large intestine reflex area, is reactive, and KI-16, ST-27 are reactive on the right side, then treat KI-1, KI7 and LI-2, LI-11 on the right side. If the points on the abdomen are reactive in a pattern of one on one side and one on the other, for example, right KI-16 and left ST-27, you would still treat on the side opposite to the gastrocnemius reactivity, i.e., treat KI-1, KI-7, LI-2, LI-11, on the right side when left B is reactive.
This pattern of treating on the side opposite the gastrocnemius reaction is the general rule to apply. However, there are some exceptions. Occasionally the abdominal reflex points and gastrocnemius reactions are all on the same side; for example, right B, right KI-16, and right ST-27. In such a case, treat on that side of the body, or, in this case, treat right KI-1, KI-7 and Ll-2, Ll-11. There is a further exception relative to the liver-small intestine pair. The liverrelated abdominal reactiveness is almost always on the right side; this is a kind of bias. The reactions on the gastrocnemius at C, the liver-small intestine reflex area, can be on the right or left leg. The reactions at ST-26, the small intestine reflex point, can also be on the left or right side. Because problems of the liver channel usually show in the crossing muscle pattern (previously described), we would treat the small intestine points SI-3, SI-8 on the right arm. The liver points LR-2, LR-8 would be treated on the same side of the body as the reactive ST-26. Thus, for reactions at right ST-26, we would treat right LR-2, LR-8; for left ST-26, we would treat left LR-2, LR-8. Based on our experience, we have found that this exception to usual treatment works well. Remember that whenever you think of stepping beyond the general rules to adapt to a peculiar case, the procedures for testing the points to guarantee optimum efficacy are critically important. STEP ONE TREATMENT USING COLOR CORRESPONDENCES AND SOURCE POINTS
In chapter six we described simple experiments using colored lights and pens. We found that the five-phase points responded to colors according to five-phase correspondences and patterns of interaction. These responses can be utilized clinically to confirm a diagnosis, and in some cases, as treatment. Rather than expound further on these concepts here, we give descriptions, illustrations, and cases where their use was supplemental to polar channel pair treatments. The color correspondences are listed in the following table: Color green/blue red yellow orange white black
Points wood fire earth source metal water
166
Clinical Treatment: Step One
As mentioned earlier, we have also found that the colors have stimulus qualities. Red and white tend to excite the channel. Black, blue, and green tend to sedate the channel, while yellow and orange tend to be neutral, neither exciting nor sedating. It is also possible to use colors that correspond to the phase correspondences of channel reflex points, such as the abdominal reflex points (mu points) and the related back-shu points; for example, red on ST-25 and CV-4 (triple burner, small intestine - fire), yellow on CV-12 (stomach - earth). The colors should be applied as a small dot to the precise point locations. When a patient is diagnosed with a polar channel pair imbalance, rather than immediately treating the supplementation and drainage points, try applying yellow to the source points. If this changes the pressure pain and 0-ring responses, it confirms your diagnosis. If it eliminates these responses, it has served as a replacement for the polarity treatment. In the former case, go ahead and treat the supplementation and drainage points as described earlier. If little or no response or change occurs, then either add red to the fire points, or white to the metal points, depending on which channels are being used. If the responses vanish, this is enough for step one. If they only decrease, go ahead with the polarity treatment, or go on to the next step, which is to burn direct moxa once on each point. Reassessment is accomplished with the same procedure. If your diagnostics and points selection are correct, this is usually sufficient for step one treatment. Jf not, or if this method is inadequate, proceed with polarity treatment of the polar channel or extraordinary vessels, depending on which pattern of reaction remains. As an example of this simple procedure, consider a patient who shows a spleen-triple burner pattern with right abdominal and left gastrocnemius reactiveness. The treatment procedure would be as follows: 1. Place yellow on right TB-4 and right SP-3.
2. Re-palpate the reflex points. If little or no change has occurred, then place red on right TB-6 and right SP-2. 3.. Re-palpate the reflex points. If little or no change has occurred, then apply one thread-size moxa to each point. 4. Re-palpate the reflex points. If little or no change has occurred, then treat the dominant pattern with the ion-pumping protocol. Note that at each stage, if the reflex point reactions were found to be improved greatly or to have vanished, then the goals of step one treatment would be accomplished. This procedure is quick and simpler to perform than to describe. When successful, all further treatment is simplified. When inadequate or unsuccessful, you will have spent only a few minutes, and will have gained insight into what is probably a more complex case.4 STEP ONE TREATMENT PATTERNS FOR UNUSUAL CONDITIONS
Although we can say that the extraordinary vessels and polar channel pairs are most frequently suitable for step one treatment, clinical reality is often complex. Sometimes signs of several patterns coexist, too few signs are present, or treatment has little of the expected effect. When faced with a case that is unclear and difficult to differentiate, and when the testing procedures yield unclear results, secondary lines of therapy and alternative strategies may be used. For more unusual or unresponsive cases, biorhythmic treatments (daily, ten day and sixty day open point methods), or whole body taiji moxa treatment are extremely effective. When the first line of treatment proves inadequate, these are reliable backups.
Clinical Treatment: Step One
167
OPEN POINT THERAPY IN STEP ONE TREATMENT
Open points can be used in place of the extraordinary vessel and polar channel treatments, or they can be integrated into the logic of one of those treatments. They can be remarkably helpful at the first step of root treatment. When detailing the nai zhi fa treatment method, we described the use of the bihourly supplementation point with a positive polarity as a means of obtaining a clearer reading of the radial pulses. A second method using open points, the hihourly supplementation and drainage points, can be an integral part of diagnosis and treatment. For instance, assume that it is between 9-11 am, or 11-1 pm, and you find reactions in the following reflex areas: right GB-26 to SP-21, right ST-25, right subcostal area, left ASIS and the spleen-triple burner region of the left gastrocnemius. In this situation, the patient shows both a clear spleen-triple burner channel diagnosis (SP-21-GB-26, ST-25, gastrocnemius) and a clear cross-syndrome pattern (right subcostal region, left ASIS). A simplified differentiation may be determined among these possible patterns: the spleen-triple burner polar channel pair, the right yin wei-chong mai, and left yang wei-dai mai connections. Because SP-5 is available as a drainage point between 9-11 am, and SP-2 is available as a supplementation point between 11am-1 pm, the use of the spleentriple burner pair will be strongly reinforced by biorhythmic effects during these hours. Thus, it would be advantageous to treat SP-2 (red+) and SP-5 (black-) with TB-3 (red+) and TB-10 (black-) on the right side. Of course, using the 0-ring test and/ or point testing with polarity devices will confirm the applicability of the treatment. The logic of selecting the treatment using an available open point can be applied at any time as a further reinforcement and confirmation. For example, if it were 4 pm and we were treating a patient with reactions at the right subcostal and left ASIS regions, with tenderness on left ST-26, and the liver-small intestine region of the left gastrocnemius, it would probably be most advantageous to apply treatment to right SI-3 (red, +), SI-8 (black, -), left LR-8 (red, +), and LR-2 (black, -), rather than the right yin wei-left yang wei connections, because SI-3 is the supplementation point at this time. The third general means of using the bi-hourly open points is as the entire first step of treatment. In these cases, one or both of the supplementation and drainage points are used to eliminate the abdominal, chest, and gastrocnemius reactions. For instance, when treating a 62-year-old female patient suffering from bronchiecstasis with a general weakness of the abdominal region and pressure pain at left ST-27, and a weak overall pulse, moxa therapy at ST-41 (since it was a little after 9 am) proved very helpful. That therapy alone reduced all the reactions, improved the pulse, and allowed treatment to progress quickly to the second stage. Similarly, a 59-year-old female patient, suffering chronic gastritis accompanied by a bitter taste in the mouth at night, was treated at 9:15 am. Tapping on ST-41 at a rate of 132 taps per minute eliminated all but the right subcostal reactions, which were then treated with ion pumping to right PC-6 (-,black) and SP-4 (+,red). Again, note that the schedule of these open points is listed in the chart that follows:
168
Clinical Treatment: Step One
Nai Zhi Fa Supplementation points TB-3 GB-43
Time 11 pm-1 am 1-3 am 3-5am 5-7 am 7-9am 9-11 am 11am-1 pm 1-3pm 3-5pm 5-7pm 7-9pm 9-11 pm
Drainage points GB-38 LR-2
LU-5 Ll-2 ST-45 SP-5 HT-7 SI-8 BL-65
LR-8
LU-9 Ll-11 ST-41 SP-2 HT-9 SI-3 BL-67 Kl-7 PC-9
KI-1
PC-7 TB-10
Earlier, we described use of the daily rhythm of the channels in conjunction with phase and point isophasality. Using the channel that is peaking at the time of treatment, we select the phase point on that channel that corresponds to the ailing phase. For example, we treated a patient who arrived around midday with acute gallstone pains. Bloodletting at right HT-9 was extremely effective, in fact, it stopped the gallstone attack completely. HT-9 was chosen because the heart channel peaks at midday, and because it is the wood point (gallbladder = wood). When another patient presented with bladder pains around 8 am, treating ST-44 was very effective. Again, the treatment stopped the pain. ST-44 was the water point (bladder = water) of the channel peaking at that time. These open point treatments utilize the relatively simple relationships of daily channel biorhythms. The next open point treatment method, the nai jia fa, uses the five phase and source points of the twelve channels in a complex ten-day sequence. This particular method can be used any time that a point is open according to this cycle. The open point is used regardless of diagnosis. Open points on the ten-day cycle, 7 am - 9 pm Day
7-9am
Sl S2
9-llam SP-5 (TB-6)
LI-5 (LI-1)
11-1pm (SP-1)
(LU-10)
BL-54 (BL-66)
TB-2 (GB-41) PC-8
(KI-2) S4
GB-34
TB-3
(GB-43)
ss S6 S7
PC-7 TB-6
SIO
7-9pm
PC-9
GB-44 (KI-3)
LR-1 (SI-5) ST-44
(LR-3)
(HT-4)
HT-9
SP-2
(SI-3)
(ST-41)
(LI-11)
ST-45
LI-2
BL-65,ST-42
SP-1
LU-10
(SP-5)
(LU-5)
KI-3,SP-3 (PC-9)
BL-66
GB-41,11-4
(LI-5)
(BL-54)
(TB-2)
KI-2
LR-3,LU-9
(KI-10)
(PC-8)
GB-43
SI-3,TB-4,BL-64
(GB-34)
(TB-3) (PC-7)
5-7pm
SI-1
LI-1
ss S9
3-Spm
LU-5
KI-10
S3
1-3pm
(ST-45)
(GB-44 SI-5
(LR-1) HT-4
(SI-1)
(ST-44 LI-11
ST-41 (SP-2)
(HT-9) (LI-2)
(BL-65)
Clinical Treatment: Step One
169
Open points on the ten-day cycle, 9 pm - 7 am Day
11-lam
S2
(GB-38) SI-2
(PC-3) KI-7 (TB-1) GB-38
ss
HT-8 (PC-5) LU-8 (LU-ll)
(LI-3) TB-1 (.KI-7)
(SP-9) LU-9,HT-7
LR-8 (.KI-1) LR-4 (HT-7) PC-5 (ST-43) TB-10
(SP-3) PC-3
9-llpm (LR-4)
SI-8
(SI-2) ST-36
S9 SlO
(TB-10) BL-60 (BL-67)
(LR-2) HT-3
S7
5-7am
HT-7,PC-7,.KI-3 (SI-8) ST-43,GB-40
(ST-36) LI-3,51-4
ss S6
3-Sam
(HT-3) SP-3,LR-3
S3 S4
1-3am
LR-2
Sl
LU-ll (LU-8)
BL-67 (BL-60)
(HT-8) SP-9
(LU-9) KI-1 (LR-8)
The first table above shows the open points during a range of working hours, 7 am to 9 pm; the second table covers 9 pm to 7 am. Points in parentheses are secondary or auxiliary open points, while those not in parentheses are primary open points. Primary points tend to be therapeutically more valuable; secondary open points tend to be more valuable when no primary points are open. Note that this occasionally occurs. The labels Sl, 52, etc. refer to the numbering of the days according to the tenstem enumerations of the revolving ten-day cycle. Every day is assigned a stem value and a branch value taken from the ten stems and twelve branches. In Chinese these labels are the traditional stem and branch names. The stem and branch cycles constantly repeat. Thus, there is a ten-day cycle associated with the ten stems: Sl ~ 510. There is a twelve-day cycle associated with the twelve branches: Bl ~ B12. There is as well a sixty-day cycle associated with the overlaying of these two cycles: Sl-Bl~ S10-B12. To use the table above, you need know only the stem assignment for that day, and the time of day in the time zone where you are.5 For example, at noon on a stem five (55) day, ST-45 is the open point. The sixty-day cycle is important to the use of open extraordinary vessel and confluence-jiaohui pairs. The determination of the stem-branch assignment for each day of the year can be made from the table on the following page, which extends the information found in the Chinese calendar from ancient times:
170
Clinical Treatment: Step One
Stem-Branch Assignments for 1995-1999 Date Jan 1 Feb 1 Marl Aprl Mayl Jun 1 Jull Augl Sep 1 Octl Novl Decl
1995
1996
1997
1998
1999
S9B5 S10B12 S8B4 S9Bll S9B5 S10B12 S10B6 S1B1 S2B8 S2B2 S3B9 S3B3
54810 S5B5 S4B10 S5B5 S5Bll S6B6 S6B12 S7B7 S8B2 S8B8 S9B3 S9B9
S10B4 S1Bll S9B3 S10B10 S10B4 S1Bll SlBS S2B12 S3B7 S3B1 S4B8 S4B2
S5B9 S6B4 S4B8 S5B3 S5B9 S6B4 S6B10 S7B5 S8B12 S8B6 S9B1 S9B7
S10B2 S1B9 S9B1 SlOBS S10B2 S1B9 S1B3 S2B10 S3B5 S3Bll S4B6 S4B12
To extrapolate, taking September 1, 1995 as our starting point, we can calculate the stem/branch configuration for each day of the month as follows: Date September 1, 1995 September 2, 1995 September 3, 1995 September 4, 1995 September 5, 1995 September 6, 1995 September 7, 1995 September 8, 1995 September 9, 1995 September 10, 1995 September 11, 1995 September 12, 1995 September 13, 1995 September 14, 1995 September 15, 1995 September 16, 1995 September 17, 1995 September 18, 1995 September 19, 1995 September 20, 1995 September 21, 1995 September 22, 1995 September 23, 1995 September 24, 1995 September 25, 1995 September 26, 1995 September 27, 1995 September 28, 1995 September 29, 1995 September 30, 1995
Stem 52 53 S4 55 56 57 58 59 510 51 52 53 S4 55 56 57 58 59 510 51 52 53 S4 55 56 57 58 59 510 51
Branch B8 B9 BlO Bll B12 B1 B2 B3 B4 B5 B6 B7 B8 B9 BlO Bll B12 B1 B2 B3 B4 B5 B6 B7 B8 B9 BlO Bll B12 B1
Clinical Treatment: Step One
171
On July 6, 1995, an 55 day, at 10 am, PC-7 is the open point. On November 16, 1997, an 59 day, at noon, SI-3, TB-4, BL-64 are the primary open points and TB-3 is the secondary open point. If a point on this cycle is open, it can be used to achieve or simplify the first step of treatment regardless of the patient's symptoms. For example, on an 59 day at 3:30 pm, a 28-year-old female who suffered from colitis came for treatment. This patient had strong right subcostal tension, and tension and soreness at right ST-25, ST-26, ST-27, tension at both the ASIS, and along the ren mai. Since ST-41 was the open point, it was needled on the right foot, because the stomach channel reactions were right-sided. This treatment eliminated all the abdominal reactions, which had previously been very stubborn, and greatly relaxed the patient, allowing treatment to immediately progress to step two.
Open points can be integrated into your treatment logic much in the same way as the nai zhi fa points. If you find one of these points is open, and that point is part of a diagnosed pattern, it may be beneficial to treat that pattern rather than another closely or similarly indicated pattern. For example, a patient presented with right subcostal and left ASIS reactions, and some tenderness on ST-26 and at the liver-small intestine gastrocnemius region. Since it was 4 pm on an 58 day when GB-41 was open, I favored treating the right yin wei-left yang wei connections rather than the liver-small intestine polar pair. Of course, testing this choice is what confirmed the treatment selection. As another example, at 6 pm on an 54 day, a patient presented with reactions on the right gastrocnemius spleen-triple burner region, both GB-26, left ST-25, and in the right subcostal and left ASIS regions. Differentiation between treating the right yin wei-left yang wei connections and the left spleen-triple burner pair was required. Since SP-2 was the open point at that time, it was advantageous to treat the spleen-triple burner pair. The sixty-day cycle of open points, the ling gui ba fa, can be used in much the same manner as above. In this cycle, there is always an open extraordinary vessel confluence-jiaohui point. When one point, KI-6 for instance, is open, its coupled point, LU-7, is always open as well. Usually, determination of which point takes the black(-) clip and which the red(+) clip of the ion-pumping cords is based on the therapeutic principles described earlier. The black clips are placed on KI-6, BL-62, TB-5, and PC-6 for the qiao or wei connections. The following tables list these open points through the sixty day cycle. Day SlBl S2B2 S3B3 S4B4 S5B5 S6B6 S7B7 S8B8 S9B9 SlOBlO
7-9am LU-7 KI-6 PC-6 SP-4 KI-6 TB-5 Kl-6 GB-41 GB-41 GB-41
Sixty day open point cycle, 7 am - 9 pm. 9-11 am 3-Spm 11-1 pm 1-3pm TB-5 SI-3 KI-6 TB-5 SP-4 GB-41 KI-6 KI-6 SP-4 SP-4 GB-41 KI-6 GB-41 KI-6 SP-4 GB-41 LU-7 GB-41 SI-3 KI-6 SP-4 GB-41 KI-6 SP-4 KI-6 LU-7 GB-41 KI-6 KI-6 KI-6 TB-5 BL-62 KI-6 SP-4 GB-41 KI-6 KI-6 SP-4 TB-5 BL-62
5-7pm BL-62
TB-5 LU-7 BL-62 TB-5 GB-41 TB-5 KI-6 KI-6 KI-6
7-9pm GB-41 BL-62 SI-3 Kl-6 BL-62 BL-62 BL-62 TB-5 TB-5 TB-5
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Clinical Treatment: Step One
Sixty-Day Open Point Cycle, 7 am- 9 pm Day
7-9am
9-11 am
11-1 pm
1-3pm
3-5pm
5-7pm
7-9pm
SlBll
TB-5
SP-4
BL-62
PC-6
SP-4
GB-41
SI-3
S2Bl2
KI-6
TB-5
BL-62
KI-6
KI-6
SP-4
GB-41
S3Bl
SI-3
KI-6
KI-6
TB-5
BL-62
PC-6
SP-4
S4B2
KI-6
SP-4
GB-41
KI-6
SP-4
TB-5
BL-62
S5B3
LU-7
SI-3
KI-6
KI-6
TB-5
BL-62
PC-6
S6B4
GB-41
BL-62
KI-6
TB-5
BL-62
Kl-6
KI-6
S7B5
KI-6
TB-5
SI-3
KI-6
PC-6
SP-4
GB-41
S8B6
BL-62
KI-6
KI-6
SP-4
GB-41
KI-6
SP-4
S9B7
KI-6
LU-7
GB-41
KI-6
LU-7
TB-5
BL-62
SlOBS
KI-6
TB-5
BL-62
GB-41
KI-6
SP-4
GB-41
Day
7-9am
9-11 am
11-1 pm
1-3pm
3-5pm
5-7pm
7-9pm
S1B9
KI-6
KI-6
LU-7
SI-3
KI-6
TB-5
SP-4
S2B10
BL-62
KI-6
TB-5
BL-62
GB-41
Kl-6
SP-4
S3Bll
BL-62
PC-6
PC-6
SP-4
GB-41
KI-6
LU-7
S4B12
KI-6
TB-5
BL-62
KI-6
TB-5
SP-4
GB-41
S5Bl
PC-6
SP-4
BL-62
GB-41
KI-6
LU-7
SI-3
S6B2
SP-4
TB-5
BL-62
KI-6
TB-5
BL-62
GB-41
S7B3
TB-5
BL-62
KI-6
TB-5
SP-4
GB-41
Kl-6
S8B4
KI-6
SP-4
TB-5
BL-62
KI-6
TB-5
BL-62
S9B5
Kl-6
TB-5
SI-3
Kl-6
TB-5
SP-4
GB-41
S10B6
KI-6
SP-4
GB-41
BL-62
KI-6
TB-5
BL-62
Day
7-9am
9-11 am
11-1 pm
l-3pm
3-5pm
5-7pm
7-9pm
S1B7
LU-7
TB-5
SI-3
Kl-6
TB-5
BL-62
GB-41
S2B8
KI-6
SP-4
GB-41
KI-6
KI-6
TB-5
BL-62
S3B9
LU-7
SI-3
SI-3
KI-6
TB-5
BL-62
PC-6
S4B10
BL-62
KI-6
TB-5
BL-62
KI-6
KI-6
SP-4
S5Bll
KI-6
LU-7
GB-41
SI-3
KI-6
TB-5
BL-62
S6B12
TB-5
SP-4
GB-41
KI-6
SP-4
GB-41
BL-62
S7Bl
KI-6
LU-7
GB-41
Kl-6
KI-6
TB-5
BL-62
S8B2
GB-41
KI-6
KI-6
TB-5
BL-62
KI-6
TB-5
S9B3
TB-5
BL-62
KI-6
TB-5
BL-62
GB-41
KI-6
S10B4
TB-5
BL-62
KI-6
KI-6
SP-4
GB-41
KI-6
Clinical Treatment: Step One
173
Sixty-Day Open Point Cycle, 7 am - 9 pm Day
7-9am
9-11 am
11-1 pm
1-3pm
3-Spm
5-7pm
7-9pm
PC-6
SP-4
GB-41
SI-3
S1B5
TB-5
SP-4
BL-62
S2B6
KI-6
TB-5
BL-62
Kl-6
KI-6
SP-4
GB-41
S3B7
SI-3
KI-6
Kl-6
TB-5
BL-62
PC-6
SP-4
S4B8
KI-6
SP-4
GB-41
KI-6
SP-4
TB-5
BL-6
S5B9
BL-62
PC-6
TB-5
SP-4
GB-41
Kl-6
LU-7
S6B10
KI-6
KI-6
SP-4
GB-41
KI-6
SP-4
TB-5
S7B11
KI-6
TB-5
SI-3
KI-6
PC-6
SP-4
GB-41
SSB12
BL-62
KI-6
KI-6
SP-4
GB-41
KI-6
SP-4
S9B1
KI-6
LU-7
GB-41
Kl-6
LU-7
TB-5
BL-62
S10B2
KI-6
TB-5
BL-62
GB-41
KI-6
SP-4
GB-41
Day
7-9am
9-11 am
11-1 pm
1-3pm
3-Spm
5-7pm 7-9pm
S1B3
BL-62
GB-41
PC-6
SP-4
GB-41
KI-6
Kl-6
S2B4
SP-4
GB-41
KI-6
SP-4
TB-5
BL-62
KI-6
S3B5
BL-62
PC-6
PC-6
SP-4
GB-41
KI-6
LU-7
S4B6
KI-6
TB-5
BL-62
Kl-6
TB-5
SP-4
GB-41
S5B7
PC-6
SP-4
BL-62
GB-41
KI-6
LU-7
SI-3
S6B8
SP-4
TB-5
BL-62
Kl-6
TB-5
BL-62
GB-41
S7B9
GB-41
KI-6
SP-4
GB-41
SI-3
KI-6
TB-5
S8B10
TB-5
BL-62
GB-41
Kl-6
SP-4
GB-41
Kl-6
S9B11
KI-6
TB-5
SI-3
Kl-6
TB-5
SP-4
GB-41
S10B12
KI-6
SP-4
GB-41
BL-62
KI-6
TB-5
BL-62
Sixty Day Open Point Cycle, 9 pm - 7 am Day
9-11 pm
11pm-1 am
1-3am
3-Sam
5-7 am
S1B1
KI-6
PC-6
SP-4
GB-41
KI-6
S2B2
KI-6
KI-6
TB-5
BL-62
GB-41
S3B3
BL-62
KI-6
KI-6
TB-5
BL-62
S4B4
TB-5
TB-5
BL-62
KI-6
TB-5
S5B5
PC-6
Kl-6
TB-5
SP-4
GB-41
S6B6
KI-6
KI-6
TB-5
BL-62
KI-6
S7B7
PC-6
Kl-6
TB-5
BL-62
GB-41
SSBS
SP-4
BL-62
GB-41
KI-6
SP-4
S9B9
BL-62
SI-3
KI-6
TB-5
BL-62
S10B10
BL-62
BL-62
KI-6
KI-6
SP-4
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Clinical Treatment: Step One
Sixty-Day Open Point Cycle, 9 pm - 7 am Day
9-11 pm
11pm-lam
1-3am
3-Sam
5-7 am
S1B11
KI-6
KI-6
LU-7
SI-3
KI-6
S2B12
KI-6
KI-6
SP-4
GB-41
BL-62
S3Bl
LU-7
BL-62
GB-41
KI-6
LU-7
S4B2
KI-6
KI-6
TB-5
BL-62
KI-6
S5B3
SP-4
TB-5
BL-62
GB-41
KI-6
S6B4
SP-4
SP-4
GB-41
KI-6
SP-4
S7B5
KI-6
PC-6
SP-4
GB-41
SI-3
S8B6
TB-5
GB-41
BL-62
KI-6
TB-5
S9B7
PC-6
KI-6
TB-5
BL-62
PC-6
SlOBS
KI-6
KI-6
SP-4
TB-5
BL-62
Day
9-11pm
11pm-1 am
1-3am
3-5am
5-7 am
S1B9
GB-41
BL-62
PC-6
SP-4
GB-41
S2B10
GB-41
GB-41
KI-6
SP-4
TB-5
S3B11
TB-5
GB-41
SI-3
KI-6
TB-5
S4B12
KI-6
KI-6
SP-4
GB-41
KI-6
S5Bl
KI-6
KI-6
LU-7
TB-5
BL-62
S6B2
KI-6
KI-6
SP-4
GB-41
KI-6
S7B3
LU-7
SP-4
GB-41
KI-6
KI-6
S8B4
GB-41
KI-6
KI-6
SP-4
GB-41
S9B5
KI-6
PC-6
SP-4
GB-41
KI-6
S10B6
KI-6
KI-6
TB-5
SP-4
GB-41
Day
9-11 pm
llpm-1 am
1-3am
3-5am
5-7 am
S1B7
KI-6
PC-6
SP-4
GB-41
KI-6
S2B8
KI-6
KI-6
TB-5
BL-62
GB-41
S3B9
KI-6
TB-5
SP-4
GB-41
KI-6
S4B10
GB-41
GB-41
KI-6
SP-4
GB-41
S5Bll
PC-6
Kl-6
TB-5
SP-4
GB-41
S6B12
KI-6
KI-6
TB-5
BL-62
KI-6
BL-62
GB-41
S7Bl
PC-6
KI-6
TB-5
S8B2
SP-4
BL-62
GB-41
KI-6
SP-4
S9B3
LU-7
SP-4
GB-41
KI-6
LU-7
S10B4
SP-4
SP-4
GB-41
BL-62
KI-6
Clinical Treatment: Step One
175
Sixty-Day Open Point Cycle, 9 pm - 7 am Day S1B5 S2B6 S3B7 S4B8 S5B9 S6B10 S7B11 S8B12 S9B1 S10B2
9-llpm KI-6 KI-6 LU-7 KI-6 SI-3 BL-62 KI-6 TB-5 PC-6 KI-6
llpm-1 am Kl-6 KI-6 BL-62 KI-6 GB-41 BL-62 PC-6 GB-41 KI-6 KI-6
1-3am LU-7 SP-4 GB-41 TB-5 KI-6 KI-6 SP-4 BL-62 TB-5 SP-4
3-Sam Sl-3 GB-41 Kl-6 BL-62 KI-6 TB-5 GB-41 KI-6 BL-62 TB-5
5-7 am KI-6 BL-62 LU-7 KI-6 TB-5 BL-62 SI-3 TB-5 PC-6 BL-62
Day S1B3 S2B4 S3B5 S4B6 S5B7 S6B8 S7B9 S8B10 S9B11 S10B12
9-llpm TB-5 TB-5 TB-5 KI-6 KI-6 KI-6 BL-62 KI-6 KI-6 KI-6
llpm-1 am LU-7 TB-5 GB-41 KI-6 KI-6 KI-6 SI-3 SP-4 PC-6 KI-6
1-3am SI-3 BL-62 SI-3 SP-4 LU-7 SP-4 KI-6 TB-5 SP-4 TB-5
3-Sam KI-6 KI-6 KI-6 GB-41 TB-5 GB-41 TB-5 BL-62 GB-41 SP-4
5-7 am TB-5 KI-6 TB-5 KI-6 BL-62 KI-6 SP-4 KI-6 KI-6 GB-41
On July 6, 1995, at 10 am, when PC-7 was the open point on the ten-day cycle, LU-7 was the open point on the sixty-day cycle, since it was an S5B11 day. On November 16, 1997, at noon, when SI-3, TB-4, BL-64, and TB-3 are all open points on the ten-day cycle, SI-3 is the open point on the sixty-day cycle, since it is an . S9B11 day. Open points can be used alone as the first step of treatment; they can be integrated into a treatment; or, they can be used to differentiate one potential first step treatment from another. One need know only the stem - branch assignment for the day and the time of day to find the open point. More detail of the open point treatments is available elsewhere.6 These three open point systems each work simultaneously and continuously; at any time at least two of the systems, the daily and sixty-day cycles are available for use. The ten-day system is available most of the time, but there are occasions when no point is open. In our use of these open points we have found the upper-limb points are not quite as efficacious as lower-limb points. In the clinic, upper-limb points often eliminate or reduce only one of the palpable reactions. Lower-limb points often eliminate or reduce more than one palpable reaction. This knowledge can be helpful when you must decide which point among a number of open points to use. This applies as a general rule in treatment, but is specifically useful in the selection of open points.
176
Clinical Treatment: Step One
STEP ONE TREATMENT WITH TAl JI (TAIKYOKU) MOXA
It is important to note, as a preface to our description of taiji moxa, that when we describe the use of any moxa, except the use of kyutoshin moxa on the handle of the needle, we are referring to very small direct moxa. In Japan, this means a highly refined, yellow, pure moxa that can be rolled into very small pieces. The moxa is rolled loosely, and molded into shape rather than firmly compressed between the fingers. It generally has the shape of a rice grain or is thready, but always comes to a point on the skin surface. Sizes of moxa range from thread size, to sesame seed size, to half rice grain size; that is, they are all very small. 0
thread size moxa
sesame seed size moxa
(J
half rice grain size moxa
The moxa is ignited with incense and allowed to burn to the skin. When correctly applied, the moxa stimulus should be felt suddenly and briefly. It is often advisable to extinguish the moxa with your finger, just as the patient feels the heat. It is also advisable to leave the ashes of previous moxas on the point, placing the fresh moxa on these ashes. This tends to insulate the skin from the excessive heating or burning that can be caused by moxa, and is thus more comfortable for the patient. Generally, moxa can be burnt three times; that is, the patient should feel the heat three times. In more serious cases, five or seven may be better. Occasionally, repeated moxa may be needed when the patient has no sensation of heat at a particular point. This condition often will be found, for example, when applying moxa to uranaitei (an extra point on the sole of the foot, below ST-44) in cases of acute digestive troubles. In these cases, care should be taken not to burn too much moxa and scar the patient. In the Japanese tradition, points are selected according to the presence or absence of palpable reactions: usually tension, tightness, and pressure pain. Also, if a number of points are listed, treatment of the palpably reactive points is often sufficient. These palpable reactions will decrease with correct treatment, just as abdominal reactions decrease with adequate general treatment. In China, the ba gang bian zheng system teaches that one should not use moxa in cases where heat is present. In this school of thought correct differentiation of hot and cold syndromes is essential. In the ba gang style of treatment, the use of moxa is quite different than we Japanese use. The amount and intensity of heat from the moxa tends to be much greater in the modern Chinese treatments. Tiny moxa are more like needle therapy than heat therapy. Despite the presence of heat, good results can be obtained by applying tiny moxa local to the area that is regarded as "hot." For instance, cystitis responds well to moxa on lower abdominal points such as CV-3, KI-12, and low back points such as BL-23, BL-32, BL-33. In the ba gang bian zheng system, cystitis is seen as damp-heat and moxa is often contraindicated. Provided the above techniques are used, you can consider the use of moxa for conditions where larger and hotter moxibustion is contraindicated. It is probable that these contraindications derived in part from ba gang bian zheng's roots in herbal medicine. The prohibition against hot herbs in a hot condition became a contraindication against moxibustion when the ba gang principles were later applied to acupuncture and moxibustion. Because moxa was equated with heat, and hot herbs were contraindicated for hot conditions, moxa become contraindicated in those conditions. In Japan, moxibustion has developed as a specialty in its own right and has its own licensing procedures; many moxibustion specialists use no needles. Long
Clinical Treatment: Step One
177
experience with the clinical application of heat, indirect and diffuse as well as direct, shows that some moxa contraindications are invalid. The source of these apparent contradictions is probably little more than the result of same or similar Chinese characters used by different traditions, but with different meanings. Also, herbal medicine is quite different from moxibustion. Whatever the reason, it is not advisable to mix metaphors. If you follow the descriptions provided in this text, direct moxa becomes subtle, point specific, and non-scarring. Taiji moxa therapy began with Takeshi Sawada (1877-1938), a famous Japanese moxibustionist. He devised a formula of points that could be used on all patients regardless of complaint or condition. This formula fortified the patient's constitution and strengthened the qi and the defensive and healing energies. Following this treatment, points were selected and moxa applied according to symptomology. Practicing these treatments regularly in the clinic and having the same treatment performed at home on a daily basis, Sawada was able to obtain remarkable results, even for extremely recalcitrant conditions. Prior to the development of antibiotics, Sawada was reputed to have regularly treated conditions such as renal tuberculosis that had been thought to be beyond the range of acupuncture. His treatments are still famous today through the work of his assistant, Bunshi Shiroda. (In chapter 11 we list their symptom control treatment formulae for over one hundred diseases. Here we mention only Sawada's taiji treatment formula.) Sawada's whole body taiji moxa treatment involved selecting from and applying moxa to the following points: Sawada's whole body taiji moxa treatment ST-36, LI-11, CV-12, GV-12
CV-6, TB-4 (especially left), KI-3 (located close to KI-6), BL-17, BL-18, BL-20, BL-23, BL-32, BL-52 The first few points are treated on virtually every patient with selection of some or all of the other points depending on condition. Shiroda recommended using at least ST-36, LI-11, CV-12, GV-12, and selecting from among the other points according to constitution, condition, and pressure pain response. We have developed our own taiji moxa formula which we have used clinically with great success. We have experimentally investigated its effects. Chapter 11 includes a description of symptom control treatment formulae for over fifty conditions that, like Sawada's, should be applied after a general treatment. These taiji moxa formulae can be used as step one treatment in the following situations: - When nothing else has helped. - Where diagnosis is too complex. - When required to derive a satisfactory polarity treatment. - Where the patient's condition is severe, chronic and/ or vacuous (xu). In these cases, this treatment will fortify the constitution and should be used as home therapy. Instructions should be given to the patient or members of the patient's household to repeat the treatment daily (see chapter 12 for further discussion). - When the practitioner does not have enough clinical experience and has difficulty selecting points, this treatment method can be
178
Clinical Treatment: Step One
very useful, giving good results, while bolstering the confidence of the practitioner. After using it, the practitioner can gradually improve his or her technique. Our own work and research has led us to formulate the following treatment: Whole body moxa treatment CV-12, ST-25, CV-4 or CV-7, TB-8, Manaka's 3-yin crossing (above SP-10) KI-7, LR-3, LR-4, GV-12, GV-20 BL-18, BL-20, BL-23, BL-32, BL-52 GB-31, GB-34, GB-40 In devising this treatment formula, we considered the general effects of each point, and we combined points to take advantage of octahedral structure. CV-12, CV-4, CV-7, GV-12, and GV-20 are midline points that treat the posterior and anterior, inferior and superior, portions of the body. ST-25 is on the belt midline and treats the anterior surface of the body. BL-18, BL-20, BL-23, BL-32, and BL-52 treat at the posterior surface of the body. TB-8, GB-31, and the Manaka san yin jiao point are yin and yang three-channel intersection-jiaohui points and are thus able to treat arm and leg yin and yang. KI-7, LR-3, LR-4, GB-34 and GB-40 are major yin and yang leg channel treatment points, treating at the inferior yin and yang surfaces of the body. We have tested this formula with the M.I.D. apparatus and found that readings after treatment tend towards a more balanced state when compared to readings prior to treatment. Japanese moxa technique uses extremely small pieces of moxa punk (see chapter 11 for more details). This moxa can leave small marks at the points. For practitioners in the West, this must be discussed with the patient and weighed against the potential benefit to the patient's condition. It is possible to use this treatment without actually burning moxa. Small hand-held electric heating filaments that deliver radiant heat to a specific point have proven useful and can be used in the clinic. These devices are recommended for home therapy. Ultimately, it is practitioner and patient preferences that determine whether these treatments will be used and how they will be used. We can emphatically state that these treatments are extremely powerful. We strongly recommend using them, while adjusting your methods according to individual need. However, we are aware of the differing perception of scarring moxibustion by Western patients and your need to take this perception into account. These moxa treatments use simple techniques that achieve the goals of the first step: reducing or ridding reactions on the abdomen, chest, and gastrocnemii, and balancing the pulses. However, no system is perfect; not all patients will clearly fit the extraordinary vessel or opposite polarity channel patterns, and some who do will present stubborn cases where key reactions hardly change. In these cases, it is advantageous to fall back on secondary treatment procedures. As therapists, we should plan like generals at war. If the first line of attack fails, or seems doomed to failure, we must adopt new tactics. Sometimes the most unconventional tactics can produce the greatest victories. Developing these tactical skills requires both skill and experience. Playing tactical games like chess or go can be extremely helpful. Intuition and sensitivity play important roles in treatment, but by combining these qualities with tactical skill you greatly enhance your ability to solve the problems patients present.
Clinical Treatment: Step One
179
It is important also to have second and third lines of defense. The psychological impact of failure or inadequacy of treatment, both for the practitioner and the patient, can interfere with or bias future progress. Failure of a particular therapy or approach is not equivalent to failure of the treatment goals. Other approaches can be taken. For the beginner with little or no experience, this is hard to appreciate and may seem overly optimistic. After years of clinical experience, we have found it invaluable to have developed such tactics. For most patients it will not come to such a point, but for the stubborn, difficult cases, especially those where clear organic dysfunction and degeneration have occurred, a sense of hope and gentle encouragement are vital.
The following completely unconventional treatment procedures can be used as second or third lines of defense. We enjoy exploring alternative tactics, stimulating strategic thought. These procedures are the result of explorations that have had clinical utility. ALTERNATIVE STRATEGIES FOR STEP ONE TREATMENT
The magnet heater This device is helpful for stubborn reactions in the upper right-lower left abdominal regions, or right subcostal-left ASIS regions. These patterns of abdominal reactions are often associated with chronic blood stasis as well as liver problems. Childbirth, trauma, surgery, or chronic liver weakness can result in poor circulation in these areas, and cause blood stasis to arise. Treatments aimed at clearing this pattern of reactions are sometimes inadequate. In these cases a stronger, more direct approach is required. This is the reason that Chinese herbal preparations are commonly given for blood stasis and acupuncture is not generally considered the treatment of choice. A strong, fluctuating magnetic field applied to the right palm, or less frequently to the sole of the left foot, is very helpful for clearing blood stasis. This field can be provided without expensive equipment by employing a magnet-heater or induction cook-top heater. This is a hot plate, but heats only magnetizable pans by rapid fluctuation of the atoms within the magnetic field provided by the device. This atomic movement heats the vessel and cooks the contents. Putting the palm or sole on the cooktop surface generates no burn, since the surface itself does not get hot. (Heat is only produced in magnetizable items.) It is best to apply this magnetic field for ten to fifteen minutes and no more.
Figure 9.2: Using a magnet heater in the clinic
180
Clinical Treatment: Step One
For patients with a stubborn cross syndrome reaction, you can speed the healing process considerably by suggesting a magnet heater for daily use at home. Ten to fifteen minutes is sufficient and the cost is small compared to more frequent office visits. However, when you recommend this home therapy, make sure that the patient returns to the office often enough to monitor their progress. This therapy is very strong and must be discontinued when the liver problem and/or blood stasis signs have disappeared. It is exceptionally helpful for women who developed chronic blood stasis after childbirth, menses, or menopause, and are presenting many varied symptoms. It is also useful for patients with organic liver problems. ISOPHASAL COMBINATIONS FOR STEP ONE TREATMENT
We also can take advantage of the isophasal concept we have described to obtain good results. For example, we have found that using a three-point isophasal combination can be very effective. The isophasal concept applies to the phase points, abdominal reflex points, the parts of the body affected, the Hirata zones, the reflex points in the auricles and on the hands. For instance, a liver problem can be treated through the wood points of the twelve channels (such as LR-1, SP-1, LI-3, 51-3), the abdominal liver reflex points (LR-14 and the subcostal region, including LR-13), the Hirata liver zones (located on the face, scalp, neck, torso, arms, and legs), the liver zone of the auricles (located in the cavum concha), or the liver channel or wood points on the hands as described by Tae Woo Yoo. A shoulder problem can be treated through points on the shoulder itself, or shoulder zones on the auricles and hands. Treating three points in an isophasal relationship addresses both the general condition and local disorders, especially acute pain. Selecting the most appropriate points is very important; the right combination can be extremely powerful. A simple method of selecting relevant phase points on the twelve channels is to treat according to the time of day and the daily rhythm of channel activities. In chapter four and in the open point section of chapter six, we discussed the daily biorhythm of the channels. In chapter four we discussed the four channel sets comprised of the three yin-three yang pairs:
tai yang tai yang shao yang shao yang yangming yangming
~ ~
~ ~
~ ~
bladder small intestine gallbladder triple burner stomach large intestine
~ ~
~ ~
~ ~
water fire wood fire earth metal
kidney => => heart => => liver => => => pericardium => spleen => => lung => =>
shao yin shao yin jue yin jue yin tai yin tai yin
It is possible to take advantage of these sets of four channels according to the time of day. The tai yang-shao yin set represent 11 am-7 pm; the shao yang-jue yin set, 7 pm-3 am; the yang ming-tai yin set, 3 am-11 am. During any of these eight-hour periods, a patient presenting with a liver problem can be treated using the wood points of all four channels. Thus, at 8 am, any single point or combination of SP-1, ST-43, LI-3, and LU-ll could be treated. Likewise, at 2 pm, a patient presenting with a clear kidney channel problem could be treated with any single point or combination of SI-2, HT-3, BL-66, and KI-10. An isophasal combination of points can be made based solely on this idea, using only three of the appropriate .channel phase points. However, the more common approach is to combine one or two points selected by this method with other isophasal points, such as the auricle point or the abdominal reflex points.
Clinical Treatment: Step One
181
As an example, consider a patient with a liver problem who presents with symptoms of right subcostal tension, pressure pain, soreness at the left Manaka san yin jiao, and a weak liver pulse. We can utilize the circadian rhythm to select one or two points in a powerful three-point combination. If it were 2 pm, small intestine channel time, we could treat SI-3, the small intestine wood point. Generally, we would treat right SI-3 because the subcostal reactions in this example are rightsided. The other two points would be selected from among the following: right LR-14, LR-13 (if very reactive), left BL-65, or KI-1. The latter two are wood points on the tai yang-shao yin channel set. The liver point in the right auricle is also a logical consideration. Check these points with palpation or the 0-ring test, magnets, etc. Select the most effective combination as revealed by your tests. For a patient with a history of heart disease, who showed substernal reaction around CV-15, the fire reflex area, treatment of right ST-41, CV-15, and left LU-10 at 10 am proved very effective. ST-41 was treated because it is the fire point and is the supplementation point for that time of day. LU-10 was selected because it is the fire point of the arm yin-foot yang relationship of yang ming-tai yin. There are many ways of forming isophasal combinations. As we have suggested, using a combination of three points (a triplet) can be helpful, but clearly there are many other possibilities and options. Sometimes this can be a simple step one procedure; generally it is a very useful secondary strategy that achieves the goals of a first stage treatment. TwO-POINT MOXA THERAPY IN STEP ONE TREATMENT
Using direct moxa on two abdominal or chest reflex points in combination with chanting a positive bias sound and maintaining a positive bias body posture is also effective, and can achieve the goals of general treatment. This method may be used either as the entire first step or as the second therapeutic application for patients with stubborn abdominal reactions. The two point combinations are usually chosen from relevant reflex points on the ren mai. Moxa is applied to the more cranial point, while the patient extends their arms overhead and tilts the head backward with mouth open wide. The patient chants "AAHH" on exhalation. Moxa is then burned at the more caudal point, while the patient places the arms at the sides, hands clenched, with chin to chest, and lip tightly pursed. "MMMM" is chanted on exhalation. These sounds and postures are derived from qigong. Moxa is usually burned three times on each point, using moxa cones of a maximum half rice-grain size. Relevant points are chosen according to the general diagnosis. Effective points are most often chosen according to polar channel pair combinations. Use of the hi-digital 0-ring test to confirm selection of the best points is helpful, as is the presence of pressure pain, tension, etc. The following combinations are commonly seen: Channel LR-SI
Cranial Point
Caudal point
BL-LU
CV-14 to CV-15 area (LR) CV-17 area (PC) CV-12 area (SP) CV-11 to CV-13 or CV-9 to CV-10 area (LI} CV-21 to CV-17 area (LU)
GB-HT
CV-17 area (HT)
CV-4 or CV-7 area (SI) CV-12 to CV-10 area (ST} CV-5 area (TB) CV-6 to CV-7 or CV-3 to CV-4 area (KI} CV3 to CV2 area (BL} CV-12 area (GB)
PC-ST SP-TB KI-Ll
182
Clinical Treatment: Step One
Select an appropriate cranial and caudal point according to your assessment of which channel pair is most relevant. When the correct pair of points is treated you will see relief of symptoms as well as improved abdominal reactions. This treatment strategy can be used for treatment of the general condition (usually using ren mai points) and treatment of specific complaints using ren mai and other related points. Generally, if the treatment is done well, and the patient chants well, the chanting distracts the patient from the heat of the moxa and the pain. The use of a metronome set to the frequency associated with the channel being treated with moxa can tranquilize the normal sensitivity to the heat of the moxa. As you study and learn, and as your proficiency increases, you can invent and develop many treatment methods to complete step one of the general treatment. Those described above represent some systematic and some not-so-systematic approaches. What is important is that the diagnostic signs and tests all be repeatable and measurably reduced. It is important to remember that a concrete means of assessing the correctness and efficacy of treatment is always required. Any treatment that meets these requirements can and should be systematically developed. The material presented here should serve only as a starting point.
CHAPTER ENDNOTES 1 The following text is very useful: Ellis, A. et al., Fundamentals of Chinese Acupuncture, Brookline, MA.: Paradigm Publications, 1988. 2 See Matsumoto, K. and S. Birch, Hara Diagnosis: Reflections on the Sea, chapter 16, for a more complete description of the extraordinary vessel diagnostic patterns. 3 Editor's note: Chapter 12, pages 278-280 of Hara Diagnosis describe Mr. Kuzome's experiences with these substernal findings. They note the same trends Manaka presents here. 4 S.B.: Given the step-by-step protocol of color treatment of points, followed by reassessment of reactive points, it is reasonable to suppose that this color therapy will be most effective on simpler, less severe conditions. According to Manaka's ideas, if we assess the stage of blood stasis present in the patient, we can judge the complexity and severity of the condition (see the last chapter). It is likely that color therapy will be most effective in stage one and early stage two blood stasis conditions. 5 S.B.: Currently, research is inconclusive as to exact timing and the effects of displacement within time zones, etc. Treat according to the time of day in your local time zone. If you are uncertain, because of daylight savings, time zone displacement, etc., test the point first with a north-facing magnet. If it reduces the reactions, treat the point, if not, check the other possible points according to your projected time differences. 6 See Matsumoto, K. and S. Birch, Hara Diagnosis: Reflections on the Sea, chapters five, nine, and eighteen.
fY
rc,-~
~-CHAPTER TEN
CLINICAL TREATMENT: STEPS Two AND THREE Steps two and three of treatment often overlap. The second step aims to relieve problems on the posterior (yang) side of the body, or in the yang channels, while the third step aims to correct structural imbalances or areas of excessive tension. These problems most commonly manifest on the posterior, yang side of the body. These two steps complete the goals of the root treatment, principally alteration of the information system to create regulatory change. They complete the procedures begun in step one, continuing with overall adjustment of the octahedral and isophasal regulatory mechanisms. Treatment of the posterior surface (yang) channels continues octahedral treatment. Selection of specific back associated-shu points, which we see as isophasal at the different vertebral levels, continues isophasal treatment.
TECHNIQUES FOR STEP Two TREATMENT Needles, moxa on the handle of the needle, direct and indirect moxa, and the "fire needle" are the techniques we usually use in the second step. Polarity agents are only infrequently used in steps two or three. THE FIRE NEEDLE (FA ZHEN)
The fire needle (ja zhen) is useful in both steps. This therapy involves heating a thick gauge needle (#20) in the flame of an alcohol lamp until it is red hot. It is then rapidly and shallowly inserted at the selected point, then withdrawn with the same rapidity with which it was inserted. Fire needle technique is described in chapter thirteen of the Ling Shu in regard to the treatment of the channel sinews. When it is correctly applied, it is of considerable utility for relaxing tight muscles. In China, they also teach the use of the fire needle for conditions of cold (han). This term is interpreted clinically as a local edema or retention of fluid in the tissues; this creates coolness and a susceptibility to cold. In our experience such local circulatory problems often respond very well to the use of the fire needle. In cases where such edema and deposits are present, and the channel on which they are located is involved in the patient's problems, the use of the fire needle at the site affected will help.
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For example, assume that a patient complains of shoulder pain and stiffness and is diagnosed and treated at step one for a liver-small intestine pattern. If this patient evidences edema and puffiness on the small intestine channel (usually at the posterior region of the axilla), there is a high probability that the fire needle technique will help this patient. Usually, a single application is sufficient. Often, applying direct moxa, or just touching the point with a heated blunt instrument which is not actually inserted, will have the same effect. This is particularly true when treating the tightness of muscles that is associated with the channel sinews. For these techniques, you should stimulate the point up to three times. KYUTOSHIN TREATMENT
As noted before, several treatment styles can be used to complete step two. At least one of these should be used, and sometimes two techniques can be used concurrently or simultaneously. The easiest and most frequently used technique is kyutoshin, literally "moxa on the head of the needle," which is moxa burnt on the handle of a needle inserted in a back associated-shu point that is indicated in diagnosis. Reactive back associated-shu points are also treated using kyutoshin. Treatment is applied to the bladder points on the back associated-shu line, or on the line lateral to the back associated-shu points, whichever is most reactive, tense, tight, or sore. The correspondences for these points are as follows: Associated shu BL-13 lfei shu) BL-14 (jue yin shu) BL-15 (xin shu) BL-18 (gan shu) BL-19 (dan shu) BL-20 (pi shu) BL-21 (wei shu) BL-22 (san jiao shu) BL-23 (shen shu) BL-25 (da chang shu) BL-27 (xiao chang shu) BL-28 (pang guang shu)
Lateral line BL-42 (po hu) BL-43 (gao huang shu) BL-44 (shen tang) BL-47 (hun men) BL-48 (yang gang) BL-49 (yi she) BL-50 (wei cang) BL-51 (huang men) BL-52 (zhi shi)
BL-53 (bao huang)
Channel lung pericardium heart liver gallbladder spleen stomach triple burner kidney large intestine small intestine bladder
Moxa on the handle of the needle involves perpendicular insertion of 11/2" (1.3 cun) gauge 3 needles to a depth of one-half to three-quarters of an inch. To ensure safety, the patient should lie prone (back side up) and remain as still as possible. Generally, this technique is not used on interscapular points. However, it can be used when treating points above the level of BL-17 (seventh vertebra) - if appropriate care is taken, and if technique is sufficiently skillful (only 1 cun needles should be used). Insertion should be shallow, in the half-inch range. For particularly thin patients the technique cannot be used above BL-17 because there is insufficient flesh to retain the needle against the weight of moxa. When treating level with BL-18 and below, depending on individual build, insertion should average around one-half to three-quarters of an inch. Further down the back, the needles may be inserted more deeply. To the level of BL-23, needles generally can be inserted up to three-quarters of an inch. When as far down as BL-25, needles can be inserted up to one inch.
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Care must be taken to not insert the needle too deeply. Do not merely follow the figures given; these are merely ranges. Chose an insertion depth based on the build of the patient. Remember that we are not trying to obtain the de qi sensation which is characteristic of modern Chinese acupuncture. Because needles are inserted one-half or more inches, an incidental de qi sensation may be elicited on occasion. In such cases, for patient comfort, generally you would be better advised to remove the needle and reinsert at a site a few millimeters from the original insertion site. The needle must be inserted deeply enough to support the weight of the moxa, but the absolutely maximum depth insertion is not critical. On the lower back where the needles are safely inserted a little deeper, the moxa balls can be a little larger. If you treat a spinal (du mai) point (GV-12, for instance) with this technique, the insertion should be at a (roughly) sixty-degree angle, angled cranially in the intervertebral space. The needle tip should be beneath the vertebral process of the vertebra above the point. Using wakakusa "semi-pure" moxa (Japanese green moxa that is specially refined for this procedure), lightly roll the balls of moxa to the size illustrated below:
Figure 10.1: Preparing moxa for Kyutoshin
To place the moxa on the handle of the needle, gently pull the ball apart, roughly in half. Hold these two halves to the sides of the handle of the needle, then press them together over the handle of the needle.
Figure 10.2: Placing the moxa on the handle of the needle
The top of the needle handle should not be visible; the bottom of the needle handle should be visible.
Figure 10.3: Placement of the needle for Kyutoshin moxa
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The needle should not be angled to the side much, if at all, and the ball of moxa should remain on the needle even while you lightly tap the ball. A firm but gentle tap of the moxa prior to lighting helps to insure that it is secure. When you are sure that each moxa placement is secure, light the moxa on all the needles at one time. Heat will pass through the shaft of the needle to the point, and in addition the area around the point will receive radiant heat.
Figure 10.4: Radiant heat penetrating skin from Kyutoshin moxa Both effects have therapeutic value; however, if it gets too hot for the patient's comfort, a small shield should be placed around the needle beneath the moxa. If you have only recently begun to include this technique in your clinical practice, you may want to keep these shields nearby as an extra assurance. When the moxa has completely burned and cooled, the ashes should be removed and another ball placed on the needle. The procedure is applied twice. So long as the needle is not inserted too deeply, nor the moxa packed too tightly, nor rolled too large, the treatment should elicit a noticeable level of comfort and relaxation. This procedure is easier and safer than it might appear. Essential to the successful application of this technique are: 1. Extensive practice on inanimate objects, such as pieces of fruit, for development of the correct moxa rolling and placement skills. 2. Availability of a metal bowl or tray and tweezers in the treatment area. Should any problem develop, you will have a place to dispose of the burning moxa ball. 3. Awareness that you should never try to lift the moxa ball off with your fingers while it is still burning or hot. 4. Avoiding the urge to fan the smoke or blow on the moxa. This usually heats up the moxa and disturbs the patient. SPECIFIC EXAMPLES OF STEP TWO TREATMENT
If you should diagnose and treat a patient for a liver-small intestine pattern, palpate BL-18, BL-47, BL-27, and the area lateral to BL-27. Treat the most reactive pair of points for the liver and small intestine. This treatment is generally applied bilaterally. Thus, treatment may, for example, be applied to BL-18 and BL-27, although BL-27 (and BL-28) are typically more reactive laterally.
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In a patient diagnosed as having a problem of the kidney-large intestine channel pair, treatment may involve BL-23 or BL-52 and BL-25. Occasionally, if either the lung or large intestine are involved, especially the lung channel, this treatment might be applied to GV-12, which is a good reflex point for the lung and large intestine. When the lower burner is weak or the~e are lower burner problems, especially those involving the kidney channels, BL-32, BL-33, or BL-34 may be treated instead of, or in addition to, BL-23 or BL-52. In chronic disorders, BL-51, or the point just lateral to it, pi gen, is often tight and sore. If you find this response, treating these reactive points usually gives good results. When treating the extraordinary vessels, your selection of back associatedshu points will often depend on the channel-extraordinary vessel overlap we have already noted. For instance, yin qiao-ren mai overlaps with kidney and lung; yin wei-chong mai overlaps with spleen, heart, pericardium, liver. If we treat right yin wei mai-chong mai because of liver-related reactiveness on the right, we would want to pay special attention to the liver points, BL-18, and the point lateral to it, BL-47. A second pair of points can be selected according to other factors that may be involved: perhaps BL-27, BL-20, BL-21, BL-22 or their lateral points. If we were to find the cross-syndrome pattern in a patient and consequently were to treat right yin wei mai-chong mai and left yang wei mai-dai mai, we would pay special attention to BL-18 because of the frequent involvement of the liver when this pattern is found. Thus, BL-27, BL-20, or BL-22 would be likely candidates for the second pair of points. We would choose BL-27 because of the association of liver-small intestine, BL-20 because the treatment point of the chong mai is a spleen point, and BL-22 because the treatment point of the yang wei mai is a triple burner point. Similarly, after treating yin qiao mai-ren mai, BL-23 or BL-52 would be the most likely targets for the first pair of points. For the second pair, you might select BL-25, BL-32, or BL-33. In a yang qiao mai-du mai treatment, BL-27 or BL-28 would be likely choices, and the second pair would be selected according to pressure pain responses and other factors involved. For the yang wei mai-dai mai, begin by checking BL-19 and BL-22. In all cases, palpation of the points is essential. Reactivity is the key. In a patient with a stubborn lung-bladder pattern, you can apply half rice grain-sized direct moxa three times to GV-12, while the patient chants "AAHH" with arms stretched above the head. Next, apply the same moxa formula to the point on the spine that lies between the BL-28 points, while you have the patient tighten and clench the muscles of the whole body, simultaneously chanting "MMMM." This fairly complex treatment has solved many recalcitrant problems. The utility of this particular treatment is based on its use of upper and lower midline points and is the posterior complement of the two-point moxa therapy described in chapter 9. In cases where polar pairs of channels have been treated, but the gastrocnemius reactions are still present, we can add the use of kyutoshin on the gastrocnemius areas to the treatment. Pay careful attention to locating the correct point(s), as the gastrocnemius reactions move as body posture changes. For a patient with extremely tight back muscles, additional points need to be treated to help relieve excessive tension. Points such as BL-40, BL-55, BL-56, BL-57, BL-58 can be checked for reactions. If one of these is very tight or sore, it may be added to the back associated-shu treatment formula. If you add leg points to the back associated-shu points treatment, use either the reactive gastrocnemius points or the bladder points, not both. Usually treatment of only the back points is sufficient. (Some practitioners in Japan recommend using leg points, rather than back
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points, when treating acute low-back problems; you might wish to take this into account.) The technique of burning moxa on the handle of the needle has many uses. It can be used for local treatments as well as the second step treatments described here. After mastering its systematic use, you should be able to design treatment procedures that expand the idea. You may also treat the points selected according to this logic with direct moxa or needling, instead of kyutoshin moxa. SELECTING YANG CHANNEL POINTS FOR STEP TWO TREATMENT
An alternate approach to step two treatment is to examine all the yang channels and treat those points best able to eliminate palpable reactions. Examining all the yang channels may be a lengthy process. Therefore, the following table drawn from our clinical experience should prove helpful for fine-tuning the range of points examined. Once the points are selected, there are several means for relieving reactions. Each method utilizes particular principles and can be performed instead of moxa on the handle of the needle, or in conjuction with that technique. However, the goal should always be to achieve the maximum effect with as few points as possible. We try to pick one to three key points.
LI-4 ST-3 SI-3 BL-2 TB-5 GB-2 GV-23
LI-10 ST-6 SI-7 BL-7 TB-8 GB-7 GV-20
Sensitive points on the yang channels LI-11 LI-15 LI-16 LI-18 ST-7 ST-8 ST-9 ST-11 SI-9 SI-ll SI-14 SI-18 BL-9 BL-10 BL-11 BL-12 TB-13 TB-14 TB-17 TB-20 GB-12 GB-14 GB-20 GB-21 GV-15 GV-14 GV-12 GV-10
LI-19 ST-12 SI-19
LI-20
TB-21
Pay close attention to relative right-left point sensitivities. Treatments aimed at releasing the reactions, or at least equalizing the differences, are the most clinically effective. Some treatment possibilities are: - Treating one or more reactive points with needles or moxa. - Treating points on yin-yang related channels (e.g., yang ming, stomachlarge intestine). In this regard, the source, luo, or five-phase points can be selected, depending on the particular findings or imbalances. - Treating points related in the yin-yang channel sets (e.g: yang ming-tai yin). As above, the source, luo, or five-phase points can be treated. - Treating three related (isophasal) points in combination. Again, the source or phasal points are typically used. - Treating point combinations that utilize the opposite polarity channel relationships (e.g., small intestine-liver, large intestine-kidney). In this method the source points are most commonly used, though the luo points can be notably effective. For a patient with stiffness of the shoulders, either as a complaint reported by the patient, or as an observation made during diagnosis, treatment utilizing reactive points is easy to apply. If GB-21 and LI-11 were sore and tight, you could needle these points bilaterally. If the stiffness were greater in the neck region, GB-20
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and/or BL-10 could be chosen, assuming they were reactive. GV-14 might be a good point if it were reactive, since it is the intersection-jiaohui point of all the yang channels. Depending on the patient's condition, and the areas most affected, selecting points from the preceding table is often all that is required. However, the points treated must be palpably reactive. If many of the points are reactive, use the hi-digital 0-ring test to aid point selection. Treatment stimulae need not be strong. Needles should be tapped lightly into the points to a depth of 2-3 millimeters. This technique can be used with the treatment of back points with moxa on the handle of the needle. Consider, for example, a patient who has been diagnosed and treated for a kidney-large intestine channel imbalance. If additional symptoms included notably stiff shoulders, and pressure pain and tension on GB-21 and Ll10, these points could be treated by tapping needles into them after placing needles in BL-23 and BL-25. Then burn moxa on the needles (kyutoshin) inserted at BL-23 and BL-25. In cases such as this, the total number of points is increased. Where reaction and/ or tension persists, an approach that combines the normal step two procedure with light needling of reactive points can be very helpful. It is also possible to add points such as SI-ll into the combination of points that are treated with kyutoshin. For example, for a patient with a liver-small intestine pattern, local pain problems along on the small intestine channel would suggest the use of moxa on the handle of the needle at BL-18 and SI-ll, instead of the more typical choices, BL-18 and BL-27. In such a case, SI-ll would be selected because it was reactive, as well as local to the small intestine channel problem. Such treatments often overlap into the fourth step of treatment, relief of the patient's symptoms. When a patient complains of problems in the head, neck, shoulders, or arms, this procedure allows for a combined and simplified approach.
By utilizing yin-yang channel relationships, we can often treat stubborn reactions on one of the channels using points on the related channel. Thus, for sensitivity along the large intestine channel, we may treat a large intestine point, such as Ll-4, in combination with a stomach channel point such as the luo point, ST-40. We might consider the source point, ST-42, as well. Usually the source point, or sourceluo point combination is sufficient. We should also keep side-to-side differences in mind. If the right large intestine channel were more reactive, you might treat right Ll-4 and an appropriate stomach channel point on the left, utilizing an arm-leg, left-right correlation. If both large intestine channels were sensitive, you could treat points bilaterally. However, since we want to apply the principle of treating the fewest points possible, it might be wise to begin treating on a contralateral axis. If this does not produce an adequate reduction of the palpatory sensitivity, treat the opposite contralateral points in turn. As always, all points treated should be palpably reactive. Such treatment can be administered without further treatment methods, or it can be done in combination with treatment of related back associated-shu points with moxa on the handle of the needles. Both approaches can complete step two treatment. In treating the yin-yang four-channel sets, rather than selecting a point on a related channel (such as stomach points for large intestine sensitivity- yang ming), we can select a point on a related yin channel, such as tai yin spleen. Recall that the four-channel sets comprise related yin-yang pairs, e.g., yang ming-tai yin. Thus for a large intestine channel problem, we would select a tai yin channel, notably the spleen channel. Again, selection of points should be based on the arm-leg, left-
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right, yin-yang, principle. The octahedral model is a great aid to point selection. Points should be palpably reactive. We might choose this procedure if the points on the related channel proved to be unreactive. Thus, in the preceding case of sensitivity on the large intestine channels, if we selected right LI-4 as a good treatment point, a point on the left spleen channel, such as SP-3, would be a good candidate for an effective combination (both are source points). For a patient with sensitivity along the small intestine channels, SI-4 on the left could be a good treatment point. But, if there were little or no reaction on right or left BL-64 or BL-58, treatment of right KI-3 could prove extremely useful. At least, it should be checked as part of your selection routine. Again, needle insertion involves simply tapping needles into the points and treatment can be done singly or in combination with related back points with moxa on the handle of the needles. Creation of isophasal point combinations arises from the three procedures already discussed through the inclusion of a third treatment point. Use of the isophasal concept and the meeting points or midline concept is extremely helpful. If we had selected right Ll-4 and left ST-42 for treatment of sensitivity along the large intestine channels, a good isophasal point would be the large intestine point of the auricle, or a point where the stomach and large intestine channels meet, such as GV-14 and ST-12. A midline point that is commonly reflective of the large intestine, such as GV-12, would be an equally good idea. These three-point combinations can be extremely helpful. We could do these treatments separately, or in combination with the kyutoshin treatments. Opposite polarity channel relationships can also be used to reduce sensitivity on one of the yang channels. In cases where the opposite polarity channel pairs have been diagnosed and treated with ion pumping in step one, it may be less advisable to use these correlations in step two, as you will have already treated by this concept. However, if a patient exhibits sensitivity along the small intestine channel, you could treat the most sensitive point, SI-ll for instance, and a liver point. Again, the polar channel point would probably be the source or luo point, with point sensitivity being the essential criteria of selection. Another method of utilizing this treatment concept is indicated when extreme sensitivity is found along a particular yang channel. At times, many of the points listed in the table above will be sensitive. For example, if the large intestine channel demonstrated extreme pressure pain sensitivity at Ll-4, LI-10, LI-11, Ll-15, and LI-20, the source point (KI-3) or the luo point (KI-4) of the kidney channel would be indicated. Usually the source point will reduce the excessive tenderness along the related yang channel. If not, then the luo point will. This particular approach can be helpful when there is pain or a problem associated with a particular channel, e.g., shoulder pain along the large intestine channel. This technique can also be helpful as part of step four, relief of symptoms. Each of these procedures is available as a therapeutic option in step two of treatment. Utilizing left-right, arm-leg, yin-yang polarities can be extremely helpful and economical. Usually, equalizing the sensitivity in two or three yang channels is sufficient for one treatment. Often several yang channels have tender points, but if the channels with the greatest left-right imbalance are treated first, usually an overall improvement can be accomplished with very few points. Try to keep the number of points used to a minimum by considering factors such as the pulse, and by looking closely for changes in sensitivity after each needle insertion. Select points with the aim of economizing point use and avoiding excessive stimulation.
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MOXA AND CHANNEL STRETCHING
A third treatment style that is applicable to step two treatments is the use of either the fire needle or moxa on reactive channel points while the patient stretches the appropriate channel and exhales. This is effective for releasing tension or stagnation in the lung, large intestine, triple burner, and small intestine channels, four channels that are typically involved in neck-shoulder stiffness problems. These can be easily stretched. This technique can be used for problems in the other channels, but we usually choose it for problems of these specific channels. It is good both for the symptomatic relief of neck and shoulder problems and for the release of functional tensions and obstructions in these regions. By itself it may be the complete second step of treatment, or it may be used with kyutoshin treatment of the back associated-shu points. It can be applicable later in step four treatment for the relief of symptoms on the shoulder, neck, and other dorsal areas. Select the most painful point from among those indicated for the specific channel and treat that point first. On occasion you may treat more than one channel sequentially, if more than one exhibits a lot of pressure pain and tension. Generally, for the lung channel, palpate around LU-1, LU-3, LU-4 with the arm stretched as follows:
Figure 10.5: Stretching the lung channel
For the large intestine channel palpate around Ll-11, LI-14, LI-15, and the front eye of the shoulder with the arm stretched as follows:
Figure 10.6: Stretching the large intestine channel
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For the triple burner, palpate around TB-9, TB-14, TB-15 with the arm stretched as follows:
Figure 10.7: Stretching the triple burner channel
For the small intestine, palpate around SI-9, SI-10, SI-ll with the arm stretched as follows:
Figure 10.8: Stretching the small intestine channel
The same treatment can be done using the fire needle technique. When using the fire needle, insert and withdraw rapidly. Insert at an oblique angle while pinching the skin between your fingers. Usually, a single insertion will loosen the point and its corresponding channel. For example, to treat a reaction at SI-10, have the patient extend the arm in the manner shown above. Hold the needle in the flame of an alcohol lamp until the tip is red. Have the patient inhale and then exhale. While the patient is still exhaling, rapidly insert and withdraw the needle. At the point of withdrawal have the patient relax and drop the arm. Be careful to catch and support the patient's arm as it is relaxed and dropped. If moxa is used instead, follow exactly the same procedure. Place a small piece of moxa, sesame to half-rice size, on the selected point. Have the patient inhale, then burn the moxa as the patient exhales. When the patient feels the heat, press the moxa to extinguish it while the patient relaxes and drops their arm. Three repetitions are necessary with moxa. For patients who dislike both the fire needle and moxa, choose the point in the same way, then use the wooden hammer and needle. With the arm extended as described above, tap the point at the frequency corresponding to the channel treated. Continue tapping until the exhalation finishes and the patient relaxes. This too should be repeated three times.
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Thus, for the large intestine points, tap at 108 beats per minute, for the lung at 126 per minute, for the small intestine use 120, and for the triple burner tap at a rate of 152 beats per minute. (See the discussion in chapter 4 for a tapping correspondence table.) This treatment can produce remarkable changes in shoulder and neck stiffness, channel sensitivity, and pain and range of motion. Sometimes you will find that the abdominal signs related to the channel treated have further ameliorated. It is possible to extend this treatment technique to other channels. For example, treatment of tension at GB-20 can be done using tiny, thread-size moxa on the point, while the patient tilts the head to the opposite side and exhales. For treating tension at right GB-20 in this fashion, the patient should tilt their head to the left. For treatment of tension at BL-10 the moxa should be applied to the point as the patient exhales and extends their head forward. In these cases, one to three moxa should suffice. Similarly, for treatment of abnormal tension with pressure pain on the front upper thigh, distal to ST-30, downward towards ST-31, LR-11 or LR-10, moxa can be applied to the most reactive point as the patient extends the foot downward and exhales. One to three small moxa should suffice. If clear musculoskeletal problems persist after the first, second, and third steps of root treatment, selection of this option (as symptom control) would be appropriate. TREATMENT WITH THE MANAKA WOODEN HAMMER AND NEEDLE
A fourth possible step two treatment utilizes application of the Manaka wooden hammer and needle at intersection-jiaohui points. Since GV-14 is the meeting point of all the yang channels, we can tap this point at any of the yang channel frequencies. For example, for a seventy-nine year-old female with deforming arthritis of the spine and feet, after treating yin qiao mai-ren mai bilaterally with ion pumping, GV-14 was selected for treatment with the wooden hammer and needle. First, GV-14 was tapped at the bladder frequency, 112 beats per minute. Then it was tapped at the gallbladder and small intestine frequency, 120 beats per minute; then, at the frequency for the stomach, 132 beats per minute. Each frequency was tapped for fifteen to twenty strokes. The patient immediately reported a comfortable, warm feeling in the feet that slowly spread across the entire body. The patient reported this experience in very positive terms. In another case, a thirty-six year-old female with chronic headaches, step one treatment of the kidney-large intestine paired channels with ion pumping and step two treatment with kyutoshin at BL-23 and BL-25, was followed by tapping GV-14 at all the yang channel frequencies. Roughly fifteen to twenty strokes per frequency were applied. This treatment was chosen because the patient's shoulders were markedly stiff and sensitive. Tapping done was at 152 (triple burner), then 132 (stomach), 120 (gallbladder/small intestine), 112 (bladder), 108 (large intestine), and 104 (du mai) beats per minute. This greatly reduced the tension and pressure pain throughout the neck and shoulders and relieved the pressure pain accompanying the headache. Step four symptom treatment followed, with intradermal needles to several auricle points, and eliminated the headache entirely. All these procedures represent options for achieving the goals of step two in the root or general treatment. One or more of these techniques can be used for any patient; we most commonly begin with kyutoshin, moxa on the handle of the needle, because it has remarkable and powerful effectiveness. These procedures are by no means the only ones available; they are simply those that have proven to be of great clinical value for us.
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ITAYA'S SUPPLEMENTARY POINTS
Kazuko Itaya has devised a simple treatment method designed to follow step one and to simultaneously address step two and symptom control concerns. She has researched a list of supplementary points from which she selects and treats those appropriate to the patient's condition. This includes points on the back on which moxa on the handle of the needle is used, and points on the limbs, abdomen, and head that can be needled, used with moxa, or treated with intradermal needles. These points and their major indications follow.
Kyutoshin: Home moxa therapy:
Points on the back: BL-17, BL-18, BL-20, BL-32, BL-34 BL-18, BL-20, CV-12, LR-3, LR-4, KI-7, SP-6
Most other points are treated with either moxa or needles, where appropriate. Home moxa is recommended for some of these. Indications and other treatment methods are given in the list. LR-3, LR-4, KI-7, and SP-6 are selected depending on kidney, liver, or spleen involvement and pressure pain responses as determined in the initial diagnostic procedure. SP-6 is also used for gynecological problems, as is the Manaka threeyin crossing point found two finger-widths above SP-10. This point above SP-10 is also good for male genital problems and problems that show with temperature variations on the abdomen. In pregnant patients, SP-6 is contraindicated for needling, and in such cases this point above SP-10 can be used instead. Point GB-34 GB-39 GB-40 CV-4
CV-7 CV-12 ST-25 ST-27 GV-20 GV-12 BL-17 BL-18 BL-20 BL-32 BL-34 BL-40 BL-58 TB-8
Indications and uses tight muscles; stomach ulcer tight muscles; stomach ulcer gallbladder problems menstrual problems (with CV-12, ST-25, ST-27 for chronic weak digestion problems) menstrual problems digestive problems digestive problems digestive problems counterflow qi * with GV-20, CV-12 for psychological problems digestive problems digestive problems digestive problems menstrual problems; lower burner problems menstrual problems; lower burner problems water regulation problems, lumbago, leg cramps back problems, around BL-58; also useful for nasal problems problems of the three arm yang channels: headache, toothache, stiff shoulders, eye fatigue, etc.
" Counterflow qi means a repletion of qi above and vacuity below. Accompanying symptoms can range from being overly emotional to a pre-stroke condition. This point, GV-20, is treated by shallowly inserting a needle obliquely into the point and burning small pieces of moxa at the junction of the skin and needle body, usually three times.
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When selecting from and treating these points according to the experience of Itaya, the following general rules apply: - Two-thirds of the points selected should be lower limb points. These are treated on one side, not both. Of these lower limb points, two-thirds are usually treated on the left leg, and one-third on the right leg. - Usually yang channel lower limb points are treated only on the left leg, yin channel points on either leg. The fewer points selected, the better. - In chronic cases, moxa is better than needles. - Aside from the general indications of the points, they are selected by palpation diagnosis: pressure pain, puffiness, tightness, tension, etc. For example, BL-17, BL-18, and BL-20 are often selected when they are visibly swollen, which usually occurs on the right side. - When selecting between CV-7 and CV-4, CV-7 is generally used for older patients and CV-4 for the rest. However, if the muscles are weak and separate easily with pressure, treat the point that evidences this condition most clearly.
- In Itaya's experience, LR-7 is a good treatment point for menstrual pain. While the point is not listed above as one of her supplementary points, it is worth drawing attention to this use. In stubborn cases of menstrual pain, if the point is palpably sore, treat it. These supplementary points represent a simple and effective integration of step two and the symptom control treatments.
TECHNIQUES FOR STEP THREE TREATMENT The objective in step three is to adjust any remaining imbalances of the muscular and skeletal structures. These physical components not only support the body's structure, but also make all physical movement possible. Balance is of great importance for health. Structural adjustment is a very effective method of treating pain in the muscles, tendons, and joints. Some exercises, usually sotai, are performed during step three, sometimes in combination with a fire needle, or the wooden hammer and needle and metronome. According to Dr. Keizo Hashimoto of Japan, imbalances in the muscular structure are the cause of imbalances in the skeletal structure. He describes pathogenesis in stages. In the first stage, abnormal sensations such as pain, numbness, discomfort, and hypersensitivity appear, but there are rarely any objective symptoms. In the second stage, along with abnormal sensitivity, functional disorders such as insomnia, poor memory, poor appetite, constipation, and dysmenorrhea begin to appear. Through these stages the pathology has not become a "disease," but is merely a combination of minor symptoms. In Chinese traditional medicine, the pattern, xiang, might be diagnosed and form a basis for treatment. In Western medicine, however, only symptomatic relief would be attempted and the idea of a basic or underlying problem would not likely arise. Finally, in the third stage of pathogenesis, structural disorders appear; the patient is diagnosed and treated as having a disease. Our experience indicates that it is important to take appropriate steps in the early stages, even with minor symptoms. With structural disorders, treating the disturbances that lie behind them is essential. Many factors are able to cause structural imbalances. Some of the most common factors are congenital abnormalities of skeletal structure, structural abnormalities from injury or disease, and imbalances resulting from unnatural postures, both
196
Clinical Treatment: Steps Two and Three
habitual and occupational. In some cases, structural abnormalities are serious and irreversible. Most structural problems, however, are not permanent orthopedic abnormalities. The majority of structural imbalances are the result of numerous small circumstances that go unnoticed. Sometimes, these small factors offset one another to yield more or less a balance, but just as often, these small factors compound their effects to produce imbalances. Some minor factors that influence structural balance are as follows: - Pathogenic factors affecting an organ on one side of the body such as the liver, gallbladder, heart. - Biased muscle tone in the neck from unbalanced vision or hearing with compensatory postural adjustments that lead to overall imbalance of the muscular and skeletal structure. - Pathogenic factors affecting one side of bilateral organs such as the kidneys and lungs. - A right-left difference in the bite of the teeth. - Old injuries and scars. - Unbalanced contact with metal from false teeth or accessories such as rings, watches, bracelets, etc. - A favored hand or foot. - Neurological disorders. - Unbalanced dress or attire, such as shoes. - Sports in which one side of the body is used more than the other, such as tennis or golf. - Extended use of one limb or a certain part of the body, for example, carrying a heavy package in one hand for a long distance. - Changes due to aging. Some minor factors are difficult to change. It is true that minor imbalances are compensated by physical habituation or stabilization. This allows the overall balance to be maintained to a degree that ordinary activities are accomplished without difficulty. It is not uncommon for older individuals to have what appear to be serious spinal deformities, and yet remain active and free from symptoms. Recognizing this possibility, we must also acknowledge the contradictory phenomena where correction of spinal alignment causes pain. While correction of structural imbalances is always a necessary consideration, you must use your clinical judgement. There is a time to apply the principle of quieta non mobile, or in colloquial terms, let sleeping dogs lie. For example, if a patient has severe scoliosis of the spine that is of many years duration, you must judge carefully if adjusting it would be aggravating or to what degree it should be attempted. Normally it is not easy to adjust such problems, but if one does cause aggravation it is usually short lived. Many methods have been devised, in both the East and West, for correcting structural imbalances. Today in the West, osteopathy, chiropractic, and other manipulative techniques are in common use. Even within the framework of orthodox medicine, physical therapy and massage are well established specialities. In
Clinical Treatment: Steps Two and Three
197
the field of Chinese traditional medicine, there are manipulative techniques including massage (tuina) and bonesetting (zhenggu), in addition to exercise systems such as qigong and taiji. It goes without saying that acupuncture, at least over time, plays a role in adjusting structural imbalances. To reinforce the effects of acupuncture in adjusting structural imbalances, Hashimoto's sotai exercises may be used with good results to effect step three. I TREATMENT OF CHANNEL SINEWS WITH SOTAI EXERCISES
The primary advantage of a yin-yang balancing system such as the treatment method we describe is that results can be obtained with minimal stimulation, shallow insertion, and the use of few points. To a large extent, step one and step two treatment are effective in alleviating symptomatic conditions. The addition of a third step enhances and consolidates the effects of the first two steps. Step three treats the channel sinews as outlined in the Ling Shu. Many different methods of treatment can be devised and a general interpretation of the Ling Shu channel sinew concept contributes to this therapeutic richness. One method we use for step three is the combination of channel sinew concepts with a simplified version of the sotai techniques developed by Dr. Keizo Hashimoto. These procedures adjust right to left imbalances in the neck, torso, and legs. These procedures alone are sufficient for restoring an overall balance, when performed after steps one and two. It is quite acceptable, however, to use additional manipulative procedures when required. When performing these sotai exercises, several factors should be kept in mind. While most can be used by any patient, the important guidelines and selection criteria are as follows: - Note any asymmetries in muscle tone. - Find restricted ranges of motion for specific movements. - Reassess these restricted ranges of motion to determine the efficacy of treatment. - Avoid discomfort and pain as a result of the exercise selected. - Determine the particular motion that elicits tightness and/ or soreness. Always perform the exercise opposite to the direction of motion that is restricted, tight, or painful. Always perform the exercise in the direction that is looser and free of discomfort. - Instruct the patient to perform movements slowly and gently, without strain, and on the exhalation. - At the point of maximum movement, a slight resistance to motion should be applied. The exhalation should be held for a moment, then on the command, "relax," the patient should relax the whole body - not just the part exercised. If required, the fire needle can be used at the point of relaxation, when the request to relax is given. Following are a few simple procedures that have proven clinically useful for the release of tension in major muscle groups.
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Clinical Treatment: Steps Two and Three
Procedure A: Range of motion test With the patient lying supine, bend each knee as far towards the chest as it will go. If one knee is more flexible than the other, the more flexible limb is treated first.
Figure 10.7-1: Sotai exercise, procedure A, range of motion test
Exercise procedure The patient is instructed to slowly extend the leg while exhaling. At the full range of motion (before the knee is straightened), the therapist provides gentle resistance. The patient should hold his or her breath for a few seconds, then with the signal to relax, immediately relax all effort and allow the leg to drop. The therapist should support the leg as it drops so that the patient will relax entirely, rather than reflexively arresting the fall of the leg. This sotai technique effectively relaxes the muscles of the back, legs, and abdomen. restoring a right/ left balance of flexibility. The use of moxa or the fire needle (jazhen) increases the effectiveness of this technique. Moxa is ignited and its heat registers at the command to relax. The fire needle is quickly inserted and withdrawn from GB-34 as the patient is requested to relax. You may need an assistant to apply the gentle resistance while you burn the moxa or insert and withdraw the fire needle. The stimulus from the fire needle should be so brief that it causes little, if any, discomfort.
Figure 10.9b: Sotai exercise, procedure A, with insertion of fire needle
Clinical Treatment: Steps Two and Three
199
When there is a right-left difference in the flexibility of the knee, treating only the more flexible limb is enough to relax and equalize both limbs. Nevertheless, it is better to perform this procedure twice on the more flexible side and once on the less flexible side.
Procedure B Range of motion test With the patient lying supine, knees bent at a ninety degree angle, turn each foot into dorsiflexion as far as it will go while keeping the heel on the treatment surface. If one ankle is more flexible, easier to bend, the more flexible side is treated first.
Figure 10.10: Sotai exercise, procedure B, range of motion test
Exercise procedure Instruct the patient to raise the foot slowly into dorsiflexion with the exhalation. At the full extent of dorsiflexion, apply a light resistance against this movement. Instruct the patient to hold the breath for a few seconds and then to relax all effort. To reinforce the effects of this exercise, the moxa or fire needle technique can be applied to LR-3 at just the last moment before relaxation.
Figure 10.11: Sotai exercise, procedure B, insertion of fire needle
The exercise should be applied twice on the more flexible side and once on the less flexible side. It is good for all the muscles of the legs.
200
Clinical Treatment: Steps Two and Three
Procedure C Range of motion test With the patient lying prone (face down), bend the knees alternately, moving first one foot then the other gently towards the buttocks. If the muscles and joints in the patient's back and limbs are pliable, the heel of the foot will touch the buttocks. If the muscles are not pliable, there can be a considerable distance between buttocks and the foot at maximum flexion. In most cases, you will find that one leg is less flexible than the other.
Figure 10.12: Sotai exercise, procedure C, range of motion test
Exercise procedure The more flexible limb is treated first as described above. The patient should slowly extend the leg on exhalation. When fully extended, the therapist applies resistance sufficient to raise the patient's leg. The patient should pause briefly as the breath is held, and then with the command to relax, the patient should immediately relax, allowing the leg to drop. The therapist should catch and support the leg.
Figure 10.13: Sotai exercise, procedure C, exercise procedure
To reinforce this exercise, the moxa or fire needle technique can be applied on a tight, sore point on the bladder shu line, typically BL-18, BL-23, or BL-58. If visual and palpatory inspections reveal a hard knot at another point, this point should be used instead. As with the other exercises, this should be done twice on the more flexible limb and once on the less flexible limb. This particular exercise is good for back, thigh, and abdominal muscle tensions.
Clinical Treatment: Steps Two and Three
201
If tightness and restricted motion persists, following this exercise, the entire exercise can be repeated on both legs, together, for a maximum of three repetitions. Stimulation can be applied at GV-8.
Procedure D Exercise Procedure With the patient lying face down, instruct the patient to arch their back, raising the head and chest off the treatment surface. As long as this does not cause discomfort, the exercise consists of extending the spine in this manner, while exhaling. Full extension is held as long as the breath is held and relaxed all at once with the exhalation. Note that the therapist applies no resistance in this procedure.
Figure 10.14: Sotai exercise, procedure D, exercise procedure
The moxa or fire needle technique can be applied with this movement on points GV-8, GV-10 or GV-12, depending on which is more reactive. Repeat the procedure two or three times. This exercise is helpful for increasing the flexibility of the spine.
Figure 10.14a: Sotai exercise, procedure D, insertion of fire needle
Procedure E Range of motion test This procedure is performed with the patient sitting on the side of a treatment table. The patient should place their hands behind the head. The practitioner then rotates the patient slowly at the waist, first to the left, and then to the right, comparing ease of rotation to each side. Generally, patients with right subcostal and
202
Clinical Treatment: StepsTwo and Three
lower left quadrant reactions - a sign of liver problems - will find that it is easier to rotate to the right. This procedure can be useful for liver problems, and liver problems are often revealed by this test. The exercise can help release the right subcostal reaction and lower left quadrant reactions.
Figure 10.15: Sotai exercise, procedure E, range of motion test
Exercise procedure
The exercise is done rotating from the more difficult to the easier side. For example, in typical liver conditions the exercise is done by having the patient rotate from the left to the right while exhaling. At full rotation the practitioner should apply light resistance to the elbows, having the patient hold position, then completely relax. This should be done three times. If the patient finds it easier rotating to the left, the rotation is right to left. You can select whether to use moxa, the fire needle, or another technique according to the comfort of the patient and your own proficiency. If you or the patient are uncomfortable using the fire needle, use a blunt needle heated in the flame of the alcohol lamp. Touch the blunt needle briefly to the selected point. Likewise, tiny thread-size moxa can be used so that the pinch of heat is felt at the moment of relaxation. Coordinating the movement, breath, and application of the blunt needle or moxa takes a little practice, particularly with moxa. It is simpler and easier to coordinate use of the Manaka wooden hammer and needle. Use the hammer to tap the wooden needle held at the relevant point while the movement is being performed, and then with a little more vigor when the movement is held and resisted. A final and harder tap coordinates with the command to relax.
Figure 10.16: Using the Manaka wooden hammer and needle with sotai
Clinical Treatment: Steps Two and Three
203
The balancing procedures just described are useful for achieving the goals of steps two and three, the correction of imbalances on the yang portions of the body and the release of asymmetric muscle tension. Following steps one, two, and three, local or symptomatic treatment often will be greatly simplified or unnecessary. AN UNUSUAL TREATMENT METHOD
If blood stasis is clearly present, especially when large areas of skin pigmentation and many moles are found, a method originally developed and still used in parts of China should be considered. An herbal salve, Po Di Gao, is applied to a relevant point. This salve is irritating and causes an ulcer to form. Once formed, an exudate will be produced. When the flow of this exudate is reduced, usually after five to ten days, a second herbal salve, Zi Yun Gao, is applied to heal the ulcer. This particular treatment is helpful in the treatment of blood stasis and for detoxifying the liver. We have found that it works more quickly if moxa is first applied to the point(s), before the salve is applied. This is called danokyu (pusforming moxa) and is used to speed the healing process when blood stasis, typically with accompanying liver problems, is a contributory factor. The treatment is directed towards back associated-shu points, typically BL-18 or the points with the tightest, hardest muscle beneath. When successfully applied, the areas of pigmentation improve within two weeks. A serious disadvantage to this treatment is that sizeable scars will remain at the points treated. Thus we hesitate to recommend its use in the West, except where you are very certain of your patient's response. Careful consultation with the patient should occur prior to using any scarring treatment in the clinic, and frequent careful monitoring should be performed when this treatment is used. In cases where this treatment is desired, but not selected, repeated treatment with moxa on the handle of the needle, direct moxa, sotai exercises, and bloodletting2 eventually can produce the same effect, when they follow step one treatment. Herbal medicines also are usually good for this condition. Provided that the blood stasis has not reached an irreversible stage, improvement throughout the course of treatment can be expected without the use of danokyu. It is important to note here that when treatments of a stronger nature are deemed necessary (e.g., scarring moxibustion, venesection, cupping), in addition to acupuncture treatments for yin-yang balandng, you must proceed cautiously. It is difficult to judge such cases in advance. Much clinical experience is required because these decisions are made only after administering gentler treatments, and after counsel with the patient to discuss these next step alternatives. If your results seem inadequate and you have begun to suspect that you have missed some complication, detailed examination from the viewpoint of orthodox Western medicine becomes a necessity. If a recent biotechnical examination has not already been performed, it is advisable with intractable cases that do not respond to treatment.
CHAPTER ENDNOTES 1 See for example: Hashimoto, K. and Y. Kawakami, Sotai: Balance and Health Through Natural Movement, Tokyo: Japan Publications, 1983. 2 Bloodletting is used as one form of symptom control treatment and is primarily indicated when strong blood stasis signs are present.
CHAPTER ELEVEN
SYMPTOM CONTROL TREATMENT: STEP FOUR Many categories of treatments are aimed at the relief of symptoms, and many techniques exist within each of those categories. You will find that completion of steps one, two, and three will have relieved or at least reduced the symptoms of many patients. But in stubborn cases where little change in the symptoms has occurred, or where little change may be expected, symptom control treatments should be simplified to be more effective. In most cases symptom control treatments should be performed after steps one, two, and three. There are cases, such as acute, severe pain, where the symptom control treatments should be performed first. This is important, not only for the patient's relief, but also because the pain and discomfort the patient suffers may interfere with or bias the treatment procedures, thus making completion of steps one through three more difficult. Where severe pain is present, the increased tension of the patient's body, their inability to assume a comfortably relaxed position, and the psychological stresses that their ill ease produces, all irritate the general condition, slowing progress. Such cases need to be assessed individually to determine whether pain or stress relief treatments need to be those applied first. The majority of cases do not require such intervention. Where it is found to be necessary, limited or minimal intervention is preferable so that any potential effects on the general treatment are reduced. While it may be rare that you will be required to perform treatments aimed more toward relief of symptoms than toward regulation of the general condition, when this is required, it is the only workable approach. Be flexible and adapt to the specific circumstance. Some of the best results in the process of symptom control come from simple treatments such as Itaya's supplementary points, moxa, or intradermals (hinaishin). In the last chapter we described the use of moxa combined with channel stretching procedures for the release of shoulder and neck tension. This method can be useful for symptom relief as well. Other moxibustion treatments presented in this chapter derive partially from our own clinical experience and partially from the works of renowned moxibustionists such as Isaburo Fukaya, Takeshi Sawada, and Bunshi Shiroda. We have used many of these treatments in our own practice and have found them outstanding.
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Symptom Control Treatment: Step Four
Other treatments we will touch on in this chapter are hinaishin or intradermal needles, auricular and Korean hand acupuncture, Chinese medical acupuncture, bloodletting, treatment of traumas, contusions, scars, etc. If you pay attention during the first three steps of treatment, you can greatly economize the number of points needed for symptom control. While most modalities can be integrated through the idea of general treatment, it is essential to always take advantage of feedback such as point sensitivity, pulse, range of motion tests, and muscle testing, to assess the adequacy and efficacy of treatment. It is important to master different approaches, not only because any primary treatment method sometimes proves insufficient, but because until the treatment methodologies described in this text have been absorbed into your thinking processes, using simpler, more familiar modes will increase your confidence. We are all indebted to the practitioners who have developed these ideas and treatments which we report here.
MOXA THERAPY Amongst Japanese practitioners, the works of Isaburo Fukaya (1901-1974) are well known. He practiced and wrote extensively, and obtained outstanding results treating many disorders.l Much of Bunshi Shiroda's work is derived from the work of Takeshi Sawada (1877-1938), a moxibustion specialist who combined both general and local moxibustion treatments to achieve excellent results.2 With his treatment style, we can perform both general and symptom control treatments using only moxibustion. Recall that in chapter nine we described the taiji (taikyoku) moxa prescriptions of both Sawada and Manaka. These have proven highly successful in bolstering the body's immune system and strengthening the overall constitution. When used with any of the following symptom treatment formularies, you will find these moxa prescriptions to be especially effective.3 The patient's condition may require that you recommend some home therapy with moxa. Either teach the patient, or a member of the patient's household, how to moxa the points or how to stimulate them with other tools. If home therapy is necessary because of the chronicity and severity of the condition and/ or because of an inability to receive sufficiently frequent treatments, selection of appropriate points and techniques is most important. (See chapter twelve, Home Therapies, for further discussion.) OUR FAVORITE MOXA TREATMENTS FOR SPECIFIC DISORDERS
Disorder
facial paralysis headache eye diseases conjunctivitis styes epistaxis stuffed nose rhinitis
Points
TB-5, LI-4, ST-36, GB-41 (figure 11.1), using touching and scratching needle techniques) GV-12, LI-11, LU-7, ST-36, GB-34 Sore points on pupil line behind the hairline (figure 11.2), GB-2, BL-18, LI-1, LI-4, ST-36 TB-21, ST-41, GV-12 SI-19 Sore points on back of neck (figure 11.3), TB-8, GB-34 GV-23, GB-12, BL-40 GV-23, LI-11, LI-4, ST-36
Symptom Control Treatment: Step Four
Figure 11.1
Figure 11.2
Figure 11.3
Disorder
Points
toothache
Sore point on side of head above ear (figure 11.4), LI-11, LI-4, ST-36, GB-34 GV-20, GB-20, TB-8, GB-34, ST-36 LI-4, LI-11 Sore points on face (figure 11.5), GB-20, GB-12, TB-4, GB-34
ear diseases facial furuncle trigeminal neuralgia
Figure 11.4
Disorder whiplash rheumatism
Figure 11.5
Points Sore points on back of neck (figure 11.6), GV-20, BL-18, LR-4 GB-21, GV-12, BL-43, BL-18, BL-20, BL-23, CV-12, ST-25, HT-7, KI-3 (figure 11.7)
I
: \ I I
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Figure 11.6
/"--,
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Figure 11.7
207
208
Symptom Control Treatment: Step Four
Disorder sore-stiff shoulder
Points GB-21, SI-11, GB-34
"40 year" shoulder shortness of breath, palpitations arm numbness, pain sciatica
LI-15, SI-ll PC-6, PC-7, GB-40, LR-4 Sore points on shoulder (figure 11.8) BL-23, BL-25, BL-37, BL-58, CV-17, CV-4, GB-31, ST-36, SP-6, sore points along PSIS (figure 11.9)
(
-
--0
-t_J
Figure 11.8
Figure 11.9
Disorder sprains, contusions
Points LR-3, LR-4, sore points around medial malleoli (figure 11.10)
intercostal neuralgia
Sore points in intercostal spaces along border of sternum and spine (figure 11.11), TB-8, PC-6 GV-20, BL-18, LR-4, insomnia point at center of heel (figure 11.12)
insomnia
Figure 11.10
Figure 11.12
Figure 11.11
Symptom Control Treatment: Step Four
209
Disorder
Points
epilepsy
GV-20, GV-12, BL-18, GB-41, TB-5, CV-14, LR-14, GB-29
high blood pressure, hardening of arteries
CV-17, CV-12, CV-4, ST-36, KI-3, GV-20, BL-10, GB-21, BL-43, BL-18, BL-23, HT-7
bronchitis
LU-6, CV-12
hiccoughs
LR-4 with sotai exercise (rotating the foot outward, then relaxing at the point of heat when the little toe reaches the floor),
common cold
sore points between the scapulae (figure 11.13), GV-14, GB-20, BL-12, LI-4
asthma
BL-18, LU-7, CV-12, LR-4
tonsillitis
ST-9, LI-4, LI-1, KI-7
acute gastric pain and spasm
BL-20, ST-34, ST-36, uranaitei** (figure 11.14)
poor appetite
stimulate around spine and navel (figures 11.15-a, 11.15-b)
** Uranaitei is located on the plantar surface of the foot, at the base of the second toe, where a dot placed in the center of the pad of the second toe touches the foot when doubled over.
Figure 11.13
Figure 11.14
Figure 11.15a
Figure 11.15b
210
Symptom Control Treatment: Step Four
Disorder
Points
fullness of stomach
ST-36, ST-39, SP-8
chronic gastritis
LI-10, ST-36
gastroptosis
CV-12, ST-25, ST-34
chronic enteritis
Sore points along spine (figure 11.16) , (hair drier massage, see chapter 12), salt moxa at navel.
acute enteritis
ST-25, uranaitei
chronic hepatitis
LR-8, LR-3
internal organ pain
Sore points along spine (figure 11.17)
Figure 11.16
Figure 11.17
Disorder
Points
lumbar pain
BL-22, BL-23, BL-25, BL-52, ST-27, BL-58
herniated lumbar disc
BL-23, BL-52, BL-25, GB-30 (good with sotai)
diarrhea
BL-25, ST-25, SP-8, SP-7, LI-10, uranaitei
constipation
GV-20, BL-25, HT-7, SP-4
hemorrhoids
BL-32, GV-20, LU-6, SP-7
eczema
BL-43, BL-18, BL-20, BL-23, PC-6, LR-3, CV-17, CV-14, CV-12, ST-25
cold feelings from poor circulation
reactive points along spine (figure 11.18); BL-32, KI-7, CV-4, SP-10
menopausal symptoms
GV-20, BL-10, GB-21, BL-43, BL-18, BL-23, PC-7, ST-36, LR-3, CV-14, LR-14
inability to enjoy sex
KI-7, LR-3, LR-4, SP-10
sterility
BL-32, CV-12, CV-4, SP-6, abdominal points (figure 11.19)
irregular, painful menses GV-20, BL-18, BL-32, SP-10, LR-4 leukorrhea
BL-23, BL-52, BL-32, ST-27, CV-4, CV-3, SP-6
night urination
GV-12, BL-32, CV-4, Kl-7 (figure 11.20)
Symptom Control Treatment: Step Four
navel
~ ,, '
211
• • Figure 11.18
\
Figure 11.19 I I I
I I I
I
I
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I
Figure 11.20: Lightly massage or tap along these lines. (Note that special shonishin tools can be used, or the wooden hammer and needle.)
Disorder
Points
knee pain rheumatoid arthritis of the knee
around knee (figure 11.21), LR-8, SP-9, BL-40, GB-34 around knee (figure 11.22), and taiji treatment
c \
Figure 11.21
Figure 11.22
Figure 11.23
212
Symptom Control Treatment: Step Four
Disorder allergy baby night crying insufficient lactation mastitis newborn nasal congestion chronic indigestion vomiting milk infantile seizures infantile asthma
Points LI-15, LI-11, Ll-10, LI-4 GV-12 GB-21, Sl-11, BL-43, Ll-10, CV-17, ST-36 CV-17, xiong tang (lateral to CV-17 at border of sternum) GV-12, GV-23, extra point near LI-4 (figure 11.23) CV-12, BL-20, GV-12 GV-12, BL-17 GV-20, CV-4 CV-14, LU-1, LR-14, GV-12, BL-13
These moxa treatments can be very helpful for control of the symptoms listed. For pain, restricted motion, or tension in an area of the body, the technique of stretching the affected channel while applying moxa to a particular point, which was described in the last chapter, can be extremely helpful. While our examples focused on the shoulder and neck regions, this technique can be used for all body areas. Again, three moxa are often all that is required. The following case study is illustrative of the usefulness of this type of channel stretching and moxa treatment:
A twenty-eight year-old female dancer had injured her left leg while attempting to stretch through a restricted leg motion. The pain and movement limitation focused at the front upper thigh muscles. After treating the yin qiao-ren mai with ion pumping cords, and using moxa on the handle of the needle at BL-25 and at BL-52, the thigh was a little looser, but still uncomfortable. Palpation revealed strong pressure pain and tension with a positive 0-ring response lateral to LR-10. Tiny moxa was applied three times to this point as the patient exhaled while stretching the liver channel by extending her foot downward and slightly lateral. This relieved the pressure pain and discomfort, but some residual tension remained. Repalpation revealed less severe reactions on a point located slightly medial and distal to ST-31. Moxa was then applied to this point, while the patient exhaled and stretched the stomach channel by extending the foot straight down. The patient then reported an 85-90% improvement in the level of discomfort and range of motion. Application of this principle to relieve tension and tightness is very simple. For instance, treatment of occipital tension by applying moxa to GB-20, or a point close to it, while tilting the head to the side is usually very effective. Palpate to find the correct point; if necessary, confirm the applicability of the point with the 0-ring test. When using this procedure on the shoulder and upper arm, the fire needle is often most efficient, as several points can be treated very quickly, when required. With the fire needle, care must be taken not to insert too deeply or too slowly.
Symptom Control Treatment: Step Four
213
MOXA TREATMENTS FROM BUNSHI SHIRODA'S SHINKYU CHIRYO KISOGAKU
The following is an extensive list of treatments from the work of Bunshi Shiroda and Takeshi Sawada. Often, symptoms that have not responded to other therapies can be alleviated with one of these prescriptions. These treatments should always be accompanied by or preceded by the application of moxa to GV-12, LI-11, and ST-36, as a general whole body treatment. If these points are mentioned in the treatment formulary for that specific disease, then that point will be especially effective for that condition. Points in bold print are especially effective for the given condition. All points are treated with moxa unless otherwise specified. Shiroda/Sawada Moxa Therapy for Symptomatic Conditions Hilar tuberculosis GV-12, BL-12, BL-11, BL-17, GV-10, GV-9, LU-6, CV-12. The same points as hilar tuberculosis. Occasionally one Infiltration in the apex needs to add BL-13, BL-15, or LU-5. of the lungs Pulmonary tuberculosis The same points as infiltration in the apex of the lungs, occasionally adding LU-1 if the temperature is over 37.5 o C. Also moxa LI-11, LU-5, GV-12, BL-11. Treatment depends on the condition of the patient. It is perhaps better to start with fewer points at first and increase the number as the patient becomes stronger. PC-4, LI-11, TB-8. Hemoptysis PC-4, BL-12, GV-9, BL-17, BL-18, GB-21, GB-36, Pleuritis above LR-14, CV-12. LU-1, LU-5, GV-12, BL-12, BL-11, GV-10, BL-17, KI-3 Bronchitis CV-12, CV-14. LU-5, KI-27, BL-12, BL-11, TB-17, (needle ST-9). Throat infection SI-3, BL-12, GV-12, BL-11, LU-5, GV-14. Pneumonia BL-12, GV-12, LU-5. Common cold GV-12, BL-12. Pertussis CV-12, CV-14, KI-27, GV-12, BL-12, BL-11, GV-10, Asthma BL-17, BL-20, LU-5, KI-3. (Needle ST-9. Insert the needle gently until it touches the wall of the caro~d artery and you can see the needle vibrate.) PC-4, CV-12, left KI-25, CV-14, BL-11, GV-12, BL-14, Palpitations BL-17, BL-10, HT-7, GB-17. HT-7, SI-11, PC-4, CV-14, CV-17, GV-12, BL-15, GV-10. Angina CV-12, KI-23, GV-12, BL-14, BL-23, BL-20, BL-18, GV-12, Irregular pulse BL-15, GV-20, PC-4, HT-7. PC-4, CV-14, CV-12, BL-17, BL-15, GV-10, GV-12, BL-12, Heart valve disease SI-11, HT-7. GV-20, GV-12, TB-15, GV-10, Sawada's LI-4*, CV-12, Hypertension CV-9, BL-18, BL-15, BL-32, Ll-11, GB-34. *Sawada's LI-4 is located at the juncture of the first and second metacarpal bones, proximal to LI-4, where one can feel a small pulse.
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Shiroda/Sawada Moxa Therapy for Symptomatic Conditions (continued) Stomatitis CV-12, BL-20, BL-21, BL-12, LI-15, LI-11, ST-36, and needling around the mouth. Toothache Pharyngitis
LI-7, BL-14, TB-17, (ST-7, LI-19, ST-5 and insert needles to the mental foramen). CV-12, BL-12, BL-11, TB-17, LU-5, KI-27, needle ST-9.
Parotitis
TB-17, LI-10, LU-5.
Esophageal spasms Acute gastroenteritis
CV-12, CV-14, BL-17, GV-9, BL-15, GV-12, BL-12, CV-17.
Chronic gastroenteritis
CV-12, ST-21, CV-9, CV-6, ST-27, BL-20, BL-21, BL-50, BL-17, BL-32.
Gastric spasms
ST-34, CV-12, CV-14, ST-21, BL-20, BL-50, LR-13, BL-17, BL-12, ST-36, uranaitei. GB-34, ST-34, BL-20, BL-18, BL-21, BL-50, BL-17, above BL-53, above ST-19.
Stomach ulcer
Uranaitei, CV-12, CV-9, CV-6, ST-21, ST-34, ST-27, BL-21, BL-20, BL-50, BL-33, ST-37, ST-36.
Stomach hyperacidity
BL-17, GV-9, CV-12, CV-14, above ST-19, BL-50, GB-34, LR-4, (do not moxa ST-36).
Stomach atony
CV-12, CV-13, BL-15, GV-9, BL-21, BL-20, BL-10, GV-20.
Gastroptosis
Same points as stomach atony, and add CV-9, ST-24, CV-6, KI-16, BL-23.
Duodenal ulcer
Same points as stomach ulcer and add right BL-50, BL-51, BL-53.
Appendicitis Intestinal hernia pain
CV-6, ST-34, BL-23, BL-25, CV-12, BL-18, LR-8.
Intussusception
Same points as gastric spasms and add ST-27, CV-6, CV-7, BL-25, BL-32. GV-4, hua to of BL-23, CV-12, ST-27, TB-4, CV-6. ST-34, BL-60, BL-33.
Diarrhea Diarrhea with intestinal gurgling
BL-60.
Constipation
HT-7, left SP-14, BL-25.
Hemorrhoids
LU-6, GV-20, BL-32, BL-33, GV-3, GV-2.
Gallstone
Above LR-14, ST-21, CV-12, BL-19, BL-20, right BL-50, GB-34, slightly lateral to ST-34, GB-41, GV-9, BL-17, right SI-11. LR-14, above ST-19, CV-12, BL-18, SI-11, LR-4.
Liver problems Jaundice Peritonitis
Nephritis Renal tuberculosis
Same points as liver problems. LR-13, CV-12, CV-9, KI-16, ST-27, CV-3, BL-23, GV-4, BL-25, LR-8. BL-20, BL-22, BL-18, BL-17, GV-10. If acute peritonitis treat only LR-13, CV-12, CV-9. CV-9, CV-7, Kl-16, CV-12, CV-3, BL-23, GV-4, BL-22, GB-25, BL-20, CV-9, SP-6, KI-3, KI-1, GV-20. Same points as nephritis. If accompanied by bladder tuberculosis, treat CV-3, BL-32, BL-33, LR-8 as well.
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Shiroda/Sawada Moxa Therapy for Symptomatic Conditions (continued) Pyelitis
BL-23, BL-22, ST-24, slightly lateral to ST-34, Kl-16.
Renal atrophy
Same points as nephritis.
Cystitis
CV-9, CV-3, Kl-12, LR-8, BL-23, BL-32, BL-33, BL-59.
Gonorrhea
CV-6, ST-27, CV-3, CV-2, LR-8, BL-23, BL-52, BL-32, BL-33, GB-34, SP-6.
Urethritis
Same points as gonorrhea.
Impotence
CV-12, CV-6, ST-27, CV-3, KI-12, BL-23, GB-25, BL-32 BL-18, LR-4.
Enuresis
CV-9, CV-6, CV-3, BL-32, GV-3, BL-23, LR-4.
Tilted uterus
TB-4, CV-12, CV-6, BL-23, BL-20, BL-31, BL-32.
Endometritis
CV-12, CV-6, ST-27, CV-3, BL-23, BL-20, BL-18, BL-31, BL-32, SP-6, GB-34.
Inflammation of tissues & organs around uterus Same points as endometritis. Irregular menses
Same points as endometritis and add BL-27.
Difficult menses
Same points as endometritis; do not treat BL-31 but particularly add BL-25.
Sterility
Same points as irregular menses.
Morning sickness
CV-12, TB-4, BL-17.
Uterine bleeding
BL-27, GB-34.
Difficult labor
BL-67.
Breast pain
SI-11, CV-17.
Insufficient lactation
Same points as breast pain, and add BL-20, BL-21, CV-12, TB-4.
Vomiting milk (infants)
GV-12.
Diarrhea in nursing child GV-12, CV-7. Fretful child
GV-12, GV-4.
Childhood pertussis
GV-12, GV-14, BL-12.
Childhood polio
GV-12, BL-18, GV-3, GB-34.
Astigmatism
GB-20, Sawada's LI-4.
Trachoma
TB-22, BL-20, BL-21, LI-11, ST-36.
Scleritis
TB-22, BL-12, GV-12, BL-42, LI-11, BL-18 ST-36, Sawada's LI-4.
Conjunctivitis
LI-11, TB-22, BL-15, BL-18, GB-34, ST-36.
Inflammation of the canthi of the eyes
Ll-11, GV-12, BL-12, BL-20.
Keratitis
Same points as trachoma and add BL-13, BL-25, GB-16.
Iritis
Same points as scleritis and add GB-5 and GB-3.
Hemorrhaging in the capillary bed at the back Treat the point one division above BL-10, which is of the eye especially helpful, and LI-4.
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Shiroda/Sawada Moxa Therapy for Symptomatic Conditions (continued) Retinitis
Same points as the last.
Rhinitis
LI-20, GV-12, BL-12, GB-20, Ll-11, LI-10, LI-4.
Hypertrophic rhinitis
GV-12, BL-12, BL-11, BL-10, GV-22, Ll-10, ST-36, LI-20.
Sinusitis
Same points as hypertrophic rhinitis, occasionally add BL-15, GV-16, HT-3, CV-12, CV-13.
Otitis media
Sl-19, TB-17, GB-12, HT-3, Kl-3, BL-23, BL-11, BL-12.
Anosmia
BL-12, GV-22, needle to Ll-20.
Tinnitus
HT-3, TB-17, GB-2, SI-19, ST-24.
Throat infection
LU-5, Kl-27, BL-12, BL-11, TB-17.
Tonsillitis
LU-5, BL-11, GV-14, BL-12, LU-6, LU-7, Kl-3.
Beri-beri
ST-36, GB-34, GB-41, SP-6, slightly lateral to ST-34, GB-31, Kl-3, Kl-9, eyes of knee, PC-4, plus whole body treatment.
Rheumatoid arthritis
BL-27, BL-32, BL-33, CV-14, CV-12, CV-6, BL-15, TB-15, SI-10, BL-20, BL-25, TB-4, HT-7, PC-4, ST-36,GB-34, KI-3, LR-8; also treat points around the swollen joints and needle ST-9 gently and slowly until it touches the carotid artery and one can see the needle vibrate.
Arthritis
Same points as rheumatoid arthritis.
Diabetes
TB-4, CV-12, left ST-21, Kl-16, CV-6, BL-20, BL-22, BL-23, GV-12, GV-20, ST-36.
Hyperthyroidism
GV-12, BL-12, BL-11, KI-27, CV-22, LI-10, BL-23, BL-18.
Stroke
GV-20, BL-10, GV-16, BL-12, GV-12, BL-15, TB-15 SI-10, BL-18, BL-23, BL-32, CV-12, TB-4, LI-10, ST-36, GB-34. Select from these points according to the condition.
Inflammation of the spinal cord
GV-12, BL-11, BL-18, GV-8, BL-23, GV-3, BL-32, CV-3.
Neurosis
GV-20, left GB-17, BL-10, GV-12, BL-15, BL-18, BL-23, Ll-10, HT-7, ST-36, GB-34, CV-12, CV-14, BL-17
Psychosis
Same points as neurosis.
Epilepsy
BL-18, GV-8, GV-12, left GB-17, GB-34, GV-16.
Migraine
GB-17, GV-20, BL-10, GV-12, LI-10, TB-9.
Sciatica
BL-32, GB-30, BL-37, GB-34, ST-36, three divisions above BL-37 and at the lateral edge of the muscle, BL-59, BL-60, Kl-3, slightly lateral to ST-34, BL-23, BL-25, BL-20, BL-18, HT-3, CV-3.
Neuralgia of the inguinal joint region Neuralgia in the lumbar region Intercostal neuralgia
LR-8, SP-10, slightly lateral to ST-34, BL-20, BL-22, BL-23, GB-30. BL-18, BL-20, BL-23, BL-25, above BL-53, BL-27, BL-32, GB-31, lateral to BL-37, BL-17, ST-36, GB-34, KI-3. CV-17, CV-14, CV-12, LR-14, LR-13, BL-18, BL-19, GV-9, BL-17, BL-15, GV-12, HT-3, PC-4, GB-34, GB-41.
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Shiroda/Sawada Moxa Therapy for Symptomatic Conditions (continued)
Neuralgia of upper arm
GV-12, TB-15, SI-10, LI-15, SI-11, BL-15, LI-11, LU-6, PC-4, TB-4, HT-7, CV-14, LU-1, BL-27.
Chronic painful shoulder with difficulty moving Same points as neuralgia of the upper arm. Neuralgia of the arm associated with the radial nerve Ll-15, LI-11, Ll-10, TB-9. Neuralgia of the arm associated with the median nerve PC-4 and PC-7 or PC-6. Numbness of the arm HT-3, HT-7, HT-4. along the ulnar nerve Trigeminal neuralgia Bell's palsy or facial spasm Occipital pain Open ulcers Scrofula Allergic skin problems Eczema Sweat rash
TB-22, GB-12, BL-10, BL-11, GV-12, BL-18, Ll-10, TB-9, ST-7, ST-5, Ll-20, Sl-18. BL-18, GV-8, BL-10, GV-12, Ll-10, GB-34, TB-17, GB-2, needle appropriate facial points. GV-12, BL-12, BL-10, GV-16, GV-20, LI-10. LI-10, LI-4, SI-6. LI-10, LI-11, HT-3, BL-12, GV-12, BL-15, GB-21, ST-36, LU-7, LU-6. BL-12, GV-12, LI-15, LI-11, Ll-10. Same points as allergic skin problems. Same points as allergic skin problems.
HINAISHIN- INTRADERMAL NEEDLE THERAPY
Intradermals can be used on most parts of the body. When intradermals are placed at the correct point, they can give immediate relief and the effects continue at least as long as the needle is retained. Often they may remain in place until the next visit, usually within one week. They are of great utility when applied locally, and are also effective when applied to the hand points described by the Korean acupuncturist, Tae Woo Yoo, or when applied to auricle points, both those of the French doctor, Paul Nogier, and those used in mainland China. 4 Intradermals produced in Japan come in a variety of materials, sizes, and lengths. They are thin, fine needles with body lengths from 3-6 mm, and are available in stainless steel, silver, or gold. Generally the stainless steel needles are appropriate for treatment. Insertion of an intradermal needle is accomplished obliquely, such that it penetrates the skin to the dermal layer, or superficial fascia, but not to the deep fascia or muscle layers. The intradermal is inserted with tweezers to about half or less the length of the needle body; it should sit comfortably and shallowly. Placement should also conform to the body's natural creases. For example, if using an intradermal at PC-7, it should be inserted with its point towards the radius or ulna, not towards the hand or forearm. Also, since the needle is left taped in place for up to a week, for safety purposes, placement should avoid muscle tissue, so the needle will remain immobile even as the patient moves. A longer 6 mm intradermal needle may be placed in an area of less movement: for example, most portions of the
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Symptom Control Treatment: Step Four
back. On areas that move more, for example, around the neck or joints, a shorter 3 mm needle is preferable. Each tiny needle is taped with two pieces of tape, one under the head of the needle, one over the entire area where the needle is inserted:
-1 ·I
,.-----·
--i--...__,: ._I ____••....I
Figure 11-24: Inserting and taping a hinaishin needle
Figure 11.25: Placement of hinaishin needles
When using intradermals in the auricles or on the hands, the shorter 3 mm needles should be used. The auricles and hands move too much to use the 6 mrn intradermals. If the intradermal works loose and begins jabbing the patient, it should be removed. Patients should be instructed how to remove these needles themselves as a precaution against a loose needle. Sometimes this needle jabbing is a negative bias; thus, it is better to remove the needle. If a needle in the auricle gives a slight achy sensation (like a de qi or hibiki), generally this is acceptable; the needle can be left in place. On the body or the hands, any intradermal needle that causes discomfort should be removed. To remove intradermals, pull the tape from point to head. Patients should be so instructed if they are to remove the needles themselves. There are many possibilities for use of intradermals on the body. The following are typical examples of their use: For patients with bursitis, palpate along the small intestine channel on the upper arm and scapular region. If the channel feels puffy, or the skin feels thick, then palpate both BL-27. If these points are reactive, place intradermals at both points. Often this is sufficient to relieve the pain and restricted motion. In a patient with typical liver problems, if after the step three exercise (procedure C) when you recheck the range of motion and the heel still will not touch the buttocks, palpate one inch below the center of the popliteal crease on the same side as the tight leg. If you find a sore point, place an intradermal there. Also place an intradermal at the " leg and loin" point (Chinese system, on the dorsal surface of the hand). This point is really two points which are located one and one half cun distal to the wrist crease on the radial side of the second extensor digitorum manus tendon and at the ulnar side of the fourth tendon. Palpate these points and place
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an intradermal at the more tender of the two. This combination should reduce the muscular tension and the heels should now be able to touch the buttocks. As well as being good for further third step treatment, this will often relieve back pain when the indications for this treatment are present. In patients with lower back pain, if there is tenderness between lumbar five and sacral one, at the point called josen, place an intradermal there. This is often effective. For treatment of acute myopia, palpate GB-14 and yu yao (at the eyebrow), compare the reactions, and place an intradermal at the most reactive point(s). It is also good to insert intradermals at BL-32; this combination will often help. Itaya recommends using intradermals in the auricles for patients who have had a stroke or are depressive. In particular, she likes to leave an intradermal in the right auricle at shen men and one in the left auricle at the "brain" point (see below.) She likes to use this brain point for various cognitive disorders, but she rarely leaves intradermals in both auricles at this point. When treating the points described in the last chapter with channel stretching and stimulation, another possibility is to place an intradermal at the reactive point, rather than use the fire needle or moxa. Intradermals can be used for simple isophasal combinations. For example, shoulder pain usually responds well to the placement of intradermal needles. Insert an intradermal needle at the most reactive point on the most affected channel on the shoulder. One point in the shoulder zone of the auricle (same side) and one point in the shoulder zone of the hand (same side) completes a three-part isophasal combination. For low back pain, placement of intradermals in the lower back, auricle zone, and hand zone has also proven very effective. The preceding are a few examples showing the use of intradermals on body points. An even simpler method of selecting points is to place intradermals at the most reactive points in the affected area. Working with the pressure pain and tension in muscle groups, along the channels, at trigger points, etc., can be useful for relief of pain. Sometimes this is necessary and helpful, but the most remarkable results are usually seen when using intradermal needles on auricular points and the hand points of Tae Woo Yoo. INTRADERMAL NEEDLES FOR AURICULAR POINTS
It is interesting that Nogier and the Chinese have different maps of the body as reflected in the ear. After Dr. N ogier made the original discovery, Chinese researchers examined these correlations and proposed a map of their own. Both describe an inverted fetus, with the ear lobe as the head and face, the upper and lower limbs reflecting in the upper portions of the auricle, and the spine along the antihelix. However, the details of how the internal organs reflect in the auricle are different. This seems contradictory, but both systems make substantial claims of effect. For our purposes, the simplest method of using these two systems is to ignore the theoretical contradiction and simply test the area corresponding to a condition for reaction. Begin with the map you prefer; if no reaction is evident, check the corresponding area of the other map. Usually, one of the maps will show reactions that correspond to the patient's problem. (In our clinic, most of the time we use the Chinese map.) Use a blunt probe to find the exact point to be treated. Since points usually show some electrical variance if they need treating, it is particularly helpful to use an electrodermal device to find points with lowered electrical resistance. The
·
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device should have a small point probe to test small areas. We have found the useful; however, there are many other suitable devices. If the point is both sore and more electrically conductive, this is usually the point to be treated. For example, in a patient with an upper limb problem, first palpate along the scaphoid fossa. If no significant reaction is found, then palpate the Nogier point on the crus of the helix. Often the Chinese mapping is sufficient, but some of the Nogier points are more useful. For example, the Nogier allergy point, #24 is very effective for conditions such as allergic rhinitis. "HIBIKI-7"'
Figure 11.26: The Chinese auricular map
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Map One - The Chinese Mapping 1 = tooth extraction anesthesia
2 = upper jaw
3 =lower jaw
4 =tongue
5 =upper chin
6 = lower chin
7 = tooth extraction anesthesia
8 = eye
9 =inner ear
10 =tonsils
11 =cheek
12 = apex of tragus
13 =adrenal
14 =external nose
15 =throat
16 =internal nose
17 =thirst point
18 = hunger point
19 =high blood pressure
20 =outer ear
21 =heart organ
22 = internal secretion
23 = ovary
24 = eye 1 and 2
25 = brain stem
26 = toothache
27 =throat and teeth
28 = brain point (pituitary)
29 = occiput
30 = parotid gland
31 = stop wheezing point
32 = testicles
33 = forehead
34 = subcortex
35 = tai yang
36 =vertex
37 = cervical vertebrae
38 = sacral vertebrae
39 = thoracic vertebrae
40 = lumbar vertebrae
41 = neck
42 =chest
43 = abdomen
44 = breast
45 =thyroid
46 = foot
47 = heel
48 =ankle
49 = knee joint
50 = sacroiliac joint
51 = sympathetic
52 = sciatic nerve
53 = kidney
54 = lumbar pain point
55= shen men
56= pelvic cavity
57 = hip joint
58 = uterus
59 = high blood pressure
60 = asthma point
61 = hepatitis point
62 = finger
63 = clavicle
64 = shoulder joint
65 = shoulder
66 =elbow
67 = arm
68 = appendix 1
69 =appendix 2
70 = appendix 3
71 = urticaria point
72=helixl-4
73 =tonsil 1
74 =tonsil 2
75 = tonsil3
76 = liver yang point
77 = liver yang point
78 = auricular apex
79 = external genitalia
80 = urethra
81 =rectum
82 =diaphragm
83 =point zero
84 =mouth
85 = esophagus
86 = stomach cardiac orifice
87 =stomach
88 = duodenum
89 =small intestine
90 = appendix 4
92 =bladder
93 = prostate gland
94 = ureter
95 = kidney
96 =pancreas (left) gallbladder (right)
97 = liver
98 = spleen
99 =ascites
100 = heart
101 = lung
102 = bronchii
103 = trachea
104 = san jiao
105 = lower blood pressure groove
106 = upper back 109 = low abdomen
107 = low back
108 = mid back
91
=large intestine
110 = upper abdomen
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Map two- Nogier's Mapping Alphabetical order
Numeral order 1 eye olfactive 2 maxillary 3 lung 4
5 6 7 8 9 10 11
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
aggressiveness allergy auditory biliary
auditory stomach
cerebral point darwin
throat
eye genital gonads
gonads pancreas-spleen heart biliary rectal sciatic knee kidney trigeminal aggressiveness tragus skin shoulder zero lower limb upper limb allergy darwin synthesis cerebral point
heart kidney knee lower limb lung maxillary medullary occipital point olfactive pancreas-spleen rectal sciatic shoulder skin stomach
17 24 5 11
27 25 1 29 8 10 15 14 22 4 3
30 28 2 9 1 13 2 19 6 26 7 18 16 23 21
synthesis throat tragus occipital point trigeminal genital upper limb medullary zero If many points are tender you may have difficulty distinguishing which to use because many are also electrically conductive. However, there is a simple method of discrimination. Increase the output of your electrodermal device by increasing the power output or by reversing the positive and negative output plugs. Either of these actions increase the current sufficiently to stimulate the point probed. Check the effectiveness of the point. If the area of pain, restricted motion, etc, improves with stimulation, you have found the point to treat. This technique is sometimes enough to treat the patient; at the least, it is helpful for discriminating between many reactive points. Select the most reactive points for intradermal placement.S
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Normally one looks for reactive points on the anterior surface of the auricles, but sometimes the corresponding area is not reactive. My experience, coupled with the results of experiments described in chapter three, suggests that treating a corresponding point on the posterior surface of the auricle can be effective if there is no reaction in the point on the anterior surface. Thus if there is no clear reaction on the anterior surface, palpate the exact opposite point on the posterior surface. When selecting auricle points, limit yourself to as few points as possible. (For example, refer to the three-point isophasal combination for shoulder pain described in chapter nine.) If you select good points, an isophasal combination is usually sufficient. You can also leave intradermal needles at corresponding organ points to reinforce the root treatment; for example at the liver point in a cross-syndrome pattern, or at the lung or kidney point in a yin qiao mai-ren mai pattern.
Figure 11.27: Nogier auricular mapping INTRADERMAL NEEDLES USING HAND ACUPUNCTURE FROM KOREA
Tae Woo Yoo's discovery that the hands are microsystems reflecting the whole body is, in some ways, a more remarkable insight than the auricular system. He has devised complex treatment strategies that work for constitutional, five phase, extraordinary vessel, and local problems.6 Not only does this system, koryo sooji chim, show correspondence between body areas and hand and finger areas, it also maps all the channels and their major acupoints, including five phase, source, luo, master-coupled, front-mu and back-shu points. Here we describe only the correspondence of body areas to hand parts and the general systems of channel pathways on the fingers and hands. Both hands reflect the whole body. The palmar surfaces reflect the ventral surfaces of the body, the dorsal surfaces reflect the dorsal surface of the body. When viewing the dorsal surface of the left hand, the left side, including the little, ring, and left half of the middle finger, reflects the left side of the body; the right side of the hand reflects the right side of the body. When viewing the dorsal surface of the right hand, the converse is true. The little finger, ring finger, and right half of the middle finger reflect the right side of the body, the left side of the hand reflects the left side of the body. On both hands the middle fingers reflect the face, back of the head, front and back portions of the neck and chest, and upper back. The second and fourth fingers reflect the arms, the thumbs and little fingers reflect the legs. The major joints of the body, hips, knees, ankles, shoulders, elbows, and wrists are also reflected.
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ARM
LEG
LEFT SIDE OF THE BODY
RIGHT SIDE OF THE BODY
Figure 11.28a: Hand/point correspondences, dorsal surface BACKSIDE OF THE BODY
BACK
DUMAI
Figure 11.28b: Hand/ anatomy correspondences, dorsal surface
Figure 11.28c: Hand/point correspondences, palmar surface
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FRONT SIDE OF THE BODY
Figure 11.28b: Hand/ anatomy correspondences, palmar surface
The channel trajectories can be seen roughly as follows: ~------------------------~
Figure 11.29a: Kidney and triple burner channel trajectory on the hands
Figure 11.29b: Small intestine and bladder channel trajectory on the hands
Figure 11.29c: Large Intestine and gallbladder channel trajectory on the hands
Figure 11.29d: Heart and spleen channel trajectory on the hands
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Figure 11.29e: Pericardium and liver channel trajectory on the hands
Figure 11.29f: Lung and stomach channel trajectory on the hands
When working with patients who have pain or problems in the following areas, look for reactive points on the corresponding hand area - neck, upper back, low back, shoulder, wrist, hip, knee, chest.
Figure 11.30 a & b: Reactive areas on dorsal aspect of hand EYE PROBLEMS
Figure 11.30 c & d: Reactive areas on palmar aspect of hand
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The best method of locating the correct point to treat is to use a small, blunt probe, ideally an electrodermal probe. On the hand, the points are very tiny and specific; finding the exact point is vitally important. As described above, you can test the applicability of the point by increasing the output current of the electrodermal device or by reversing the positive and negative outputs to give a small stimulation to the point. If this decreases the patient's pain and/ or produces an increased range of motion, it is the correct point to treat. It is better to use fewer points. First, palpate the relevant area with the pad of your finger. After finding a reactive point, use the electrodermal probe or small blunt probe to find the exact point. If the problem is with the left shoulder, start looking on the left hand. If treating this point is not enough, then check the same area on the right hand. Similarly, for a problem of the right knee, check the right knee area on the right hand. If treatment there is not sufficient, check and treat the right knee reflex area on the left hand. Selection of points for placement of intradermals on the hands and auricles is relatively simple. One can often get good symptom relief from this alone. After steps one through three, the effects are pronounced. In patients with severe pain or discomfort, where symptoms must be relieved first, the hand and auricle points are usually sufficient to permit the general treatment to begin. OTHER USES FOR INTRADERMAL NEEDLES
In step one, treatment is designed to immediately double check effectiveness by repalpating and retesting the reactive areas. In this final stage, when treating to reduce symptoms, effectiveness can also be assessed. Cases of pain, decreased range of motion, tension, or tightness can be reassessed easily. If the correct point or combination of points is treated, an improvement of the main symptoms should be immediately apparent, except in severe or degenerative disease conditions. It is good to repalpate and retest the reactive areas after each intradermal is placed. This way it is easier to determine which and how many points must be treated. On their own, these treatments are quite effective anyway, but when applied following steps one through three, you may be surprised how much more effective they will be. In less easily reassessable cases (digestive, gynecological, cardio-pulmonary, chronic recurrent pain, etc.), where immediate feedback may not be available, observation of the bodily signs described in chapter eight becomes most important. In such cases, just placing intradermals at relevant auricular points is helpful.
Intradermals can also be useful for treatment of problems such as contusions, herpes zoster, pimples, cysts, or tumors. For these conditions they are used with a slightly different technique. When treating palpable cysts or tumors, provided they are not malignant,7 palpate around the periphery of the cyst or tumor, and place an intradermal at the most reactive point on the edge. The intradermal needle should be pointed towards the cyst or tumor. Heat the needle gently with a stick of incense. Itaya comments that many ovarian or uterine cysts are discharged during menses when one uses a combination of ion pumping (based on the abdominal diagnosis), direct moxa, intradermals in the manner described above, and Chinese herbal medicine.s The treatment of pimples using intradermals is similar to the treatment of cysts or tumors. Palpate around the pimple, find the most reactive point, place an intradermal pointed towards the pimple, then heat gently with incense. If treatment is successful, relief of pain and discomfort will follow, and the body's healing mechanisms will work faster.
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For the treatment of contusions, palpate around the edges of the contusion and place intradermals at one or more reactive points. Larger and more severe contusions require more needles. This should help relieve pain and discomfort and speed the reabsorption of fluids and cells that have been released into the tissues causing blood stasis. Contusions are a condition of local blood stasis and can lead to more systemic problems; for example, a more general blood stasis or liver problem. It is important to help the body heal itself to prevent more systemic problems. Thus, use of intradermals can be very important. Generally, the use of laxatives or laxative herbal formulas is also indicated. Increasing intestinal motility helps speed the body's microcirculatory healing mechanisms. In Germany, some medical researchers have suggested that contusions - especially multiple contusions - can cause liver congestion (decreased microcirculation of the liver), sometimes seen in some forms of hepatitis. If these speculations are correct, then we can explain the effects of the laxative as causing an increase in hepatic portal vein pressure, which flushes out the liver. On one occasion, a thirty-five year-old female patient came for treatment of epigastric pain. She reported that she had been in an automobile accident only three days before, and had suffered whiplash and severe contusions on both legs, the thighs, and around both knees. Treatment of the yang wei mai-dai mai and yang qiao mai-du mai was applied bilaterally for the whiplash. Moxa on the handle of the needle was used on BL-28 and BL-20. Intradermals were placed at reactive neck points in the auricles and on the middle fingers. Following this treatment, the patient felt much improved, but her legs were still painful. A laxative was prescribed to help resolve the contusions. She returned for treatment the following week. The contusions were almost completely gone and there was very little residual pain. She reported that relief followed use of the laxative and now only her neck was slightly stiff. Treatment of herpes zoster with intradermals is similar to the treatment of contusions. Intradermals should be placed around the edges of the affected area at the most reactive points. Frequently this will relieve the pain. In one case, a patient with weeping facial sores from herpes zoster gained significant relief from what had been intractable pain by placing intradermals at reactive points as a symptom control technique (step four). Intradermal needles also can be effective for treating complications from surgical or accidental scars. When treating, it is important to pay attention to such scars. Sometimes the scar will block the channels and/ or cause secondary problems. In some cases, treatment of reactive points on or around a scar will give an improvement where other treatments have failed. For example, we had a patient with chronic shoulder pain and stiffness who showed immediate improvement and relief following injection of 1 cc of novocaine into a reactive scar on her leg. Other treatments had helped, but had not provided lasting relief. This scar was quite old, from a surgery for an osteomyelitic condition. Cases like this are not uncommon. Sometimes scars will give negative biases that need to be recognized and treated appropriately. A simple method of checking is to palpate the scar. If it has tender points along it, causes radiating pain or unusual sensations, it needs to be treated. In addition to placement of intradermal needles along the reactive points at the edge of the scar, many techniques can be used, such as moxa or needling on the scar, or on reactive points along the edge of the scar if there is too much scar tissue.
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AURICULAR POINT TREATMENTS The following compilation of auricular point treatments are selected from Chugoku no Atarashi Chiryooten (New Chinese Treatment Points), by Yoshihide Kobayashi.9 Besides the simple auricular acupuncture treatment approaches described earlier, these more specific and complex treatments can be used. We recommend leaving intradermals in the relevant points. Where a number of points are indicated, choose at least the main points, or if these are too numerous, at least those which are more sensitive to pressure and/ or more electrically active. At the least, these treatment formulae should give some idea how to use auricular acupuncture for specific disorders.
Figure 11.31: Basic Chinese auricular map.
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INFECTIOUS DISEASES
Disease acute/chronic infectious hepatitis pulmonary tuberculosis
Main Points 97, 51, 55 76, 96,95 101, 42, 13, 22
Secondary Points 22,51,29 34, 104
GASTROINTESTINAL DISORDERS
Disease acute I chronic gastritis gastric ulcer duodenal ulcer gastroptosis nervous gastroenteritis enteritis constipation dyspepsia abdominal pain and diarrhea abdominal distension (constipation)
Main Points 87,51,55 87, 51, 55 88, 51,55 87, 51,34 87, 51, 55, 97 91, 81, 51, 55 78, 12, 13 (bloodlet), 22, 97, 98, 55 89, 22, 51, 98, 96 91, 89, 51,55 91, 89, 51, 87
Secondary Points 98,43 34,88 34,87 55,97 88 89,98
91, 104, 55 81,98 43, 104
PULMONARY DISORDERS
Disease bronchitis asthma cough chest pain
Main Points 102,55,31,13 55, 31, 51, 13 55, 31, 13 55 + reactive points
Secondary Points 51,29 101,29,22,60 29, 101
CARDIOVASCULAR DISORDERS
Disease arrhythmia hypertension hypotension
Main Points 100, 51, 55 100,51,55,19 100, 51, 29, 13
Secondary Points 34 105
UROGENITAL DISORDERS
Disease acute nephritis general renal disease urinary retention impotence ejaculatio praecox prostatitis
Main Points 95, 92, 51, 55, 97 95, 92, 51, 55, 99 95, 92, 51, 79 58, 79, 32, 22, 95 58, 79, 32, 22, 55 93,92,95,22
Secondary Points 13,98,22 13 34
29
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ENDOCRINE DISORDERS
Disease hypothyroidism hyperthyroidism diabetes mellitus
Main Points 45,22,28,55 45,22,28,55 98(left), 95, 55, 96 (left), 28,22
Secondary Points 37
ARTHRITIC DISORDERS
Disease periarthritis humeroscapularis rheumatoid arthritis
Main Points 55,64,65 relevant pressure pain points, 22, 29, 95, 55
Secondary Points 13,63 34,55
NEUROLOGICAL AND PAIN DISORDERS
Main Points 11, 5, 6, 55, 29 11, 8, 84, 29 95, 55, 29, 9 42,29 52, 55, 29, 53 35, 55, 95, 34 33,29,55,34 100, 95, 55, 29
Disease trigeminal neuralgia Bell's palsy Meniere's disease intercostal neuralgia sciatica migraine headache and vertigo insomnia and many dreams
Secondary Points 20 2, 3, 97 34,87 13
INTERNAL DISORDERS
Disease mastitis gallstone disease chronic pancreatitis hernia chronic cholecystitis internal/ external hemorrhoids cystitis motion sickness broken bones, sprains, contusions
Main Points 44, 22, 13, 29 96, 51, 55 96, 22, 51, 55 110, 34, 22 96, 97, 51, 55 81,91 92, 95, 51, 55 29,87 relevant pressure pain points, 55, 34, 95
Secondary Points 97,88
22 34,98,13 13,29 9,55 13
GYNECOLOGICAL DISORDERS
Disease menorrhalgia menopause functional uterine bleeding leukorrhea
Main Points 58, 22, 51, 55 58, 22, 23, 13, 95 58, 22, 97, 98, 95, 28 58,23,22
Secondary Points
13
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OCULAR DISORDERS
Main Points 8,97 8, 97, 95, (eye 1)24, (eye 2)24 8,97,95,24
Disease acute conjunctivitis glaucoma myopia
AURICULAR AND NASAL DISORDERS
Main Points 95, 9, 20,29 16, 13,33 16, 13, 33, 22 16, 13,33
Disease tinnitus simple rhinitis allergic rhinitis epistaxis
Secondary Points 101
DERMATOLOGICAL DISORDERS
Disease folliculitis & herpes zoster eczema or flat wart allergic dermatitis urticaria alopecia acne
Main Points relevant pressure pain points, 101, 29, 22, 13 101, 22, 13, 29, 91 101, 22, 13, 29, relevant pressure pain points 101, 55, 13, 29, 22 relevant pressure pain points, 101, 95, 22 101, 22, 32, 11
SYMPTOMATIC ION-PUMPING CORD TREATMENTS We would like to recommend a few other treatments with which we have had good success treating certain associated problems. In patients with chronic pancreatitis and symptoms of recurrent or daily stomach pain, use of ion-pumping cords with the black clip on left SP-7 and the red clip on right LU-6 has proven very useful. These points are used because they both lie within different spleen and pancreas Hirata zones of the arms and legs. For patients who suffer from allergic rhinitis and who show pressure pain on LU-1 and ST-21 (lung and stomach channel reflex points), treating LU-5 and ST-44 bilaterally with ion-pumping cords (placing black on LU-5 and red on ST-44) has proven very helpful. These two points are water points. The lung channel is used because it controls the nose; the stomach channel is used because of its pathway. The normal ion pumping (nip1) or taiji, taikyoku treatment can be used for the treatment of patients who are physically and emotionally fatigued, stressed, and anxious. It is also good as a non-specific treatment for knee joint pain, generalized joint pain and neck pain. This treatment utilizes eight needles and four ion-pumping cords at the arm and leg yin and yang intersection-jiaohui points, TB-8, Manaka's arm three-yin crossing point, SP-6, and GB-35.10 The cords are attached as follows: bilaterally bilaterally
SP-6 (black) - Manaka arm three-yin crossing (red) TB-8 (black) - GB-35 (red)
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Note that TB-8 is located halfway between the elbow and wrist creases, Manaka's three arm yin point is located halfway between the elbow (PC-3) and wrist (PC-7) on the pericardium channel, and GB-35 is located halfway between the lateral head of the fibula and the external malleolus. Use of these variations of ion-pumping cord treatments should replace the regular ion-pumping cord step one treatments, since this is an adaptation of the use of ion pumping for symptom control purposes only.ll We mention them here because of their efficacy, and as a stimulus for the reader.
MODERN CHINESE POINT FORMULARIES Symptom control treatments can be performed using regular needles on body points. While this is not a technique that we use often, since moxa and intradermals are usually sufficient after steps one through three, we will outline some applicable principles. These treatments were developed in mainland China and will help those who are using a T.C.M. approach to integrate general treatment into their practice. We have focused on the use of minimal numbers of acupoints with light stimulation for completion of steps one through three. These steps are supplemented with auricle, hand, and body points for symptom control. Except for moxa on the handle of the needle, we have used only shallow needling. This emphasizes one of the themes of this text, that better clinical results can be obtained with minimum stimulae. However, the treatment ideas that follow were developed in mainland China to target the various problems listed. These Chinese treatments are used with different needle and moxa techniques. The needles used are thicker (gauges 28- 32), inserted more deeply, and a strong hibiki (deqi) is typically obtained. While it is possible that these points may respond adequately to lighter techniques, we have not studied this sufficiently to make such a statement. Practitioners of modern Chinese acupuncture (T.C.M.) can take advantage of the general treatment system by incorporating their treatment logic into the selection of points for step four, in particular, those points that address both global and local symptom control targets. In this stage, treatments with which you are comfortable and certain can be easily incorporated. The following table lists local and distal points that have proven clinically effective for targeting the corresponding body areas or organs.12 Problem area head-frontal head-temporal head-occipital head-vertex eye nose mouth & teeth ear tongue throat bronchi
Local points yin tang taiyang GB-20, BL-10 GV-20 BL-1, ST-1, GB-20 yintang, LI-20 ST-4, ST-6, ST-7 TB-17, Sl-19, GB-2 CV-23 SI-17 CV-22
Distal points LI-4, ST-44 TB-3, GB-41 BL-65, SI-3 LR-3 LI-4 Ll-4 LI-4 TB-3, TB-5 LI-4 Ll-4 LU-7
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Problem area lungs heart stomach liver gallbladder intestines kidneys bladder reproductive organs anus upper limbs lower limbs
Local points BL-13, CV-17, CV-22 BL-14, BL-15, CV-17 BL-20, CV-12 BL-18 BL-19 BL-25, BL-27, CV-4, ST-25 BL-23, BL-52 BL-32, CV-3 CV-3, CV-4, uterus point**
Distal points LU-7, LU-5 PC-6, HT-7, PC-5, PC-4 PC-6, ST-36 LR-3 GB-34, gallbladder point* ST-36, ST-37 KI-3 SP-6 SP-6
GV-1, BL-54
BL-57
LI-4, LI-11, LI-15
spine C5- T1
BL-40, GB-30, GB-34, GB-39
spine L3- 51
* The gallbladder point is one cun below GB-34. ** The uterus point is three cun lateral to CV-3.
When required, point selection can be based on pressure pain responses. In the next table we list median line intersection-jiaohui points, or typically used points in the head region, for each of the twelve channels. We also list the three yinthree yang channel relationship for each channel. Following the table is an example of how to use these points.13
Channel Midline Points LU CV-13, CV-12, CV-9 GV-26, GV-14, LI ST
SP HT SI BL
KI
CV-13, CV-12, CV-24, GV-20, GV-28, GV-26, GV-24 CV-17, CV-12, CV-10, CV-4, CV-3 CV-17, CV-10 CV-17, CV-13, CV-12, CV-10, GV-14 GV-20, GV-24, GV-17, GV-16, GV-14, GV-13
CV-4, CV-3, CV-1, CV-17, CV-23, GV-14, CV-12
Head Area LI-19, LI-20, ST-3, ST-4, GB-14,
Three Yin-Three Yang LI, SP ST, LU
CV-24, GV-26, GV-24, ST-8, GB-3, ST-7, BL-1, ST-1, ST-3, ST-4, ST-6
SP, LI
opens into root of tongue
ST, LU
BL-1, GB-1, SI-19, SI-18 BL-1, BL-2, GV-24, BL-4, BL-5, BL-6, BL-7, GV-20, BL-8, BL-9, BL-10, GB-20, GB-8, GB-10, GB-11, GV-17, GV-16 opens into throat
SI, KI HT, BL Kl, SI
BL,HT
Symptom Control Treatment: Step Four
Channel Midline Points PC CV-17, CV-13, CV-12 CV-7 TB CV-17, CV-12, CV-7, GV-14
GB
GV-14, GV-1
LR
GV-20, CV-12, CV-4, CV-3, CV-2
Head Area
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Three Yin-Three Yang TB, LR
CV-22, TB-16, TB-17, TB-18, TB-19, TB-20, GB-6, GB-4, GB-14, BL-1, SI-18, TB-21, LI-19, GB-1, TB-23 GB-20, TB-16, GB-19, GB-18, GB-17, GB-16, GB-15, BL-1, GB-14, BL-4, GB-13, TB-20, GB-12, GB-11, GB-10, GB-9, GB-8, GB-7
PC,GB
GV-20
GB,PC
LR,TB
Use of these relationships is straightforward. For example, if you have a patient with a toothache you diagnose as associated with the large intestine channel, select points in the following sequence until you obtain the desired therapeutic effect: 1. First treat the major point for toothache, Ll-4. 2. If the effect is insufficient, try LI-11, the second point, or the luo point of related channels, lung (LU-7) or stomach (ST-40). 3. If the effect is still not enough, try a medial intersection-jiaohui point (such as GV-26, GV-14), or one of the facial points (LI-19, LI20, ST-3, ST-4, GB-14), or the large intestine auricle point. Selection of points can also be made according to the pressure pain responses of the points. Problems of the back, especially the lumbar region, shoulders, and neck, are very common. Based on our clinical experience, the following common local points can be used effectively to treat these problems.l4 Points used for lumbar pain: GV-2, GV-3, GV-4, GV-5, GV-12, GV-20, CV-12, CV-9, CV-6, BL-18, BL-20, BL-22, BL-23, BL-25, BL-27, BL-43, BL-51, BL-52, BL-53, GB-25 Select from among these points. Frequently you will find pressure pain on BL-43, BL-51, BL-53, and KI-16. These acupoints all have the huang character in their name; if several of these points evidence pressure pain, it is useful to treat these, especially in cases of lumbar pain associated with the bladder channel. In cases where the gallbladder channel is involved, as well as palpating GB-25, palpate GB-20, GB-21; if these are sore, treat them. In cases of acute lumbar pain, palpate LR-4, ST-41, and GB-40 at the level of the malleoli; treat the most painful of these points. These points at the level of the malleoli all lie in the liver Hirata zone. Often in acute lumbar pain conditions, the liver channel is involved.
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Points mostly used for shoulder problems BL-10, GB-21, SI-14, BL-43 Points mostly used for whiplash GB-12, GB-20, GV-16, GV-20, GV-14 Points used for scapulo-humeral periarthritis
BL-10, GB-20, BL-43, LI-15, LU-2 In these cases palpate and treat reactive points. It is important to relieve tension and tightness in the neck, shoulders, and back. For any problem of the upper limbs, it is important to relieve the neck and shoulders; likewise, any problem of the lower limbs requires relief of the tension, tightness of the hips, inguinal region, and lower back. For any problem of the face, head, eyes, ears, throat, nose, or mouth, it is important to relieve reactions in the neck and shoulder regions. Use of the points listed above, or the techniques described in this and the preceding chapter, are very useful for this purpose. The list of treatments that follows are taken from a modem Chinese acupuncture text recently translated into Japanese, the Shinkyu Rinsho no Riron to Ji Sai (Theory and Practice of Acupuncture and Moxibustion)15 As we mentioned above, these formularies use ideas and treatment techniques that are different from those described elsewhere in this text. If you select one of these treatments for symptom control, you should use techniques appropriate to these formulae, such as those described in many modem texts in English.l6 Also, some diagnostic terms and descriptions used here are different from those elsewhere in this text. You can find such descriptions and their confirming patterns in the same modem texts. Generally, if you have understood the treatment procedures already covered in this text, and applied them well, the treatments in the following list will be unnecessary. However, if you have not understood them well or have not been able to obtain sufficient effect, these treatments might prove useful.
Symptom Relief Points from the Tianjin Chinese Medical College Text
Cough Asthma
Stomach pain Lumbar pain
Diarrhea
Constipation Anuria
LU-7, LU-10, LU-9. If a lot of phlegm, ST-40; with cold/heat GV-14, LI-11 ding chuan, LU-5, CV-22, CV-17. If a lot of phlegm, ST-40; from vacuity, CV-4, CV-6; from heat/cold, GV-14, LI-11 CV-12, ST-36; if liver and stomach are not harmonious, LR-3, PC-6, SP-4 local pressure pain points, BL-40; from kidney vacuity, GV-4, BL-23, BL-52; from cold wind, GV-4, BL-23, GV-3, BL-25, BL-40 CV-12, ST-25, ST-36, LI-11; from cold, salt moxa on CV-8; with undigested food, BL-20, BL-21, BL-25; 5 am diarrhea, moxa GV-4, CV-4 ST-40, left ST-28, left ST-29 GV-26, CV-3, CV-4, SP-6, TB-5
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Symptom Relief Points from the Tianjin Chinese Medical College Text Edema CV-9, ST-28, BL-23, BL-22, BL-20, SP-9, ST-36; if cold and vacuous, salt moxa on CV-8; if facial or upper limb, LU-7, GV-26 Insomnia alternate between the following combinations: 1- HT-7, SP-6, PC-6 2- BL-15, BL-18, BL-20, BL-23 3- yintang, GB-20, HT-7 Tinnitus, deafness TB-17, GB-2, SI-19, TB-21; if wind pathogen: TB-5 SI-3; with gallbladder fire: LR-3, GB-41; phlegm: ST-40, SP-9; kidney vacuity: KI-3 Toothache
upper teeth ST-7, ST-44; lower teeth ST-6, LI-4
Acute bronchitis
wind cold: LU-10, GB-20, LU-9; wind heat: GV-14, LU-10, ST-40, LU-5, BL-12, BL-11, BL-13, GV-14 lung vacuity: LU-7, LU-5, ST-40, CV-4, SP-3; liver fire scorching the lungs: LU-10, LR-3, GB-41, CV-22; kidney vacuity: CV-22, BL-23, KI-3, CV-6 liver depression with stagnant qi: CV-12, PC-6, ST-36, GB-34, LR-3; spleen/ stomach cold and vacuous: CV-12, PC-6, ST-36, SP-4, BL-20 bad dietary habits: CV-12, PC-6, ST-36, SP-4, CV-10, CV-22; external evil (if hot): CV-12, PC-6, ST-36, LI-4, ST-44; external evil (if cold): LI-4, ST-44, CV-13, BL-21
Chronic bronchitis
Gastritis
Gastroptosis Enteritis
Ulcers
Cholecystitis, cholelithiasis
ST-36, CV-12, ST-21, CV-6, ST-25, CV-4, BL-18, BL-22, GV-20 acute, with external pathogen: LI-11, GB-20, ST-36; damp heat: GV-14, LI-4, SP-9, ST-37; from bad dietary habits: CV-12, ST-25, ST-39; chronic, with spleen/ stomach vacuity: ST-21, CV-4, ST-36, SP-6; with kidney yang vacuity: KI-10, ST-25, CV-6, ST-36, BL-20, BL-21, BL-23, BL-32; with liver qi insulting the spleen LR-3, LR-4, LI-4, SP-9 qi stagnation: PC-6, CV-12, ST-36, LR-14, GB-34, LR-3; blood stasis: PC-6, CV-12, ST-36, BL-17, SP-4, LR-3; vacuity and cold: PC-6, CV-12, ST-36, BL-20, BL-21, LR-13; stomach heat with stomach fire: PC-6, SP-4, CV-12, ST-36, CV-11, ST-25, ST-44; stomach yin insufficiency: PC-6, CV-12, ST-36, BL-21, BL-20, ST-44, PC-6; phlegm dampness: PC-6, CV-12, ST-36, ST-40, SP-9, SP-6 obstructed liver qi with gallbladder fire brewing: BL-18, BL-19, GB-34, LR-3; damp heat brewing: SP-9, LR-8, GB-38, ST-36
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Symptom Relief Points from the Tianjin Chinese Medical College Text Pancreatitis
spleen and stomach damp heat: BL-20, BL-21, CV-12, ST-36, ST-39, GB-34, PC-6, pancreas shu (lateral to below T8)
High blood pressure
liver fire LR-3, GB-20, KI-3; phlegm damp GB-20, ST-40, ST-36, LR-3; yin vacuity and yang rising: GB-20, LI-11, PC-6, SP-6, KI-3
Headache from external pathogen
GB-20, GV-16, GV-20, LI-4; with wind cold: BL-12, BL-60; with wind heat: GV-14, TB-5; with wind damp: CV-12, SP-6
Headache , liver yang rising and counterflow:
GV-20, GB-20, GB-38, LR-3
Headache, phlegm damp obstructing the middle:
GB-20, taiyang, CV-12, ST-40
Headache, kidney qi vacuity:
GB-20, GV-20, BL-23, KI-3
Headache, qi stagnation with blood stasis:
GB-20, GV-20, taiyang, LI-4, LU-3
Frontal headache
(yangming)
Headache, temporal
(shaoyang)
Headache, occipital
(taiyang)
Headache, crown of head)
(jueyin)
select from one of the following: 1. yintang, taiyang, LU-7 2. GB-14, taiyang, LI-4 3. BL-2, taiyang, LI-4 select from one of the following: 1. GB-20, taiyang, TB-5 2. GB-20, ST-8, GB-38 3. GB-20, GB-39 select from one of the following: 1. GB-20, SI-3 2. GB-20, BL-60 3. GB-20, GV-16, BL-65 select from one of the following: 1. GV-20, LR-3 2. GV-20, LU-7
Headache, inside of head (leg shaoyin)
select from one of the following: 1. GB-20, GV-20, KI-3 2. GB-20, taiyang, KI-7
Trigeminal neuralgia
GB-20, TB-17, LI-4; then add according to the affected branch of the nerve: 1st branch: taiyang, BL-2, ST-8 2nd branch: ST-7, ST-2, LI-20 3rd branch: GB-2, ST-6, ST-4 if wind pathogen: TB-5; if liver yang rising: LR-3, ST-44 if yin vacuity and yang rising: KI-3 BL-25, GB-30, BL-40, GB-34, GB-39, BL-60
Sciatica
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Symptom Relief Points from the Tianjin Chinese Medical College Text Intercostal neuralgia
liver qi horizontal counterflow: LR-3, TB-6, GB-34; coagulation of blood stasis: LR-14, BL-17, BL-18, LR-3, TB-6; phlegm stagnation: LR-13, SP-9, ST-40, TB-6
Urinary incontinence
spleen and lung qi vacuity: CV-13, CV-12, ST-36, SP-6, BL-28, CV-3; insufficient kidney qi: BL-23, BL-22, CV-6, CV-4, SP-6 CV-4, GV-4, BL-23, SP-6
Impotence Menstrual pain
vacuous type: 1. blood type: BL-17, BL-20, CV-6, SP-10; 2. kidney vacuity type: BL-23, SP-6, SP-10, LR-8; replete type: 1. qi stagnation: LR-2, SP-8, CV-3, BL-32; 2. blood stasis: LI-4, SP-6, SP-10, ST-25; cold type: 1. repletion cold: BL-10, BL-23, GV-4, Kl-12, CV-3; 2. vacuity cold: CV-4, ST-36, CV-6, SP-6; heat type: SP-6, SP-10, LR-2
Amenorrhea
1. loss of blood leading to amenorrhea: BL-20, BL-18, BL-17, BL-23, CV-6, SP-9. 2. blood stasis leading to amenorrhea: SP-8, ST-30, LI-4, SP-6, CV-3, SP-10
Irregular menses
qi vacuity: CV-6, SP-4; blood vacuity: SP-6, ST-36; spleen vacuity: BL-20, SP-6, ST-36; liver and kidney injured (vacuity): BL-18, BL-23, GV-4, CV-4; blood stasis with repletion: CV-3, SP-10, LR-2; qi stagnation with repletion: LR-3, PC-6, CV-12; damp heat with repletion: SP-6, BL-20, ST-36, ST-40; cold pattern: CV-8 (salt moxa), CV-4, GV-4, SP-6; hot pattern with hot blood: SP-10, Kl-3, LR-2, SP-6; hot pattern with vacuity heat: BL-17, SP-6, Kl-3, LR-3
Menopausal symptoms
liver and kidney vacuity: BL-23, BL-18, Kl-3, SP-10, LR-2, SP-6; spleen and kidney yang vacuity: BL-20, CV-6, SP-6, CV-4, BL-23, GV-4
Leukorrhea
spleen vacuity: BL-20, ST-36, CV-6; damp heat: GB-26, SP-6, SP-9, LR-2; phlegm damp: BL-20, SP-6, ST-36, ST-40; liver depressed: GB-26, BL-18, TB-6, LR-6; kidney yang vacuity: GB-26, CV-6, CV-4, BL-23, ST-36; kidney yin vacuity: GB-26, CV-3, SP-6, Kl-3, LR-2 LR-5, LR-8
Morning sickness Lumbar and back pain
acute lumbar strain: BL-23, BL-40, GV-3; chronic, with cold and damp: BL-23, BL-25, BL-32, BL-60 plus moxa BL-23, BL-25, CV-4, GV-4; chronic, with kidney vacuity: GV-4, BL-52, BL-23, KI-3
Inflammation of the tissues
1. pathogen obstructing the jing-luo; qi and blood around the shoulder joint coagulated and obstructed LI-15, SI-9, LI-11, TB-14, HT-1, GB-34. 2. pathogen has been present for a long time so the muscles and blood vessels are not nourished: LI-15, TB-14, SI-9, ST-38 through to BL-57
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Symptom Relief Points from the Tianjin Chinese Medical College Text Arthritis lower jaw: ST-7, SI-19, TB-17, LI-4 cervical: GB-20, BL-10, GV-14, LU-7 thoracic: shu points in affected area, GV-26, BL-40 lumbar, sacral: GV-3, josen, BL-26, BL-40, BL-60 shoulder: GB-21, Ll-15, Sl-9, TB-14, jian nei ling*, jian wai ling**, GB-34 elbow: LI-11, LU-5, SI-8, TB-10, TB-5 wrist: TB-5, TB-4, Sl-4, LI-5, PC-7 fingers: ba xie of the finger joints, Ll-4, Sl-3 iliac joint: BL-26, BL-27, BL-30, BL-54 hip: GB-30, GB-34 knee: ST-35, knee eye, GB-33, SP-9, BL-40, BL-55, GB-34, he ding (moxa only on he ding) ankle: ST-41, SP-5, GB-40, BL-60, KI-3, BL-62, KI-6 foot: pressure pain points on the feet and toes, ST-41, LR-3, ba xie, ST-43, GB-41, SP-4 wind bi: GB-30, BL-17, SP-10, LR-3 damp bi: ST-36, SP-5, SP-6 cold bi: BL-23, CV-4 hot bi: GV-14, LI-11, LI-4 Herpes zoster alternate between: 1. BL-18, LI-11, TB-6, local points 2. GV-14, LR-3, along the affected dermatome Allergic dermatitis GV-14, LI-11, Ll-4, SP-10, BL-17, GB-21, SP-6 Eczema GV-14, LI-11, SP-6, SP-10, ST-36, BL-40 Rhinitis yin tang, LI-20, Ll-4, GB-20 LU-11, LU-5, Ll-4, Kl-6 Pharyngitis Myopia HT-7, PC-6, BL-15, plus alternate between the following local prescriptions: 1. ST-2, BL-1, yu yao through BL-2 2. GB-20, BL-1, ST-1 3. BL-2, TB-23, GB-14, LI-4 4. BL-4, qiu hou, located at the inferior border of the orbit,l/4 from the lateral to the medial side of the orbit Diabetes mellitus pancreas shu, BL-13, BL-20, BL-23, SP-6, KI-6, LU-11, BL-17, BL-21, CV-12, CV-4 Hemorrhoids BL-25, GV-1, BL-57, er bai * Jian nei ling is located halfway between LI-15 and the top of the anterior axillary crease. ,.,. Jian wai ling is located halfway between LI-15 and the top of the posterior axillary crease.
BLOODLETTING We have found bloodletting to be another quite useful technique. In some schools it is only thought to be good for conditions where heat or local repletion persists. It can, however, be used more generally for conditions of poor or impaired circulation. For example, in patients with high blood pressure, or
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patients who have had a stroke, often the occipital region will be thick, puffy, and red. In such cases, bloodletting will improve circulation to the head and reduce the blood pressure. Generally, where thickness, puffiness and/ or redness of the occipital and posterior portions of the neck are present, it is a good idea to use bloodletting techniques at the end of the treatment (following steps one through three and symptom control treatment). Light jabbing with a blood lancet or syringe needle at several points in the area is very effective. To relieve discomfort from the technique, lightly pinch the skin and superficial flesh prior to pricking with the needle or lancet. You need obtain only a little blood from each spot. However, if the blood is very dark, keep squeezing until the blood takes on a fresher color. Patients with fingernails, or more typically, toenails, that are discolored, misshapen, cracked, thick, or generally unhealthy looking, are evidencing a clear sign of poor circulation to the nail bed. This usually indicates a problem with the channel that begins or ends at the finger or toe affected by poor circulation. Treatment to improve circulation will benefit both the channel(s) and the nail. Bloodletting at the relevant jing points, daily or every other day until the nail is normal, is a good idea. This can be done at the end of each treatment. With proper instruction and the appropriate instrument (a small blood lancet), the patient or family member also can regularly undertake a similar bloodletting technique at home. Unfortunately, many patients are resistive to wJ:tat seems to be a fairly barbaric treatment and will not follow through. However, bloodletting is not just cosmetic; it is important for restoration of normal channel circulation. While it may not give good symptom relief, it does help prevent future disorders. Venesection, blood letting from the venous system, is an old technique. It is useful, but rarely used today. Often, poor circulation, especially of the legs, causes pooling of blood in the venous system. This further irritates poor circulation and leads to blood stasis. There are, as we saw earlier, many possible causes of poor circulation and blood stasis. Sometimes removal of the pooled blood is helpful. This is a strong technique that, like bloodletting, is a useful preventative rather than a means of symptom control. When there is clearly poor circulation in the legs with signs of blood pooling, have the patient stand in a large tray, and, using a syringe needle, quickly and carefully needle into the visible small venules. Blood will run out quite freely and should be dark colored. Have the patient stand until the blood stops. The patient will need soap, water, and a small towel for washing up after this procedure. Usually a few cubic centimeters of dark-colored blood will have drained. Bloodletting and venesection need only be used in a few cases, where the signs that indicate their use are clear. The last venesection technique can be particularly helpful for treatment of disorders related to menopause. In our experience, occasional but regular use of this technique for women with menopausal symptoms and signs of venous blood pooling in the legs, can help relieve both current complaints and potential problems. Generally, these techniques are not essential to treatment; rather they speed the treatment process. Bloodletting is also an important technique for the treatment of fevers. In chapter eight, we briefly mentioned fevers in relation to blood stasis. In acute fevers due to a viral infection, such as cold or flu, bloodletting can be applied at J:he jing or terminal points of the channels involved, or on the upper back, usually in the inter-scapular region. This can be very helpful. In such a case, a couple of drops of blood are drawn from the visible vascular spiders marking the congested spots in this region. To obtain greater effect, apply the technique of cupping (vacuum suction) at these spots. If the problem is not severe, only a little
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blood will flow; if the problem is quite severe, accompanied by symptoms such as high fever, multiple viral infections, etc., much more blood will flow, usually of darker color. Many years ago, I treated a patient with a very high fever using this technique. Several cubic centimeters of dark colored blood flowed into the cup and his fever improved almost immediately. As a precaution, at the end of treatment, I ordered the lab to check for typhoid fever. Several days later, the results came back positive. Despite the fact that the patient was symptom-free, he was quarantined. This technique is very strong. For delicate patients, it might be a good idea not to use this technique, or to use it with less suction for only a few seconds. If it is overapplied, the patient may become faint, dizzy, or weak.17 If you see many vascular spiders in an area such as the upper back and interscapular region and the patient is complaining of stubborn shoulder or neck problems, bloodletting and cupping are often helpful. Generally, bloodletting and its associated techniques of venesection and cupping are used for treatment of disorders where blood stasis is present. Attending to blood stasis will tend to speed the whole healing process. In cases where you want to use the danokyu technique, but believe it inappropriate, bloodletting can be very helpful. Acute febrile conditions of the type described earlier often respond to bloodletting as well.
THE MANAKA WOODEN HAMMER AND NEEDLE Another simple technique that can be used for relief of symptoms, and for problems like contusions and sprains, is the wooden hammer and needle, depicted below.
Figure 11.31: The Manaka wooden hammer and needle (peg)
This tool can be especially useful in combination with channel frequencies (see chapter four above). These frequencies, timed by a metronome, are listed below. Yin channels
ren mai lung spleen heart kidney pericardium liver
Beats 104 126 132 126 120 176 108
Yang channels
du mai large intestine stomach small intestine bladder triple burner gall bladder
Beats 104 108 132 120 112 152 120
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To reduce the swelling and pain and improve circulation of, for example, a sprained ankle, do the following treatment. 1. Palpate the edges of the swollen area.
2. Find reactive points and tap these gently for 20 taps. Tap each point at the frequency of the channel for that point. 3. Tap all jing points on the toes at their relevant frequencies. 4. Palpate the intersection-jiaohui points on the legs, like SP-6, GB39, GB-35 and the three yin intersection-jiaohui point above SP-10. 5. If these points are tender, treat them with gentle tapping at the frequencies of the channels that meet at each. For example, if using SP-6, tap at 108 (liver), 120 (kidney), and 132 (spleen). Use approximately twenty taps for each frequency. If using GB-39, tap at 112 (bladder), 120 (gallbladder) and 132 (stomach), about twenty blows per frequency. 6. Be careful not to tap too hard; never cause discomfort. This simple technique can help reduce swelling and improve circulation. The patient can repeat the procedures at home (see chapter 12 for further discussions). The same method can be used for other sprains or contusions. For non-acute, non-traumatic musculoskeletal problems, the wooden hammer and needle combined with channel stretching works very well. Tapping at the frequency rate for the affected channel can be used instead of the fire needle, moxa, or intradermals. Treatment at many body locations, focusing on releasing the reaction of specific points on the affected channels, is often successful. Treatment of more general problems, such as digestive problems, gynecological problems, and respiratory disorders, can be done in much the same way. Tap points relevant to the condition at the frequencies of the channels. Since the general uses of points for specific conditions are described in many textbooks, there is no need to repeat these indications here. At the least, the lists of moxa treatments and Chinese needle treatments give some ideas about selecting points for specific conditions. As always, the points should be palpably reactive and can be tested with the 0-ring test. If the points are sufficient, you should see improvement of the palpatory reactions and 0-ring responses.
THERAPEUTIC SUMMARY As we have tried to show, there are many treatment strategies for a specific problem, just as there are many strategies for addressing problems in general. There is no "one right way," no absolute directive or procedure. Many strategies can be substituted for others, equally interchangeably. However, not all strategies are equal. Sometimes you will select a treatment "out of the blue" and it will address the patient's problem immediately. It also may not work for other patients with what seems to be the same problem. Always, each case must be judged individually and on its own merits. We have already described the case of a patient who came more than twenty years ago for treatment of an asthmatic condition that had lasted twenty years. After moxa was burnt on CV-22, the patient felt better and simply left the office. It was not until twenty years later that the same patient returned for treatment again.
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When questioned, the patient reported that the one moxa on CV-22 had completely eliminated the asthma, which only recently had begun to return. No one knows in advance when such cases will occur. You must develop your sensitivity and allow your intuition to develop. If you can open your senses and your mind, you will learn to see the subtle nuances of each patient's condition. Understand the exact nature of their qi and you will slowly master treatment and develop your own treatment style. Developing tactical skills is also essential. Having a range of options to choose from in difficult or stubborn cases, and having tactics for their general use, allows a flexible and thorough methodology. Try reading Sun Zi's The Art Of War or playing board games like chess or go to develop your strategic skills. With such a flexible and well rounded methodology, the goal of shu ha ri can be achieved.
CHAPTER ENDNOTES 1 See for example Fukaya Kyu Ho (Fukaya's Moxibustion Therapy), written by Fukaya's senior student, Seiji lrie. 2 See for example Shinkyu Chiryo Kisogaku (The Fundamentals of Acupuncture and Moxibustion Therapy), and Shinkyu Shinzui (The Essence of Acupuncture and Moxibustion). 3 The following treatment formulae are selected mostly from Okyu no Kenkyu (Moxibustion Studies), pp. 60-85, supplemented with further treatment formulae from Kyu to Hari (Moxibustion and Acupuncture), pp. 93-228 (both by Dr. Yoshio Manaka). 4 Auriculotherapy and hand needle therapy are both specialities that can be integrated into the general treatment as well as be used for symptom control therapy. Earlier, we discussed their use in isophasal combinations. Here, we will focus on their use in symptom control treatments. 5 For more detail of Chinese auriculotherapy, see further in this chapter, where a selection of treatments for common problems can be found. There are other books in English that serve as reference guides, such as: Bensky, D. and J. O'Connor, Acupuncture: A Comprehensive Text, pp. 472-491. For the auriculotherapy of Nogier, see From Auriculotherapy to Auriculomedicine and Handbook of Auriculotherapy. 6 Yoo, Tae Woo, Koryo Sooji Chim: Koryo Hand Acupuncture vol. 1, Seoul: Eum Yang Mek Jin Publishing Company, 1988. 7 We advise treating malignancies only in cooperation with a consulting physician. In those countries where the legal status of non-physician acupuncturists has not been established by tradition, this is both a good way to "train" physicians to the capacities of acupuncture, and a reasonable form of protection both for the patient and the acupuncturist. Western tests and records can also provide useful clues and documentation. 8 Herbal medical prescription is not described in this text. Occasionally we will prescribe such medicines for some chronic or difficult patients. 9 Published by the Osaka Kobayashi Ryodoraku Institute, Osaka, Japan: 1972. 10 S.B.: See Matsumoto, K. and S. Birch, Hara Diagnosis: Reflections on the Sea, pp. 388-391 for further discussions. 11 S.B.: In Hara Diagnosis: Reflections on the Sea, p. 393, the authors list a number of ion-pumping treatments collected by Dr. Makio Maruyama. These can also be substituted in place of the regular ion pumping treatments. Also note further uses of the ion-pumping cords for both step one and symptom control purposes in the same text (pp. 384-392), for liver problems, tai ji treatment, whiplash treatment, etc. Manaka and Itaya strongly recommend following their simple methodology first, until full mastery and understanding of the use of ion pumping is achieved. Afterwards, one can begin to branch out and explore further usee of ion pumping. 12 From Manaka, Y., Kata Kori to Yotsu, p. 208. 13 From Manaka, Y., Shinkyu Rinsho lten, p. 50-51. 14 Taken from Manaka, Y., Kata Kori to Yotsu, pp. 184-198. 15 Ikegami, S., Shinkyu Rinsho no Riron to Ji Sai V 2, lianjin Chinese Medical College, Acupuncture and Moxibustion Department, Number One Hospital, Tokyo: Kokusho Publishing Association, 1988. 16 See for example Ellis, A. et al., Fundamentals of Chinese Acupuncture, Brookline, MA: Paradigm Publications, 1988. 17 S.B.: If this happens, apply light moxa stimulation to the area bloodlet, or to GV-14.
>~~~'':, /\
~"=' ~7JJ CHAPTER TWELVE
HOME THERAPIES: STEP FIVE Often it is necessary to relieve the pathological bias in the patient's lifestyle, whether it is dietary, psychological, or environmental. It is thus important to determine what bias has influenced each patient and to address it therapeutically. Psychological factors which therapy cannot address may require consultation with an appropriate expert. Having patient involvement and cooperation speeds and facilitates the healing process. Providing methods for home therapy, and recommending dietary and lifestyle modifications, offer effective ways of accomplishing this goal. In addition, encouraging patients to monitor themselves and become more aware of their bodily functions is an important and empowering step that should be encouraged by the practitioner. When we talk to our patients, we should try to understand their fears and to engender their confidence in treatment and in themselves. When discussing the treatment procedures with a patient, it is often helpful to talk about successful treatment of similar conditions, as this may increase their confidence and determination. Showing the patient changes that have occurred after each step of treatment is also helpful. If a patient's condition cannot be easily or quickly rebalanced with clinical treatment alone, often a number of simple steps can be taken at home to augment healing. These include sotai exercises, home moxa therapy, wooden hammer and metronome, Hirata zone therapy, and dietary recommendations. Situations such as the following may require home therapies, in addition to root treatment and symptom control treatment. - When the patient is in a weakened or xu condition (e.g., severe anemia, poor nutrition, etc.), diet and home therapy, especially moxa, will be necessary. Supplementing herbs or pharmaceuticals may also be required. As a practitioner, if you are not qualified to administer traditional medicinal supplements, consultation with appropriate experts is in the patient's best interest. - When a patient's condition is intractable (e.g., malignant tumors, degenerative diseases, severe damage to the central nervous system), treatment may still help; however, it will take longer. Home therapies and lifestyle modifications will be vital.
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- When signs of blood stasis (xue yu) are present, these must be attended to and ameliorated. There are many treatments aimed at blood stasis; for example, ion pumping, use of a magnet heater, bloodletting, venesection, cupping, dietary change. The administration of blood-clearing medicinals is also indicated, but here again, consultation with appropriate experts may be necessary. Where signs of blood stasis are clearly present, treatment aimed at the blood stasis will speed the healing process. If due attention is not given to this condition, progress will be slower. - When special consideration and instruction are required due to dependence on food, drink, or drugs (including tobacco, alcohol, or prescription and non-prescription drugs), recommendations for life style change are appropriate. - When poor dietary habits are evident, dietary recommendations are worthwhile. - When hidden structural disorders are impeding progress, there will be signs of structural abnormalities and asymmetries. Simple corrective exercises can be used to help with these problems, and may be performed either in the office or as an aspect of home therapy. Sotai exercises are an example of such therapy.
SOTAI EXERCISES In chapter 10 we described sotai exercises that are of clinical utility in treating problems of muscle tension, pain, and restriction. There are many other more general sotai exercises which can be done at home to relieve stiffness and to maintain a healthy and supple body. If a patient seems to have bodily stiffness and limited range of motion for many movements, then the following daily exercises can provide help and relief. In implementing the exercises, remember the following general principles:
- The movements should always be comfortable and painless. Any motion that is uncomfortable for the patient should not be attempted. (The exception here is the first exercise given below. If the toes are uncomfortable in this exercise, this is a sign that it is a good exercise for the patient.) - The exercises should be done slowly, gently, and completed on the exhalation. Movements should be done throughout the duration of one slow exhalation, stopped for the next inhalation, repeated for the next exhalation, etc. Done as a series every day, these simple exercises can contribute to greater body flexibility and suppleness. Tension in the musculature can be a significant factor in various health complaints. Simple procedures which the patient can do at home to release this tension will contribute to long-term optimal health. EXERCISE ONE
With the patient kneeling, buttocks sitting on the heels, following the breath, move the buttocks over to one side, then back over to the other side, then back to the first side, etc., establishing a swinging motion of the buttocks back and forth over the heels. This simple exercise is good for the lumbar region, knees, hips, ankles, and toes and for all the leg channels in general. This exercise can be done for a few minutes only or for as long as it is comfortable for the patient.
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Figure 12.1: Sotai exercise one
EXERCISE TWO
With the patient on the knees and palms (on " all fours"), swing the buttocks back and forth to each side, simultaneously swinging the shoulders to the opposite side. This exercise is good for the spine, hip, and shoulder girdles. It can be done for a few minutes only or for as long as it is comfortable for the patient.
Figure 12.2: Sotai exercise two
EXERCISE THREE
The patient stands facing a wall, feet placed at a distance of about two footlengths from the wall and shoulder-width apart; arms raised so that the palms are
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placed flat against the wall. Swing the buttocks slowly from side to side. This can be done for a few minutes only or for as long as it remains comfortable for the patient. This exercise is good for the spine and hip girdle.
Figure 12.3: Sotai exercise three EXERCISE FOUR
Standing straight up, feet shoulder-width apart, place one hand on the hip. Slowly bend over to that side, then return to the upright posture. Repeat for the other side. Complete a total of three or four movements to each side. This exercise is often helpful for conditions of lumbar pain.
Figure 12.4: Sotai exercise four
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EXERCISE FIVE
Assume the same standing posture as in exercise four. Raise one arm and hold it over the head, then bend to the opposite so as to stretch the side with the raised arm. Remember to synchronize the movement with the exhalation. Lower the arm, then repeat for the other side. Complete three or four times to each side.
Figure 12.5: Sotai exercise five EXERCISE SIX
Standing upright with feet almost together, slowly bend as far forward as is comfortable. At this point, relax; inhale; raise the head so as to look forward. Then slowly come back to the upright posture. This can be done three or four times.
Figure 12.6: Sotai exercise six
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EXERCISE SEVEN
Standing with feet hip-width apart, place the palms on the buttocks and slowly exhale while bending as far backwards as is possible (which may not be very far). Return to an upright posture and repeat a total of three or four times.
Figure 12.7: Sotai exercise seven EXERCISE EIGHT
Standing with feet hip-width apart, raise the arms up to shoulder height, and extend them out to the sides. Swing first to one side and then to the other. This should be repeated a total of three or four times.
Figure 12.8: Sotai exercise eight
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EXERCISE NINE
Stand with the feet hip-width apart. With exhalation, very slowly raise the arms out to the side until reaching shoulder height at the end of exhalation. Then relax and drop the arms. This should be done a total of three or four repetitions.
Figure 12.9: Sotai exercise nine EXERCISE TEN
From a sitting posture, reach behind the neck. Using thumb and forefinger, find some tense, sore points. Apply pressure to these points. Then move the head around back and forth and from side to side, to locate the most comfortable direction of movement. On exhalation, move the head towards the most comfortable direction while pinching the sore points. At the end of movement and exhalation, relax and drop the arm. This can be repeated a total of three or four times.
Figure 12.10: Sotai exercise ten
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EXERCISE ELEVEN
From a sitting position, place the palm of one hand flat to the sole of the opposite foot, interweaving the fingers through the toes. Rotate the foot by using the hand, first one way and then the other, on the exhalation. This can be done a total of three or four exhalations in both directions and on both feet.
HOME MOXA TECHNIQUES AND SIMPLE TREATMENT FORMULAS DIRECT MOXA
In Japan, the use of moxa by the patient is greatly encouraged and there is a long tradition of home moxa use. In the West, unfamiliarity with this concept, and the fear that the patient will suffer a self-inflicted bum, discourage widespread usage. Consequently we do not advise this method for home therapy unless the person administering treatment is competent and trained in the Japanese technique. Ideally, heat should be felt lightly at each point 3, 5, or 7 times, depending on need and severity. If the patient is in an extremely xu (vacuous) condition, it is better to use fewer moxa, with less stimulation. ELECTRICAL MOXA DEVICES
In an earlier chapter, we explored the use of simple electrical heating devices that affect specific acupoints in the same manner as burning moxa, but with a greatly lessened risk of burning or blistering the skin. There are also some ingenious methods we have devised for heating the points that require no extra equipment, and that are adequate for achieving the desired heat stimulus. Instruments which are commercially available include the Tai-i kenkyu, or electric moxa instrument, and the Sanko denkyuki, also called the "Akabane heater." They deliver a small amount of radiant heat to a small point and can be turned off or withdrawn from the point quickly and easily when the heat is felt at the point. A new electric cigarette lighter is now available that works very well to heat acupuncture points as it too delivers heat focused to the point. If such an instrument is used, the heat should be felt as light pinches only 3, 5, or 7 times at each point. The points should not be overused or overheated as such excess may cause some blistering. More is not necessarily better! Hot air moxa is another simple technique which can be employed at home. Using a hair dryer and a piece of cardboard with a small hole cut out of it, hold the cardboard over the point to be treated while aiming the hair dryer at the point. The cardboard shields the surrounding area from the heat, while point-specific sensations of heat are felt at the desired point. As with the electric moxa instrument, heat should be felt at the points 3, 5, or 7 times each, depending on need. This technique is probably the easiest, safest, and cheapest. Usually no investment is needed because most patients already have a hair dryer or can easily borrow one. In chapter eleven, we described and listed a number of moxibustion treatment formulae for a wide range of health problems. For patients who are committed to home therapy, locate and mark the pressure-sensitive points and give them the appropriate formula and directions. At times when these specific prescriptions are too complex or have too many points for the patient to handle, suggest one of the simpler prescriptions listed below. If a patient's condition is too complex to fit a single symptom control treatment, we recommend having the patient use the tai ji treatment formula described in chapter nine (repeated below).
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TAl JI MOXA TREATMENT
This is good for complex, chronic conditions or advanced conditions of vacuity. Select a few of the following points according to the pressure pain reactions present and the general uses and principles described in chapter 9. Points for Taiji moxa treatment: CV-12, ST-25, CV-4 or CV-7, TB-8, Manaka's three-yin crossing point (above SP-10), KI-7, LR-3, LR-4, GV-12, GV-20, BL-18, BL-20, BL-23, BL-32, BL-52, GB-31, GB-34, GB-40.
OTHER MOXA POINTS FOR SPECIFIC CONDITIONS
Gynecological problems: CV-4 or CV-7, SP-6 (do none of these if pregnant); or SP-10, LR-3 or LR-4, BL-32. Stomach problems: ST-36, SP-8, CV-12, BL-20. Intestinal problems: LI-11, CV-10 or CV-12, CV-4, BL-25, if acute- uranaitei. Bladder problems: CV-3 or CV-2, SP-6, GB-39 (after Fukaya). Lung problems: LU-7, GV-12, BL-13. Heart problems: PC-4 (especially acute problems such as palpitations; this point is located 3/10 of the way from PC-3 to PC-7), BL-14, or BL-15. If new or unpromising symptoms appear, it is always a good idea to counsel the patient to see a heart specialist. Skin problems: LI-10 or LI-11, SP-10, GV-12, BL-12. Head, face problems: LI-4. Contusions, wounds: sore points around the edges of the problem. HOME THERAPY WITH THE MANAKA WOODEN HAMMER AND NEEDLE 1
In Japan, the use of hammers and needles as a form of acupuncture therapy dates back at least four hundred years. Mubun Ryu treated in the imperial court in the late sixteenth century using a small wooden mallet and large gold needles. He concentrated exclusively on the patient's abdominal region. Today his techniques are still practiced by specialists in Japan such as Fujimoto Renpu of Nara. As my curiosity was stimulated by this treatment method, I tried and tested a variety of different hammers and needles, finally settling on this specific wooden hammer and needle. People everywhere are frightened of needles and with the fast pace of modern life, many cannot make regular appointments. I thought that the use of the wooden hammer with a blunt wooden needle might be a useful tool in such cases. It is painless, completely non-invasive and comforting, and can be used by patients at home on a daily or regular basis. Even if it is overused, it never seems to cause any fatigue or ill feeling. It is not possible to overstimulate, except of course by hitting the needle too hard with the mallet and bruising the point. When used daily, the Manaka wooden hammer and needle relieves the stresses and tensions that would otherwise accrue in the body and predispose the patient towards other health complaints. In our experience, it has also proven effective in treating the following common complaints: headache, toothache,
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discomfort of the stomach or intestines, allergic skin conditions, constipation, hemmorhoids, shoulder stiffness, restricted movements of the shoulder, lumbago, acute traumatic injuries (fractures, wounds, sprains etc.), hemiplegia, and imbalances of the autonomic nervous system (general disorders, typically difficult to diagnose, with varying symptoms). During the day, energy reserves are used up, stress is encountered, the muscles tense, and often remain tensed into the next day. Though these are only slight changes from one day to the next, when they occur asymmetrically (from repeated use of one hand in a particular movement at work, for example), or occur repeatedly, they often build into pathological conditions. The wooden hammer and needle technique can successfully alleviate this daily accrual of tiredness, fatigue, tension, and stress. If a patient can address these conditions at the end of each day, so that they do not carry over into the next, it is helpful not only in the relief of symptoms, but in the treatment of specific disease patterns and for general health maintenance. The effects of the wooden hammer and needle are similar to shallowly inserted needles, and in some cases, to more deeply inserted needles, especially when a quite deep and distinctive sensation is evoked by the vibration of the needle. The wooden hammer and needle are an ideal alternative for many patients to use at home, even if for nothing other than neck and shoulder stiffness and fatigue. For treatment, the wooden needle should be held loosely between either the thumb and forefinger or forefinger and middle finger. It should be held lightly at the point to be treated, and the free fingers placed lightly on the skin to secure the point of the needle. With the other hand, lightly tap the more rounded and wider end of the needle. The mallet has a soft leather pad on one surface. This is the surface that should be used for the tapping. Tapping should be done rhythmically and evenly. Correct tapping will allow the needle to vibrate slightly between the finger and thumb and transmit vibrations to the point treated. Practicing on yourself first is a good idea to make sure that you can determine a comfortable and rhythmic tapping technique. Each point should be tapped 10-30 times. For elderly persons or for patients who bruise easily, tap lightly. Usually tapping is administered to the acupoints or to other pressure-reactive points that are found. For patients who are not familiar with the acupoints, treating the points found by pressure or in the same treatment area will often suffice. Optimal treatment usually starts with points on the feet, gradually working upward. If you can get the desired effects from just a few of the selected points, without having to treat all of them, it is good to stop treatment there. For example, menstrual difficulties often respond well to treatment of LR-3, LR-4, SP-10, SP-6, BL-32. If the difficulties are alleviated after treating LR-3, then LR-4 and SP-6, there is no need to progress to SP-10, BL-32. When acupoints or points on the back of the body are to be treated, it is best if a friend or relative can administer the tapping. If the patient has no one to help them at home, self-treatment can be administered by holding the wooden needle firmly in one hand, pressed to the point to be treated, and rhythmically pressing into and releasing from the point. This vibration is a little different than when the needle is actually tapped, but therapeutic effects can be obtained. When using this particular technique, the angle of application is often important. Use the angle that feels the most comfortable. If an area or point is hard to reach, use the leatherpadded surface of the hammer to tap the point/ area. Do not tap too hard; the blow should be light and comfortable. Try out each technique, then select the one that is easier and more comfortable.
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SIMPLE PARTNER-ASSISTED WOODEN HAMMER AND NEEDLE TREATMENT
A simple general method that requires the help of a partner is as follows: - With the patient sitting upright, tap a point on either side at the base of the occiput, then 1 or 2 points on both shoulders. - With the patient lying prone (face down), starting at the upper back and working downward, tap along the length of the spine at a distance of 3 em and 6 em to each side. Tap each point about 10 times, alternating from side to side as you move down each line on the back. - Have the patient tum over to a supine position (lying face up). Tap lightly from the inferior border of the sternum out along the costal arches. Then tap along the top of the pubic symphysis, then down the ren mai from the sternum to the pubis. Following this, tap down along the big muscles of the leg. Finally, tap each jing point on the fingers and toes about 10 times each. Altogether, this should take no more than 20 minutes. Since you are working on many body areas and not necessarily the channels, this tapping can be done without the aid of the metronome. Treatment of specific problems usually requires tapping at specific acupoints. This can be reinforced by first applying the general treatment just described, then tapping the specific acupoints. Depending on the point treated, select from the following metronome frequencies and tap at the frequency of the corresponding channel: Yang channel
ren mai
Rate 104
lung spleen heart kidney pericardium liver
126 132 126 120 176 108
large intestine stomach small intestine bladder triple warmer gallbladder
Yin channel
du mai
Rate 104 108 132 120 112 152 120
A few specific problems are listed below with suggested acupoint treatment: Headaches, migraines: For headaches caused by qi counterflow, have the patient stand and tap at tender points around the achilles tendon. Then with the patient sitting upright, tap at LI-4 (108). Migraines usually involve the liver and/ or gallbladder channels. If there is tenderness along the gallbladder channels on the head, treat LR-3 (108), BL-18 (108), and PC-6 (176). This will often reduce the pain. If you palpate on the opposite side of the head and find a notably sore point, treat it, then stimulate GB-31 (120) and GB-34 (120). If a headache is present at the time, limit stimulation at the painful area. For migraines and other headaches, you can also treat GV-20 (104), BL-10 (112), and GB-20 (120). Use very gentle tapping. To release any tension found in the neck and shoulder regions, tap at reactive points. Toothache: For the abatement of tooth pain, it is usually important to release neck and shoulder tension by tapping at locally reactive points. Treating pressuresensitive points on the arms will often help as well. Check especially around LI-10 (108). LI-4 (108) is an excellent point to treat. For lower teeth problems, treat ST-39 (132). For upper teeth problems, treat ST-37 (132).
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Digestive upset or discomfort: ST-36 (132) can be treated for almost all digestive problems, and by itself can often provide effective relief. Poor diet and stress are among the many causes of digestive problems. Thus dietary changes usually need to be counselled and stresses need to be dealt with. The general treatment above can be useful. In chronic conditions, you may find the musculature of the back to be either too tense or too loose. Stimulating the reactive muscles found here, along with ST-36, will often help. For gastroptosis, add ST-41 (132). For chronic problems, especially with food allergies or sensitivities that can cause rashes, etc., also treat: BL-18 (108), BL-20 (132), BL-25 (108), SP-8 (132), SP-7 (132), and around both medial and lateral malleoli. Constipation: Along with general recommendations to improve the patient's dietary habits and exercise habits, increased fiber in the diet may be necessary. As well as stimulating BL-25 (108) and ST-27 (108), it is useful to stimulate on the abdomen in a clockwise fashion, LRQ ~ URQ ~ ULQ ~ LLQ ~ LRQ, etc. This can be done while sitting on the toilet. This should increase the motility of the intestines. Hemorrhoids: Sitting with the legs pulled up, so as to cause retraction of the hemorrhoid, tap SP-7 (132), LU-6 (126), GV-2 (104) and GV-20 (104). GV-20 should be tapped lightly. For bleeding hemorrhoids, if this has not already helped and the anus seems to be spasming, use the fingers to stretch the anal muscles. Shoulder problems (stiffness, limited motion, etc.): Even if the patient does not complain of shoulder problems, generally it is important to release shoulder stiffness and tension. The general treatment given above can be helpful, particularly when augmented with more focused treatment of reactive, tense points on the shoulders. Of the many acupoints purportedly good for shoulder problems, we have found BL-10 (112), GB-21 (120), SI-14 (120), and BL-43 (176/112) to be notably helpful. Check these points carefully and treat if reactive. If the shoulder is very stiff, inflamed, or has limited motion, it is better not to stimulate too much locally. Local points should be tapped more gently and it is better to look for distal points to treat, such as LI-10, LI-11, ST-38, GB-34, etc. Lumbar pain: Both internal and musculo-skeletal conditions can cause lumbar pain. Regular acupuncture and moxibustion therapy, sotai therapy, wooden hammer and needle therapy, and stretching exercises and movements are important. To relieve tension in the musculature in the lumbar region, the first area to treat is along the musculature at the tight, sore points to the sides of the lumbar vertebrae. Along with the reactive points, BL-18 (108), BL-22 (152), BL-23 (120), BL-25 (108), BL-52 (120), GB-34 (120), BL-40 (112), BL-58 (112) are good points to treat. If a patient is able to lie prone (face-down) and perform the sotai leg extension exercise (procedure C in chapter ten), simultaneously tap at the most tense or sore point on the back.2 Acute traumatic injuries: Wooden hammer and needle treatment can be useful in the treatment of fractures, wounds, contusions, sprains, etc. because it accelerates the healing process by reducing the accompanying local swelling. Typically the local swelling that occurs with a fracture or wound will decrease circulation at the area and thus slow down the natural healing process. If the sweUing can be reduced, even temporarily, it can greatly enhance the natural healing powers and speed the process of recovery. Tap at sore points slightly distal and proximal to the swollen area, and tap around the swollen area. Tap at the jing points on the toes or fingers, especially of the channels most affected by the swelling. Also tap at confluence-jiaohui points, like SP-6, TB-8, etc., whichever is more local to the problem area. For example, for treating a sprained ankle, first palpate around the
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swollen ankle and tap gently at the more reactive points. Thel) tap at the jing points of the more affected channel, perhaps, GB-44 (120), BL-67 (112). Next, tap at the confluence-jiaohui points, perhaps GB-39 or GB-35 (112, 120, and 132). It is sometimes helpful to treat the area on the opposite limb that corresponds to the affected area.
Rehabilitation for hemiplegia following stroke: Acupuncture, exercise, and massage can be helpful in treating this condition, particularly if the treatment begins as soon as possible after the stroke. The wooden hammer and needle treatment can also be helpful because it provides simple daily treatment. The dedication and determination of family members are important to accomplish such daily rehabilitation. With the wooden hammer and needle, tap all the jing points on the fingers and toes, both on the affected side and the healthy side. When you do this, use the relevant frequency of tapping for each channel. Generally, treatment of many points is required. Palpate and treat from among the following points: Ll-10 (108), BL-40 (112), BL-58 (112), KI-7 (120), LR-3 (108), LR-4 (108), GB-34 (120), SP-6 (108, 120, 132), SP-10 (132), CV-12 (104), ST-25 (132), CV-4 (104), GV-20 (104), GV-12 (104), BL-18 (108), BL-20 (132), BL-23 (120),
BL-32 (112),
BL-33 (112).
If the patient has difficulty talking, stimulate the brain point in both auricles.
Miscellaneous dysfunctions (imbalance of the autonomic nervous system): This kind of imbalance is often difficult to diagnose in Western medicine, as many varied symptoms can appear. Generally, acupuncture can gradually bring about functional balance. Prolonged therapy with the wooden hammer and needle can help in this process. For example, for insomnia, select and treat from the list of points in the table above (LI-10 to BL-33), and add KI-1 (120) and the insomnia point in the center of the heel. It is best to do this treatment just before going to bed, or at least to do the above points sometime during the day or preferably evening, and treat Kl-1 and the insomnia point just before retiring. If the patient suffers from cold feet, tap at both corners of the nails of the feet (including the jing points). Tap the soles of the feet and rub the bottom of the feet, too. This will often cause the feet to warm up, and when coldness of the feet has been disturbing sleep, it will help with the sleeping problem. If the upper parts of the body run warmer than the lower parts of the body (which can be visually assessed by a redder or ruddier color of the upper torso or face), tapping around the achilles tendon will often help. For sexual dysfunctions, such as impotence in men and menstrual difficulties in women, select and treat from the above list of points (LI-10 to BL-33). For impotence add LR-3 (108), GB-40 (120), CV-2 (104) and tapping on the sacrum and down the medial line of the thigh. For menstrual difficulties, make sure that LR-3 (108), LR-4 (108), SP-10 (132), SP-6 (108, 120, 132) and BL-32 (112) are treated, plus down the medial line of the thighs, in the inguinal regions, and on the sacrum. It is important to begin treating these points 4-5 days before menses begin. In cases where the imbalance has caused emotional symptoms such as irritability or emotional stress, we may focus on the liver channel. To do this, use the general treatment given above, and add treatment for LR-3 (108), GB-39 (120), and GB-40 (120).
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There are many uses for the wooden hammer and needle; the above represent a few simple guidelines. Many different treatment strategies and point combinations can be devised with this easy, simple, and safe method. East Asian medical supply companies stock the wooden hammer and needle so that practitioners can have sets available for use or purchase by their patients.
HIRATA ZONE THERAPY Earlier this century in Japan, the Hirata zones were used for diagnostic purposes as well as for treatment. Kurakichi Hirata, the originator of this system of correspondences, used a method of stimulation for these zones involving the burning of ethyl alcohol poured over asbestos in a metal cone-shaped container placed at the end of a short handle. The treatment involved tapping points within the relevant zone with the hot tip of the cone. The instrument used can be seen in the following illustration.
Figure 12.11: Hirata zone stimulator cone
Mr. Hirata developed a diagnostic procedure using the zones and a simple method of treatment that could be used easily and safely by the patient at home. It is relatively easy to make an instrument that gives heat and point stimulation. It is not advisable to use asbestos and burning ethyl alcohol. Perhaps something as simple as a metal awl heated in hot water and tapped to the relevant areas can be sufficient. An adapted moxa instrument that has a slight point on it and is heated by burning moxa inside it can also be used. When using a cone-shaped instrument with burning materials inside it, there are several important points to remember: 1. The point of the cone should be sealed so it does not leak onto the skin. 2. The handle is best made of wood rather than metal so that it does not heat up too much. 3. Once the cone is hot, tapping is done lightly so that the contact with the skin at each point is of short duration only. 4. Tapping should be done at a rate that is comfortable for the patient. 5. Tapping can be done within any of the relevant zones.
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The table3 that follows lists a number of diseases and the zones and parts of the body that are typically tapped. In these descriptions, there are references to the zones by both their topographical location, i.e. on the head, or arm (see the illustration on the following page) and by the number of the zone, as described in chapter eight. There are also references to reactive lines, such as the stomach line or ren mai line, etc. These references are to imaginary lines that traverse the body surface in the general vicinity of the twelve channels and the two extraordinary vessels, the ren mai and du mai. Thus they do not refer to the specific anatomical locations of each channel, but more broadly to the area of the surface of the body along which the channel traverses. Treatment is optimal when stimulus is applied to a particular line in the specific zone referenced. Thus in the first case, for anemia, treating on the spleen line on the leg and thoracic #3 zones (through which the spleen line passes) will have particularly good effects. Disease Anemia Diabetes Bronchial asthma Cough Chronic gastritis, gastrectasis Anorexia Chronic enteritis Hemorrhoids Apoplexy Impotence Nicotine addiction Alcohol addiction Depressive condition Dysmenorrhea Deafness Tinnitus Chronic rhinitus Insomnia
Reactive Lines SP, all yang lines LU, ren mai line all lines
Head 3
Neck 3
Face 3
Arm 3
Trunk 3
Leg 3
6
6
6
6
6
6
1
1
1
1
1
1
all lines LI, ST, BL, SI lines
1
1
1
1
1
1
7
7
7
7
7
7
SI, BL lines SI, BL lines
7
7
7
7
7
7
9
9
9
9
9
9
all yin lines all yin lines all yin lines all yin lines
12 3 8-12 3-8
12 3 8-12 3-8
12 3 8-12 3-8
12 3 8-12 3-8
12 3 8-12 3-8
12 3 8-12 3-8
all yin lines
3-8
3-8
3-8
3-8
3-8
3-8
all yin lines
3-8
3-8
3-8
3-8
3-8
3-8
all yang lines stomach line stomach line all yang lines
12 8 8 4-5
12 8 8 4-5
12 8 8 4-5
12 8 8 4-5
12 8 8 4-5
12 8 8 4-5
all lines
3
3
3
3
3
3
As an example of how to use this table, take the treatment of anemia. Palpate all the number 3 zones of the various parts of the body, focusing especially on the areas traversed by all the yang lines (channel areas) and the spleen line. Once you have found reactive points or areas, light the alcohol or moxa in the instrument, and, when the tip of the cone begins to warm up, start tapping lightly in the region of the reactive points and areas on the relevant zones. This tapping should be done so that it is comfortable for the patient, and should be continued, moving the point of the cone around so as not to overstimulate any single area, until the reactive points or areas become looser and less reactive. Generally this does not take too
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long. When the patient is doing this as home therapy, it might be necessary to have a relative or friend administer the tapping. In such cases, it would be advantageous to have that person present when you instruct the patient how to perform the techniques and select points and areas for stimulation. Following are a few more conditions with recommended zones and lines for therapy. Fatigued feeling in the whole body: Treat on the 4-10 zones of the body, focusing especially on the bladder and ren mai lines. Constipation: Treat zones 9-10 of the body, focusing especially on all the yang lines including the du mai line. It is particularly helpful to focus on the intersection points/areas of the du mai and bladder lines in zones 9-10 on the trunk and lumbar regions and the intersection points/areas of the stomach line in the 9-10 zones on the lower abdomen. Migraine headaches: Treatment of the more distal parts often gives dramatic results for relief of the pain. For example, when treating the gallbladder line, treat first the gallbladder zone, #5 on the feet. Similarly, when treating the bladder line, treat it in the bladder zone, #11 on the legs, and for the small intestine line, start by focusing on the small intestine zone, #10 on the arms. Menopausal Complications: Palpate all lines and zones and treat the reactive points/ areas, especially on the trunk. It is often helpful to treat on the spleen line on zones 6 and/ or 12.
Figure 12.12: The Hirata zones on the body
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DIETARY RECOMMENDATIONS Dietary adjustment has proven useful for many health problems. Many patients have destructive dietary habits, which if not changed, will contribute a continuous negative bias and hamper treatment. These patients usually need some simple guidelines for change. Patients who are severely ill, even if they are diet-conscious and eat relatively well, will still need some basic guidelines; few patients know much about complementary eating habits. The following foods in a well-balanced diet can be recommended to virtually all patients, for at least as long as they have their health problems. A less stringent version of these guidelines contributes to general health maintenance. Staple foods: - Unrefined grains: unpolished brown rice; polished rice with germ; cereals; whole wheat flour; whole wheat bread; wheat vermicelli; buckwheat. Subsidiary foods - Foods containing animal protein: seafoods; white-meat fish; small fish; sardine; salmon; mackerel; squid; octopus; crab; shell fish (except cultured fish). - Foods containing vegetable protein: soybean products (e.g. tofu, natto, etc.); beans, aduki beans, broad beans; nuts; wheat-gluten bread. - Vegetables: colored vegetables; lightly colored vegetables; root crops (carrots, potatoes, etc); sea vegetables including wakame, hijiki, kombu, nori.
- Seasonal fruits in limited amounts. - Beverages: herb teas, especially senna tea (if there is any tendency towards constipation or if there are signs of blood stasis), hako tea, persimmon tea; natural fruit and vegetable juices; soymilk. - Seasonings: natural sea salt; lightly refined sugar; pure honey; naturally brewed miso; natural soy sauce; vinegar; unrefined vegetable oils. Foods to be avoided or taken in moderation: - Refined grains: polished rice, white bread, refined flour noodles; - Meat: chicken, pork, beef, lamb; fish paste products or meat products with aqditives, including ham; sausage; boiled fish paste. - Other foods: fried foods, butter, lard, refined sugar, chemical seasonings, coffee, black tea, refined juices, carbonated beverages and other canned drinks, alcohol. Tobacco use should be discontinued. When consumed excessively, these contraindicated foods are often related to disease. Patients who have liver problems, especially when accompanied by blood stasis signs, should particularly avoid hot, spicy, oily, and greasy foods, and alcohol and coffee.
CHAPTER ENDNOTES 1 S.B.: The information in this section is a translated from a paper written by Manaka and Itaya several years ago, and published in a popular Japanese health journal. It has been slightly adapted here so that Western practitioners can easily utilize the treatments and teach them to their patients. 2 S.B.: This procedure with the tapping is described completely in Matsumoto, K. and S. Birch, Hara Diagnosis: Reflections on the Sea, pp. 381-384. 3 Selected from Manaka, Y., Hiratashi funihannotai Nesshin Shigeki Ryoho, Yokosuka: Ido no Nippon Sha, 1982, pp. 111 passim.
SECTION FOUR RIDING THE DRAGON
CASE STUDIES FROM CLINICAL PRACTICE
CHAPTER THIRTEEN
CASE STUDIES FOR STEPS ONE AND
Two
These case studies are presented to illustrate both common patterns and exceptional cases. Note the common use of the yin qiao mai-ren mai connections for problems involving the kidneys and lungs; the yin wei mai-chong mai connection for problems involving the liver, heart, spleen, stomach, and a psychological component; and the right yin wei mai-1eft yang wei mai connection for problems involving the liver.
Female, age 38. Pain and difficulty using both thumbs since giving birth two months previous. Soft overall. Abdominal Reactions: KI-16, LU-1, CV-10, ST-27 all give positive 0-ring responses. Gastrocnemius Reactions: Left kidney-large intestine region. Kidney and liver pulses weak. Pulse: Open Point: KI-6 (see below). Confirming Test: Electrostatic adsorbers: Kl-6 negative, LU-7 positive. All signs improved. Test Results: Ion pumping: Step One Treatment: bilaterally, KI-6 black(-), LU-7 red(+). Step Two Treatment: Kyutoshin moxa: bilaterally, BL-52, BL-25. In formulating a successful treatment for this patient, it was necessary to determine the predominant pattern: whether to treat the yin qiao mai-ren mai connection indicated by the soft abdomen, KI-16, LU-1, and CV-10 reactions, and the weak kidney pulse, or to treat the kidney-large intestine channel pair as indicated Patient 1, K.R.: Main Complaint:
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Case Studies for Steps One and Two
by the gastrocnemius reactions, KI-16, ST-27, and the weak kidney pulse. The symptom of pain in the thumbs, following the course of the lung channel, suggested trying the yin qiao mai-ren mai first. This treatment improved all the abdominal reactions and decreased the thumb pain. Step two, kyutoshin moxa therapy for BL-52 and BL-25, diminished reactiveness at the treatment points. These points were selected because BL-52 is a kidney reflex point and BL-25 is a good point for lower burner problems. We do not recommend this technique on the lung associated-shu point, BL-13. In our experience, use of BL-23 or BL-52 with BL-25 is good for yin qiao mai-ren mai step two treatments and lower burner kidney xu.
Male, age 37. Main Complaint: Recurrent low back pain and spasm. Occasional left leg involvement of three years duration. Medical History: Surgical correction of spondylolisthesis at age 23. Abdominal Reactions: Subcostal regions, especially right side; ASIS regions, especially left side; tightness along the ren mai; tight at bilateral ST-25, ST-26, ST-27; with PC-1, GB-26 both bilaterally sore with positive 0-ring responses. Gastrocnemius Reactions: Many regions reactive, worst on right liver I small intestine region. Pulse: Liver pulse weak. Confirming Tests: Electrostatic adsorbers: (-)to right PC-6, (+)to right SP-4; (-)to left TB-5, (+)to left GB-41. Test Results: Slight abdominal and 0-ring improvements. Step One Treatment: Ion pumping: Right PC-6 black(-), SP-4 red(+); Left TB-5 black(-), GB-41 red(+). Step Two Treatment: Kyutoshin moxa: bilaterally, BL-18, BL-25. For this patient, the liver channel was determined to be the primary problem (recurrent low back problems, left leg involvement, right subcostal and gastrocnemius reactions, weak liver pulse). However, on this occasion and for several further treatments, the right yin wei mai-left yang wei mai connection was the most appropriate therapy, because the general upper right quadrant-lower left quadrant reactions, the ST-25, PC-1, and GB-26 reactions, and the weak liver pulse were distinguished as a cross-syndrome pattern. This patient's abdomen was very reactive. Step one treatment reduced most of the abdominal reactions but did not eliminate any gastrocnemius reaction. For step two, BL-18 was treated because of the obvious liver involvement and because it was tight and sore. BL-25 was treated because of tension and soreness at the bilateral points. This combination helped release tension in the back muscles. Patient 2, D.R.:
Patient 3, J.E.: Main Complaint:
Female, age 59. Stiff shoulders and neck; lumbago; cold lower extremities.
Case Studies for Steps One and Two
Abdominal Reactions:
Right subcostal region; left ASIS.
Step One Treatment:
Ion pumping: Right PC-6 black(-), SP-4 red(+). Left TB-5 black(-), GB-41 red(+).
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This patient clearly showed the upper right quadrant and lower left quadrant pattern that we call "cross-syndrome." Treatment was successful and released these reactions allowing progression to step two.
Patient 4, 1.1.:
Female, age 79.
Main Complaint:
Arthritic deformity and pain in spine and feet.
Abdominal Reactions:
Overall flaccid and weak; some reaction at KI-16.
Step One Treatment:
Ion pumping: bilaterally, KI-6 black(-), LU-7 red(+).
In this patient, age and the advanced state of the disease indicated kidney involvement (flaccid, weak abdomen; bone disease). These problems are clinically accessible through the yin qiao mai-ren mai connection. The KI-16 reaction was reduced. (Only repeated treatments would change the overall weakness and flaccidity of the abdomen.) At this time, the change was enough to allow treatment to progress to step two.
Patient 5, Y.S.:
Female, age 47.
Main Complaint:
Gallstones; cysts and fibroids of the uterus.
Abdominal Reactions:
Right subcostal region; CV-17, left ST-25; left ASIS.
Step One Treatment:
Ion pumping: Right PC-6 black(-), SP-4 red(+). Left TB-5 black(-), GB-41 red(+).
Here again, the cross-syndrome was clear. The patient's reactions at the right subcostal and left ASIS with secondary yin wei mai and yang wei mai signs, CV-17 and left ST-25 were strong. Since the cross syndrome is closely related to the liver, as is the gallbladder, this makes sense. Likewise, the uterine problems could be related to cross-syndrome because both are usually attributed to blood stasis. Treatment reduced the abdominal reactions allowing progression to step two.
Patient 6, M.W.:
Female age 25.
Main Complaint:
Occipital pain; excessive menstrual flow. Kl-16
Abdominal Reactions: Pulse: Step One Treatment:
Kidney pulse weak. Ion pumping: bilaterally, KI-6 black(-), LU-7 red(+).
This patient's appearance was notable for marked darkness below the eyes. The weak kidney pulse and the Kl-16 reactions were further indications of an underlying kidney involvement. KI-6 was the open point at the time of treatment. Thus the yin qiao mai-ren mai connection was used. Treatment released the KI-16 reactions and strengthened the kidney pulse, allowing progression to step two.
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Case Studies for Steps One and Two
Male, age 25. This patient was unable to move his head or neck, Main Complaint: following surgery to the trachea for a cancerous growth. Mild ASIS; ST-26, KI-11. Abdominal Reactions: Bilateral testing with ion beam: BL-62 (-), SI-3 (+). Tests: Tests Results: No change on the abdomen. (+) to BL-62, (-) to SI-3; improvement in abdominal Retest with ion beam: findings. Step One Treatment: Ion beam: (+)to BL-62, (-)to SI-3. The ASIS, ST-26 and KI-ll findings for this patient and the neck immobility suggested the yang qiao mai-du mai connection. But, when tested, the du mai-yang qiao mai proved to be the more effective treatment. This illustrates how you can start with a common treatment pattern and arrive at its opposite, when the common approach is insufficient. The treatment released the abdominal reactions and gave the patient some improvement in neck mobility. Further treatment steps greatly improved neck and head mobility. Patient 7, J.I.:
Female, age 54. Insomnia; hypertension; angina; extreme Main Complaint: nervousness. Abdominal Reactions: Right subcostal region. Step One Treatment: Ion pumping: right PC-6 black(-), SP-4 red(+). Step Two Treatment: Kyotoshin moxa: bilaterally, BL-51. This patient is a clear example of a condition requiring the yin wei-chong mai connection. The symptoms and abdominal reaction fit with textbook clarity. Step one treatment softened the subcostal reactions. Step two treatment further improved the abdominal reactions. Patient 8, Y.M.:
Male, age 21. Severe chronic constipation. (A successful bowel Main Complaint: movement required half an hour.) This condition had already improved through treatment; completion had formerly taken one hour. Right subcostal region; left ASIS region. Abdominal Reactions: Step One Treatment: Ion pumping: Right PC-6 black(-), SP-4 red(+). Left TB-5 black(-), GB-41 red(+). This patient exhibited another clear case of cross-syndrome with liver involvement. Because of the underlying liver involvement, the metronome was set at 108 beats per minute and placed near the patient's right ear during the ion pumping application. The abdominal reactions quickly changed, allowing treatment to proceed to the next step. Patient 9, M.H.:
Case Studies for Steps One and Two
Patient 10, H.M.: Main Complaint: Abdominal Reactions:
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Male, age 59. Obesity; history of manic depression. Right subcostal region; left ASIS; left ST-25, right GB-26.
Step One Treatment:
Ion pumping: Right PC-6 black(-), SP-4 red(+). Left TB-5 black(-), GB-41 red(+). Step Two Treatment: Kyotoshin moxa: bilaterally, BL-20, BL-23, BL-25. Another clear cross-syndrome pattern was clearly exhibited by this patient. In terms of the extraordinary vessels, manic depression is a yin wei mai-chong mai symptom. Step one treatment improved the abdominal reactions. For step two treatment, BL-20 was selected because of the yin wei mai-chong mai involvement and the problem of obesity. The other moxa points were selected based on visual observation of muscular tightness and pressure sensitivity. This combination allowed considerable loosening of the patient's back muscles.
Female, age 54. Main Complaint: Headache; psychological stress. This patient had been violently attacked nine years earlier and had suffered from chronic shock ever since. Both subcostal regions, especially right side. Abdominal Reactions: Step One Treatment: Ion pumping: bilaterally, PC-6 black(-), SP-4 red(+). This patient provided another good example of the psychological symptom relationships often found associated with the yin wei mai-chong mai pattern. The stress, shock, and abdominal reactions all indicate yin wei mai-chong mai. The patient became very relaxed during the treatment and the reactivity of the subcostal regions lessened allowing treatment to progress to the next step. Patient 11, S.T.:
Female, age 38. Nervousness; hypotension; anemia; weak stomach Main Complaint: and intestines; low back and suprascapular pain. Abdominal Reactions: Right LU-1,left ST-26; right KI-16, left KI-11. Step One Treatment: Ion pumping: Right LU-7 red(+), KI-6 black(-). Left SI-3 red(+), BL-62 black(-). Step Two Treatment: Kyotoshin moxa: bilaterally: BL-23, BL-25, KI-7. Essentially, this patient exhibited a vacuous condition with some repletion signs in the upper portions of their body. These symptoms and the pattern of yin qiao mai-ren mai (LU-1, Kl-16) and yang qiao mai-du mai (ST-26, KI-ll) reactions were the clues to this unusual combination. Before treatment began, the patient complained of many things and manifested a nervous disposition. During first step Patient 12, M.Y.:
270
Case Studies for Steps One and Two
treatment she became quite relaxed and the abdominal reactions vanished, both of which were seen as signs of success. For step two treatment, BL-23 and BL-25 were selected to help with the underlying lower burner-kidney xu condition. KI-7 was used expressly for the purpose of strengthening the kidney channel.
Main Complaint:
Female, age 51. Glaucoma with decreased visual acuity; alopecia (which had already improved with previous treatments).
Abdominal Reactions:
Subcostal regions.
Patient 13, A.R.:
Step One Treatment:
Ion pumping: bilaterally, PC-6 black(-), SP-4 red(+). Patients with alopecia are often treated via the yin wei mai-chong mai pattern. The abdominal reactions here indicated bilateral application since both subcostal regions were tight and sore. These released with ion pumping application, allowing treatment to progress to the next step.
Patient 14, N.S.:
Female, age 60.
Main Complaint:
Decreased liver function since gallstone surgery. Right subcostal region; CV-17, left ST-25; Left ASIS.
Abdominal Reactions: Step One Treatment:
Ion Pumping: Right PC-6 black(-), SP-4 red(+). Left TB-5 black(-), GB-41 red(+).
The liver-gallbladder problems experienced by this patient and the cross-syndrome pattern indicated treatment utilizing the extraordinary vessels, which provided a successful decrease of abdominal reactions allowing treatment to progress to the next step.
Patient 15, Y.S.: Main Complaint: Abdominal Reactions: Step One Treatment:
Female, age 62. Left shoulder pain; history of severe herpes zoster. Subcostal regions; CV-17, GB-26. Ion pumping: bilaterally: PC-6 black(-), SP-4 red(+).
Herpes zoster is commonly treated with the yin wei mai-chong mai treatment pattern. For this patient the abdominal reactions indicated bilateral application since both subcostal regions and both GB-26 were reactive. These signs improved with treatment allowing the next step of treatment to be applied.
Patient 16, Y.O.: Main Complaint: Abdominal Reactions:
Male, age 59. Right shoulder stiff and painful, with limited movement ("50-year shoulder"). ST-25; along dai mai.
Case Studies for Steps One and Two
Step One Treatment:
271
Ion pumping: bilaterally: TB-5 black(-), GB-41 red(+).
The symptoms and abdominal reactions of this patient clearly fit the yang wei mai-dai mai treatment pattern. Treatment was applied bilaterally because the reactions on the abdomen were bilateral. The abdominal reactions were reduced, allowing progression to the next step of treatment, and the shoulder problem improved.
Patient 17, S.O.: Main Complaint: Abdominal Reactions: Step One Treatment:
Female, age 69. Angina with numbness of the upper extremities and feet. Left KI-16; right LU-1. Ion beam: left KI-6 positive(+). right LU-7 negative(-).
This patient was in a condition of general vacuity. The reactions on Kl-16 and LU-1 indicated a yin qiao mai-ren mai pattern. Since KI-6 was open, the yin qiao mairen mai was treated. Left KI-6 was treated because left KI-16 was reactive, right LU-7 because right LU-1 was reactive. Intuition recommended the polarity application of the ion beam with positive (+) to KI-6, which successfully reduced the abdominal reactions.
Patient 18, H.M.: Main Complaint: Abdominal Reactions: Step One treatment:
Step Two Treatment:
Male, age 61. Numbness of the arms; difficulty walking; diagnosed as having multiple sclerosis. Subcostal regions. Electro-acupuncture: bilaterally, scalp motor zones. Ion pumping: bilaterally, PC-6 black(-), SP-4 red(+). Kyotoshin moxa: bilaterally, BL-25 and KI-Ll gastrocnemius points.
In cases where organic degenerative changes have occurred, such as the condition of this patient, the basic approach emphasized in this work must be augmented. Using an electrodermal point finder, we located two points on either side of the skull in the motor zones, needled these shallowly and applied gentle electrical stimulation to both sides. The yin wei mai-chong mai was treated bilaterally with the ion-pumping cords because the abdominal reactions were bilateral. Further treatment applied kyutoshin moxa to the handles of the needles, bilaterally, at BL-25 and the kidney-large intestine gastrocnemius points, because of the numbness on the large intestine channel. The chronicity and nature of this patient's condition made immediate reassessment difficult. The moxa on the handles of the needles was followed immediately by further procedures to address specific symptoms. It should be noted that the gentle electrical stimulation of the motor zone regions on the skull need not occur simultaneously with ion-pumping treatment. It was addressed in this fashion for this patient because stimulation of these zones
272
Case Studies for Steps One and Two
is often helpful for locomotor symptoms. The beginner may want to apply one, then the other, in a two-step process, to assure confidence that no adverse interaction (such as countering the effects of the ion pumping) has occurred.
Male, age 36. Main Complaint: Arthritis of spine and hips, especially left hip, diagnosed as Reiter's syndrome. Abdominal Reactions: LU-1, KI-ll both sore, with positive 0-ring test; right subcostal region reactive. Other Reactions: Musculature in the cervical, thoracic, and lumbar regions swollen, tight, and tender to the touch. Gastrocnemius Reactions: Right lung-bladder region. Pulse: Lung pulse weak; bladder, liver pulses slightly weak Confirming Tests: Electrostatic adsorbers: (+)to left LU-9, (-)to LU-5; (+)to left BL-67, (-)to left BL-65. Test Results: Improvement in reactive areas and 0-ring test to LU-1 and KI-11. Step One Treatment: Ion pumping: left: LU-9 red(+), LU-5 black(-). BL-67 red(+), BL-65 black(-). Patient 19, R.R.:
Point testing for this patient was performed with electrostatic adsorbers. Treatment was accomplished with needles and ion-pumping cords. Because cord application usually lasts for 10-15 minutes, the patient was able to relax during treatment. This patient clearly manifested problems involving much of the bladder channel, and signs indicating the lung-bladder treatment (LU-1, Kl-11, gastrocnemius reactions, pulses). He also showed signs of a liver problem (right subcostal region, tight muscles, pulse). Treatment produced an immediate relaxation of the musculature down the entire back with release of much of the pain and stiffness; it also produced an improved range of motion. Later treatments began to address the liver problem.
Patient 20, S.W.: Main Complaint:
Female, age 31. Headache every day for the last few weeks, neck and shoulders chronically tight.
Both KI-16 sore with positive 0-ring test; both ST-27 sore. Gastrocnemius Reactions: Both kidney-large intestine regions reactive, especially left. Weak kidney and large intestine pulses. Pulse: Electrostatic adsorbers: Confirming Tests: (-)to right KI-1, (+) to right Kl-7. (-)to right LI-2, (+)to right Ll-11.
Abdominal Reactions:
Case Studies for Steps One and Two
273
Test Results:
Improvement in reactive areas and 0-ring test at KI-16.
Step One Treatment:
Ion pumping: Right KI-1, black,(-) KI-7 red(+). LI-2 black(-), LI-11 red(+).
Step Two Treatment: Kyotoshin moxa: BL-23, BL-25. Testing was accomplished with the electrostatic adsorbers, and treatment with needles and ion pumping. This patient had given birth only a few weeks before and was suffering headaches because of an ensuing kidney vacuity condition. The abdomen, gastrocnemius, and pulse all clearly indicated the kidney-large intestine treatment, which released the abdominal reactions, and softened the patient's shoulders somewhat, reducing pressure sensitivity. Step two treatment was directed to the kidney and large intestine associated-shu points. Patient 21, R.F.: Main Complaint:
Gastrocnemius Reactions:
Male, age 42. Severe sciatica of left leg since a trauma to the lower back and left buttock region several months before. Pains mostly down the bladder channel, some down the gallbladder channel. Numbness of the fourth and fifth toes, diagnosed as a pinched sciatic nerve. Right subcostal tension; right LR-14 sore with positive 0-ring test; left ASIS sore with positive 0-ring test; left ST-26, ST-27 sore with positive 0-ring test on ST-26. Left liver-small intestine region.
Pulse:
Weak liver pulse.
Confirming Tests:
Ion beam: (-)to left LR-2, (+)to left LR-8. (+)to right SI-3, (-)to right SI-8. All signs improved.
Abdominal Reactions:
Test Results: Step One Treatment:
Step Two Treatment:
Ion pumping cords: (-)to left LR-2; (+)to left LR-8. (+)to right SI-3; (-)to right SI-8. Kyotoshin moxa: bilaterally: BL-18, BL-27.
Testing was performed with the electrostatic adsorbers, and treatment with needles and ion pumping. This patient's general condition was strongly influenced by his liver condition. The abdomen, gastrocnemius, and pulse all indicated a liver problem. Treatment could have been applied to the cross-syndrome (upper right and lower left abdominal quadrant), as well as the liver-small intestine channels. On this occasion, treatment focused on the liver channel to obtain a more direct effect. The logic for this choice was that if the liver channel improved, the general level of muscle tension and spasm would improve, relieving the long-term pressure on the sciatic nerve. This logic proved correct. Step two treatment selected the back associated-shu points corresponding to the channels treated in step one, thereby reinforcing the first step and further completing the octahedral-isophasal correspondences.
274
Case Studies for Steps One and Two
Female, age 68. Main Complaint: Stiff shoulders. Abdominal Reactions: Right ST-25, GB-26. Gastrocnemius Reactions: Right spleen-triple burner region. Step One Treatment: Ion beam: (+) to left SP-2, (-) to left SP-5; (+) to right TB-3. Here, step one treatment was performed with a 30-second application of the ion beam device. In this patient the spleen-triple burner channel pair reactions were clear. This treatment utilized a three-point combination, rather than the usual 4-point combination. The effectiveness of this treatment confirmed my growing sense that combinations of three strategically selected points could be very powerful. Patient 22, Y.T.:
Female, age 41. Pain in the right leg (history of diabetes; fracture of the right leg). Abdominal Reactions: Right KI-16, ST-27; right PC-1; CV-12. Gastrocnemius Reactions: Left kidney-large intestine region. Step One Treatment: Ion beam: (-)to right Kl-1, (+)to right KI-7. (+)to right LI-11. Two possibilities were available here: diagnosis and treatment of either the kidney-large intestine channel pair (KI-16, ST-27) or the pericardium-stomach channel pair (PC-1, CV-12). Palpation of the gastrocnemius reaction evinced a clear indication in favor of the kidney-large intestine pair; thus treatment using the ion beam device focused on this pair, reducing the KI-16, ST-27 reaction and the PC-1, CV-12 reactions, allowing progression to the next step. Patient 23, H.O.:
Main Complaint:
Female, age 72. Left hip painful; lower extremities numb; loss of Main Complaint: appetite. ST-25, GB-26. Abdominal Reactions: Gastrocnemius Reactions: Left spleen-triple burner region. Step One Treatment: Ion beam: (+) to right SP-2, (-) to right SP-5, (+) to left TB-3. For this patient, the digestive problem and abdominal and gastrocnemius reactions all suggested that the treatment focus on the spleen-triple burner channel pair. The GB-26 reactions were worse on the right and the ST-25 reactions were worse on the left. Step one treatment with the ion beam apparatus reduced all the reactions as well as reducing the hip pain. Patient 24, M.K.:
Case Studies for Steps One and Two
Patient 25, H.A.: Main Complaint: Abdominal Reactions:
275
Male, age 17. Excessive fluid accumulation in the stomach, with a feeling of general malaise and low energy. Both GB-26, ST-25.
Gastrocnemius Reactions: Right and left spleen-triple burner regions. Pulse:
Spleen pulse very weak.
Step One Treatment:
Ion pumping: bilaterally,(+) to SP-2, (-)to SP-5; (+)to TB-3, (-)to TB-10.
This patient was in a markedly depleted condition with an advanced spleen weakness. Since the abdomen, gastrocnemius, and pulse all confirmed this condition, bilateral treatment on the spleen-triple burner channel pair was used to directly strengthen both spleen channels. Step one treatment with the ion-pumping cords released the abdominal reactions and allowed progression to the next step.
Patient 26, T.I.: Main Complaint: Abdominal Reactions: Gastrocnemius reactions:
Female, age 35. Pain on the lateral side of the right leg and hip. Right subcostal region; left lower quadrant region; other points: Manaka san yin jiao. Left liver-small intestine region.
Ion beam: (-)to left LR-2, (+)to left LR-8; (+) to right SI-3. This patient clearly showed a cross-syndrome pattern of reaction (right subcostal, lower left quadrant and left Manaka three-yin crossing) calling for treatment of the right yin wei-chong mai and left yang wei-dai mai, and as well as a pattern indicative of the liver-small intestine channel pair. Ion beam treatment was done in the cross pattern - right arm, left leg, to address the cross reactions. Either of these treatments would have addressed the underlying liver problem and crosssyndrome. In this case, the cross-syndrome reactions were released using treatment on the liver-small intestine channel pair, allowing treatment to progress to the next step. Step One Treatment:
Male, age 44 Left elbow and shoulder painful, with intraMain Complaint: scapular pain; occasional numbness of the left upper arm; occasional stomach problems. Abdominal Reactions: Right subcostal region; left lower quadrant region; left Manaka san yin jiao. Gastrocnemius Reactions: Right liver-small intestine region. Step One Treatment: Ion beam: (-)to left LR-2, (+)to left LR-8, (+) to left SI-3. The patient's pattern of reactions clearly indicated the cross-syndrome.
Patient 27, K.I.:
276
Case Studies for Steps One and Two
However, with the strong gastrocnemius reaction, treatment of cross-syndrome was done with the liver-small intestine channel pair instead. Since the symptoms were mostly of the left shoulder, the small intestine point was treated on the left. Treatment using the ion beam device relieved the abdominal reactions and improved the left elbow and shoulder pain, allowing treatment to continue to the next step.
Patient 28, K.F.:
Female, age 36.
Main Complaint:
Nephritis.
Abdominal Reactions:
GB-26, Right ST-25.
Gastrocnemius Reactions:
Right spleen-triple burner region.
Ion beam: (+)to left SP-2, (-)to left SP-5, (+) to left TB-3. Western diagnoses do not always indicate a clear problem in what could be considered an equivalent channel. In this patient, the spleen-triple burner channel pair was clearly indicated and the kidney pattern we might have expected from the allopathic diagnosis was not apparent. Treatment using the ion beam device reduced the abdominal reactions. Step two treatment addressed reactive points lateral to BL-23 and the kidney-large intestine points on the gastrocnemii with bilateral treatment using kyutoshin moxa. These were selected because the patient's main complaint was nephritis, and all these points have an effect on the kidney channel. Step One Treatment:
Patient 29, D.K.:
Female, age 60.
Main Complaint:
Gallstones. KI-16.
Abdominal Reactions:
Gastrocnemius Reactions: Right and left kidney-large intestine regions, especially right. Step One Treatment:
Ion beam: (-)to left KI-1, (+)to left KI-7, (+)to left Ll-11.
As with the previous patient, the kidney-large intestine channel pair was clearly indicated, despite the gallbladder symptomology. Treatment using the ion beam device released the KI-16 reactions and allowed progression to the next step.
Patient 30, M.Y.: Main Complaint: Abdominal Reactions: Pulse:
Female, age 40. Arthritis of the elbows; history of hepatitis. Right subcostal region. Weak overall pulse. To aid differentiation, we applied thumbs to ST-41, the open supplementation point, for 15 seconds. This improved the overall pulse and revealed a weakness in the liver pulse.
Case Studies for Steps One and Two
277
Electrostatic adsorbers: (-)to left LR-2, (+)to left LR-8, (+)to right SI-3. Metronome: 108 beats per minute. Clear symptoms of a liver problem were evident: a history of hepatitis, right subcostal reactions and weak liver pulse. We treated the the liver-small intestine channel pair using the electrostatic adsorbers. In addition, we set a metronome at 108 beats per minute and the adsorbers vibrated back and forth on the points to the beat of the metronome. This method of combining regular polarity treatment with the metronome frequency successfully reduced the abdominal reaction, as well as relieving some of the elbow pain, and allowed progression to the next step. Step One Treatment:
Female, age 69. Cataracts; stiff shoulders; tension in the back from the neck to the lumbar region; difficulty sleeping; history of anemic heart problems. Abdominal Reactions: LU-1, KI-11. Gastrocnemius Reactions: Left bladder-lung region. Step One Treatment: Ion beam: (+)to right BL-67, (-)to right BL-65; (+)to right LU-9. Symptomatically this patient showed many bladder channel symptoms - eye problems, back tension, etc. The abdominal and gastrocnemius reactions confirmed this condition and indicated a lung-bladder treatment pattern. Treatment using the ion beam device improved the abdominal reaction and released some of the neck and shoulder tension, allowing treatment to progress to the next step. Patient 31, K.M.:
Main Complaint:
Female, age 72. Manic depression; sternal occlusion. Right subcostal region; mild left ST-26. Abdominal Reactions: Ion beam: Step One Treatment: (-)to left LR-2, (+)to left LR-8, (+)to right SI-3. The facial coloration of this patient was notably dark, especially around and below the eyes. This patient could have been treated with the yin wei-chong mai connection (and on many occasions was). On this occasion, the liver-small intestine channel pair was selected because of the additional ST-26 reaction. Treatment with the ion beam device reduced the abdominal reactions and allowed treatment to progress to the next step. This case shows the overlap between the yin wei maichong mai and liver. Patient 32, Y.K.:
Main Complaint:
278
Case Studies for Steps One and Two
CASE STUDIES ILLUSTRATING TREATMENTS WITH COLORS
Patient 1, Y.O.:
Female, age 31.
Main Complaints:
Infertility, allergies, headaches.
History: Abdominal Reactions:
Unsuccessful hormone therapies. Right subcostal region tight; pressure pain and positive 0-ring tests at CV-4 and right LR-14. Liver pulse weak.
Pulse: Step One treatment:
Color: Yellow ink to left LR-3. Red ink to left LR-2 and CV-4. Moxa: once to each point (above). Ion pumping: Right PC-6, black(-), SP-4 red(+).
Tests using color application caused the patient's 0-ring response to improve, but there was no improvement in the pressure pain and tightness. Moxa was then applied once to each point. This relieved the pressure pain at LR-14 and CV-4, but the general tightness of the right subcostal region remained unchanged. Application of the ion-pumping treatment eliminated the subcostal tightness. This case study illustrates the step-by-step approach we have described: assessment, application of method of choice, reassessment; if little or no improvement, a revised choice. Or, if definite improvement shown, progression to the next step. Here we started with the color application, reassessed, found marginal improvement, selected moxa therapy, rechecked the indications, then selected ion pumping to finally achieve a notable improvement in the pulse and abdominal indications.
Patient 2, K.S.: Main Complaint:
Female, age 56. Insomnia.
Flushed face and neck. Hardness above the navel, especially the right subcostal region; looseness below the navel; pressure pain with positive 0-ring tests at CV-4 and right LR-14. Step One Treatment: Color: Yellow to left LR-3 and right SI-4. Red to left LR-2 and CV-4. Moxa: once on each point (above). This patient showed a relatively clear liver-small intestine channel pair problem: right subcostal tightness, with positive 0-ring tests at LR-14 and CV-4 (see the traditional mu points). Color and moxa treatment eliminated all the abdominal reactions, allowing treatment to progress to step two. Appearance: Abdominal Reactions:
Case Studies for Steps One and Two
279
Patient 3, K.N.:
Female, age 42. Main Complaint: Dermatitis with itching of the face (onset at age 18). Abdominal Reactions: Tension with slight pressure pain at CV-7 and CV-12; positive 0-ring tests at CV-7 and CV-12. Step One Treatment: Color: Yellow to left SP-3 and both TB-4. Red toCV-7. Moxa: once on each point (above). This patient showed a clear case of the spleen-triple burner channel pair as indicated by the CV-7 and CV-12 reactions. Treatment with colors and moxa rid the abdominal reactions and allowed therapy to continue to step two.
Female, age 60. Headaches for the last six months; low blood Main Complaint: pressure (80/50). Successful surgery for a brain tumor the year History: before. Pressure pain and tension along the dai mai, from Abdominal Reactions: GB-26 through SP-15, ST-25, KI-16 and back to GB-26. Electrostatic adsorbers: Step One Treatment: (-)to left TB-5, (+)to left GB-41. Color: Yellow to left SP-3 and left TB-4. Blue to left GB-41. This step one treatment with electrostatic adsorbers improved the reactions across the abdomen, but did not eliminate them, being least effective at GB-26. For reinforcement, colors were applied. This considerably reduced the remaining reactions, allowing treatment to continue to step two. Patient 4, Y.B.:
CASE STUDIES FOR ALTERNATE STRATEGIES
Female age 53. Chronic hepatitis; hands numb in the morning; irritated by standing. Abdominal Reactions: Right subcostal region; left lower quadrant region; left Manaka san yin jiao very sore. Step One Treatment: Magnet heater: placement on left sole. This therapy released the patient's cross-syndrome pattern of reaction, allowing treatment to progress to the next step. Patient 1, A.B.: Main Complaint:
280
Case Studies for Steps One and Two
Patient 2, M.F.:
Male, age 40.
Main Complaint:
Severe hemorrhoids.
Abdominal Reactions:
Right subcostal region; severe pain, left ST-26, ST-27.
Pulse:
Weak overall.
Step One Treatment:
Magnet heater: placement on right palm.
This released the patient's cross-syndrome pattern of reactions with followed up treatment in step two.
Patient 3, M.K.:
Female, age 42.
Main Complaint: Abdominal Reactions:
Stiff shoulders; fatigue; history of hernias; chronic appendicitis. Right subcostal region; left Manaka san yin jiao.
Step One Treatment:
Magnet heater: Placement on right palm.
This released the patient's reactions allowing progression to the next step.
In each of these cases the cross-syndrome pattern was present. Use of the magnet heater produced notable change. Generally, this treatment procedure is helpful for stubborn cross-reactions, where regular ion-pumping treatment has not been sufficient. It is also useful for the opposite cross-pattern of the upper leftlower right abdominal quadrants. In a patient with pain on the left elbow, mostly on the large intestine channel, treatment of the kidney-large intestine channel pair produced little change of abdominal reactions. The left subcostal and right ASIS regions were also reactive and particularly stubborn. Placing the left palm on the magnet heater for ten minutes not only reduced the abdominal reactions, but also greatly improved the left elbow pain and mobility.
CASE STUDIES FOR MOXIBUSTION OF CRANIAL Patient 1, M.D.: Main Complaint: Abdominal Reactions:
& CAUDAL POINTS
Female, age 48. Shoulder and back pain. Right subcostal tension; left ST-26, CV-14, CV-7.
Gastrocnemius Reactions: Right liver-small intestine region.
0-ring: CV-14, CV-7. Step One Treatment: Moxa: 3 times CV-14 with arms stretched above head while chanting AAHH; 3 times CV-7 with arms by the sides while chanting MMMM. The diagnosis for this patient was of the liver-small intestine channel pair because of the right subcostal, left ST-26, and gastrocnemius reactions. The related Confirming Tests:
Case Studies for Steps One and Two
281
ren mai points were also reactive. With this treatment the patient experienced immediate relief of the shoulder and back pain and became notably relaxed. She requested that she be allowed to sleep for a few minutes. Becoming relaxed and sleepy during treatment is a good sign. In this case, one treatment was able to cure the patient's problem.
Main Complaint:
Female, age 76. Tendonitis of the left hand.
Abdominal Reactions:
Kl-16, ST-27, CV-12, CV-6.
Confirming Tests:
O-ring. Moxa: 3 times CV-12 with arms stretched above head while chanting AAHH; 3 times CV-6 with arms by the sides while chanting MMMM.
Patient 2, S.B.:
Step One Treatment:
Involvement of the kidney-large intestine channel pair was evident in this patient. Kl-16, ST-27, and the relevant ren mai points all showed positive 0-ring responses. This simple moxa treatment was followed by the placement of intradermal needles in the left auricle: lung, large intestine, and hand points, and on left LU-7. This eliminated the pain in the left hand.
Patient 3, R.A.:
Male, age 31.
Main Complaint:
Agoraphobia; difficulty writing; kidney problems; recent surgery for anastomosis of the bladder and large intestine. Right LU-1, Kl-11.
Abdominal Reactions:
Gastrocnemius Reactions: Many areas sore, especially left bladder-lung region. Confirming Tests: Step One Treatment:
0-ring: CV-21, CV-3. Moxa: 3 times CV-21 with arms stretched above head while chanting AAHH; 3 times CV-3 with arms by the sides while chanting MMMM.
This patient had multiple problems. Reactions indicated a lung-bladder channel problem (LU-1, Kl-11, and gastrocnemius reactions). With the moxa treatment directed at the lung and bladder reflex points, the abdominal reactions were reduced quickly and simply, allowing step two treatment to follow.
Female, age 25. Pain and numbness of the right fingers, especially the index finger. Abdominal Reactions: Right ST-27, Kl-16. Gastrocnemius Reactions: Left kidney-large intestine region. Step One Treatment: Ion beam: (-)to right Kl-1, (+)to right Kl-7 (+)to right Ll-11.
Patient 4, M.I.:
Main Complaint:
282
Case Studies for Steps One and Two
Moxa: 3 times to right Ll-11 while chanting AAHH. 3 times to right Ll-2 while chanting MMMM. 3 times to right ST-27 while chanting MMMM. In this case, regular treatment with the ion beam device had proven insufficient, accomplishing only mild improvement in the abdominal reactions. In an effort to improve both the abdominal reactions and the patient's symptoms, treatment was directed at the affected right large intestine channel points and reflex point. This unusual tactic proved useful: both abdominal reactions and pain of the fingers were reduced.
Patient 5, R.W.: Main Complaint: Abdominal Reactions: Pulse: Confirming Tests:
Male, age 69. Palpitations. Left KI-16, right ST-27. Kidney pulse weak. 0-ring: CV-9, CV-6.
Moxa: 3 times to CV-9 with arms stretched above head while chanting AAHH. 3 times to CV-6 with arms by the sides while chanting MMMM. 3 times to right Ll-5 with thumb and index finger stretched apart while chanting AAHH. 3 times to left KI-6 while chanting MMMM. This elderly patient evidenced a condition of kidney vacuity. Diagnostically the large intestine-kidney channel pair was indicated (KI-16, ST-27, weak kidney pulse.) Because of the patient's advanced age and the nature of the patient's problems, the treatment of the open points was added. (Treatment time was 8:15am on an S2B8 day- Ll-5 and KI-6 open.) The effects of this treatment were reinforced by adding the open points. It is worth noting that we can utilize the same principles of treatment without using moxa. This is important when treating children, or others for whom moxa may be inappropriate. Step One Treatment:
Female, age 6. Rhinitis. CV-21,CV-3. 0-ring: CV-21, CV-3. Manaka wooden hammer and needle: Step One Treatment: CV-21 (lung), 20 seconds, 126 beats per minute frequency. CV-3 (bladder), 20 seconds, 112 beats per minute. This child clearly showed a lung-bladder channel pair pattern of reactions (CV-21, CV-3). Rather than moxa the points, which might have upset the child, the wooden hammer and needle were used with a metronome. This tactic worked well, reducing the abdominal reactions and improving the nasal congestion. Patient 6, K.H.: Main Complaint: Abdominal Reactions: Confirming Tests:
Case Studies for Steps One and Two
283
CASE STUDY FOR MOXA WITH STRETCHING
Patient 1, Y.Y.:
Female, age 30. Pain and stiffness of the left shoulder; pain of the right knee. Abdominal Reactions: CV-21, CV-3. 0-ring: CV-21, CV-3. Confirming Tests: Step One treatment: Ion pumping: Bilaterally, yin qiao-ren mai. Step Two treatment: Kyotoshin moxa: BL-23, BL-18. Moxa with stretching: 3 times to SI-10, with stretching of the small intestine channel; 1 time to right ST-34 with foot extended downward; 1 time to right SP-10 with foot extended downward and lateral. Following the step two kyutoshin treatment, motion palpation of the left shoulder revealed a reaction at SI-10. Moxa with stretching immediately improved the range of motion to almost normal and the pain subsided. Examination of the painful right knee revealed strong pressure pain at ST-34 and SP-10. Moxa applied to these points greatly reduced the discomfort. Main Complaint:
CHAPTER FOURTEEN
INTEGRATING A TOTAL TREATMENT ILLUSTRATIVE CASE STUDIES The following selection of case studiesl are illustrative of the overall flow of treatment, step-by-step and visit-by-visit. Readers will note that most of the principles and techniques outlined in the text are used routinely. It is worth noting as well that the same treatment usually is not used time and time again. Reassessment is made at each visit, adaptations are made as pattern changes are observed. Generally, a patient's condition progresses in a positive direction. Some cases were chosen to show the normal ups and downs in a course of treatment, occurring in the context of steady improvement. One strength of this treatment approach is its flexible methodology which allows for such steady progress. CASE ONE
Patient:
Female, S.A., age 37
FIRST TREATMENT DATE: Main Complaint:
11/8/88 +++++++++++++++++++++++++++++++ Reactive asthma, more than two years duration. Allergies, many years duration; patient is taking Optimine. Stiff shoulders, occasionally stiff neck. Occasional migraines; catches cold easily; occasional bouts of vaginitis.
History:
Asthma worse with wind, draft, cold, dust, smoke. If patient catches cold or exercises, it precipitates an attack. Patient has one child, works a stressful computer-related job.· Patient has been using Albuterol.
Pulse: Abdominal Reactions:
Step One Treatment:
Lung and spleen weak. Overall soft and weak tonus. Tight and sore ren mai above and below the navel. Reactive on bilateral Kl-16, LU-1; both ASIS; right ST-26, ST-27. Ion pumping: bilateral LU-7 black(-), KI-6 red(+).
Step Two Treatment:
Bilateral needling: BL-13, BL-17, BL-23.
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Step Three Treatment:
Intradermals in both ears at allergy points, both asthma shu points (one cun lateral and slightly superior to BL-17).
SECOND TREATMENT DATE: 11/18/88 ++++++++++++++++++++++++++++++ Report:
The patient caught cold the day after treatment, but felt she had not experienced as much accompanying asthma as usual.
Pulse:
Kidney, lung, liver weak.
Abdominal Reactions:
Bilateral KI-16, LU-1.
Step One Treatment:
Ion pumping: bilateral LU-7 black(-), KI-6 red(+).
Step Two Treatment:
Bilateral needling: BL-13, BL-23.
Step Three Treatment:
Direct moxa: uranaitei, asthma shu points.
Step Four Treatment:
Bilateral intradermals: ding quan (lateral to GV-14); shen men & lung points in left ear.
THIRD TREATMENT DATE:
11/22/88 +++++++++++++++++++++++++++++++
Report:
Shoulders looser, a little more congestion; she reports that she has not yet begun exercising as she had been encouraged to do.
Pulse:
Lung, kidney, liver weak.
Abdominal Reactions:
Bilateral LU-1, right KI-16, subcostal, and ST-26.
Step One Treatment:
Ion pumping: bilateral KI-6 red(+), [open point]; LU-7black (-).
Step Two Treatment:
Supplement right KI-7, LU-5.
Step Three Treatment:
Direct moxa: uranaitei, asthma shu points.
Step Four Treatment:
Intradermals: bilateral at ding quan, right BL-13, left BL-23.
FOURTH TREATMENT DATE: 12/2/88 ++++++++++++++++++++++++++++++++ Report:
No colds, no major breathing difficulties, breathing good; there is a knot at her left scapula, no exercise as yet.
Pulse:
Lung, kidney weak.
Abdominal Reactions:
Left LU-1, weak below navel.
Step One Treatment:
Ion pumping: bilateral KI-6 red(+) [open point]; LU-7black (-).
Step Two Treatment:
Bilateral needling: BL-13, BL-23.
Step Three Treatment:
Direct moxa: bilateral uranaitei, asthma shu points.
Step Four Treatment:
Intradermals: bilateral ding quan, left BL-13, right BL-23.
FIFTH TREATMENT DATE:
12/6/88 ++++++++++++++++++++++++++++++++
Report:
Shoulders and upper back much looser, breathing good, now able to do limited exercise without asthma attack following.
Pulse:
Lung, kidney weak
Integrating a Total Treatment
Abdominal Reactions: Step One Treatment: Step Two Treatment: Step Three Treatment: Step Four Treatment: SIXTH TREATMENT DATE:
Report:
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Bilateral KI-16, LU-1; ren mai above navel. Ion pumping: bilateral Kl-6 red(+), LU-7 black(-). Bilateral needling: BL-13, BL-23. Direct moxa: uranaitei, asthma shu points. Intradermals: bilateral ding quan, right BL-13, left BL-23. +++++++++++++++++++++++++++++++ She has been doing well, breathing much better, but her chest has been a little tight for the last two days. A vaginitis flare up is in progress, and has disturbed her sleep for the previous two days. She reports being very happy with progress so far. 12119/88
Pulse: Abdominal Reactions: Step One Treatment:
Lung, kidney weak. Bilateral Kl-16; left LU-1. Ion pumping: bilateral Kl-6 black(-), LU-7 red(+).
Step Two Treatment:
Bilateral needling followed by bilateral moxa at LR-5 for the vaginitis. Bilateral needling: BL-13, BL-23, BL-31.
Step Three Treatment: Step Four Treatment: Step Five Treatment:
Bilateral direct moxa: uranaitei, asthma shu points. Bilateral intradermals: ding quan, left LR-5, GV-3. +++++++++++++++++++++++++++++++ Antibiotics' now have the vaginitis under control. She reports her breathing has been good, but her neck is a little stiff. Lung, kidney weak. Generally soft tonus; bilateral LU-1. Ion pumping: bilateral KI-6 red(+), LU-7black (-). Bilateral needling: BL-13, BL-23. Bilateral direct moxa: uranaitei, asthma shu points, GV-14. Intradermals: bilateral ding quan, right BL-13, left BL-23 left auricle- neck point.
SEVENTH TREATMENT DATE:12/27/88
Report:
Pulse: Abdominal Reactions: Step One Treatment: Step Two Treatment: Step Three Treatment: Step Four Treatment: Step Five Treatment:
Indirect moxa: GV-3. +++++++++++++++++++++++++++++++++ Her lungs have been clear, she can perform a little exercise without an asthmatic reaction; there is a mild nasal and eye allergic irritation. Lung weak, kidney weak (but improved). Generally soft tonus; bilateral LU-1. Ion pumping: bilateral LU-7 black(-), KI-6 red(+). Needle GV-12, BL-13 (bilateral), BL-23. Bilateral direct moxa: uranaitei, asthma shu points, left BL-20.
EIGHTH TREATMENT DATE: 1/2/89
Report:
Pulse: Abdominal Reactions: Step One Treatment: Step Two Treatment: Step Three Treatment:
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Step Four Treatment:
Intradermals: bilateral ding quan, right BL-13, left BL-23.
Indirect moxa: GV-3. Step Five Treatment: This case exemplifies a gradual but steady improvement through the course of treatment. Her main problem was weakness of the lower abdomen with symptoms in the lungs; typically, this takes time to resolve. Thus, treatment was much the same on each occasion because the signs and tests were consistent. With the exception of treatment six, ion pumping [LU-7 black(-), KI-6 red(+)] was used as the first step. The black clips were placed at LU-7 because of the predominance of lung symptoms. On the sixth treatment when the vaginitis had flared up, the black clips were instead placed at Kl-6 in response to the acute lower burner problem. Moxa on the handle of the needle would have been more desirable than just needling the back shu points. However, with the patient's reactions to smoke and other airborne particles in mind, the use of needles and intradermals at the lung and kidney back shu points, BL-13, BL-23, was chosen instead. The point uranaitei was used because it is indicated for asthma and allergic problems. On the eighth treatment, moxa at left BL-20 was added for the allergies. The indirect moxa at GV-3 that was administered during the seventh and eighth treatments was for the weak lower burner. This patient was able to stop using the asthma medication, significantly cut down on the use of the allergy medication, and return to normal levels of activity.
Patient:
Female, L.A., age 41
FIRST TREATMENT DATE:
10/21/86 +++++++++++++++++++++++++++++++ Right shoulder pain often accompanied by right hip and knee pain; the conditions have occurred with greater or lesser intensity for one year.
Main Complaint:
History:
The patient has a long history of tight shoulders and neck, occasional left-sided tightness at mid-back. She had broken her coccyx years before in a fall, and it had been surgically removed.
Pulse:
Kidney weak.
Gastrocnemius Reactions: Right kidney-large intestine. Slight reaction at right gallbladder-heart. Abdominal Reactions:
Overall soft. Bilateral ASIS, KI-16, ST-27 (left KI-16 and ST-27 worse), CV-12. Positive 0-ring tests at left KI-16 and ST-27.
Step One Treatment:
Electrostatic adsorber: (-)to left Kl-1, (+)to left KI-7, (-)to left LI-2, (+)to left LI-11.
Step Two Treatment:
Direct moxa: left kidney-large intestine; right gallbladder-heart reflex points on the gastrocnemii. Sotai: leg extension procedure.
Step Three Treatment: Step Four Treatment:
Wooden hammer and metronome: sequential tapping at the following points and rhythms: BL-20 (132), BL-57 (112), TB-15 (152), GV-14 (112, 120, 132), GB-21 (120), left GB-20 (120).
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SECOND TREATMENT DATE: 10/28/86 +++++++++++++++++++++++++++++++ Report: No further knee pain since the first treatment, but some residual stiffness. Her whole body feels looser but she injured her left shoulder lifting during the week. Pulse: Gallbladder, liver, large intestine, kidney weak. Gastrocnemius Reactions: Right gallbladder-heart. Left kidney-large intestine. Abdominal Reactions:
CV-6, bilateral ST-26, ST-27, GB-24. Positive 0-ring at left GB-24.
Step One Treatment:
Electrostatic adsorbers: (+)to left GB-43, (-)to left GB-38; (+)to left HT-9, (-)to left ill-7.
Step Two Treatment:
Sotai: leg extension procedure. Direct moxa: left kidney-large intestine and right gallbladder-heart reflex points on the gastrocnemii; and bilateral BL-15, BL-19. Wooden hammer and metronome: tapping on TB-2 (the open point) at rate of 120, 152.
Step Three Treatment:
Step Four Treatment: THIRD TREATMENT DATE: Report:
11/4/86 ++++++++++++++++++++++++++++++++ Patient reports knee much better; left shoulder only residually stiff, mild rash on thighs (stomach and gallbladder channels).
Pulse:
Kidney, large intestine, and gallbladder weak.
Gastrocnemius Reactions: Right gallbladder-heart. Abdominal Reactions: Left ASIS; right KI-16, CV-17; bilateral KI-23, ST-27. Positive 0-ring right GB-24, CV-17. Step One Treatment:
Ion pumping: left: GB-43, red(+), GB-38 black(-); left HT-9 red(+), HT-7 black(-).
Step Two Treatment:
Kyutoshin moxa bilaterally to BL-19, BL-25, and right gastrocnemius gallbladder-heart. Sotai: leg extension procedure with heat to right BL-19. Wooden hammer and metronome: left TB-15 (152).
Step Three Treatment: Step Four Treatment:
FOURTH TREATMENT DATE: 11/18/86 +++++++++++++++++++++++++++++++ Pain and stiffness of shoulder and knee much Report: better; rashes of right upper thigh and left shin better. Patient thinks rashes may be seasonally related. Pulse: Kidney weak. Abdominal Reactions: Bilateral KI-23, ST-11, ST-26, SI-9, sides of cervical vertebrae; left Kl-16, ASIS, PSIS, LU-1. Confirming Tests:
Left SI-3, BL-62 with electrostatic adsorbers.
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Step One Treatment:
Ion pumping: bilaterally, SI-3 red(+) and BL-62 black(-).
Moxa on handle of needle: bilaterally to BL-19, BL-27. Sotai: leg extension procedure. Step Three Treatment: Wooden hammer and metronome: sequentially Step Four Treatment: tapped at the following points and rhythms: KI-6 [open point] (120, 132), LR-3 (108), ST-36, ST-32 (132). Following the fourth treatment, the patient reported cessation of pain and musculoskeletal problems, and disappearance of the rashes on the legs. Subsequently, the patient returned for nine more treatments to address various acute musculoskeletal problems with various onsets due to overlifting, long periods of sitting, etc. The dates of these incidents were: 12/30/86, 1/13/87, 2/13/87, 9/4/87, 1/8/88, 1/15/88, 8/26/88, 9/23/88, 12/9/88. On all but one occasion, a single treatment eliminated the problem. Treatments on these occasions were usually to the yang wei mai-dai mai with ion pumping, or to the yin qiao mai-ren mai with ion pumping, followed by kyutoshin moxa on appropriate points, sotai, a few applications of direct moxa and a few uses of intradermals. In this patient, problems of the gallbladder channel frequently appeared symptomatically, while she showed weakness of the lower burner (kidney vacuity) as her underlying imbalance. We speculate that the kidney vacuity was in large part the result of two childbirths and the coccyngeal trauma. Simple treatments, usually with very small doses of stimulation, were sufficient to eliminate this patient's complaints and return her to normal levels of activity. She is on a maintenance program, returning only when acute problems arise. Step Two Treatment:
CASE THREE
Patient:
Male, R. R., age 36
FIRST TREATMENT DATE:
9/5/86 ++++++++++++++++++++++++++++++++
Main Complaint:
Reiter's syndrome- arthritis of spine and hips. Severe pain and stiffness of back; when lying down, the back goes into severe spasm, causing difficulty sleeping. Impaired normal activities, previously was very active; now cannot exercise, cannot sit for extended periods. The problem had begun five years earlier in the left hip. It was treated with Indocin and aspirin; three and a half years later, arthritis appeared in the spine. Over the last few weeks it had appeared in the right hip. The condition had been treated with 600 mg Clinoril daily for the last 18 months. Physical therapy and chiropractic helped only for the duration of the treatment itself. The patient was well muscled, full chested. The back muscles were tight and swollen; noticeable pigmentation was visible in the upper back. Lung weak, bladder slightly weak.
History:
Pulse:
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Gastrocnemius Reactions: Right lung-bladder. Abdominal Reactions: Right subcostal tension; left lower quadrant tension; left LU-1, KI-11. Positive 0-ring test at left LU-1, KI-11. Step One Treatment: Electrostatic adsorbers, then ion-pumping: (-)to left LU-5; (+)to left LU-9; (-)to left BL-65, (+)to left BL-67. Step Two Treatment: Moxa on handle of needles: BL-18, BL-28. Step Three Treatment: Sotai: leg extension procedure. Step Four Treatment: Intradermals: placed on on the posterior surfaces of both auricles for the back. Step Five Treatment: Wooden hammer and metronome: sequential tapping at the following points and rhythms: GB-20 (120), GV-14 (112, 120), TB-15 (152). Comments: After step one, the patient reported an immediate and dramatic reduction of back tension, pain, and stiffness, and was able to lie on the treatment table without discomfort. By the end of treatment, the patient showed a dramatically increased range of motion and flexibility in the spine. SECOND TREATMENT DATE: 9/12/86 +++++++++++++++++++++++++++++++ Report: The patient enthusiastically reports a very good week. His back was less tense and painful, much more mobile. He was able to sleep on his back. His shoulders were looser, but his hips still hurt, especially the right hip. Pulse: Lung and liver weak. Gastrocnemius Reactions: Right liver-small intestine; left lung-bladder. Abdominal Reactions: Right subcostal tightness; left ASIS tight; left KI-16, LU-1; bilateral tightness at ST-25, ST-27. Step One Treatment: Ion pumping: right: PC-6 black(-), SP-4 red(+), left: TB-5 black(-), GB-41 red(+). Step Two Treatment: Sotai: knee to chest procedure and leg extension procedure, with heat applied to BL-18. Step Three Treatment: Kyutoshin moxa: bilaterally, BL-18, BL-21. Step Four Treatment: Intradermals: bilateral auricle placementhip, low back, for a total of six needles. THIRD TREATMENT DATE: 9/19/86 +++++++++++++++++++++++++++++++ Report: Right hip is much better, back little tighter, but still good. The previous night was the first night the patient had felt any discomfort at all. Pulse: Liver weak. Gastrocnemius Reactions: Right liver-small intestine. Abdominal Reactions: Bilateral LR-13, ST-26; CV-14; slight right
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subcostal tension. Positive 0-ring at right ST-26, LR-13, CV-14. Step One Treatment:
Ion pumping: right SI-3 red(+), right SI-8 black(-); left LR-2 black(-), left LR-8 red(+).
Step Two Treatment:
Sotai: knee to chest procedure; leg extension procedure with heat applied to BL-18, GV-8. Kyotoshin moxa: BL-18, BL-22.
Step Three Treatment: Step Four Treatment:
Intradermals: placement at the low back points on the anterior and posterior surfaces of both auricles (total of four needles).
FOURTH TREATMENT DATE: 9/26/86 +++++++++++++++++++++++++++++++ Back and hips both very good. Report: Liver weak. Pulse: Gastrocnemius Reactions: Left liver-small intestine. Abdominal Reactions:
Right LR-13; left ST-26, ASIS; mild right subcostal tension; CV-10,(and above) sore and with positive 0-ring test.
Step One Treatment:
Ion pumping: right PC-6 black(-), SP-4 red(+), left TB-5 black (-), GB-41 red (+).
Step Two Treatment:
Electrostatic adsorbers: (-) to left BL-62, (+) to left SI-3.
Step Three Treatment: Step Four Treatment: Step Five Treatment:
Sotai: leg extension with heat applied to BL-18. Kyutoshin moxa: BL-18, BL-21. Intradermals: bilaterally to hip points and to low back points on anterior and posterior surfaces of auricles (total6 needles). 10/3/86 ++++++++++++++++++++++++++++++ Back and hips are very good. Liver weak. Right subcostal tension; bilateral KI-16, ST-26, ST-27 are a little sore; left ASIS is a little tense. Positive 0-ring at left ST-26, ST-27, right LR-13, left ASIS. Right LI-4 (open point)- all responses improved. Needle to right LI-4. Ion pumping: right: PC-6 black(-), SP-4 red(+), left: TB-5 black(-), GB-41 red(+). Kyutoshin moxa: BL-20, BL-22. Intradermals: low back and hip points in each auricle, total of 6 needles. Because the patient was doing so well, the
FIFTH TREATMENT DATE: Report: Pulse: Abdominal Reactions:
Confirming Tests: Step One Treatment: Step Two Treatment:
Step Three Treatment: Step Four Treatment: Comments:
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possibility of gradually cutting back on the Clinoril with the intention of halting its use was discussed with the patient. SIXTH TREATMENT DATE: Report:
Pulse:
10/10/86 ++++++++++++++++++++++++++++++
The patient stopped the Clinoril abruptly after the last treatment. This led to a flare up of the back symptoms within 24 hours. However, the hips were still without problems. Liver and kidney weak.
Abdominal Reactions:
Both subcostal regions slightly tense and sore; left ASIS quite sore, left KI-16 sore. Positive 0-ring test at left KI-16, right LR-14, left ASIS.
Step One Treatment:
Ion pumping: right: PC-6 black(-), SP-4 red(+), left: TB-5 [open point] black(-), GB-41 red(+).
Step Two Treatment:
Sotai: leg extension procedure with heat to BL-18, GV-8.
Kyutoshin moxa: BL-18, BL-22. Massage, upper back area. Step Four Treatment: Intradermals: bilaterally to anterior and posterior Step Five Treatment: auricular points for the low back and hip, total6 needles. Since the patient had suddenly stopped the Comments: medication, rather than withdraw gradually (as was proposed), we agreed that he should return to the use of Clinoril at the previous dose and then reduce the dose slowly over the course of treatment. SEVENTH TREATMENT DATE: 10/17/86 ++++++++++++++++++++++++++++++ Report: Back is good again, left hip a little active. Pulse: Kidney and large intestine weak. Gastrocnemius Reactions: Mild reaction at right kidney-large intestine. Abdominal Reactions: Bilateral Kl-16, ST-27, ASIS; mild right subcostal tension. Step One Treatment: ion pumping: left: Kl-1 black(-), KI-7 red(+), left LI-2 black(-), Ll-11 red(+). Step Two Treatment: Direct moxa: ST-27. Step Three Treatment: Sotai: leg extension procedure. Step Four Treatment: Kyutoshin moxa: BL-21, BL-23, BL-25. Step Five Treatment: lntradermals: bilaterally at BL-18, and hip and low back points of both auricles. EIGHTH TREATMENT DATE: 10/24/86 ++++++++++++++++++++++++++++++ Report: The patient reported feeling so well that he had played basketball. He had hurt his back, but not Step Three Treatment:
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Pulse:
too badly, and his dose of Clinoril was down to 400 mg per day. Kidney and liver weak.
Abdominal Reactions:
Bilateral ASIS tight and sore, ST-25, ST-26.
Step One Treatment:
Ion pumping: bilateral TB-5 black(-), GB-41 red(+); bilateral SI-3 red(+), BL-62 black(-).
Sotai: leg extension procedure with heat to GV-8. Step Three Treatment: Kyutoshin moxa: BL-21, BL-23. Step Four Treatment: Intradermals: bilateral auricle points for low back, shoulders. Comments: The patient was counselled on the importance of taking less dramatic advantage of his new-found well being, and proceeding cautiously before launching into strenuous physical activity. NINTH TREATMENT DATE: 11/14/86 ++++++++++++++++++++++++++++++ Report: The patient has reduced the Clinoril to 200 mg. daily and feels very good. Pulse: Kidney, liver and large intestine weak. Gastrocnemius Reactions: Both kidney-large intestine. Abdominal Reactions: Right subcostal; left ASIS, CV-12, left KI-16; bilateral ST-27; CV-12. Confirming Tests: Left TB-5, GB-41; no change. Step One Treatment: Ion pumping: left: KI-1 black(-), KI-7 red(+), right: Ll-2 black (-), LI-11 red (+). Step Two Treatment: Sotai: leg extension procedure. Step Three Treatment: Kyutoshin moxa: BL-18, BL-23. TENTH TREATMENT DATE: 12/4/86 +++++++++++++++++++++++++++++++ Report: The patient stopped the Clinoril entirely following the previous treatment. His back has been a little tight, but otherwise he has no complaint. Pulse: Large intestine and kidney weak. Gastrocnemius Reactions: Right kidney-large intestine. Abdominal Reactions: Subcostal tension, left KI-16, ST-27, mild left ASIS. Step One Treatment: Ion pumping: left: KI-1 black(-), KI-7 red(+); left: LI-2 black(-), LI-11 red(+). Step Two Treatment: Sotai: leg extension procedure with moxa to BL-18, GV-8. Step Three Treatment: Kyutoshin moxa: BL-23, BL-25. Step Four Treatment: Wooden hammer and metronome: tapping at the following points and rhythms: BL-18 (108), GV-14 (108, 112, 120, 132, 152, 104), GB-21 (120, 152). Step Two Treatment:
Integrating a Total Treatment
Comments:
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The patient was operating on a limited budget, thus intradermal needles were not left in place, so as to see how he would do without them. Further treatment was reserved for any acute circumstance.
ELEVENTH TREATMENT DATE:l/16/87 +++++++++++++++++++++++++++++++ The patient had not done as well as expected and wanted to see if there were some way of extending the effects of treatment. The back pain and tightness had come and gone throughout the last six weeks and he was now using 400 mg. per day of Clinoril. Pulse: Kidney weak. Gastrocnemius Reactions: Left kidney-large intestine. Abdominal Reactions: Left KI-16, right ST-27, subcostal tension. Positive 0-ring tests at left KI-16, right ST-27. Step One Treatment: Ion pumping: right: KI-1black (-), KI-7 red(+); right: LI-2 black(-), LI-11 red(+). Step Two Treatment: Kyutoshin moxa: BL-18, BL-47. Step Three Treatment: Intradermals: josen, low back point in both auricles, both BL-38. After this treatment the patient fared very well. Again he was able to stop the Clinoril entirely. Over the next few months he was able to slowly increase his levels of activity. However, at a certain level of activity he irritated his back again. He used Clinoril at 200 mg per day, but this was not enough, so he returned for treatment twelve times between May and October of 1987. Through the course of these treatments the patient was able to return to a condition of no discomfort or minimal symptoms, stop using Clinoril, and return to regular activities, including some sports. Treatments during this period were similar to those preceding. Treatment focus alternated between the liver-small intestine pair, the yin wei mai-chong mai, or the kidneys through the yin qiao mai-ren mai pair. More symptomatic treatment focused on the yang qiao mai-du mai pair. Several treatments combined the yin qiao mai and yang qiao mai pairs with ion pumping. Kyutoshin moxa was applied to relevant back shu points and to pressure-sensitive points on the hips. Intradermals were left in the lower back, auricles, and occasionally the hands. Following this series of treatments the patient was able to maintain normal activity, including basketball, volleyball, jogging, and other fairly strenuous exercise. On occasion when some tightness has reappeared, he has come for treatment. On each of these occasions, treatment has been simple and rapidly effective. Eight treatments administered between March and September of 1988 were much the same as above. He has been completely off the Clinoril since the treatment series in 1987. Reiter's syndrome is seen as an inherited disorder, and is not often amenable to traditional Western therapy. In his case, the liver and kidney seem to be the source of the problem, with the bladder and secondarily the gallbladder channels becoming symptomatic. It is unclear whether he has been "cured" of the condition, meaning that there will be no recurrences. However, the condition is now easily managed, and the patient is able to sustain levels of activity sufficient to maintain his sense of well being. Report:
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CASE FOUR
Patient: FIRST TREATMENT DATE:
Female, B.S., age 72.
6/12/87 +++++++++++++++++++++++++++++++ Main Complaint: Six months earlier this patient had been struck by a bus. She had suffered a badly broken right foot and right arm; both were fractured in multiple locations. These had been surgically repaired with metal plate implantations. She had also suffered several broken ribs and collapsed lungs. Extensive physical therapy and some acupuncture had been administered. She was now mobile, but suffered from occasional breathing difficulties. She was unable to abduct her right arm beyond shoulder height. She felt as though she had a clamp on her right foot. Occasionally she would experience pain in the neck and side of the head with headaches. When bending over, she had pain in the right arm, shoulder, and neck. The patient appeared somewhat frail, but considering the multiple traumas, looked rather well. The surgical scars on the right arm cut across the small intestine and large intestine channels. Pulse: Kidney, liver, and small intestine weak. Gastrocnemius Reactions: Right liver-small intestine. Abdominal Reactions: Right subcostal tightness and soreness; Right LR-14; left Kl-16, ST-26. Positive 0-ring tests at right LR-14 and left ST-26. Considerable tenderness on arm and foot scars. Step One Treatment: Ion pumping: Left: LR-2 black(-), LR-8 red(+), Right: SI-3 red(+), SI-8 black(-). Step Two Treatment: Needling: right SP-6. Step Three Treatment: Intradermals: right SP-6, right Sl-9, on the scar on the arm around LI-14 and LI-13 (total of 4 needles). Comments: Following treatment, abduction was somewhat improved, with generally less discomfort overall. Treatment was kept simple because of the patient's age and concern not to overstimulate. SECOND TREATMENT DATE: 6/19/87 +++++++++++++++++++++++++++++++ Report: Most improvements shown at the time of the initial treatment had been retained, though today her arm felt stiff. She reported that she had only one remaining physical therapy session. Pulse: Liver weak. Gastrocnemius Reactions: Right liver-small intestine. Abdominal Reactions: Right subcostal, ASIS; left ST-26; CV-12 area tight and sore.
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Step One Treatment:
Ion pumping: Left: LR-2 black(-), LR-8 red(+); Right: SI-3 red(+), SI-8 black(-).
Step Two Treatment:
Needling: SP-6 bilaterally.
Step Three Treatment:
Intradermals: right KI-7, right SI-10, and along the scar on the arm in three places.
Step Four Treatment:
Needling: bilaterally to BL-14, BL-18, GB-21, then right SI-11.
THIRD TREATMENT DATE:
6/26/87 +++++++++++++++++++++++++++++++ The patient reported increased range of motion for the arm, a more natural feeling in the arm, and improved ability to walk. She has now finished physical therapy.
Report:
Pulse:
Large intestine, liver, spleen, and pericardium weak.
Gastrocnemius Reactions: Right liver-small intestine. Abdominal Reactions:
Right subcostal tension and soreness; bilateral KI-16; left ST-27. Scar tenderness is greatest on the large intestine channel.
Step One Treatment:
Ion pumping: Right: LI-2 black(-}, LI-11 red(+); Left: LR-2 black(-), LR-8 red(+).
Step Two Treatment:
Intradermals: right SP-6, ST-34, LI-11, SI-10, with two sore points on the scar, and at the right auricle points for ankle and shoulder (total of 8 needles).
Step Three Treatment:
Needling of pressure pain points on the right upper back.
FOURTH TREATMENT DATE:
7/3/87 ++++++++++++++++++++++++++++++++ The arm is the same as last week; the patient reports sleeping better.
Report:
Liver weak. Pulse: Gastrocnemius Reactions: Right liver-small intestine. Abdominal Reactions:
Right subcostal region; left ST-26.
Step One Treatment:
Ion pumping: right: SI-3 red(+), SI-8 black(-), left: LR-2 black(-), LR-8 red(+).
Step Two Treatment: Step Three Treatment:
Needling: ST-36. Intradermals: right LI-11, SI-9, SP-6, ST-36, and two on sore points on the scar on the arm.
FIFTH TREATMENT DATE:
7/11/87 +++++++++++++++++++++++++++++++ The patient is maintaining the improvement. Liver, spleen, and small intestine weak.
Report: Pulse:
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Gastrocnemius Reactions: Left liver-small intestine. Abdominal Reactions: Right subcostal region; right LR-14, ST-26. Step One Treatment:
Ion pumping: Right: SI-3 red(+), SI-8 black(-), Left: LR-2 black(-), LR-8 red(+).
Step Two Treatment:
Needling: left SP-6. Intradermals: right SP-8, ST-36, LI-11, two on sore points on the scar.
Step Three Treatment:
SIXTH TREATMENT DATE: Report:
Pulse: Abdominal Reactions:
7/18/87 +++++++++++++++++++++++++++++++ The patient's condition is about the same. She expressed concern about continuing treatment because of time and cost. Liver, spleen, and small intestine weak. Right LR-14, subcostal region, ST-26.
Step One Treatment:
Ion pumping: Right: SI-3 red(+), SI-8 black(-), Right: LR-2 black(-), LR-8 red(+).
Step Two Treatment:
Needling: right LI-10, the most reactive point on the scar, and several sore points in the right upper back.
Comment:
No intradermals were placed, to see if the patient would maintain her progress nevertheless.
SEVENTH TREATMENT DATE: 7/25/87 +++++++++++++++++++++++++++++++ Report: The patient had been more active this week and had maintained her gains even without the intradermals. Pulse:
Liver, spleen, and small intestine weak.
Abdominal Reactions:
Right subcostal region, ST-26.
Step One Treatment:
Ion pumping: Right: SI-3 red(+), SI-8 black(-), Right: LR-2 black(-), LR-8 red(+).
Step Two Treatment:
Needling: right LI-4, right LI-10, right GB-34, on the scar, and several sore points on the right upper back.
This patient clearly showed a problem of the liver-small intestine channel pair. The small intestine channel was severely traumatized, the liver may have been problematic before the accident, but following the accident and all the contusions, breakage, etc., the liver was now definitely weak. Treatment along this axis seemed to be notably helpful. It is not clear how much more ground might have been gained if treatments had continued. By the end of this course of treatment, the patient had greater usage of the right arm and was able to walk better. It is also probable that secondary problems resulting from all the blood stasis may have been lessened or averted.
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Patient FIRST TREATMENT DATE: Main Complaint:
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Female, M.T., age 75
2/2/88 ++++++++++++++++++++++++++++++++ The patient had suffered a lower left humeral fracture one year before. She still had pain in arm, elbow, forearm, wrist and into the fingers. There was restricted motion of the wrist, poor grip, poor abduction, right-sided sciatica that became worse with sitting, and obesity. History: Following the broken humerus the patient underwent extensive physical therapy, but with the resulting inactivity, the patient became depressed and obese. This irritated an old right lower back problem causing sciatic pain that radiated down the back of the leg. The patient had a long history of migraines, but now suffered only occasional headaches, and was otherwise healthy. The patient was obese, but considering her age, was in good condition. The left arm was swollen along the triple burner channel between the elbow and wrist. Pulse: Spleen, triple burner, and liver weak. Gastrocnemius Reactions: Left spleen-triple burner. Abdominal Reactions: Right subcostal tension, ST-25, GB-26. Step One Treatment: Ion pumping: Right: SP-2 red(+), SP-5 black(-), Right: TB-3 red(+), TB-10 black(-). Step Two Treatment: Needling: left Tae Woo Yoo arm point. Step Three Treatment: Intradermals: left LI-14, upper and lower arm points on left hand, ankle and sciatic points on right auricle. Step Four Treatment: Needling: right GB-39, GB-41. Comments: Treatment was kept siinple. Each additional step added produced an increased motion and decreased pain. After steps one and two, the arm was less painful and abduction improved. After steps three and four, the sciatic pain was greatly reduced. SECOND TREATMENT DATE: 2/9/88 ++++++++++++++++++++++++++++++++ Report: The patient maintained the gains of the last treatment. The arm was still improved, there was no sciatic pain. The patient complained of only an achy sensation in the right buttock and a little ankle pain. Pulse: Kidney, liver, and large intestine weak. Gastrocnemius Reactions: Left kidney-large intestine.
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Abdominal Reactions:
Right subcostal tension, KI-16. Bilateral 5T-27.
Step One Treatment:
Ion pumping: Right: KI-1 black(-), KI-7 red(+), Right: LI-2 black(-), Ll-11 red(+).
Step Two Treatment:
Intradermals: hip point of right auricle; left LI-13, left LI-10; left hand points for the right hip, left arm (total of 6 needles).
Step Three Treatment:
Needling: right GB-38, GB-43.
THIRD TREATMENT DATE: Report:
2/16/88 +++++++++++++++++++++++++++++++ Ankle pain now gone, right buttock less achy, left arm still improved, achiness now more on the triple burner and small intestine channels. The patient expressed concern over her obesity.
Pulse:
Kidney and bladder weak.
Gastrocnemius Reactions: Right liver-small intestine. Mild right subcostal tension. Abdominal Reactions: Left 5T-26. Mild bilateral A5I5. Step One Treatment:
Ion pumping: Bilateral BL-62 [open point] black(-), 5I-3 red(+).
Step Two Treatment:
Intradermals: left LI-14, stomach point of left auricle, low back point of right auricle, low back points of both hands (totalS needles).
FOURTH TREATMENT DATE: 2/23/88 +++++++++++++++++++++++++++++++ Report: The abduction is almost normal now, but there is still a sensation of tightness in the arm and a little discomfort in the right low back region. Overall, the condition is greatly improved and the patient reports experiencing less hunger. Pulse: Bladder and liver weak. Abdominal Reactions:
Mild right subcostal; bilateral A5I5 tension; left 5T-26.
Step One Treatment:
Ion pumping: bilateral BL-62 black(-), 5I-3 red(+).
Step Two Treatment:
Intradermals: left BL-42, distal to the left olecranon process, low back points of both hands. Moxa 5I-8 while stretching the small intestine channel. Needling: right GB-39, right GB-41.
Step Three Treatment: Step Four Treatment: FIFrH TREATMENT DATE: Report: Pulse:
3/1/88 ++++++++++++++++++++++++++++++++ Overall, little change from last treatment, no weight loss as yet. Liver weak.
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Abdominal Reactions:
Bilateral tension at ST-25, ST-26, ST-27; right subcostal region.
Step One Treatment:
Ion pumping: bilateral TB-8 black (-), GB-35 red (+).
Step Two Treatment:
Intradermals: right GB-35, left LI-10, left SI-10, sore point on right buttock, stomach point of left auricle.
Comments:
In this treatment, it was decided to try the three yang arm and leg meeting points, since all three arm yang channels seemed involved.
SIXTH TREATMENT DATE:
3/8/88 ++++++++++++++++++++++++++++++++ Further improvements in the right low back and hip; left arm unchanged; lost two pounds. Liver weak. Right subcostal; left lower quadrant.
Report: Pulse: Abdominal Reactions: Step One Treatment:
Step Two Treatment:
Ion pumping: Right: PC-6 black(-), SP-4 red(+), Left: TB-5 black(-), GB-41 red(+). Needling: stomach point of left auricle.
Step Three Treatment:
Intradermals: left LI-10, sore point on right side of sacrum, stomach point of left auricle.
SEVENTH TREATMENT DATE: Report: Pulse: Abdominal Reactions:
3/15/88 +++++++++++++++++++++++++++++++ Overall feels again a little better, lost five pounds. Liver and pericardium weak. Right subcostal; left of navel.
Step One Treatment:
Ion pumping: right: PC-6 black(-), SP-4 [open point] red(+), left: TB-5 black(-), GB-41 red(+).
Step Two Treatment:
intradermals: right side sacrum, left Ll-14, left SI-8, stomach point, and shen men point of left auricle.
EIGHTH TREATMENT DATE: 3/22/88 +++++++++++++++++++++++++++++++ Report: The patient reports that her back has been very comfortable, her appetite is still decreased, but that she feels a little tightness on the left arm (small intestine channel). Pulse: Liver, bladder, small intestine, and kidney weak. Abdominal Reactions: Right subcostal, ASIS, ST-26. Step One Treatment: Ion pumping: Right: SI-3 red(+), SI-8 black(-) Left: LR-2 black(-), LR-8 red(+). Step Two Treatment: Needle: stomach point of left auricle. Step Three Treatment: Intradermals: left Ll-14, right side sacrum, stomach and shen men points of right auricle. Step Four Treatment: Needling: bilaterally to ST-45.
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After this, treatment followed the same format. The ion-pumping cords were used for all step one treatments, with intradermals and needling of other points as steps two and three. The step one treatments followed the shifting patterns of tension in the left arm. If the tension was primarily in the small intestine channel, small intestine reflex points showed reaction and the small intestine was treated through either the liver-small intestine pair or the yang qiao mai-du mai. The patient was treated eight more times, from March to June of 1988. The left arm showed slow but continuous improvement. The back remained asymptomatic, and the patient slowly shed more pounds. Because of the patient's age, treatment was always kept simple, with minimal stimulation. Prior to the beginning of treatment, the patient had shown no improvement in her condition since stopping physical therapy some months before. She was virtually housebound and thus depressed much of the time. By the end of treatment, the patient reported very little depression (this was confirmed by her family) and was now able to perform tasks around the house and go walking again.
Patient:
Male, G.R., age 32
6/13/87 +++++++++++++++++++++++++++++++ This young man suffered severe stomach pain, indigestion, and heartburn, complicated by either diarrhea or constipation. He was experiencing considerable stress at work and had a deviated septum with nasal obstruction. History: Three years before, surgery was performed for a stomach tumor with a partial gastrectomy. The current symptoms began in April1987 and were the same as those prior to surgery. The patient was scheduled to see a gastro-intestinal specialist in two weeks time, but was currently being treated as though suffering from an ulcer and not a recurrence of the cancer. The cause of his deviated septum and nasal problems resulted from a mugging he had suffered six months earlier, where his nose had been broken. His job was extremely stressful, which further exacerbated his condition. Strong and bounding, with liver weak. Pulse: Gastrocnemius Reactions: Right liver-small intestine; kidney-large intestine. Abdominal Reactions: Strong subcostal tightness and tenderness on both sides, especially on the left side, which i.s very tender. Both ASIS are tense and sore, particularly the left, which is tight along the ren mai from CV-6 to CV-15. The area around CV-12 is exceptionally sore, left ST-25 very sore, and right ST-25 to ST-27 tight. Step One Treatment: Ion pumping: Bilateral to PC-6 black(-), SP-4 red(+). FIRST TREATMENT DATE:
Main Complaint:
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Step Two Treatment:
Direct moxa: applied to the tender point below T6 (for stress) [after Fukaya].
Step Three Treatment:
Direct moxa: bilaterally to BL-18, left BL-19, left BL-20.
Step Four Treatment:
Intradermals: bilaterally to pi gen; stomach and shen men points of left auricle.
SECOND TREATMENT DATE: 6/16/87++++++++++++++++++++++++++++++ Report:
The patient reported that overall he was better for 24 to 30 hours following the treatment. He felt more relaxed and the nasal congestion was also improved.
Pulse:
Liver and spleen weak.
Gastrocnemius Reactions: Left kidney-large intestine. Abdominal Reactions:
Strong subcostal tightness and soreness, especially on the left; left ASIS sore and jumpy; CV-12; left ST-21, SP-21.
Step One Treatment:
Ion pumping: bilaterally to PC-6 black(-), SP-4 red(+).
Step Two Treatment:
Needling: left ST-21.
Step Three Treatment:
Kyutoshin moxa: bilaterally to BL-18, BL-21. Intradermals: left SP-9, stomach & spleen points of left auricle, shen men point of right auricle.
Step Four Treatment:
THIRD TREATMENT DATE: Report:
Pulse:
6/25/87 +++++++++++++++++++++++++++++++
The condition improved for six days following treatment; however, the stomach pain worsened again. Nasal congestion continued on and off; the upper G.l. examination was completed and the results were to be available soon. Spleen and pericardium weak.
Gastrocnemius Reactions: Left liver-small intestine. Abdominal Reactions: Right subcostal region better; left side is still very tight and sore; left ASIS sore and jumpy; ST-21. Step One Treatment: Step Two Treatment: Step Three Treatment:
Step Four Treatment: Comments:
Ion pumping: left: PC-6 black(-), left SP-4 red(+), left ST-21 black(-), right ST-40 red(+). Kyutoshin moxa: bilaterally to BL-18, BL-21. Intradermals: left BL-22, right SP-8, triple burner point of left auricle, stomach and shen men points of right auricle. Moxa: GV-23. In this treatment, ST-21 and ST-40 were treated with ion-pumping cords to relieve the acute problem of the stomach more directly. Moxa was applied to GV-23 to address the nasal problems.
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FOURTH TREATMENT DATE: 7/1/87 ++++++++++++++++++++++++++++++++ Report: Again, the patient's condition was notably improved for several days following treatment, but then soreness returned. His physician feels that he has a stomach ulcer and has prescribed Tagamet. His work has been very stressful. Pulse:
Liver and spleen weak.
Abdominal Reactions:
Both subcostal regions tight and sore, especially the left. Left ASIS little less jumpy; ST-21; right ST-27.
Step One Treatment:
Ion pumping: Bilaterally to PC-6 black(-), SP-4 red(+).
Step Two Treatment:
Intradermals: left ST-21.
Step Three Treatment: Step Four Treatment:
Kyutoshin moxa: bilaterally to BL-18, BL-21. Intradermals: bilaterally to BL-21, left SP-8, liver & stomach points of left auricle. Direct moxa: GV-22. 7/9/87 ++++++++++++++++++++++++++++++++ Following the last treatment the stomach neither improved nor worsened. However, the nasal congestion is considerably better. Spleen and liver weak. Left subcostal and ASIS regions tight and very sore. Ion pumping: Right TB-5 black(-), left GB-41 red(+), Right SP-4 black(-), left PC-6 red(+). Needling: left ST-21. Intradermals: left SP-8, left ST-18, left BL-21, stomach and shen men points of right auricle. Kyutoshin moxa: bilaterally to BL-18, BL-21. 7/16/87 +++++++++++++++++++++++++++++++ The patient reports that he felt very good all week following the last treatment. The nasal congestion was still improved. His gastroenterologist diagnosed the condition as esophagitis with hiatial hernia and acid reflux. Eight weeks of Tagamet and a tightly restricted diet are the current program. Liver and kidney weak. Both subcostal regions tight and sore, especially the left. There is tension and jumpiness to the left of the navel and at the left ASIS. Ion pumping: Right LI-4 black(-), left ST-41 red(+); Right KI-6 black(-), left LU-7 red(+).
Step Five Treatment: FIFTH TREATMENT DATE: Report:
Pulse: Abdominal Reactions: Step One Treatment:
Step Two Treatment: Step Three Treatment: Step Four Treatment: SIXTH TREATMENT DATE: Report:
Pulse: Abdominal Reactions:
Step One Treatment:
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Step Two Treatment:
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Kyutoshin moxa: CV-12; bilaterally to BL-17,left side BL-19. Step Three Treatment: Needling: right BL-19. Step Four Treatment: Intradermals: left SP-8,left ST-18, right BL-19, stomach and esophagus points of left auricle. Comments: This treatment addressed the symptoms more symptomatically, rather than through the general diagnosis. As we will see, this strategy did not work. It is often better to stay with a treatment that is working. SEVENTH TREATMENT DATE: 7/23/87 +++++++++++++++++++++++++++++++ Report: The patient reported that his stomach was quite active this week: diarrhea, much gas, more pain. Pulse: Spleen and liver weak. Abdominal Reactions: Both subcostal regions tight and sore, left less than before. Left ASIS still reactive. Step One Treatment: Ion pumping: Right PC-6 black(-), right SP-4 red(+). Left foot placed sole down on the magnet heater; needling to left TB-5 [open point]. Step Two Treatment: Kyutoshin moxa: bilaterally to BL-17, BL-21. Step Three Treatment: lntradermals: right BL-22,left BL-27, shen men, liver, stomach, and esophagus points of right auricle. Step one treatment here treats the condition as Comments: cross syndrome. EIGHTH TREATMENT DATE: 7/28/87 +++++++++++++++++++++++++++++++ Report: The patient had a much better week, almost no pain; the effects of treatment were continuous and he was sleeping better. Pulse: Kidney weak. Abdominal Reactions: Tight right subcostal and sore left subcostal; jumpy left ASIS, a little tension at right ASIS. soreness on left ST-25 and ST-26; tightness on CV-12. Step One Treatment: Ion pumping: Right PC-6 black(-), right SP-4 red(+). Left foot placed sole down on magnet heater. Step Two Treatment: Kyutoshin moxa: bilaterally to BL-17, BL-21. Step Three Treatment: Intradermals: right BL-22, shen men, esophagus and stomach points of left auricle. Following these last two treatments, the patient continued to show improvement, with occasional ups and downs. This basic treatment regimen, combining the ion-pumping cords with the magnet heater for step one, was used for most of the following treatments. It was indicative of an accompanying problem of blood stasis, which the magnet heater seemed helpful in resolving. There were two circumstances when the spleen-triple burner pair was used. The other steps in treatment
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followed the same pattern. The patient was seen nine more times, from August through October of 1987. During this time the patient took a ten-day vacation, through which he was completely symptom free. He came to realize that the stressful nature of his job was a major factor in his health problem. Some weeks after this, he changed his work to a less stressful occupation. By the end of treatment, the patient was almost symptom-free, the nasal problem was completely resolved, and his stomach irritation was rare and mild. Of course, it is hard to know how much the Tagamet improved the condition and how much the acupuncture improved the condition, but when improvement is seen immediately following treatment, it is usually a good indication that the acupuncture has been effective.
ILLUSTRATIVE CASE STUDIES OF EXTREME DIFFICULTY In the two cases that follow, the effectiveness of this method of treatment for very difficult conditions is easily seen. In the first case (from Yoshio Manaka's caseload), note the flow of treatment. In the second, note the remarkable effects achievable through this method of treatment. This second case is the rare successful treatment of a child with spina bifida (Kazuko Itaya was the practitioner). While this is a remarkable case, and a difficult problem, it is illustrative of the efficacy of this simple and systematic method of treatment.
M.M., male, age 74 Main Complaint: Severe headache following surgery. History: One year earlier the patient had acute rhinitis that caused otitis media. Antibiotic treatment of the otitis media caused enteritis; medical examination of the colon revealed a cancerous growth that was surgically removed. Following the surgery, the patient suffered bilateral inguinal hernias, lumbago and left-sided sciatic neuralgia. The patient then had surgery for the inguinal hernias. Under the spinal anesthetic, the patient felt some sensation, like a blow, to the left side of his head. Following this surgery and sensation, the patient suffered a continuous severe headache through the whole of his head. This surgery had been administered eight months prior to the first acupuncture visit. The patient appeared well nourished and evidenced no sign of psychological biases. Pulse: Weak liver pulse. Gastrocnemius Reactions: Right side, liver-small intestine. Abdominal Reactions: Right subcostal and lower left quadrant tension and soreness. Positive 0-ring tests at right LR-14, left ST-26, CV-14, CV-2. Assessment: Problem of the liver-small intestine channel pair. Step One Treatment: Ion beam: Patient:
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left LR-8 positive(+), LR-2 negative(-); right SI-3 positive (+), SI-8 negative(-). Sore points on abdomen and gastrocnemius released. Step Two Treatment:
Moxa: CV-14, chanting AAHH; CV-2, chanting MMMM.
Step Three Treatment:
Sotai: leg extension procedure with fazhen (fire needle) to BL-18.
Step Four Treatment:
Moxa with channel stretching to three-arm yang channels.
After these procedures, the patient's abdominal, gastrocnemius and back reactions were released; his shoulders and neck were also more flexible. The patient in this example experienced remarkable relief of his headache after a few symptom control procedures following the root treatment. In this instance, the headache, which had been continuous for eight months, was relieved. With a few more similar treatments, the patient suffered no recurrence of this headache. Comments:
We presented the results of this next case at the 18th Gakkai meeting of the Shinkyu Topology group in Kyoto, July, 1988. We had been treating an infant with early stage spina bifida and were able to report extremely good results at this time. We first saw this infant female at twenty-one months of age. At that time her problems were multiple; she had a history of several surgeries, but was unable to walk. She had dysuria and needed urethral catheterization. She was unable to speak, suffered atopic dermatitis, recurrent fevers, and infectious diseases (such as colds, flu, etc.). Five hours after birth, she had preventative surgery for the spina bifida. One month later, she had a second surgery to insert a shunt to conduct fluids from the right temple region to the abdominal cavity. After this procedure, she developed an infection and fever. She spent three weeks in intensive care, after which time the shunt was removed. Two months later, further surgery was performed. She was discharged one month after that surgery. At age one, she developed urine reflux and again required surgery. Following this surgery, she developed an infection and septicemia; after treatment of two months duration for these complications, she was discharged again. Thereafter, she frequently developed high fevers, and showed white blood cells in the urine. She was treated with antibiotics. She had not been treated specifically for the dysuria, inability to walk, or inability to speak. She could evacuate her bowels by herself. In Japan, treatment of children with acupuncture is a speciality called shonishin, where various instruments and needles are used to scratch, rub, and scrape the skin in lieu of insertion techniques. At first, only these instruments were used until she became comfortable with treatment. Direct moxa was then added to the regimen, as was sotai exercise combined with moxa. To deal with her fevers, ionpumping cords were used, as was micropuncture (bloodletting of the jing points). Auricular acupuncture at the brain point was used for the speech disorder. The mother was given an electric moxa instrument, and therapy was given daily at home. Treatment at the clinic was given two to four times a month.
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After one month of treatment, she was able to walk when we held her hands. After three months, she was able to walk as much as thirty meters on her own. When she reached the age of three, she was able to run back and forth up to twenty five meters at a time; she was also able to jump. At thirty-three months she spontaneously spoke. Although she had needed catheterization five times daily, through the course of treatment the catheterization was cut back and she was able to urinate freely and naturally at this point. The infections stopped altogether, as did the fevers. She stopped catching colds and flus, and antibiotics were no longer necessary. Her mental development appeared normal; her growth seemed slightly slow, but improving. When she first came for therapy, her physician was pessimistic about her condition, and stated that she would probably need crutches all her life. However, following appropriate therapy this was no longer the case. According to our studies of the fundamental effects of acupuncture on the microcirculatory system, we propose that routine treatment of such disorders will become possible in the future.
SUMMARY In the preceding sample cases, you can see that simple application of the treatment formulae we have described can be sufficient to handle a variety of health problems. Problems acute or chronic in nature, of serious or mild intensity, all can be treated successfully. The flexibility afforded by this method of treatment allows the practitioner to follow the patient's condition as it "unwinds." In the traditional literature of China, there are occasional references to meng gen, which is a kind of healing crisis. On a very few occasions, you may see that for a period of roughly 24 hours, a patient's symptoms become temporarily exacerbated, or that new symptoms or very old symptoms occur. This is often meng gen. You should closely monitor the patient's condition, as it is difficult to distinguish such reactions from an iatrogenic condition, due, for example, to overstimulation or wrong treatment. Further, you should always bear in mind that it is not unusual for symptoms to fluctuate, getting better and worse; as long as there is a trend towards fewer symptoms, and as long as lessened abdominal reactions are noted, the treatment will succeed. It is thus not unusual to see step one treatment procedures vary as treatments progress. For example, the first patient described in this chapter was treated with ion pumping to KI-6 and LU-7 on each visit. The fourth patient was treated with the liver-small intestine channel pair on all but one visit. The second, third, fifth, and sixth patients were treated with a variety of methods according to the patterns of reaction and the accompanying state of functional changes. It is also worth remembering the discussions above in chapter 8 on hypoesthesia and hypotonus and hyperesthesia and hypertonus. As a patient with a more advanced condition (hypoesthesia and hypotonia) improves, it is normal to see a flare-up of hyperesthesia and hypertonia. Your treatments will evolve according to these changes. For example, a patient with celiac syndrome in an advanced state of weakness, showing hypotonic abdominal muscles and flaccidity, was first treated with ion pumping to KI-6 and LU-7. As the patient improved and the muscle flaccidity improved, strong subcostal tightness began developing and treatment shifted to the use of ion pumping on PC-6 and SP-4 with good success. This simple but flexible approach has proven useful in many cases and for many years. You will likely find it necessary to read and reread most of the information given in this book. For an effective clinical practice, you will need to absorb the basic treatment protocols described in earlier chapters. Much of the last chapter
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can be accessed quickly by referencing the sections as needed. We believe that the information described in this book is sufficient for you to be able to treat virtually any patient. It is now up to you as to how you use this approach and the information in the text. We would also like to remind you of shu ha ri. It is useful, when starting out, to imitate and follow the guidelines in this text. After a few years' experience with these procedures, we hope you will be able to move beyond the frontiers we have mapped herein. We look forward to sharing the ideas and modalities you develop on your own.
IN CONCLUSION The modern practice of acupuncture, following modern tendencies in science and medicine, is to make more and more complex pictures and descriptions of the body, to dissect and redissect, to examine smaller and smaller parts. In the end, many factors need to be considered and treatment becomes fractured and symptomatic or complex and difficult. With each increase of complexity there is a concomitant reduction of the practitioner's ability to decide, perform, and assess. Recently in China, the system of bagang bianzheng, differentiation of syndromes by assessing the imbalance of four pairs of complementary factors yin/yang, vacuity I repletion, hot/ cold, internal/ external - has become established as the basic model of diagnosis, and as the central means of selecting and combining points for treatment. Actually, any number of diagnostic models can be applied as the basis of a system of treatment. For example, we have applied yin/yang, right/left, anterior/posterior, inferior/superior. These are the essential yin-yang components of octahedral theory that we have found to be part of the signal system. Nevertheless, as long as the issue is one of imbalance, the question is always one of a difference between two complementary factors. The method we have devised is actually very simple. But, mastering simplicity is not easy. Living in the modern world, where we are always encouraged to look to the complex, makes swimming against this stream a matter of conquering one's own mental habits and training. Learning to recognize and appreciate simplicity is a challenge. We have argued that the software of the body is clearly and simply understood in acupuncture, without dependence on an understanding of the body's hardware. Like the expert fisherman who knows best where to fish, or the craftsman who can produce a masterpiece, there is no hardware, only software. Mastering acupuncture by understanding the nature of traditional ideas is hard work. It is necessary to develop your feelings and intuitions without surrendering the advantages of feedback and assessment. Further, we think that by beginning with simple, straightforward treatment procedures, with readily reassessable signs, you will develop a successful practice while simultaneously refining your techniques and improving your skills.
CHAPTER ENDNOTES 1 These studies are taken from the caseload of Stephen Birch, from the period 1986-1990. The measure of this system, as with any other, is its repeatability, that it can be successfully learned and applied by others.
~""
APPENDIX ONE:
PRESSURE PAIN: PATTERNS, INrERPRErAnONS, AND PossmLE ORIGINS
Pressure pain in diagnosis, reassessment, and research is described repeatedly throughout this text. Palpation's modem uses and history in East Asian medicine have been described briefly elsewhere.l Hence practitioners will find this summary useful as a reference to: 1. Specific disease diagnostic pressure pain points commonly used in Western medicine; 2. Their overlap with the pressure pain points described herein; 3. Theories about the origins of "pressure pain" in the body. As we will see, not all practitioners and researchers view pressure pain in the same way. It depends on the methods of treatment someone employs as to how they describe pressure pain and its cause or significance. Neurologists always find neurological causes; kinesiologists find kinesiological causes; osteopathic researchers find still other relationships, as do acupuncture researchers. Further, the background from which the pressure pain response is determined usually tailors the finding and descriptions of the points. For example, acupuncture researchers will primarily palpate acupoints. Researchers with a neurological background mostly look at motor points or trigger points. Researchers with more of a cardio-pulmonary background will look at vascular structures. Internists will look to underlying organ structures. In other words, the scientific study of the pressure pain response is sorely in need of rigorous, unbiased inquiry. The following set of pressure pain points, illustrations, and tables are a compilation of findings from various Western medical practitioners, taken from Yoshio Manaka's published writings.2 It is noteworthy that some of these points correspond to acupoints. Many of the appendicitis points correspond to the stomach, spleen, and kidney channel points that are treated in cases of appendicitis. One of the Boas gastric ulcer points corresponds to BL-21, the stomach back-shu point, and so on. Using the model described in this text, it is probable that many of these points could be treated if they were found to be reactive in conjunction with the corresponding condition.
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~navel
9 15
0
10 0°
0 013
14
Os
012
°u
Figure 15.1: Pressure pain points on the front of the body Key 1 2 3
Onodera's sternum point Borges' pressure pain point Mussy's point
4
Schmidt point
5
Onodera lung point
6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Hattori's pressure pain point Hattori's pressure pain point Kummel's point Morris' pressure pain point Munro's pressure pain point Lanz's pressure pain point Hattori's pressure pain point Clado's pressure pain point Lenzmann's pressure pain point McBurney's pressure pain point Dejardin's pressure point Robson's pressure point Onodera's pressure point Onodera's diagnostic pressure point Tsuda's sternum point
Swollen bronchial lymph glands Lung disorders, pleuritis Tuberculosis, bronchial asthma, bronchitis, peritonitis Apical pulmonary tuberculosis, inflamed bronchial plexus, hemoptysis Intercostal neuralgia, pneumonia, disorders of liver and biliary tract Gastric ulcer Duodenal ulcer Appendicitis Appendicitis Appendicitis Appendicitis Appendicitis Appendicitis Appendicitis Appendicitis Pancreatic diagnosis Gallbladder diagnosis Gallbladder diagnosis Biliary tract disorder Duodenal ulcer
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Figure 15.2: Pressure pain points on the back of the body
Key 1.
2. 3. 4. 5. 6. 7. 8. 9.
10. 11. 12. 13. 14. 15.
Petruschky point Mackenzie thoracic vertebrae diagnostic pressure point Mackenzie pressure pain point Boas' gastric point Boas' diagnostic pressure point Onodera's buttock pressure r.ain point (3-4 em below high point of 1liac spine) Pregnancy and menstruation point Sacrum pressure pain point Pregnancy and menstruation point, prostate point Onodera's buttock pressure pain point Onodera's pressure pain point Edward's point Onodera's pressure pain point Duodenal pressure pain point Kudo's scapula point
16. Interscapular region pressure pain point
17. Mastoid pressure pain point 18. Occipital region pressure pain point 19. Gastric ulcer pressure pain point
Infantile bronchitis, pertussis, measles Cardiac disorders, gastric disorders, liver disorders Gallstone colic Mainly gastric ulcer Gallstone colic Gastric ulcer Reactive during pregnancy & menstruation Large intestine problems, esp. of rectum Uterine, cervical, & accessory organ disorders (reactive during menstruation & pregnancy) Prostate point (reactive with prostate disorders) Duodenal ulcer Gallstones Gallstone, gastric ulcer, kidney problems Biliary tract disorder Duodenal ulcer Inflammation of the shoulder joint or surrounding area; brachial neuralgia Swollen bronchial lymph nodes, tuberculous spondylitis Chronic headache, encephalitis, inner ear disorders, etc. Encephalitis, inner ear disorders Gastric ulcer
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The next set of tables is taken from research conducted in China. For a number of different diseases many points were palpated to determine which were commonly painful in the presence of that disease. These tables are taken from the work of Dr. Li Ding Zhong. 3 This work focuses primarily on an examination of the occurrence of pressure pain at the acupoints. There were a number of earlier studies,4 some of which ran into methodological problems, but the following seem to based on reasonable methodologies. Typically there is a general pressure pain point, one reflecting the diseased organ, and a specific pressure pain point, which tends to reflect the nature of the problem exhibited by that organ. Because Chinese palpation research is almost always directed towards finding palpable reactions in the presence of Western disease entities, e.g. stomach ulcer, tuberculosis, etc., and not in the presence of Chinese disease entities, e.g. stagnant liver qi, kidney qi vacuity, it is more difficult to know the veracity of the information. In Japan, there have been numerous practitioners and researchers who similarly investigate palpable reactions with regards to both Western disease entities and Oriental disease entities.s Because Japanese research tends to be more directed by the principles of biostatistics, these studies are less easily dismissed for methodological errors. For statistics and research findings in this area to have relevance, attempts need to be made to correlate findings to both Western and Oriental disease entities. While it is diagnostically and therapeutically useful and important to know Western disease entity relationships, these are not statistically relevant without research of the Oriental correlations as well. The investigation of pressure pain at acupoints in the presence of Western disease entities is actually a valuable contribution to the clinical practice of Western medicine. Clearly this is a technique acupuncture and its associated methods can contribute to the West. However, for this research to be considered relevant, Chinese researchers need to apply the same approach to diagnostic and therapeutic constructs in acupuncture and herbal medicine. In modem Chinese literature on acupuncture, moxibustion and herbal medicine, palpation is given a very lowly place. Typically the radial pulses and a shi points are palpated and more rarely the front mu points. Japanese practitioners have shown that there are actually many important correlations to Oriental disease entities that can enhance the practice of traditional medicines. It is here that we have been able to develop reasonable diagnostic and reassessment methods which, we argue, are important in a clinical medicine. The tables below present palpatory points for specific conditions. PALPATION FOR RESPIRATORY DISEASES DISEASE
GENERAL POINT
SPECIFIC POINT
Pneumonia Bronchitis Bronchiecstasis Pulmonary tuberculosis Lung cancer
BL-13 BL-13 BL-13 BL-13
LI-13
ST-14 ST-16 Tuberculosis point 3.5 divisions lateral to GV-14
BL-13 Cancer point (xin da xi) 1/2 division lateral to midpoint of line connecting BL-37 and BL-40
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315
PALPATION FOR DIGESTIVE DISORDERS DISEASE
GENERAL POINT
SPECIFIC POINT
Gastritis Gastrospasm Gastric ulcer
CV-12 CV-12 CV-12
Gastroptosis
BL-20 (depression)
Stomach cancer Acute enteritis Dysentery Irritable bowel Intestinal spasm Duodenal ulcer Dyspepsia Constipation
Cancer point ST-25 ST-25 ST-25 ST-25 CV-12 CV-12 ST-25
Left ST-20 Left ST-20 Right gastric ulcer point 2 divisions lateral to BL-50 Gastroptosis point 2.5 divisions above navel CV-12 ST-39 Extra point 1 division lateral to navel Extra point 2.5 divisions below navel Extra point 2 divisions lateral to CV-6 Right ST-21 Extra point 1 division lateral to CV-11 Extra point 1 division lateral to ST-25
PALPATION FOR LIVER AND GALLBLADDER DISEASES DISEASE
GENERAL POINT
SPECIFIC POINT
Hepatitis
BL-18
Liver cancer Acute cholecystitis
Cancer point BL-19
Hepatitis point 1.8 divisions above the medial malleolus BL-18 Gallbladder point 1 finger-width below GB-34 GB-36 Extra point 1 division above SP-10 GB-41
Biliary tract infection Gallbladder point Biliary tract ascariasis Gallbladder point Gallbladder point Cholelithiasis
PALPATION FOR CARDIOVASCULAR DISEASES GENERAL POINT
SPECIFIC POINT
Rheumatic heart disease Myocarditis Pericarditis Ischemic angina pectoris Myocardial infarction Cardiac insufficiency
BL-27
Extra point 3 divisions distal to HT-3 PC-7 BL-45 HT-4
Tachycardia Bradycardia Hypertension
BL-44 BL-44 Blood pressure point 2 divisions lateral to sixth cervical vertebra Blood pressure point BL-44
DISEASE
Hypotension Arrhythmia
BL-44 BL-44 BL-44 BL-44 BL-44
HT-1 Extra point 0.4 divisions radial & 1 division proximal to midpoint on the dorsal wrist crease PC-4 HT-7
HT-7 BL-15
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Appendix One: Pressure Pain
PALPATION FOR NEUROLOGICAL DISORDERS DISEASE
SPECIFIC POINT
GENERAL POINT
Neurasthenia
GV-11
Mental disorder
Extra point in the depression between thoracic 2 and 3
Epilepsy
Extra point in the depression between cervical 7, thoracic 1
Headache
Extra point 2.5 divisions lateral to cervical2
Migraine
BL-7
Intercostal neuralgia
Extra point at midpoint on line from LU-9 to LU-5
Sciatica
BL-23 on the ischium
Cerebral apoplexy
blood pressure point
Diabetic coma
Extra point 1 division distal to ST-32
Extra Point located where thenar and hypothenar eminences meet on the palmar surface of the hand
PALPATION FOR URINARY DISORDERS DISEASE
GENERAL POINT SPECIFIC POINT
Nephritis
BL-23
KI-3
Pyelonephritis
BL-23
Uterus point 3 divisions lateral to CV-3
Urethritis
BL-23
KI-16
Cystitis
BL-23
ST-27
Urinary incontinence
CV-3
Extra point 0.5 divisions inferior and 1 division lateral to CV-3
Urinary retention
CV-3
SP-11
PALPATION FOR ACUTE DISEASES REQUIRING SURGERY DISEASE
GENERAL POINT
Acute pancreatitis
Extra point 1.5 divisions SP-8 (will be very sore) lateral to inferior border of the spinous process of thoracic 8
Appendicitis
ST-25
Perforation of the digestive tract
SPECIFIC POINT
Extra point 2 divisions inferior tc ST-36 Ll-7
Acute peritonitis
ST-25
Extra point on the axillary line in 7th intercostal space
Renal calculi
GB-41
Urethral calculi
GB-41
Uterus point KI-16
Vesical calculi
GB-41
ST-27
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317
PALPATION FOR BONE-RELATED DISEASES DISEASE
GENERAL POINT
SPECIFIC POINT
Leg and back pain Osteoarthritis BL-23 Rheumatoid arthritis BL-27
Extra point 0.5 divisions lateral to Kl-1 BL-11 Extra point 1 division superior and 0.5 division lateral to ST-34 SI-ll
Inflammation of the shoulder joint Thrombophlebitis
Extra point 0.5 divisions inferior and 3 div. lateral to second sacral foramen
PALPATION FOR GYNECOLOGICAL DISORDERS DISEASE
GENERAL POINT
SPECIFIC POINT
Functional uterine bleeding Menorrhagia
SP-6
SP-10
SP-6
Leukorrhea
SP-6
Dysmenorrhea Menopause Pelvic inflammatory disease Endometritis Uterine cancer Uterine prolapse Ovarian cystoma
SP-6 SP-6 SP-6
Extra point in depression between sacral 1 and 2 Extra point 0.5 divisions inferior to media1 malleolus ST-26 Extra point 2 div. medial to ASIS BL-32
BL-32 Cancer point BL-20 (depression) BL-32
Extra point 0.5 div. latera[ to BL-32 Postpartum discharge SP-6
Morning sickness
GB-26 BL-32 GB-26, BL-32 Extra point 4 divisions lateral to the spinous process of lumbar 2 ST-24 CV-7
PALPATION FOR PROBLEMS OF THE FIVE SENSE ORGANS DISEASE
GENERAL POINT SPECIFIC POINT
Glaucoma
BL-18
Pharyngitis, laryngitis Tonsillitis Ulcer of the oral cavity Rhinitis Allergic rhinitis Paranasal rhinitis Nasal bleeding Meniere's disease
Extra point at hairline on horizontal line postenor to protuberance of mastoid process Extra point 2.5 div. lateral to cervical 5 Extra point 1 finger-width radial to PC-8 Extra point .5 div. anterior to auricular lobule Extra point directly below nostril at midpoint between ala nasi and septum nasi Extra point inferior and lateral to LI-20 at midpoint of the nasolabial groove Extra point where the nasal bones meet the lateral nasal cartilage Extra point in depression on posterior hair line on protuberance of trapezius muscle in occipital region Extra point 9 div. superior to popliteal crease on lateral aspect of thigh, midline of femur
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Appendix One: Pressure Pain
STATISTICAL ANALYSIS OF THE PATTERNS OF REACTION
As a supplement to the diagnostic information in the preceding tables, the statistics that follow, derived from preliminary studies of pressure pain occurrence on the abdominal quadrants, the new mu points, and on the gastrocnemius reflex areas, provide a measure of clinical certainty. Having some standard reference to establish the "normal range" of palpatory responses is important for the continued development and refinement of these procedures. There are tendencies in the general population that can be seen in these statistics. The first set of figures represents statistics of the abdominal quadrant reactions in a group of one hundred people:
(F) 14
1
11
2
3
0
7
(M) 21
2
7
13
3
2
14
We have found that the upper right/lower left quadrant pattern (I) is the most common, found in 35% of cases. The opposite reaction in the upper left/lower right quadrant (II) was found in only 3% of all cases. The upper right/lower right pattern (III) showed in 18% of cases and the upper left to lower left pattern (IV) was found in 15% of the cases. Many patients (68%) exhibited patterns I, III, and IV. By devising general balance treatments for these three patterns, we were able to help a large percentage of our patients, treating chronic migraines, lumbago, etc. On occasion, great results occurred with only one treatment. Hence knowledge of these tendencies and the formulation of simple treatment procedures for them has proven clinically very useful. The next set of figures represents statistical measures of the occurrence of palpable reaction at important diagnostic points. In a group of 95 subjects, comparing left and right point reactions, we found the following: Acupoint Main correspondences Right Left ST-11 chong mai 34.7% 34.7% 9.5% 12.6% ST-12 yin qiao mai 8.4$ 18.9% lung, ren mai LU-1 55.8% 10.5% LR-14 liver, yin wei mai 28.4% 40.0% KI-16 kidney, yin qiao mai 12.6% 27.4% triple warmer, yang wei mai ST-25 0.5% 31.6% spleen, chong mai GB026 12.6% 16.9% large intestine ST-27 14.7% 44.2% yang wei mai, yang qiao mai, gallbladder GB-29 3.2% 6.3% KI-11 bladder, yang qiao mai 37.9% 33.7% LI-4 12.6% yin wei mai CV-22
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319
These statistics emphasize some of the normal or more common tendencies as with the upper right and lower left quadrants, right LR-14 and left GB-29 show statistically significant tendencies. The next set of figures shows the 15 dominant correlations in order of degree of correlation. Here we measure the occurrence of pressure pain in pairs of commonly reactive body points. These figures were complied after palpating one hundred subjects. FIFTEEN DOMINANT CORRELATIONS BETWEEN PAIRS OF ACUPOINTS
1. 2. 3. 4. 5.
left ST-25 -left Kl-16 right LR-14 -left GB-29 right Ll-4- right ST-11 right Ll-4- right LR-14 left ST-11- right LR-14
0.52381 - 0.38715
right KI-16 - left KI-16 7. right LR-14 -left KI-16 8. left ST-11- right ST-11 9. right Ll-4 - left GB-29 10. right ST-11-left LR-14
0.38298 - 0.36508
11. 12. 13. 14. 15.
0.35593 - 0.33939
6.
right LR-14- right KI-16 left GB-29 -left KI-16 right Ll-4 - left GB-26 right ST-11 - left KI-16 right ST-11-left GB-29
The right superior (3, 4, 10), left inferior (1), and thus the cross reaction patterns and tendencies (2, 7, 9) can be seen again. The last set of statistics compares the occurrence of left-right gastrocnemius pressure pain with the occurrence of left-right abdominal pressure pain. One hundred subjects were palpated to obtain these figures. The percentages of occurrence of pressure pain on the gastrocnemius muscles broke down as follows: AREA
PERCENTAGE
spleen - triple burner kidney - large intestine liver - small intestine bladder - lung stomach -pericardium gallbladder - heart
50 28 16 3 2 1
Clearly, reactions at the three leg yin reflex points were much more predominant than the three leg yang (94% versus 6%). This correlates well with our own clinical observation that most problems arise at the three leg yin channel level. Comparing the occurrence and correlation of abdominal pressure pain to the gastrocnemius reactions yields the following figures:
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Appendix One: Pressure Pain
SPLEEN - TRIPLE BURNER (50%) AREA
SIDE
NUMBER
abdomen
right
13
abdomen
left
30
7
other gastrocnemius
right
29
gastrocnemius
left
21
Comparing the ratios of abdominal to gastrocnemius correlations yields: ABDOMEN
GASTROCNEMIUS
NUMBER
right
right
11
left
left
18
left
right
12
right
left
2
7
other
The general pattern of same-side correlation was 58%, contralateral correlation was 28%, and other was 14%. KIDNEY - LARGE INTESTINE (28%) AREA
SIDE
NUMBER
abdomen
right
7
abdomen
left
16
gastrocnemius
right
5 17
gastrocn~mius
left
11
other
Comparing the ratios of abdominal to gastrocnemius correlations yields: ABDOMEN
GASTROCNEMIUS
NUMBER
5 7 left right 9 right left 2 other 5 The general pattern of same-side correlation was 43%, contralateral correlation was 39%, and other was 18%. right
right
left
left
LIVER- SMALL INTESTINE (16%) Area
Side
Number
abdomen
right
14
abdomen
left
2
gastrocnemius
right
gastrocnemius
left
0 8 8
other
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321
Comparing the ratios of abdominal to gastrocnemius correlations yields: ABDOMEN
GASTROCNEMIUS
right left left right other
right left right left
NUMBER
8 2 0
6 0
The general pattern of same-side correlation was 62.5%, contralateral correlation was 37.5%, and other was 0%. BLADDER- LUNG (3%) AREA
SIDE
NUMBER
abdomen abdomen other gastrocnemius gastrocnemius
right left
1
right left
2 1
2
Comparing the ratios of abdominal to gastrocnemius correlations yields: ABDOMEN
GASTROCNEMIUS
NUMBER
1 right right 1 left left 1 right left 0 left right 0 other The general pattern of same-side correlation was 66.7%, contralateral correlation was 33.3%, and other was 0%. STOMACH - PERICARDIUM (2%) AREA
SIDE
NUMBER
2 right abdomen 0 left abdomen other gastrocnemius right 2 0 gastrocnemius left Comparing the ratios of abdominal to gastrocnemius correlations yields 100% right-sided abdominal to right gastrocnemius reactions. GALLBLADDER- HEART (1%) AREA
SIDE
NUMBER
abdomen left 1 gastrocnemius right 1 Comparing the ratios of abdominal to gastrocnemius correlations yields 100% left abdominal to right gastrocnemius reactions.
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Appendix One: Pressure Pain
ALL ABDOMINAL AND GASTROCNEMIUS REACTIONS AREA
SIDE
(100%)
NUMBER
37 right abdomen 51 left abdomen 12 other 59 gastrocnemius right gastrocnemius left 41 Comparing the ratios of abdominal to gastrocnemius correlations yields: Abdomen Gastrocnemius Number 27 right right 27 left left 24 left right 10 right left 12 other The general pattern of same-side correlation was 54%, contralateral correlation was 34%, and other was 12%. In these statistics the upper right/lower left body correlations are not so clear. Reactions found on the gatrocnemius muscles are usually treated on the side of the body opposite to the reaction. While the reactions on the gatrocnemius evidence certain channel asymmetries, these are not contralateral like the abdominal and other point reactions. These tend more towards the monolateral. Hopefully further research will make the correlations clear.
THEORIES ABOUT THE CAUSES AND ORIGINS OF PRESSURE PAIN Probably the earliest major study of pressure pain was conducted by Henry Head in the U.S. in the late 1800's. Head correlated the occurrence of abnormal sensitivity to patterns that cover the body surface.6 ~------------~------------,
Figure 15.3: Chart of the Head zones
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323
These patterns are now known more accurately as the neural dermatomes. A problem along a particular nerve branch can cause reflex reactions along associated surface nerve branches in very specific areas on the body surface. Thus visceral problems can cause abnormal sensitivity at the body surface within particular dermal zones, supplied by the affected cutaneous nerves. This is important both diagnostically and therapeutically and shows some correlations to the channel system?
c,
Figure 15.4: Chart of the neural dermatomes
These correlations suggested early on that pressure pain responses were neurological phenomena, needing neurological mechanisms and models to explain how they arise. Extensive studies were undertaken to analyze pressure pain, the trigger points, motor points, and their correlations to the acupoints. Explanations of neural pain relief mechanisms, such as the neural gate theory and the double gate theory of pain control, and the enkephalin and endorphin theories, seemed to all but solve the problem of how acupuncture was able to produce analgesia and anesthesia and why it was so good for relief of painful conditions.s From this literature it is not clear whether the pressure-sensitive points (as acupuncture points) can be said to be myofascial trigger points, motor points, or even Golgi tendon organs.9 It is more likely that the sensitive points can be any of the above. When we begin to look at all possible structures that can give rise to sensitive points, there are numerous possibilities. There are, for example, the neuro-lymphatic reflexes of Chapman,lO the soft tissue or connective tissue zones of Ebner,ll and a whole host of other neurological, vascular, ligamentous, and suture-line structures and sites.l2 In the first half of the twentieth century, French author George Soulie de Morant cor., related other European palpatory systems with East Asian medical ideas.13 Localizing exactly which structures are responsible for the phenomenon of pressure pain thus becomes a complex problem. It is perhaps more useful to look functionally to the causes of the pressure pain. The pressure pain itself is a neurological phenomenon, since pain is a signal transmitted through nerve fibers to the brain where it is registered as pain. But we should not confuse the pain itself with the causes of the physiological change that result in the pressure-evoked tenderness at particular loci. What is more important are the causes. On this topic, there are hosts of theories. Trigger points are known to arise as a result of infections, trauma, the strains of normal or abnormal growth,14 abnormal tension and thus pressure
324
Appendix One: Pressure Pain
pain resulting from stress, emotional distress,lS poor posture and repeated daily movements.16 Poor posture can cause pressure pain points acting through strains in the interconnected fascial systems, which in tum can cause internal changes in the organ systems, and in particular, functional changes of the organs. Changes of the internal organs can also cause changes in the fascial systems and thus give rise to pressure pain points. 17 Osteopathic manipulations, sotai exercise therapy, rolfing, acupuncture, and a host of other therapies can work through these mechanisms. Relief of the problems that gave rise to the pressure pain (in the form of myofascial binding, trigger points, etc.) can relieve these points and their associated problems. Thus it is not always necessary to treat the reactive point to relieve its reaction. This is exactly what we find in acupuncture. The most important part of treatment is the first step, which usually uses the five phase, source-yuan and confluence-jiaohui points, all of which are on the limbs, from the knees and elbows down. Clearly there is no neurological correlation between these points and their channel-associated reflex points or areas. Even a cursory study of the above dermatomes will reveal this. Thus we must extend our look beyond the nervous system to explain the phenomenon of pressure pain, especially pressure pain and its correlations in acupuncture. Common to many of the above speculations about pressure pain and pressure pain structures are the body's muscular systems. When a muscle becomes abnormally tight or tense, so that it will not relax when the rest of the body relaxes, this hypertonia is both caused by some underlying problem, such as those suggested above, and causes other problems. In terms of problems that it might cause, we need only think of simple physics to begin speculation. An abnormally hypertonic muscle will compress blood vessels, lymph vessels, and nerves, causing poor lymph flow, poor blood flow to and from the musculature underlying structures, and error signals in nearby nerve fibers - acting like a bias.lS The important correlation here is that underlying all these ideas are the integral structure-function relationships we have been postulating throughout this book. Any change in overall muscle tonus can cause reflex problems in a variety of locations, through a variety of possible mechanisms. A problem in function can alter the structure by changing the tonus of a muscle or group of muscles. This is seen in the diagnostic patterns described in chapter eight. It is also seen in chapter four where we described the relations of each channel to a series of muscles. In chapter four we described Tada Kono's findings and theories about this. Other sets of correspondences are found primarily in the kinesiological literatures, which mostly agree with Kono's correspondences, but disagree in places.19 According to the research of Dr. Omura, who uses the hi-digital 0-ring test, the phenomenon of electromagnetic resonance is a probable mechanism underlying how this test works.20 If this is the case, then it is possible that the mechanism underlying the kinesiologically demonstrated relationships between the channels and groups of muscles may also be electromagnetic resonance. These are not the only possible explanations for such relationships; it is possible that some normal biomagnetic properties of muscular tissues can also provide a plausible explanation. It is known, for example, that as muscles contract, they generate electrical and magnetic fields, which are specific to each muscle. There is a "corresponding signature in the temporal features of the accompanying electrical and magnetic signals"21 of a contracting muscle, to which other tissues and structures may show sensitivity. Thus it is possible that the specific tissues and structures involved in a particular channel may be sensitive to the electrical and magnetic field signatures of particular muscle groups.
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325
Omura has shown possible anatomical relationships of specific channels to specific physical structures and organs, which may also be related to these phenomena.22 The important point to note is that changes in muscle tonus can occur in response to organismic structure-function changes, such as the tightness of the cross-syndrome pattern that is associated with changes of liver function. Going a step further, it is possible that pressure pain patterns can arise in octahedral-like patterns, or yin-yang or five-phase patterns, none of which can be clearly explained through purely neurological mechanisms. The fact that we can eliminate pressure pain in points by using polarity agents of minute, low-level energy content suggests a reciprocal mechanism that caused the pressure pain. Perhaps the signal system is involved in the formation and distribution of pressure pain points. Omura's ideas and the biomagnetic research of muscle tissues suggest possible mechanisms. As another example of the participation of the signal system in the formation and distribution of pressure pain, there are the microsystems of the auricles and the hands. The auricular patterns of reaction of Nogier and the Chinese are very exact. Studies have even shown reasonable correspondence.23 If a particular part of the body has some pain or other problem, an exact counterpart in the auricles will exhibit both pressure pain and changed electrical resistance. These correspondences are difficult to explain by purely neurological mechanisms. The patterns of reaction found by Tae Woo Yoo are even more precise. Almost all the body's acupoints are mapped on the hands, at least all the important acupoints, channels, and body parts. A problem at a particular location of the body exhibits pressure pain reactions and changed electrical resistance at precisely fixed points on the hands. This too is hard to explain by neurology. We have suggested that the signal system has holographic modeling as part of its basis. This can go some way towards explaining both of these systems of correlations. We think that as the multiplicity of obvious biomechanical and neurological mechanisms of pressure pain are explored, it will become evident that the signal system also generates pressure pain responses. At any time, all these systems can contribute to the formation of pressure pain and tension, together and overlapping or independently. The problems of the origin and nature of pressure pain in the body are complex and require much more careful and rigorous research than has been done to date. At the least, research methods need to be designed to elucidate and differentiate each possible cause.
ENDNOTES 1 See for example, Yoshio Manaka et al., "Abdominal diagnosis and indications in traditional Chinese medicine," American Journal of Acupuncture 13:3, p. 223-234; and Matsumoto and Birch, Hara Diagnosis: Reflections on the Sea, chapter 2. 2 Hiratashi Junihannotai Nesshin Shigeki Ryo Ho (Hirata-style hot needle therapy), pp. 190-191, Yokosuka, Japan: Ido no Nippon Sha, 1982. 3 Li Ding Zhong, Jing Luo Phenomena Part II, pp. 198-224, Kyoto: Yukonsha Publishing Co., 1985. 4 See for example: Chinese Scientific and Technological Information and Research Institute, Xue Wei Ya Tong Bian Bing Zhen Duan Fa, Beijing: Science and Technology Document Publishing Company, 1978. Research like this is ongoing in China. See for example, Chai Wenju, "Researches on diagnosed method at points (a review)," Journal of Chinese Acupuncture and Moxibustion 1:1-2, 1987. 5 See for example the SOOth special issue of Ido no Nippon Journal of Japanese Acupuncture and Moxibustion 45:4, April1986. 6 Henry Head, "On disturbances of sensation with special reference to pain of visceral disease," Brain Part 1.16, 1-133, 1893; Part Il.17, 339-480, 1894; Part III.19, 153-276, 1896. 7 For a good discussion of these correlations, see J. Needham and Lu Gwei-Djen, Celestial Lancets, a History and Rationale of Acupuncture and Moxibustion, pp. 204 passim. 8 S.B.: There is extensive literature on this subject and equally extensive review of this literature.
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Appendix One: Pressure Pain
As examples of the mechanisms involved and trigger point correlations, see: Nathan, P.W., "The gate control theory of pain, a critical review," Brain 99(1), 123-158, 1976; Melzak, R. et al., "Trigger points and acupuncture points for pain: correlations and implications," Pain 3:3, 1977; Wall, P.D., "The gate control theory of pain mechanisms: a reexamination and restatement," Brain 101(1), 1-18, 1978; Melzak, R., "Myofascial trigger points, relation to acupuncture and mechanisms of pain," Arch.Phys.Med.Rehabil. 62(3), 114-117, 1981. As examples of the motor point correlations see: Gunn, C.C. et al., "Acupuncture locii, a proposal for their classification according to their relationship to known neurological structures," Amer.Jour.Chin.Med. 4, 183-195, 1976; Liao, S.J., "Acupuncture points, concordance with motor points of skeletal muscles," Arch.Phys.Med.Rehab. 56; 550, 1975. For good reviews of these literatures see: Chaitow, L., Soft-Tissue Manipulation, Wellingborough, England: Thorsons Publishing Group, 1987, pp. 64 passim. See also Ulett, G.A., Principles and Practice of Physiologic Acupuncture, St. Louis: Warren H. Green Inc., 1982. This last book contains extensive discussion of the use of acupuncture at the motor points. Extensive discussion of the use of acupuncture at the trigger points can be found in Baldry, P.E., Acupuncture, Trigger Points, and Musculoskeletal Pain, Edinburgh: Churchill Livingstone, 1989. 9 See Chaitow, L., Soft-Tissue Manipulation p. 64 passim. 10 Ibid., pp. 121-172, especially pp. 163-172. 11 Ibid., pp. 85-89. 12 For good reviews of these structures see: Dung, H.C., "Anatomical features that contribute to the formation of acupuncture points," Amer.Jour.Acup. 12:2, 139-143, 1984; and Bossy J., "Morphological data concerning the acupuncture points and channel network," Acup. & Electro-Ther. Res. Int. Jour. 9:79106, 1984. 13 See Soulie De Morant, George, Chinese Acupuncture, Brookline, MA: Paradigm Publications, 1994, pp. 21-22. Noted there are: the Points of Weihe, correlations to homeopathic provings where points
become sensitive; the renal points of Guyon, Albarman, Bazy, and Pasteau, where correlations are made to renal diseases; and the points of Dejardin, Marinet, Valleix, and Wetterwald. 14 See Melzack, R. et al., "Myofascial trigger points and acupuncture points for pain; correlations and implications," Pain 3:3, 1977. 15 S.B.: There have been many theories about the roles of stress, emotional disturbances, mental states, and personality traits in physical changes that manifest in the body. Many of these theories look to such triggers initiating tension patterns in the musculature (and therefore the development of, e.g. trigger points), which can become fixed and thus lead to numerous medical complaints. See for example the bioenergetic theories in the work of Wilhelm Reich (The Function of the Orgasm, New York: Meridian Books, 1971, pp. 266 passim); and in Mann, E.W., Orgone, Reich and Eros: Wilhelm Reich's Theory of Life Energy, New York: Simon and Schuster, 1973. For other interesting ideas, see Diamond, J., Life Energy: Unlocking the Hidden Power of Your Emotions to Achieve Total Well-being, New York: Dodd, Mead and Company, 1985. The work of Yves Requena is particularly interesting, because he has thoroughly compared Chinese and Western conceptual medical systems. Implicit within his work are the body type (and therefore muscle tension/pressure pain) patterns associated with particular personality and dispositional types. See Requena, Y., Terrains and Pathology in Acupuncture, Paradigm Publications, Brookline, MA., 1986; and his more recent Character and Health, Paradigm Publications: Brookline, MA, 1989. 16 See for example Hashimoto, K. andY. Kawakami, Sotai: Balance and Health Through Movement, Tokyo: Japan Publications, 1983. 17 As examples of both these possibilities, see the works of the craniosacral therapists, osteopaths, and rolfers. See: Barra!, J.P., Visceral Manipulation; Seattle, WA: Eastland Press, 1988. See also Rolf, I.P., Rolfing: The Integration of Human Structures, New York: Harper and Row, 1977. 18 For further speculation on this idea, see for example: Matsumoto and Birch, Hara Diagnosis: Reflections on the Sea, pp. 265-266. 19 For examples based on the work of Volland Goodheart, see Khoe, W.H., "Referred pain: A holistic approach in acupuncture," Amer.Jour.Acup. 5:4, 323-328, 1977. See also, Walther, D.S., Applied Kinesiology, Pueblo, CA: System D.C., 1976; Kapel, P., The Body Says Yes, San Diego: A.C.S. Publications, 1981; Thie, J. F. and M. Marks, Touch for Health, Marina Del Rey, CA:, DeVorss and Company, 1973. 20 Y. Omura, "Electro-magnetic resonance phenomenon as a possible mechanism related to the hidigital 0-ring test molecular identification and localization method," Acup.&Electro-ther.Res.Int.Jour. 11, 127-145, 1986. 21 Williamson, S. J. and L. Kaufman, "Biomagnetism," Jour.Mag.and Mag. Mater. 22: 129-201, 1981. 22 Y. Omura, "Meridian-like networks of the internal organs, corresponding to traditional Chinese 12 main meridians and their acupuncture points as detected by the 'hi-digital 0-ring test imaging
method.' Search for the corresponding internal organ of Western medicine for each meridian - part 1," Acup.&Electro-ther.Res.Inst.Jour. 12, 53-70, 1987. 23 T. D. Oleson et al., "An experimental evaluation of auricular diagnosis: The somatotropic mapping of musculoskeletal pain at ear acupuncture points," Pain 8, 217-229, 1980.
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APPENDIX Two SELECTED RESEARCH PAPERS AND fiNDINGS OF YOSHIO MANAKA AND KAZUKO ITAYA The following studies represent basic clinical and scholarly research into the vast field of acupuncture and moxibustion. We have selected them from the research articles and findings we have published during the last two decades. Our basic premise in these studies is that the effects of acupuncture and moxibustion therapy are not clearly differentiated in the research typically done in the field. In fact, the majority of studies on the effects of acupuncture focus on neurological and biochemical effects, using strong stimulation with deeply inserted needles that are electrically or manually stimulated. Either way, in this kind of study the neurological, biochemical, and acupunctural effects are mixed and undifferentiatable. We elected to design a number of basic studies to look at single effects as distinct from the vast array of effects that are simultaneously brought about in most studies. We hoped that such experiments would help us understand the simple baseline effects of needle insertion, or help us observe the phenomena that lead to traditional theoretical descriptions of the body (yin-yang, five phases, etc.). We were curious to see if what we observed would match the traditional theories, and/ or our own theories as to the nature of qi regulation (octahedral theory, isophasal theory, etc.). We designed the following simple studies: - The meridian imbalance diagramming (M.I.D.) method) This is a simple method of measurement aimed at retrieving objective data on the nature of imbalances in acupuncture and moxibustion practice. It is used both for the purpose measuring the body from a traditional theoretical perspective, and to reliably follow measurements through the course of treatment, thus allowing therapeutic effects to be quantified. It was designed in an effort to measure the channels and their yinyang categories. - The rabbit ear chamber (R.E.C.) method. This is a method of observing the microcirculation in the ears of laboratory rabbits. We used it to observe the effects on microcirculation following the insertion of a single needle into the dorsum of the experimental animals for a fixed period of time. This was done to try to establish baseline effects of needle insertion.
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- The deep body temperature measurements method. The purposes of this simple method were several. First, we wanted to see if measurement of the deep body temperature might yield patterns of temperature distribution that matched the predictions of traditional yin-yang theory. Second, we wanted to see if acupuncture and moxibustion could alter the deep body temperature, and if so, if they created regular patterns of change. Third, we wanted to examine the effects of body position and posture on the distribution of deep body temperature. - The electrodermal measurements of the auricles. The purposes of this experiment were to try to determine if electrical mappings of the auricle would coincide with anatomophysiological structures, pressure pain distribution, etc. Further, we wanted to observe differences in the reactive point distributions using different applied voltages as the measurement voltages. This study was done in an effort to establish basic protocol and distribution patterns. - The moxa review study. This was done to elucidate something of the nature, history, functions, and types of moxibustion that are currently in use in China and especially in Japan, where moxibustion practice has its own licensing procedures and is a profession in its own right. Thus this study was a literature search and review only. The acupoint contraindications study. We devised this presentation because of the interesting contradictory nature of the historical literature. Most texts on acupuncture and moxibustion in the West are cursory at best on the subject, with no historical knowledge of the subject. We felt it enlightening to present something of the changing and evolving nature of acupuncture and moxibustion from an historical perspective focusing on a single limited topic.
THE MERIDIAN IMBALANCE DIAGRAMMING (M.I.D.) METHOD A SUMMARY OF RESEARCH
FINDINGS BASED ON TWENTY YEARS OF STUDY RELATED TO
ABNORMALITIES OF SENSITIVITY OF THE ACUPOINTS, BOTH IN DISEASE AND HEALTH. ThE ORIENTAL MEDICAL DEPARTMENT ATTACHED TO THE KITAZATO INSTITUTE. BY: KAzUKO ITAYA AND YOSHIO MANAKA
PURPOSES AND METHODS:
Acupoints have the following two significant characteristics: 1. They are useful as diagnostic points. 2. They are useful as therapeutic points. During the disease process, various abnormal conditions appear on the surface of the body, such as hypersensitivity (pressure pain and/ or cutaneous sensitivity with pinching diagnosis, etc.), tightness of the underlying muscles, palpable depressions, etc. These were often related to the original descriptions of point location in Chinese medicine, since they frequently proved useful as therapeutic points. With experience, people found that these points had vertical correlations, from which arose the systematizing concept of jing luo, the meridians or channels. Recently many scholars have tried to obtain reliable statistics for the acupoints by measuring them with a variety of different methods and techniques. Some of these methods of measurement are:
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- skinten1perature - deeper body ten1perature - electrical resistance - n1agnetic fields - electrical current - electrical potential - heat-pain threshold response (Akabane testing) We have devised a n1ethod of n1easuren1ent that can be easily utilized in the clinic with as little tin1e as possible required to perforn1 it and which can be used to n1easure n1any acupoints. We also hope that this can becon1e a useful diagnostic n1ethod for acupuncture and n1oxibustion. THE MERIDIAN IMBALANCE DOLORIMETER
The focus of our research involved the developn1ent and diagnostic in1pleD1entation of the Meridian ln1balance Dolorin1eter, a developn1ent of Akabane's original idea. This is a sn1all electric heating coil located inside a hand-held heating device that is used with constant electric flow to generate radiant heat which is projected through the 4 sq. n1n1. opening onto the subject's skin. The tiD1e taken for the subject to feel pain with the radiant heat at each point is n1easured in tenths of a second. There are n1any acupoints on the surface of the body, but as key points of the channels, we chose the 24 jing points as fixed observation points. These jing points are located at the proxin1al corners of the nails of the fingers and toes. As coD1parative points, we also chose sixteen non-acupoint points located at the unoccupied proxin1al corners of the nails (see diagran1l6.l). We devised a few diagran1s for the purposes of organizing and observing the results of these n1easuren1ents. First, we con1pared the tiD1e taken for the heat-pain to be felt in each of the forty points following Akabane's original idea. Next, we con1pared figures for the upper and lower, left and right lin1bs and yin and yang channels taking sun1s and ratios of the SUD1S of the various con1binations of these. These we termed the Meridian ln1balance Diagran1s (M.I.D.)
LEFT HAND
Figure 16.1: The jing points, after Akabane
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Appendix Two: Research Papers of Manaka and Itaya
331
By taking the sums of the various readings we can look at all the yin-yang readings, hand-foot readings, and left-right readings and investigate the octahedral relationships. Further, taking the ratios of these sums allows us to develop a simple graphical representation of the results with which to explore the relative balance of the yin-yang relationships. In an ideal balance, the ratios all tend to 1. But, as we suspected, this is not always the case; there are some ratios that deviate from the perfect ratio. We used this method of measurement on healthy individuals and on patients with a variety of diseases, making repeated measurements over as long a period as was possible in each case. The conclusions we have drawn from these lengthy studies of several hundred individuals are as follows. Since Head discovered the correspondence of internal organ disease and the appearance of specific regions of hypersensitivity on the body surface, which are related to the spinal dermatomes, these Head zones have become familiar to professionals. But the fact that insensitivity to pain also appears on the surface of the body in relation to specific diseases is little known except for diseases of the nervous system. We have been able to prove the significant occurrence of functional insensitivities of varying degrees at the surface of the body. These appear in different patterns without the presence of organic nerve changes. They appear without relationship to the spinal dermatomes, the hypersensitivity zones of Head. When we measured hospitalized patients (for instance patients with stomach ulcers who had no acupuncture therapy) from the time of their admittance to the hospital, to the time of their discharge, the abnormal tendencies in the diagrams tended to coincide with the pathology. Before having their operations, we typically saw a wide disparity in the insensitivity and hypersensitivity of points. However, after recovery from the surgery and just before leaving the hospital, the figures tended to return to a more normal range. This test in principle is similar to the pain measurement tests devised by Hardy.2 However, this instrument is more suitable for the measurement of heatpain threshold of single acupoints, since the area of irradiation with Hardy's instrument is too large. The Meridian Imbalance Dolorimeter is much more convenient for the measurement of a greater number of smaller points. In general there is a tendency during the course of a disease for the heat-pain threshold response of the lower limbs to become higher, but if the patient is depressive or experiencing depression this ratio peculiarly reverses. An interesting fact is that in samples of the general population the ratio between upper and lower limbs, including non-acupoints, is closer to 1 than is the ratio of the channel points alone. In other words, we can say that the non-acupoint points show less abnormal figures. In the group of depressive patients, the ratios of the figures for all the points are further from 1. That is, in the depressive patients, the heat-pain threshold response rises in non-acupoint points more distinctly than the general population. When we are observing the tendencies of insensitivity or hypersensitivity of non-acupoints in different diseases, at certain times in the disease process distinctive peaks of insensitivity occasionally appear. But in general the insensitivity or hypersensitivity in the acupoints show a more distinctive tendency. Along with improvement of the patient's complaints over the span of treatment, the insensitivity of each acupoint tends to normalize. Very often the ratio of the difference between right and left sides of the same point remains at the same level until the end. As a whole, the peaks of the heat-pain threshold response are stable until the end of treatment. Therefore we can surmise that
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there are permanent tendencies in the relationships between the same acupoints, that is, constitutional tendencies. With continuous measurements of the same subjects for several years, we could see changes of the ratios of the upper and lower figures at certain times of the year. Chinese medicine recognizes the annual rhythms (changes of the four seasons) of the living body. These tendencies in the figures seem to substantiate the Chinese theories. When we looked at a number of patients with the same symptoms, their M.I.D. patterns were not necessarily the same; each showed unique characteristics. The explanation can be found in the Oriental medical principle that treatment is not administered according to disease or symptom, but according to the patient's conformation, or sho. Another principle is that the same treatment is not given to different people with the same disease. Each treatment is tailored to the individual's indications (sho), which may vary even from day to day. Sometimes treatment improves the patient's condition so that the symptoms disappear. For instance, treatment of amenorrhea may improve the patient's condition so that the menses return. However, when treatment is stopped, the menses again stop. In these cases we found that when the menses returned, the abnormalities apparent in the M.I.D reading did not change significantly. But in the cases where treatment was continued after the menses normalized until the M.I.D. readings turned towards normal, the menses remained normal after treatment was discontinued. While insufficient numbers of cases have been measured to draw clear conclusions regarding this observation, preliminary findings show that patients for whom acupuncture analgesia was only moderately successful evidenced a reversal in the ratio of hand to foot readings in favor of the hand, i.e., showed the depressive tendency. At the present time, finding organic changes is considered most important in Western scientific diagnosis. Yet it is difficult to draw clear lines between disease and health and their abnormalities when definitions are not clear. This is the case with "pre-disease conditions," "functional diseases," "imbalances of the autonomic nervous system," or "psychosomatic disorders," all of which are common modem diagnoses. We need a system for approaching cases where no organic changes exist or, if they appear to exist, they are not necessarily the cause of the complaint. In other words, it is important that functional pathological diagnosis should be considered as important as the diagnosis of organic changes. From this perspective, the M.I.D. can be a useful diagnostic method that while both relatively objective and quantifiable is complementary to the diagnostic methods of traditional Oriental medicine. We asked twelve healthy volunteers to allow the M.I.D. measurements to be taken twice a week for two years. There was a fluctuation in the figures for each volunteer from which the average figures and ratios were calculated. As a whole, they showed similar patterns but there are some points to which we must pay particular attention. Though there was considerable variance among each of the ratios, the ratio between the sums of the values of the yin channels when compared to the yang channels was close to one. The notable exception was one case where there was a reverse phenomenon in the ratio of the upper and lower limbs. After questioning the volunteer we found that the subject sometimes had a tendency towards depression and there was a tendency in the family to depression with one relative hospitalized. In the first category, in the cases of those able to recover easily from a minor ailment and able to derive a distinctive benefit from acupuncture, we can see the
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333
tendency of the ratios of yin and yang as almost 1. Also in the cases of chronic disease where recovery is gradual, we can see the tendency of yin and yang returning to 1 sooner than the other tendencies of the ratios in the diagrams. Therefore, looking at the heat-pain threshold response and comparing the ratios, we have a good key for measuring the tendencies of imbalances throughout the body. CONCLUSIONS
The following conclusions are based on our work with the M.I.D.: 1. Besides the zones of pain hypersensitivity described by Head and which correlate with the nervous system, there exists the phenomenon of heat-pain hyposensitivity. 2. The former appear along with the divisions of the spinal cord, the latter appears in different patterns.
3. The acupoints and non-acupoints evidence this insensitivity, but from among these two categories of points, there is a difference according to time and other factors. 4. The traditional acupoints are said to be on the channel line which has certain relationships to diseases and the functional properties of the internal organs, but the correlation with the internal organs is not exclusive. 5. ·we can presume that this insensitivity as well as hypersensitivity appears by common mechanisms such as the inhibition and excitation of the afferent fibers of the sensory nerves, but this needs further clarification with more research. 6. We think that this method of measurement of the heat-pain threshold responses can be used not only for studying the acupoints, but also as a diagnostic method in the territory of modem medicine.
MICROCIRCULATION RESEARCH EFFECTS OF ACUPUNCTURE NEEDLE APPLICATION UPON THE CUTANEOUS MICROCIRCULATION OF RABBIT EAR LOBE3 (1), (1), CHIYOJI 0HKUBO (2), MAKISHIGE ASANO (2).
COLLABORATIVELY WRITTEN AND RESEARCHED BY KAZUKO ITAYA YOSHIO MANAKA
(1) ORIENTAL MEDICINE RESEARCH CENTER, KITAZATO INSTITUTE, TOKYO, JAPAN. (2) DEPARTMENT OF PHYSIOLOGICAL HYGIENE, INSTITUTE OF PuBLIC HEALTH, TOKYO, JAPAN.
Abstract: Microcirculatory effects of the application of an acupuncture needle (32 gauge-silver) to the back (corresponding to geshu, BL-17, in human beings), were microscopically studied in vivo using a transparent ear chamber in conscious rabbits. Although no striking findings were obtained during the 30 minute period of needle application, it was clearly observed that the microvascular blood flow increased gradually in parallel with augmenting spontaneous rhythmic fluctuations of the vessel diameter, namely vasomotion. This was observed throughout a continuous period of greater than two hours following removal of the needle. Diameters of arterioles
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and venules at the full-dilating phases of vasomotion reached respective levels greater than 200% and 250%, respectively, compared to the initial values monitored just before application of the needle. The clinical efficacy of acupuncture was suggested to be explained at least in part by the increased rhythmic microvascular blood flow in parallel with vasomotion. Keywords: acupuncture, microcirculation, in vivo microscopic study, conscious rabbits.
Introduction: It has been widely experienced that better results often may be achieved with acupuncture treatment in various chronic diseases, where results were unsatisfactory in Western medical care. Currently no one is able to completely explain the mechanism of action. Traditional acupuncture includes a great variety of techniques in its practice. As one author suggested previously [1], a probable application of acupuncture to modern Western medicine would follow from the establishment of fundamental concepts common to the varying techniques of acupuncture. Based on other reports [2], the authors have assumed that acupuncture treatment has a desirable influence on the systemic microcirculation and that this plays an important role in its therapeutic efficacy. The present study was attempted to elucidate in vivo microscopic evaluation of such acupuncture-induced changes in the cutaneous microcirculation in healthy conscious rabbits. For that purpose, qualitative and quantitative analyses were made on hemodynamic microcirculatory events and the results are discussed from a physiological viewpoint. Materials and Methods: Healthy male rabbits were subjected to the experiment without anesthesia in a metal drum where they lay on their bellies. Each had transparent round-table chambers (rabbit ear chamber, R.E.C.) [3] previously installed into both ear lobes. Each R.E.C. contained a cutaneous microvascular net in its observing tissue space (50 micra in depth). Hemodynamic events observed in vivo with a microscope in the R.E.C.'s of both ear lobes were projected onto TV monitors and stored on videotape via a microscope-closed TV system [4], before, during, and after acupuncture needle application. The stored microcirculatory events were reproduced later for qualitative and quantitative analysis using visible assessment and the technique of microphotoelectrocplethysmography (MPPG) [3,4].
Vascular diameters of selected arterioles and venules were measured at the same locations on the images on the TV monitor and their changes expressed in percent of the initial diameters just before the application of an acupuncture needle. Diameters at the full-dilating and full-constricting phases of vasomotion were defined as top and bottom diameters of vessels. Thus the difference between top and bottom diameters for a single wave of vasomotion designated the amplitude of vasomotion. An acupuncture needle (32 gauge, silver) was used at a point in the upper part of the back of the animals corresponding to geshu (BL-17) in human beings. The needle was retained for 30 minutes. The microcirculatory behavior was observed and recorded throughout each experimental period of 3 hours, in 22 trials with 9 animals. The experiment was carried out with conscious animals; room temperature was kept at 23 celsius with 60% relative humidity. Results: Hemodynamic behavior of the microcirculation under basal conditions. The cutaneous microcirculation under basal conditions before the acupuncture needle application was characterized by spontaneous rhythmic changes consisting of increase and decrease in both the caliber of blood vessels and the volume of blood flow. The rhythmic changes were recorded continuously by MPPG as shown in Figure 16.5 on which the full-dilating phases of the fluctuation coincide with the tops of wave-like tracing and the full-constricting phases do so with the bottoms.
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Figure 16.5: Cutaneous microcirculation prior to needle application
In general, frequency of the fluctuation due to vasomotion ranged from 1 to 4 counts per minute, as previously reported elsewhere [3,4,5], although during the pre-treatment period the microcirculatory fluctuation due to vasomotion appeared to be rather indistinct.
Figure 16.6: Cutaneous microcirculation during needle application
Thereafter, the blood vessels dilated with the top diameters of arterioles and venules, reaching 140-150% of the initial values:
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Appendix Two: Research Papers of Manaka and Itaya
Figure 16.8: Cutaneous microcirculation immediately after needle withdrawal
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Figure 16.10: Cutaneous microcirculation 60 minutes after needle withdrawal
Figure 16.11: Cutaneous microcirculation 90 minutes after needle withdrawal
The microvascular rhythmic blood flow rapidly increased beginning immediately after needle withdrawal. About 30 minutes later, the amplitude of vasomotion was much enhanced with the top diameters of the arterioles and venules reaching dilation levels greater than 150% and 200% of the initial values, as seen in Figure 16.6. The top diameters then maintained levels greater than 200% and 250% respectively for the arterioles and venules (Figure 16.7).
Figure 16.12: dilation of the microvessels before (left) and after (right) acupuncture
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A typical sequence of the effect of acupuncture needle application on the microvessels is presented in Figure 16.12. The increased top diameter of venule (V) is much more demonstrable than that of arteriole (a), comparing the right to the left picture. The successive changes in the top and bottom diameters are diagrammatically illustrated in Figure 16.7. Discussion. The present study clearly demonstrated that a 30-minute application of an acupuncture needle (32 gauge, silver) to the back of a rabbit, corresponding to geshu (BL-17) in humans, can cause definite vasodilating effects upon the cutaneous microcirculatory system and an enhancing effect upon the occurrence and activity of vasomotion of the microvessels, as observed in the R.E.C. Vasomotion, generally referred to as "spontaneous constriction and relaxation of microvasculature, especially arterioles," has been observed to have a frequency ranging from 1-10 counts per minute in different tissues and organs, such as the skin, skeletal muscle, intestinal serosa, mesentery, gastric mucosa, lung, spleen, and kidney of various species [6], including the human skin [7]. Vasomotion has been suggested to facilitate the oxygen diffusion across capillary walls in the tissue according to the rhythmic distribution of blood caused by it [8]. The vasodilating effect of some drugs that did not interfere with the existence of vasomotion has been suggested to be physiologically acceptable to improve microcirculation [9]. Moreover, it has been supposed that the peripheral resistance of the microvascular system maintaining vasodilation is less than that of the other microvascular system having equivalent mean caliber without vasomotion [10]. Accordingly, the in vivo microscopic findings obtained in the present study suggest that under selected conditions, acupuncture may facilitate the oxygen supply to tissues by increasing microvascular blood flow due to vasodilation. This facilitation of oxygen supply may also be due to the lowering of regional peripheral resistance accompanied by enhancing the spontaneous rhythmic fluctuation of blood flow due to vasomotion. In addition, the clinical efficacy of acupuncture which has been experienced for cases of refractory chronic diseases might be partially explained by the microcirculatory activation which will probably occur similarly to the cutaneous microcirculation in normal rabbits. Conclusion: A 30-minute application of acupuncture with a silver needle (32 gauge) to the back, corresponding to geshu (BL-17) in humans can induce vasodilation effects, an activation of vasomotion, and an enhancement of rhythmic perfusion of blood flow due to vasomotion in the microcirculatory system for a period longer than two hours following cessation of needle application in the skin of the rabbit. Based on the results, a possible participation of the increased rhythmic microvascular blood flow, due to vasomotion, could be proposed to explain, at least partially, the clinical efficacy of acupuncture for refractory chronic diseases. Acknowledgements. This work was supported in part by a grant from the Science and Technology Agency in Japan. The technical assistance given by the laboratory of Yone Productions is gratefully acknowledged. REFERENCES [1] Y. Manaka, "Acupuncture, a therapeutic method of modifying the biological information system," Prof. Symposium and Satellite Symposium 8, 17th Intern. Congr. Intern. Med., Kyoto, Oct. 1984, Intern. Congr. Series No 693: Excerpta Medica, Amsterdam, pp. 344-349, 1985. [2] Y. Omura, "Patho-physiology of acupuncture treatment: effects of acupuncture on cardiovascular and nervous systems," Acup. & Electro-Ther. Res. Int. four. 1:1-4, pp. 51-141, 1975. [3] M. Asano, C. Ohkubo, "Physiological and pathophysiological events of cutaneous microcirculation observed in the rabbit ear chamber"; "intra-vital observation of organ microcirculation," Intern. Congr. Series No. 625: Excerpta Medica, Amsterdam, pp. 31-48, 1983.
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[4] M. Asano et al., "Microphotoelectric plethysmography using a rabbit ear chamber," f. Appl. Physiol. 20, pp. 1056-1062, 1965. [5] M. Asano, "Microphotoelectric plethysmography in studying the cutaneous microcirculation," Basic aspects of Microcirculation, Inter. Congr. Series No. 578, Excerpta Medica, Amsterdam, pp. 47-60, 1982. [6] W. Funk, M. Intaglietta, "Spontaneous arteriolar vasomotion," Progr. Appl. Microcirc. 3, Karger, Basel, pp. 66-82, 1983. [7] M. Asano, P.l. Branemark, "Microphotoelectric plethysmography using a titanium chamber in man," Adv. Microcirc., vol. 4, Karger, Basel, pp. 131-160, 1972. [8] A. Kamiya, "The effect of intermittent capillary flow on tissue oxygen transport in the skeletal muscle at rest," f. Physiol. Soc. Jpn. 38, p.179, 1976. [9] M. Asano et al., "Cutaneous microcirculatory effects of various vasodilator agents on the conscious rabbit, with special regard to changes in the rhythmic property of vasomotion," Bioch. Exp. Bioi. 16, pp. 341-348, 1980. [10] A. Colantuoni et al., "Quantitation of rhythmic diameter changes in arterial microcirculation," Am. f. Physiol. 246, H508-H517, 1984.
The authors of the previous paper have conducted further research looking at the microcirculatory effects of acupuncture. The next abstract describes the findings of research with rabbits fed a high-cholesterol diet, some of which were given acupuncture, the rest given no acupuncture.
ON THE EFFICACY OF ACUPUNCTURE TREATMENT FOR DECUBITAL ULCER FORMATION DURING DIETARY-INDUCED HYPERLIPIDEMIA IN THE MALE RABBIT KAzuKO ITAYA
(1), YOSHIO MANAKA (1), CHIYOJI 0HKUBO (2), MAKISHIGE ASANO (2).
(1) ORIENTAL MEDICAL RESEARCH CENTER, Kl:TAZATO RESEARCH INSTITUTE
(2) DEPARTMENT OF PHYSIOLOGICAL HYGIENE, INSTITUTE OF PUBLIC HEALTH, TOKYO, }APAN.
The effects of repetitive application of acupuncture needles (32 gauge, silver needles applied two or three times weekly), to the forehead (one needle), the back (two needles) and the hips (two needles), corresponding to yin tang (EX-HN3), geshu (BL-17), and huantiao (GB-30) in humans, was studied. Specifically, changes of the biochemical and hematological parameters of peripheral circulating blood was studied, as was the formation of decubital ulcers in male rabbits, induced by six weeks of high-cholesterol diet. In the study, no appreciable changes were observed in measuring the hyperlipidemic and anemic levels of the rabbits. However, it was observed that no decubital ulcers formed in the acupuncture group of rabbits. Three out of five animals, nine out of twenty pads, developed ulcers in the non-acupuncture group, where no ulcers formed in the group of rabbits given the acupuncture applications. These findings, specifically for the prevention of decubital ulcer formation, were discussed from the macro- and microcirculatory perspectives, based on the present and previous investigations.
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COMMENTS ON THE MICROVASCULAR R.E.C RESEARCH YosHro MANAKA
This article speculates on the importance and roles of the microcirculatory changes observed with the R.E.C. method, both in the practice of herbal medicine and more relevantly, the practice of acupuncture, especially with reference to treatment of the condition termed blood stasis. The R.E.C. methods of observation of the microcirculatory system have the advantage of allowing an ecological observation of the system. Other methods of observation typically disturb the system, through anesthetic effects, surgical effects, etc. For example, were we to open the abdominal cavities of animals to expose the mesenteries and observe the microvessels with a microscope, we would be disinclined to consider this as an infallibly accurate method. Some researchers have opened the chest of a test animal and observed the blood vessels on the surface of the heart, while applying a needle on a distal point on the animal. The obvious drawback to this method of observation is that the stimulation effects from the surgical procedure are far greater than the effects of applying a needle to the body. Thus what these researchers observe is far from what might be occurring in a normal body, with only a needle applied. Further, as some of the researchers have concluded, they could see no obvious changes in the blood vessels, when, for instance, an intradermal needle is applied. These researchers typically find that only when strong stimulation is applied, such as that given by electroacupuncture, can changes in the blood vessels be observed. Were we carelessly to believe such "scientific experimentation," we would be inclined to think that needling with strong stimulation is more effective and that methods such as shonishin (children's needles) or sanshin (touching needles) might be understood as only some kind of magical rite. Inappropriate methods of observation bias the experiment so that the effects one is supposedly looking for cannot be found. Thinking that the R.E.C. might be a useful method of observing the microcirculatory system, I asked Dr. Makishige Asano of the Institute of Public Health why this method was not more popular. His answer was that this kind of study required immense patience and careful attention for extended periods of time, which make it actually very difficult to do. Fortunately, Kazuko Itaya, my co-worker at the Kitazato Institute, has unusual tenacity and has been quietly performing such experiments for over ten years. Thus it was through her initiative that we were able to conduct such research. Over a number of years, it had been our hypothesis that while needling the body naturally had obvious stimulatory effects, there were also effects related to the body's signalling systems, utilizing tiny amounts of energy that cannot be said to be stimulation. We tentatively named this the X-signal system. We also wondered if the traditional theories of yin-yang and the five phases, so often ridiculed and ignored by modern "scientific" acupuncturists, might not be part of this system, and therefore unobservable by stimulation effects. If so, we thought that finding an appropriate method of testing and observing this would be an important breakthrough. It was in this context that we undertook the R.E.C. experiments. Many biochemical, immunological, and hematological studies on the phenomenon of blood stasis have been vigorously performed over the last twenty or so years, particularly in China. Considerable progress in pharmacological research has occurred, and this is laudable. However, we think that what plays the most important role in the disease condition of blood stasis is the microcirculatory system.
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This is hard to observe in the living body, especially the pumping function of the blood vessels, called vasomotion, which is a key factor in the metabolism of cellular systems. These movements are controlled by tiny changes in the body fluids and nerves. We have found that it is influenced by leaving one silver needle for thirty minutes, but the changes do not happen immediately; they mostly occur after needle removal and last for quite a long time. We call such an action a "bias," and believe that it constitutes evidence for the remarkable effects that very small energies can have on the living system. It would also be true that various internal and external biases could push the microcirculatory system in a negative direction, adversely affecting cellular metabolism. Dr. E.H. Starling, an English physiologist, formed the hypothesis that "the net filtration though the capillary membranes is proportional to the transmembrane hydrostatic pressure difference minus the transmembrane oncotic pressure difference." That is, filtration across the capillary membranes requires that the internal pressure in the arterioles be higher than the external osmotic pressure. Leakage back across the membranes also requires that the internal pressure in the venules be lower than the external osmotic pressure. However, those who have seen vasomotion under the microscope can understand that the change of pressure in the vessels, from the expanded capillary vessel state to the closed or contracted vessel state, is much bigger than the change of internal pressures brought about solely from the static factors suggested by Starling. Thus this vasomotion function must play a significant role in cellular metabolism. Because cellular metabolism may be maintained by the pumping function of blood vessel movement, it can be understood that the existence of vasomotion is extremely important both in the normal and the diseased condition. Further, blockage of vasomotor activity will block cellular activities, creating various secondary diseases and finally reaching to a fixed, irreversible state. The effects of needle insertion on cellular activity and health are thus very important and can be very profound. Finally, I would like to draw attention to facts described by Dr. Asano and others: 1. When he and his colleagues examined the effects of the blood circulation accelerator medications using the R.E.C. method, they found that blood circulation does indeed increase, but that vasomotion in the microvessels of the kidneys and liver often decrease. Thus they are not good medications for total metabolic function.
2. It is commonly said that application of heat to an area is good to increase circulation of blood in that area. However, they found that depending on the method of application of the heat, congestion of blood in the venules and small veins can occur, thereby leading to local edema. It is commonly thought that we can apply heat to a painful site to help relieve the pain. If this is so, then why not drink alcohol to accelerate blood flow, too? Alcohol is certainly a good vasodilator. It is obvious that this is not the answer. Further, from the perspective of the microcirculatory movements, application of heat to an area may actually be the worst thing in terms of how it affects the circulation. The reason so many doctors make such elementary mistakes is because of the enormous difficulty observing the microcirculation in vivo. In East Asian medicine, where we have the concept of blood stasis (xue yu or oketsu), it is much easier to explain how simply activating the blood can cure many difficult diseases that have not responded well to Western medical treatments. There are many herbs used specifically to activate the blood. We would also like to point out that based on our
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R.E.C. experiments, acupuncture is also excellent for activating the blood and is thus highly useful for treatment of conditions of blood stasis. Based on our own clinical experience, we think that moxibustion is also good for the same condition, as are dietary and fasting therapies.
DEEP BODY TEMPERATURE RESEARCH: OBSERVATION OF TEMPERATURE DIFFERENCES IN EACH BODY PART, USING A DEEP BODY THERMOMETER4 I
INTRODUCI'ION
One characteristic of East Asian medicine is the principle that it grasps both local and systemic body changes systematically and then addresses the imbalances. We have paid particular attention to the octahedral and quadrantal characteristics as an important pattern of change in the living body. Here we observe deep body temperature to see if other tests will show the same results as the M.I.D., which looks at the changes of the ratios of heat pain thresholds at the jing points, to study these quadrantal and octahedral characteristics. PuRPOSE
The measurement of deep body temperature has been done in many fields and many practical applications have been developed. We conducted a basic study to determine the following: 1. Can this method be used to ascertain changes in the body before and after the stimulation of acupuncture and moxibustion? 2. Can it be used to judge the effects of acupuncture and moxibustion? 3. How do the changes of the body's position affect the deep body temperature? 4. Are there physiological differences between the right and left halves of the body in deep body temperature? If so, what tendencies do they show? 5. What kinds of differences and patterns of differences appear between the central and peripheral body temperatures? 6. Are there characteristic patterns when we apply acupuncture, moxibustion, and other methods of stimulation on the body? 7. Are there characteristics in the temperature distribution of an individual who does not respond well to acupuncture and moxibustion therapies? (We have measured the pain thresholds of 40 points on the ends of the fingers and toes using the M.I.D. method, calculating ratios of left-right, superior-inferior, yin and yang channels, to grasp the patterns of disease and disease tendencies. Is it possible to use the measurement of deep body temperature to grasp the same?) 8. In conjunction with (7) above, what pattern of deep body temperature would appear in the case of subjects with imbalanced autonomic nerve disease? 9. Using strong needle techniques, such as those utilized for acupuncture anesthesia, it is easy to observe neuro-peptide changes. Yet when using tiny stimulation
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such as those in our methods of treatment, these changes are hard to measure. Is it possible that tiny stimulation can cause changes in the deep body temperature? If so, how much change can we see and how does it change? METHODS OF EXPERIMENTATION
We used the deep body thermometer made by the Thermo Company. Following recommendations made by other deep body temperature researchers, we taped the sensors, each 4.5 em in diameter, on 10 points on the body. We used the same points in both healthy and diseased subjects. These points are seen in the following diagram:
Figure 16.12a: Points measured using the deep body thermometer 1 = forehead region 2 = lower abdominal region (CV-4) 4 = right heel region (insomnia point) 3 = left heel region (insomnia point) 5 = left palm region - thenar eminence 6 = right palm region - thenar eminence 7 =left femoral region (Manaka 3 yin meeting point above SP-10) 8 = right femoral region (Manaka 3 yin meeting point above SP-10) 9 = left lower limb (ST-38) 10 = right lower limb (ST-38) CIRCUMSTANCES OF OBSERVATION
1. Change of temperature depending on the body position: a) standing on the head (yoga style) b) lifting the lower limbs while supine, with the legs vertically positioned against the wall c) dangling the lower limbs (sitting on the edge of a bed, toes not touching the floor) d) prone position (face down) 2. Change of temperature from stimulation with the M.I. Dolorimeter: a) M.l. stimulation on the left foot b) M.l. stimulation on the right foot c) M.l. stimulation on the right hand d) continuous M.l. stimulation on LI-4
3. Change of temperature by moxa stimulation: a) medial side of the left foot (LR-3, LR-4, KI-7, SP-6) b) medial side of the right foot (LR-3, LR-4, KI-7, SP-6) c) both SP-6
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4. Change of temperature by stimulation with needle application: a) intradermal needle b) with kyutoshin (moxa on the handle of the needle) c) inserting and leaving a needle for some time 5. Change of temperature caused by smoking: a) the subject smoked half a cigarette three times in a supine position. OTHER PERTINENT FACTORS
Room temperature: 23-24° Celsius Humidity: 55-68% Equipment: deep body thermometer made by Thermo company CONCLUSION
Our results from the above experiments have lead us to conclude as follows:
1. When the stimulation of acupuncture and moxibustion is given on one side of the body, the influence on deep body temperature is not necessarily seen only on that side. Chapter 27 of the Huang Di Nei Jing Su Wen (The Yellow Emperor's Classic of Internal Therapy: the Basic Questions) says that when treating a problem on one side, treat the other side. Regarding this left-right characteristic, observation of the deep body temperature showed some interesting phenomena. We had a female patient visit us because she had a cold feeling in the left lower limb and a dull pain in the lower back. She had no pathology diagnosable by Western medicine. When moxa was applied to left LR-3, LR-4, KI-7, SP-6, the temperatures of both heels dropped, even as much as fifteen minutes afterwards. When moxa was applied to the same points on the right side, the temperature of the right heel rose, while the left heel stopped dropping. Following actual treatment, with the body more balanced, the temperature of both heels rose and came closer to normal. 2. Smoking causes the peripheral temperature of the hands and feet to drop. However, at the thigh region (Manaka's three yin meeting point), no temperature variation was noted. If the subjects were extremely tired or were taking some medication, unusual changes were observed. 3. When the subject changes position from the prone to the supine with legs raised, the temperature of both heels is observed to drop. However, the temperature of the thighs does not drop. When the subject comes to the sitting position, with lower limbs dangling, the temperature of the thighs drops to that of the heels. 4. When changing from the prone to the sitting position, the temperature of the heels generally drops. Exceptions were noted in patients on certain medications, who had amenorrhea, or had some hormonal imbalance, where the temperature of the heels was observed to rise. This suggests the importance of paying attention to non-normal regional changes of the body temperature, especially when hormonal or autonomic nerve imbalances exist. 5. No corroboration was obtained for the observations in the literature on deep body temperatures, where some authors have said that changes of temperature of the forehead, chest, and abdominal regions differ from those of the four limbs. 6. When an intradermal needle was inserted on the medial side of the left lower limb, changes appeared at both heel regions and thigh regions, with little change in the other regions. Such needles seem to employ a very tiny but powerful stimulation.
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7. When moxa, intradermal needles and M.I. stimuli were applied on one lower limb, the same lower limb generally showed temperature changes. 8. During sleep, the temperature of the heels changes very little. We did have one case where the temperature actually dropped. This was seen in a patient who had suffered recurrent alopecia each spring for the previous three years. 9. The measurement of deep body temperature can be a useful clinical indicator. We were treating a patient whose adrenal glands had been surgically removed some time before. This patient needed a constant supply of adrenal hormone. She suffered many complaints such as muscle aches of the whole body, insomnia, depression, amenorrhea. She had undertaken herbal therapy without success. We wondered whether it would be possible to cure her in such a condition, as we had no information on whether we might cause some kind of shock reaction with therapy. Thus we treated her cautiously and used her deep body temperatures as a monitor of how we were doing. Her complaints greatly reduced with therapy, and the patterns of her deep body temperatures improved greatly from the beginning of treatment to the end of treatment, becoming normal, when compared to the normal values for a healthy individual. 10. There were some cases where the two sets of temperature readings did not correspond to each other, in our experiments, though it is said that the deep and surface temperatures often change together. 11. We did not notice big changes in temperature where there were surgical conditions, or where there were problems of the surface circulation and blood flow. 12. We found that in some cases it took 35 to 100 minutes to get a stable reading of the deep body temperature. According to the literature, it usually takes 20 to 30 minutes to get a stable reading of the deep body temperature. We have described a very rudimentary, basic experiment. Our findings are intriguing, and we hope to continue studying how to use the deep body temperature measurements in our studies of acupuncture and moxibustion. We also think that by improving the equipment (shortening the time it takes to arrive at the deep body temperature, improving the mobility of the subjects, etc), it is possible to expand the usefulness of this technique in research.
AURICULAR INVESTIGATIONS: FUNDAMENTAL STUDIES OF THE AURICULAR ACUPOINTS USING AN ELECTRICAL PROBE5 KA.zUKO ITAYA AND YOSHIO MANAKA INTRODUCTION
Auriculotherapy, first proposed and introduced by Dr. Paul Nogier, has gradually found adherents and practitioners throughout the world. China, the birthplace of acupuncture, has its own style of auriculo-acupuncture, claiming it as its own, since there are some references to such ideas in the Chinese classics. We have applied these forms of auriculotherapy clinically and we have no doubt as to their therapeutic validity and value. As it has developed, there has been an evolution in the manner by which the auricular points are located. Dr. Nogier first began by applying pressure to
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points on the auricle to locate the sensitive points. He then noticed that certain changes in the skin could be found, such as redness, thickening, pigmentation, etc., which he theorized would correlate to the desired treatment points. The electrodermal acupoint probes employed in various body acupuncture methods were utilized for finding reactive points (points that show a decreased electrical resistance). Use of such probes led to the development of specific auricular acupoint probes. Lately we have been looking into a method of finding points using magnetic contact. In this study, working jointly with the Stanley Electric Company, we designed and manufactured an experimental device, by which we probed the auricles to investigate the distributions of reactive points on the auricles. EXPERIMENTAL METHOD
Subjects: 56 sitting subjects (52 male, 4 female), aged 18 to 55. Method of measurement: The inner and outer surfaces of both ears were probed. The patterns of distribution of reactive points were marked and photographed. Environment: Room temperature, 23° Celsius; relative humidity 60%. Analysis: As well as measuring the reactive auricular points, we used the M.l. Dolorimeter to measure the patterns of heat-pain threshold ratios of the hands and feet, to compare findings for each subject. FINDINGS
1. The reactive points concentrated at specific areas, with distributions that appeared as points, lines, or areas (see Figures 16.13.a-d).
Figures 16.13a-d : Reactive auricular points concentrated at specific areas
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2. The patterns of reaction appear to correlate to the embryologically derived areas of the auricles (see Figure 16.14). 3. Even for a single individual, we could see obvious differences between left and right, anterior and posterior surfaces of the auricles. 4. We tried various measurements of the exact boundary between the anterior and posterior surfaces of the auricles. These seemed to be present, but nothing is said about this in the literature.
Figure 16.14: Patterns of reaction correlating to embryologically derived areas of the auricles
5. Patients showing a high density of reactive points on the auricle had at least some abnormality, though not always a pathology. When we compared the readings of the M.I.D. for patients with these areas of high density of reactive points, we found correlations between the presence of the high density of reactions and abnormalities in the M.I.D. 6. When we mapped out the distribution patterns, there seemed to be areas of the auricle where reactions were easily manifest, and areas where they were not shown as regularly:
Figure 16.15. Auricle mapping of reactive areas
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Zone A B
c
D E F G
H I
J
K L M N
0
p
Left auricle 0 5.4 17.9 1.8 37.5 30.4 41.0 3.6 19.6 23.2 28.6 17.9 1.8 42.8 39.2 37.5
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Right auricle 0 5.4 23.2 3.6 39.3 28.4 55.4 1.8 32.1 16.1 23.2 19.6 3.6 39.2 37.5 25.0
Percentage of subjects showing reaction in corresponding auricular zones (Figure 16.15) CONCLUSIONS
1. Further studies are necessary and appropriate to define the optimal characteristics of the electrical measurements needed to determine the locations of the reactive points, taking into account individual variations. In the experiment we conducted, we applied from 220 kilo ohms to 148 kilo ohms and also 108 kilo ohms as our measurement range. Differing patterns of reactive points showed with the different resistances. In Figures 16.16a-d, the ringed dots were measured in the range of 220 kilo ohms, while the filled-in dots were measured in the range of 154 kilo ohms.
Figures 16.16a-d: Differing patterns of reactive points
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2. It is difficult to agree with Dr. Nogier's initial thoughts about the specificity of auricular points to body parts. Depending on the methods of observation, different points can manifest. We feel it necessary to check more exactly whether stimulation of one point in the auricle produces a reaction at a specific point or area of the body. 3. Dr. Nogier says that the upper part of the auricle correlates to the distal parts of the four limbs and the lobe of the auricle to the head, with all other parts of the body distributed within the rest of the auricle. The lack of ear lobes in anencephalies and the occurrence of tophi on the toes and helix of the auricle seems to bear out these correlations, though modem medical practices are changing these patterns of distribution. We hope that the above discussions serve as a useful basic study of the correlations of auricular points to the body.
MOXIBUSTION (KYU): HISTORY, EFFECTS AND METHODS Moxibustion is a traditional medical therapy, the purpose of which is to cause certain organismic reactions by applying heat stimulation to certain parts of the body surface. This heat is given directly or indirectly by the moxa, activating the body's natural healing powers, both curatively and preventatively. HISTORY
Moxibustion is one of the traditional Chinese therapies, often combined with acupuncture in clinical practice. Chapter 60 of the Su Wen states: "Put moxa three times on the part of a body bitten by a dog." Further it is recorded as a method of therapy from injury of the body. Though it is difficult to trace the origin of such a form of therapy, it is worth noting that varieties of heat therapy similar to moxibustion existed in the West as well as the East. Hippocrates (460-375 Be) said: "If medication cannot cure the disease, apply an iron. If the iron cannot cure the disease, apply heat. If heat cannot cure the disease, it is incurable." In China, heat therapy was used from olden times for the treatment of internal diseases as well as injury. Chapter 73 of the Ling Shu states: "If all the yin and yang are vacuous, treat them with heat." It points out that moxibustion therapy is helpful for chronic disease when the patient's physical strength had begun to wane. Later, when the systematization of the correlations between acupoints and diseases was made, this developed as a major portion of what we now call Chinese acupuncture and moxibustion therapy. The Mawangtui archeological remains, excavated in 1973, brought to light two medical texts that described moxa therapy, the Yin Yang Shi Yi Mai Jiu Jing (The Yin Yang Eleven Vessel Moxa Treatise), and the Zu Bi Shi Yi Mai Jiu Jing (The Leg and Arm Eleven Vessel Moxa Treatise). The characters used in these texts were of the style of the Qin dynasty (255-206 Be). Thus we may surmise that the practice of moxibustion therapy was already systematized by that time. In the ancient classical medical literature, acupuncture and moxibustion were always discussed and developed together. Because moxibustion could be easily utilized by lay people, it developed as a folk remedy tradition in both China and Japan.
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Because this kind of folk practice cannot be found clearly in the traditional or professional literature, it is hard to say much about its history or popularity. Since the Meiji reformation era in Japan, when the practice of acupuncture and moxa therapies were legislated by the government, moxa therapy was outlawed as a folk remedy. Its practice has been declining since then, almost to the point of vanishing. Yet one can still find "family recipe" moxa therapies, doyo moxa, moxa to prevent stroke, etc. According to the literature, moxa was first introduced to Japan from China through Korea, by Chiso, who brought the Ming Tang Tu and other texts with him. By 701, acupuncture was already an established profession, with practitioners, teachers, and students. Moxibustion was part of the whole system. In 984 Yasuyori Tamba wrote his massive, 30-volume !shin Po [The Heart of Medicine]. Two of these volumes were dedicated to describing the principles and practice of acupuncture and moxibustion. Between the Kamakura era (1185-1333) and Muromachi era (1333 -1568), moxa was used popularly, but mostly for the treatment of the many war wounds of that time. It was also used for treating problems such as furuncles, scrofula, and Whitlow's disease. Dr. Gonzan Goto, who lived in the middle of the Edo era (1600 - 1853), thought that all diseases were the result of stagnant qi. He recommended moxa as one of the better external therapies for this, as well as certain herbs and hot baths for internal effects. Of moxa he said: Moxa has the ability to reach to the stagnation of coldness in the earth immediately because it has the active qi of the sun. It is thus good for curing 7 or 8 out of 10 cold stagnation diseases that affect the abdominal region.
Since then, moxa has been recognized for its efficacy in the treatment of internal diseases as well as external problems and injuries. According to Sorei Yanagiya, who conducted extensive research of the traditional literatures, the Japanese body of literature on moxa therapy is more extensive, with a greater variety of techniques described, than the Chinese body of literature. In 1674, during the second half of the Edo era, when acupuncture and moxa therapies were very popular in Japan, the Dutch doctor, W. Ten Rhijn, visited Japan. Several years later, in 1690, the German doctor E. Kampfer visited. Upon returning to Europe, they wrote books about Japan that mentioned moxa frequently, and it was then that moxa therapy was introduced to Europe, along with the Japanese word "moxa" (derived from the Japanese "mogusha") and the word "moxibustion" - a compound derivative of moxa and combustion. When the Medical Practitioners' Law was passed in 1895 during the Meiji era, acupuncture, moxibustion, and massage were not recognized as medical therapies. They were given a much lowlier status, as a kind of folk remedy, and their practice was forbidden except by the blind. In 1905 a movement was undertaken to try to elucidate acupuncture and moxibustion therapies using Western medical research methods. Its leader was Dr. Kinnosuke Miura, who was a professor in the medical department of the Tokyo Teikoku University. As a result of this movement, the use of serological and immunological studies became common in medicine and many of these were presented relative to moxibustion techniques. One study showed findings that moxibustion therapy created bum injuries on the skin that resulted in the destruction of skin tissues. The study found that some of the products of these bums, e.g., denatured proteins, were absorbed into the blood stream and could work in the body, much like a drug does. With these kinds of studies, moxa therapy was recognized as a reasonable and meaningful therapy, even from the perspective of Western medicine.
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While these developments were occurring in Japan, most Western-trained physicians tended either to ignore or to look contemptuously at the traditional theories. In order to justify their work to the majority of these Western-trained physicians, many medical researchers studying the effects of moxibustion looked primarily at the effects of the toxins created by the burns, focusing on the non-specific immunological effects and the pharmacological effects of these substances. They tended to ignore many other important concepts and variables such as the acupoints selected and their various effects. After the Second World War, the American army tried to prohibit the practice of traditional medicine in Japan, including acupuncture and moxibustion, but ultimately was persuaded not to banish these important therapies. Following this, the Japanese government decided to legitimize and standardize the practice of acupuncture and moxibustion. In 1947, laws were passed regulating the practice of moxibustion, acupuncture, and anma massage such that each started being separately licensed. These laws were revised in 1970 to include the practice of shiatsu. Since Nixon's visit to China in the 1970's, when acupuncture anesthesia was introduced to the Western world, the interest of the physicians and medical community expanded greatly, with more and more studies into the mechanisms of the action of acupuncture being conducted around the world. But while this occurred, interest in moxa therapy began to decline. The custom of using home/folk therapy began to wane, partly because of the gradual decline of the family unit in Japan. More and more people began to disdain the scarring effect of moxa and were afraid of the heat of the moxa. Because of these fears, the use of electric moxa apparati arose, with many forms of indirect moxa/heat therapy becoming popular. MECHANISMS AND FUNCTIONS
We can hardly say that the exact mechanisms of how moxibustion affects the human body have been satisfactorily elucidated. However, if we combine ancient knowledge with clinical experiences and the research conducted at the beginning of this century (see the end of this paper for a list of research documents), we can compile the following factors: 1. Among the substances that are produced as a side effect of the burn from moxa application, some possess pharmacological functions that have a therapeutic effect. 2. According to the studies on the effects of moxibustion on alkalosis and acidosis, moxibustion can prevent some pathological effects of such conditions, e.g., experimentally induced osteoporosis in animals can be prevented.
3. According to the studies on the effects of moxibustion on blood serum, we can deduce that it has immunological therapeutic effects. 4. Recent studies on the analgesic effects of acupuncture are numerous. Moxibustion has also been used for its analgesic effects. Thus it is possible that some mechanisms elucidated for acupuncture may also be operating with moxibustion. 5. Because moxibustion can leave scars after application, or occasionally create ulcerous sores, it can be said to have a more continuous stimulation effect, and thus must also have functions and mechanisms that differ from those of acupuncture. 6. When inflammation occurs, moxa has the effect of inhibiting the spread of the infection and localizing it. It is believed that this is achieved because moxibustion has the effect of inhibiting hyaluronidase (an enzyme produced by bacteria.)
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7. Applying moxibustion to an injured area has the functions of antisepsis, promotion of blood coagulation, and regeneration of the granulation tissues. It has been used for its anti-inflammatory effect since ancient times. 8. When we stimulate the skin with moxa, a neural dermatome reflex occurs. When the body reacts to pathological phenomena, its reactions often lead to repletions and depletions. For example, diarrhea can lead to intestinal spasms and the feeling of needing frequent bowel movements. The inadvertent ingestion of a foreign substance can trigger spasms of the trachea and esophagus, causing the substance to become lodged. In these cases, if we apply a stimulation to the relevant dermatome, for example with the application of moxibustion, we can interrupt these reflex reactions and regulate the problem. Many other aspects of the functions and effects of moxa therapy exist. We might list the e'ffects of particular acupoints and their channels beyond the baseline effects of the stimulation, or the change in a patient's internal condition following prolonged use of moxibustion. We must wait for future studies for an elucidation of these effects. METHODS OF MOXA APPliCATION
Therapeutic application of moxa can be roughly divided into two main types: scarring and non-scarring. Sometimes the former is called direct moxa and the latter indirect moxa, though direct moxa is often applied without scarring. Besides these, a number of related techniques have been developed, such as pasting medicinal rouge, varnish, Japanese ink, pepper, or ginger on the skin to elicit similar effects. Scarring moxa: In this therapy, moxa is applied directly onto the skin, ignited by incense, and left to burn down to the skin, where it may cause some scarring. There are three types of scarring moxa: too netsu kyu, shoo shaku kyu, and dana kyu. The more general and commonly used is the too netsu kyu. Small pieces of cone or rice-shaped moxa the size of a grain of rice, a half grain of rice, a sesame seed, or a tiny thread areplaced on the acupoints and ignited. The shoo shaku kyu method is a less refined form of the latter method and is employed specifically to cauterize, and is used on warts, corns, and the wounds of poisonous insects or snakes. The Dana kyu method utilizes large pieces of moxa followed by the application of certain herbal pastes on the point to intentionally cause ulcers to form. This method is applied to give strong stimulation. Though not widely used today, in the past it was applied for chancre, atrophy of the optic nerve, etc. It was also used once a year to correct disease tendencies, e.g., people who easily catch cold, have asthma, diarrhea, etc. Similar Western therapies would be the fontanelle blister plaster therapy of Dutch medicine and the abces de fixation of French medicine (creating non-bacterial inflammation by injecting a little turpentine oil into the gluteal muscle to promote non-specific immunity and as a modulation therapy.) Non-scarring moxa: This method gives heat only indirectly to the skin and is thus non-scarring. For example, slices of garlic or leek are placed on the skin and moxa burnt on these. There are many kinds of non-scarring moxa, the following being the most popular: - Beanpaste moxa: Here beanpaste (miso) roughly the thickness of a quarter is placed on the skin; then moxa in the size of an aduki bean is placed on top of it and ignited. Sometimes ground herbs or garlic are mixed in the bean paste. - Garlic moxa: Garlic cut to about 5 mm thickness is used as above instead of the beanpaste.
352
Appendix Two: Research Papers of Manaka and Itaya
- Ginger moxa: A slice of ginger cut to either a thickness of 5 mm or 2 em is used in the same manner as the miso or garlic. - Salt moxa: Salt is placed inside a column to a depth of about 1 em and moxa is burnt on the salt. If applied to CV-8, which might for example be used in the case of diarrhea with coldness, the moxa is applied until warmth is felt inside the abdomen. - Kyutoshin (moxa on the handle of the needle): The needle is inserted at the acupoint, and a piece of moxa, the size of the head of the thumb, is affixed over the tip of handle of the needle, ignited, and allowed to burn completely. Sometimes a safety shield of some kind is placed to prevent accidentally dislodged moxa or excessive heat from contacting the patient's skin. - Chinetsukyu: With this technique, moxa heat is given for only one brief moment. A large cone is applied to the acupoint and then ignited. At the moment the patient begins to feel heat, it is removed, or a smaller cone is applied, and at the moment the patient feels the heat of the second cone, it is either removed or extinguished at the point by pressing it with the finger. If placed every 2 or 3 em around an inflamed area, it has anti-inflammatory effects. It works well for conditions such as inflammation of the knee joint. This method has a more powerful effect than simply applying hot compresses over the entire area. It is also good for promoting reabsorption of blood if subcutaneous bleeding occurs upon removal of the needle. Kazuko Itaya has found that using tweezers to pick up the moxa and move it closer to or further from the acupoint is even more effective for this problem. It is also possible to use small pieces of moxa at the point where the needle or intradermal needle punctures the skin, to heighten the effects of the needle. Chinetsukyu usually elucidates a comfortable feeling, and provides a stronger effect than the moxa pole (see below). This method can be used distally to an inflamed area, and can also be used on the 8liao points (BL-31, BL-32, BL-33, BL-34), for people who are sensitive to cold. - Onkyu: This method uses moxa placed in a bamboo tube, ceramic bowl, or unglazed bowl. It is ignited and when the heat is felt at the surface of the container, the container is gently rubbed on the skin. - Moxa pole: Moxa is firmly compressed into a cigar-shaped pole. One end is ignited and held close to the skin. When heat is felt it is withdrawn and then reapplied again, withdrawn when heat is felt again, and so on. It can be used on the acupoints or pressure pain points for about 10 minutes or until the skin turns reddish. - Dennetsukyu: Heat is applied by some kind of electrical heating element instead of burning moxa. There are a variety of devices used for this purpose. CAUTIONS WHEN USING MOXIBUSTION
1. Avoid moxibustion when the stomach is too full or too empty, i.e., if hungry or just after a meal. 2. Avoid the use of moxibustion in serious illnesses, such as the last stage of cancer, high fever, extreme fatigue. 3. Avoid moxa on the lower abdomen of a woman who is pregnant or possibly pregnant. 4. Avoid using moxa one hour before or after taking a hot bath. 5. Moxibustion administered after drinking alcohol might cause abnormal reactions.
Appendix Two: Research Papers of Manaka and Itaya
353
6. Avoid the use of moxibustion directly over areas of skin disease and on large superficial blood vessels. 7. Moxa scars on severely diabetic or allergic patients can easily become infected. 8. When applying moxa, it is a good idea always to locate and treat the points while the patient remains in the same position. 9. Do not moxa on the face, the front of the neck, or the chest region without good reason. 10. There are points which are prohibited for use with moxa. Although these restrictions vary in each of the classical texts, it is important to pay attention to these prohibitions. (See part 6 below.) IMPORTANT JAPANESE RESEARCHES IN THE FIELD OF MOXIBUSTION, FROM 1912-19406
The following is a list of important papers published between 1912 and 1940 in various journals, describing some observed effects of moxibustion. Since 1940, many more research papers in many journals have been published- too many to list here- with many more findings. Schools in Japan use the research described in the sources listed below as basic information in the study of moxibustion practice. Michio Goto, "Head's zones and ancient Japanese acumoxa therapy," Chugai Iji Shinpo 763,1912. Jujiro Kashida, Shigeo Harada, "Moxibustion therapy", Tokyo Igakkai Zasshi 26:12, 1912. Michio Goto, "Head's zones and acumoxa therapy," Kyoto Igakkai Zasshi 11:4, 1914. S. Ochi, "The effects of moxa therapy on kidney function, especially diuresis," Kyoto Igakkai Zasshi 11:5, 1918. Kaoru Tokieda, "An experimental study of moxibustion (report 1)," Nihon Yakubutsu
Zasshi 2:1, 1926. Kaoru Tokieda, "An experimental study of moxibustion (report 2)," Nihon Biseibu-tsug-
aku Zasshi 20:16, 1926. Kaoru Tokieda, "An experimental study of moxibustion (report 3)," Nihon Biseibu-tsug-
aku Zasshi 20:16, 1926. Henryo Otani, "Homeopathy and stimulation therapy," Therapy 3:8, 1926. Shimentaro Hara, "Effect of moxa on hemoglobin and RBC count," Iji Shinbun 1219, 1927. M. Aochi, "Effects of moxa on blood cells and serum, "Nisshin Igaku 17:3, 1927. Shimentaro Hara, "Histological study of skin treated with moxa," Fukuoka Ika Daigaku
Zasshi 22:2, 1929. Shimentaro Hara, "Effects of burns on the blood and serum of bum-injured rabbit,"
Fukuoka Ika Daigaku Zasshi 22:2, 1929. Henryo Otani, "Stimulation therapy," Jikken Iho 174, 1929. Henryo Otani, "Therapeutic effect of stimulation therapy," Chiryo Oyobi Shoho 107,1929. Henryo Otani, "Stimulation therapy," Naika Gaku, 1929. Shimentaro Hara, "Recovery tendencies of tuberculous animals treated with moxa," Fukuoka Ika Daigaku Zasshi 22:5, 1929. Shimentaro Hara, "Tuberculosis and moxibustion," Jiechi Ika to Rinsho 6:9, 1929. Shinji Ota, "Effects of moxa on subcutaneous histiocyte cells (report 1)," Nihon Biseibutsugaku Zasshi 24:4, 1930. Shinji Ota, "Effects of moxa on subcutaneous histiocyte cells (report 2)," Nihon Biseibu-
tsugaku Zasshi 24:4, 1930.
354
Appendix Two: Research Papers of Manaka and Itaya
Shimentaro Hara, "Moxa therapy for chronic bladder problems," 1930. Noriteru Takino, "Experimental study of bums on serum potassium levels," Shinkeigaku Zasshi 31:9, 1930. Kazuo Komai, "A physiological study of moxa," Kyoto Furitsu Ikadagaku Zasshi 4:4, 1930. Tan Katase, "The effects of nutrient elements on the organism and my conclusions about health and disease based on this study," Nisshin Igaku 20:12, 1930. Henryo Otani, "Stimulation therapy," Nihon no Ikai 20:1, 1930. Bunkichi Kamei,"Effects of bums in rabbits on blood coagulation time," Tohoku J. of Experimental Medicine 15:5-6, 1930. M. Aochi, "General stimulation therapy," 1931. Hisashi Kurozumi, "Effects of non-oral intake of same or different organic emulsions and milk on the development of the bone system and the generation of alimentary and bone disorders," Osaka Igakkai Zasshi 3:11, 1931. Shigeteru Sugiyama, "Real movement of the Amet nucleus, based on the functions of WBC," Nihon Iji Shinpo :485-7, 1931. Shimentaro Hara, "Neglected moxa therapy," Chiryogaku Zasshi 1:12, 1931. Shigemoto Mizuno, "Effects of shading the radiation of moxa on the change of acidosis in bone," Osaka Igakkai Zasshi 32:5, 1932. Shigemoto Mizuno, "Effects of moxa on the change of alimentary acidosis in bone," Osaka Igakkai Zasshi 32:6, 1932. Kazuo Komai, "Experimental study of moxa therapy and theory," Jikken Irigaku 2:3, 1932. Kiyokichi Yamashita, "Function & form of WBC in various kinds of experimental disease (No.2)," Kllnazawa lkadaigaku Juzenkai Zasshi 38:8, 1932. Yasuichi Nagato, "Experimental study on moxa therapy" Osaka Igakkai Zasshi 31:8, 1932. Shigeteru Sugiyama, "Examination of the movement of nuclei in multinucleate WBC," Kilnazawa Ikadaigaku Juzenkai Zasshi, 38:1, 1933. Shiro Watanabe, "Changes in the voracity of subcutaneous histiocytes in various experimental diseases," Kilnazawa lkadaigaku Zasshi 38:7, 1933 Tatsusaburo Obayashi, "Study of the patho-anatomy of the organic changes following moxa and similar stimuli of the skin," Kurashiki Chuo Byoin Nenpo 7:2, 1933. Yoshiharu Oshima, "Effects on the organism of moxa heat-stimulation on points," Teikoku Shinkyu Zasshi 3:7, 1933 Saburo Watanabe, "The viscero-(cutaneous) reflex from a therapeutic view," Osaka Iji Shinpo 5:1-4, 1934. Shoichi Tamura, "Effects of moxa on the functions of WBC in the human body," Kilnazawa Ika-daigaku Juzenkai 39:11,41:2, 1934-36. Ryo Irie, "Study on the effects of moxa and bums on the viscosity of blood in rabbits." Shigeo Kanda, "Effect of moxa and hot and cold compressions on the acidity of gastric juice," Shokakibyogaku 3:1, 1938. K. Takeda, "Effects of moxa on aqueous and vitreous humors," Hokuriku Igakkai Zasshi 36:,1937. K. Takeda, "Effect of moxa on the blood and eyeball," Nihon Gankkai Zasshi 41-43:, 1937-39. Katsuji Okino, "Effects of moxa on the accumulation of pigment in the reticuloendothelial and histiocyte cells in the mouse," Okayama Igakkai Zasshi 49:12, 1937. Ichiro Deguchi, "Relation of sedimentation rate of RBC and the movement of the nucleus of WBC in various experimental diseases," Kilnazawa Ikadaigaku Juzenkai Zasshi 45:6, 1940.
Appendix Two: Research Papers of Manaka and Itaya
355
ACUPOINT CONTRAINDICATIONS: AN HISTORICAL REVIEW
F'rRsr COMPILED BY SoREl YANAGIYA IN HIS TEXT, SHINKYU [JUTSU NO MON, FROM TWENTY EIGHT DIFFERENT SOURCES TEXTS USED IN THE COMPILATION
1- Shinkyu Jyu Hoki (1726) 2- Nei Jing (circa 300 BC) 3 - Zhen Jiu Jia Yi Jing (282) 4- Ming Tang Jing (circa 300 BC ?) 5- Zhen Jiu Ju Ying (1529) 6- Tong Ren Shu Xue Zhen Jiu Tu Jing (1026) 7- Yi Xue RuMen (1575) 8- Xi Fang Zi Ming Tang Jiu Jing (1311) 9 - Zi Sheng Jing (1220)
Legend d not in pregnancy e not in women f not in eight year-old or younger
no moxa no needle no deep needle
a b c
10- Kei Ketsu I Kai (1807) 11 - Wakan Sansai Zue (1712) 12 - Lei Jing (1624) 13- Wai Tai Pi Yao Fang (752) 14- To I HoKan (Korea, 1613) 15- Qian fin Fang (652) 16- Mr. Yamomoto (early 20th century) 17- Mr. Matsumoto (early 20th century)
LUNG CHANNEL
Text 1
LU-1
LU-8
LU-10
LU-11
a
a
a
a
b
a
a
b
a
a
b/c b
a
a
LU-2
LU-3
b
LU-5
a
2
3 4
5 6 7
b/c a
a
a
a
a
a
a
a
a
a a
a
8 9
10 11
a
a
b
a
a
a
12 13
a
a
14
b
a
a
15
b/c b
a
a
b/c
a
16 17
a a
a
a a
a
a
a
a
Appendix Two: Research Papers of Manaka and Itaya
356
HEART AND PERICARDIUM CHANNELS Text
HT-2
HT-3
PC-8
PC-9
1 2 3 4 5 6 7
b
a
a
a
b b
a a
b
8 9
10 11
12 13 14 15 16 17
b
a
b b
a
LARGE INTESTINE AND SMALL INTESTINE CHANNELS Text
LI-1
1 2
LI-4
LI-13
LI-19
LI-20
Sl-9
Sl-18
b
b b
a
a
a
a
b
b b b
a a a a
a a a
a a/b
a
a
a
a/b
a
a a
a
a
a a
a a
a a
a a
3
4 5 6 7
a
a
8 9
10
a
b/d
11
12 13 14 15 16 17
b
a
b b
b b b b
Appendix Two: Research Papers of Manaka and Itaya
357
TRIPLE BURNER CHANNEL Text TB-4 TB-7
TB-8 TB-16
1
b
a
TB-18 TB-19 TB-20
a
TB-21 TB-22 TB-23
b
2 3
b
a
b
a
a
4 5
a
b
a
b
b
6
a
b
a
b
a/b
b b
b b
b
b
b
b
7 8 9
a
10
a
11 12 13 14
b b
b
a
a a
a
a
a a
a
a
a
b
a a
a
a
15 16
a/b a
a
b b
a
a
b
a
a
b
a
17
b
a a
b
a
b
b
b
b
a
a
a
SPLEEN CHANNEL Text
SP-1
1
a
SP-6
SP-7
SP-9
SP-11
SP-16
SP-20
a
a
b
a
a
a
a
b
a
a
2 3
b/d
4 5
a
b/d
6
7 8 9
a
a
a
b
a/b a
a
10
a
a
a
b
a/b
a
11 12 13 14 15 16 17
b
b/d a a a
b
a
a
b
a
a
a a
b b
a
Appendix Two: Research Papers of Manaka and Itaya
358
KIDNEY CHANNEL Kl-21
KI-11
KI-7
KI-2
Text
b
1 2 3 4 5 6 7
b
b
b b
8 9
10
b a/d
11
12 13 14 15 16 17
b
STOMACH CHANNEL Text ST-1 ST-7 ST-8 ST-9 ST-12 ST-17 ST-30 ST-31 ST-32 ST-33 ST-35ST-38
1 2 3 4 5 6 7 8 9
a/b a
a
a/b a
a
b
a
b
a/b
a/b
b
a/b
a
a
a
a/b
b
a
a
a
b
a
b
a
a
a/b
b
a
b
a/b
a
a/b
b
a/b
b
a
a
a
a
a
a
a/b
a
a
a
a
10
a/b a a
a
11
a/b
a
a
a
b
a
a
a
a
a
a
a
a
a
a/b
a a
a
a
a/b
a
a
a b
a/b/c b/c a b
a/b a/b
a/b
12
a
a
a
a
a
13
a
a
a
a
14 15 16 17
a/b a a
a
a
a
a
a
a
a
b/c b
a/b
b
a
a
b
b
a
b
a/b
a a/b a
a
b
a a
a
a
Appendix Two: Research Papers of Manaka and Itaya
BLADDER CHANNEL
Text
BL-1
BL-2
1
a
a
BL-5
BL-6
BL-8
BL-9
BL-10
BL-11
a
b
b
a
a
a
2 3
a
a
4 5 6 7
8 9 10
11
a a a/b a a a a
a a a/b a a a
a
a a a/b
b
b
b
b
a a
b b
b b b
b
b
b
a
b b
b b
a
12
a a a a a
13 14
a
a
15
a a
16 17
BLADDER CHANNEL (CONTINUED)
Text
BL-15
BL-30
BL-36
BL-37
BL-40
BL-56
BL-62
1
a
a
a
a
a
b
a
2
a
3
b
4 5 6 7
8 9
a a a/b a
10
11
a/b
a a a/b
a a
a
a
a
a
a
a
b b b
a
a
a
a a
b b
a
a
a
a
a
a a
a a
a a
b b b b
a
12 13 14
a
15 16 17
b
a a a a a
a
359
Appendix Two: Research Papers of Manaka and Itaya
360
GALLBLADDER CHANNEL
Text
1 2 3 4 5 6 7 8
GB-1
GB-3
GB-15 GB-18 GB-21 GB-22 GB-32 GB-33 GB-42
a
b
b
b
a/b a
b b b/c
a
b
b/c
a a
a
a
a
a
a
a
a a
a
a
a
a/b
a/b a
a a/b a
a
9
10
a/b
b/c
11
12 13 14 15 16 17
a a a
b
a
b/c b b
b a/b b/d
b
b a a
b
b
a/b a
a/b
a a
a/b a
a/b
a a a
a a a a
a a
a
a
CV-7
CV-8
CV-9
CV-15 CV-17
b
b
b
a/b
RENMAI Text
CV-1
1 2 3 4 5 6 7
b
CV-3
CV-5
CV-6
b
b
a
b
b b a
b b b
b
b b
b a
a/b b b b
a/d
9 10
12 13 14 15 16 17
a/b a a/b a
8
11
b
b
a/d
b a/e a/b/d a/d a/e a b/d
b
a/b/e
a/d a/d
b b b b
b b
a/b a/b a a/b a/b a/b
b b
b b
Appendix Two: Research Papers of Manaka and Itaya
361
DuMAI
Text GV-6 GV-10 GV-11 GV-15 GV-16 GV-17 a a/b b a a b a a a a a a a b b a a b a a a b a/b b b a a a 8 b a a 9 10 a/b b a 11 a a a/b 12 a/c 13 a a a a 14 a b b a a a/b 15 a a a a 16 a b b a a b 17 a/b b b a a b
GV-18 GV-22 GV-24 GV-25
1 2 3 4 5 6 7
b
b
a
b b b/f b
b b b
a
b b
b a
a a a a a
a b b b
b b b b
a a a a
NOTES
1 S.B.: I have called this the Meridian Imbalance Diagram rather than the Channel Imbalance Diagram because earlier English translations used the term "meridian," which is the term by which these papers are generally known. 2 S.B.: An American physiologist from the 1950's. 3 The following article was published in "Manaka Yoshio Ronbunsho" (Collected essays of Yoshio Manaka), in Shinkyu Topology Gakkai 15, 1988, pp. 244-251. A version of the same paper also appeared in Acupuncture and Electro-therapeutics Research International Journall2, 1987, pp. 45-51, and was abstracted in vol. 2 of Microcirculation: An update, proceedings of the Fourth World Congress for Microcirculation, Tokyo, July 1987, published in Excerpta Medica, Amsterdam, New York, London, 1987. The article was first presented in part at the Symposium on Traditional Oriental Medicine, the Science and Technology Agency, Tokyo, Japan, October 5, 1985. 4 First published in Clinical Body Temperature, vol. 3, supplemental issue. 5 Outlined from a paper originally presented at the 29th Nihon Toyoigakkai Gakujutsu Sokai, May 1978. 6 This list is partially selected from Sorei Yanagiya's Shinkyu Ijutsu no Mon (Introduction to the Medical Art of Acupuncture and Moxibustion), pp. 101 passim, where he compiled a list of research papers on acupuncture and moxibustion.
APPENDIX THREE
SPECULATIONS AND RESEARCH ON THE ROLE OF YI }lNG SYMBOLS AND SIGNALS IN ACUPUNCTURE THEORY & PRACTICE REAUSM AND SYMBOliSM IN THE YIN YANG CATEGORIES OF CHINESE MEDICINE
We have explored the use of colors of the five phase and other points in relation to the symbols of the Yi Jing. We stimulate the acupoints using a biphasic threechannel fiber optic light source (and other methods) using classes of acupoints that we have found respond favorably to specific signals. The following tables summarize these findings and correspondences. After the tables we look at further findings which show the importance of the Yi Jing symbols and concepts in acupuncture) According to traditional theory, the trigrams correspond to the five phases. We have matched each with coded signals as follows: Trigram Li
Kun Dui Qian Kan Gen Zhen Xun
Phase
Signal
M.
Fire
Red-green-red
:lljl
Earth
Green-green-green
ft
Metal
Green-red-red
~t
Metal
Red-red-red
~
Water
Green-red-green
N
Earth
Red -green-green
Wood
Green-green-red
Wood
Red-red -green
Character
• cc
~~
The color red matches the unbroken (yang) line and green the broken (yin) line. To use the color coded sequences, the color of the bottom line in the trigram should be placed closer to the beginning of the channel and the top line equivalent color, closer to the end of the channel. Thus to use zhen (green-green-red), on the large intestine channel, red is placed closer to LI-1 and green towards the end of the channel along its flow. Investigations using the same methodologies as those described earlier in this text have shown the following correspondences to date:
364
Appendix Three: Yi Jing Symbols and Signals
Correspondences of Trigrams to Phases and Points
Zhen Xun
Wood
wood points
Xi-cleft points
Wood
wood points
Xi-cleft points
Li
Fire Earth
fire points
Source points of yang channels
earth points
Source points of yin channels
Earth
earth points
Last point on channel; source points of yin channels
Metal
metal points
Metal
metal points
Water
water points
Jing points on yang channels Jing points on yang channels First point on channel; luo points
Kun Gen Dui Qian Kan
The wood trigrams have shown favorable responses (decrease in associated pressure pain points) when applied to the xi-cleft points. The earth trigrams have shown favorable responses when applied to the yin channel source points, with gen producing favorable responses when applied to the "last points" of the channels. These "last points" are not actually the "last points" on the channel flows; rather they are the first or last points on the face for the yang channels and midline meeting points for the yin channels. Essentially they are the most medial points on the channel flows (see the tables below for details). The water trigram, on the other hand, has shown favorable response when applied to the jing points of all the channels and the luo points of all the channels. The effects of gen most medially and kan at the most extreme portions (the jing points) are important. We have formulated principles based on their combined uses, the "kan-gen phenomenon" (see below). The fire trigram, li, has shown good responses when applied to the source points of all the yang channels, as have the metal trigrams when applied to the jing points of the yang channels. Each trigram also shows favorable responses when applied to the corresponding class of five phase points.
Figure 17.1: Manaka's Yi Jing signalling device
THE KAN-GEN PHENOMENON A simple way of using some of these correspondences takes advantage of the stop-start characteristics of the gen and kan trigrams. An extended meaning of the kan trigram is "to start." An extended meaning of the gen trigram is "to stop." These meanings can be realized when we look at the parallels of the Yi Jing trigramhexagram correspondences and the DNA code, both of which are based on a sixtyfour signal basis (see below for details). In these particular parallels, each "start" codon can be seen corresponding to the kan trigram-signal. Each "stop" codon can be seen corresponding to the gen trigram-signal.
Appendix Three: Yi Jing Symbols and Signals
365
I reasoned that a simple method of testing these ideas was to apply the kan signal (green-red-green) to the first point of a channel and the gen signal (redgreen-green) to the last point of the same channel, and observe any changes in the channel. In our experiments described later, we found that the channels have a direction of flow which agrees with the descriptions of the flow of ying qi. However, there are also descriptions of the channels which place them all running centripetally, from fingers and toes (extremities) to the body (center). These descriptions are probably not related to the actual flow of qi, but instead are related to some other phenomenon. For example, for all the channels, the five phase point sequences start at the jing points at the corner of the nails of the fingers and toes and run through to the he points at the elbows and knees.2 When I applied the kan signal to right LI-1, palpating LI-4, I found that the pressure pain at right LI-4 was improved, but that the left LI-4 pressure pain was worse. I then applied the gen signal to right LI-20 and found that now the left LI-4 pressure pain was relieved, without an increase in the right LI-4 pressure pain. I tried this on all the other channels, placing the kan signal at the first point and the gen signal at the last point of each, and observed the same responses, decrease of pressure pain at the corresponding reflex points. On occasion I noticed that muscle tightness and soreness along the pathway of the channel was often improved with this technique. Next I started focussing its use on the yang channels because they all run through the neck and shoulder region and stop or start on the face. With this approach, I have been able to help a number of patients with a variety of problems that are focused in the neck and shoulder regions. Thus the following treatment patterns can be utilized: Treatment Patterns Applying Trigram-Color Signals Kan (green-red-green) Gen (red-green-green) Channel LI-20 LI-1 Large intestine TB-23 TB-1 Triple burner SI-19 SI-1 Small intestine ST-1 ST-45 Stomach GB-1 GB-44 Gallbladder BL-1 BL-67 Bladder When I examined and compared the effects on the yin channels, I found that using the kan and gen signals on the first and last points was not as effective as using the terminal (jing) and midline meeting points. This gave the following treatment patterns: Treatment Patterns Using the Jing and Meeting Points Gen (red-green-green) Kan (green-red-green) Channel CV-12 LU-ll Lung CV-17 PC-9 Pericardium CV-17 HT-9 Heart CV-24 SP-1 Spleen GV-20 LR-1 Liver CV-23 KI-1 Kidney It is interesting to speculate on the phasal characteristics of some of these findings and show how they might relate to the traditional five-phase theories. On the yang channels, the jing points are the metal points, on the yin channels, the wood points are the metal points. The kan trigram signal corresponds to the water phase.
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Thus when we place the kan signal at the yang channel jing points, this is like placing a "child" signal at the mother phase point, i.e. water on ?'etal. Thu~ the e~fect is like that of draining. When placing the kan signal at the ym channel ;mg pomts, this is like placing a "mother" signal at the child phase point, i.e., water on wood. Thus the effect is like that of supplementation. This is similar to the Nan Jing dictum that for a vacuous condition, supplement the mother, for a replete condition, drain the son. On the yin channel (typically and by nature more vacuous), we add a mother phasal signal, water to wood. On the yang channel (typically and by nature replete), we add a child phasal signal, water to metal. In our experiences with these methods, we have found it better to apply the signals to the yang channels on the same side as the associated muscle hypertonicity and pressure pain. Thus for hypertonicity along the right small intestine channel with pressure pain at right ST-26, add the kan signal to right SI-1 and the gen to right SI-19. When applying the signals to the yin channels, it is better to apply them to the side that is not showing the muscle hypertonicity or pressure pain. For example, for hypertonicity and pressure pain along the left lung channel, with hypertonicity and pressure pain at left LU-1, apply the kan signal to right LU-ll with the gen signal to CV-12. If hypertonicity and pressure pain is present on both sides, for the yang channels, apply the signals to the more reactive side. For the yin channels, apply the signals to the less reactive side. These treatments can reduce the hypertonicity and pressure pain on both sides. Using these simple treatment ideas, it is possible to compose simple and effective treatments that are particularly useful for hypertonicity along particular channel trajectories, especially of the neck and shoulder regions, and are thus especially useful for single yang channel problems.
YI /INC CODING AND ISOPHASALITY Much of our research has used plus-minus signal carriers with a relatively low energy content (being more informational in nature). However, in other research we have explored the effects of electric current delivered by an electrodermal instrument through a fine probe to a specific small point. Using an electrodermal instrument where the polarity could be reversed easily, we found that a positive probe can act like a north magnet, copper, etc. If we reverse the current to turn the probe into a negative source, it will act like a south magnet, zinc, etc. With this device we observe the same responses on a channel as when using other polarity agents. For example, a short burst of positive stimulation distally on the large intestine channel followed by a short burst of negative stimulation more proximally is able to reduce LI-4 pressure pain. Reversing the placement of positive and negative stimulation causes an increase in LI-4 pressure pain. Having observed these correlations, I then started thinking about further applications. Because the use of the electrodermal instrument allows us quick polarity reversals, I started exploring the effects of positive-negative sequences at specific acupoints on the channels. In particular, I wondered if we could use a positive stimulation to represent the yang (unbroken) line of a trigram, with a negative stimulation as a yin (broken) line of a trigram from the Yi Jing. According to traditional theory, the trigrams correspond to the five phases as earlier described. Coding each trigram as bursts of positive (+) and negative (-) current, I then tested different acupoints and observed the responses, for example,(-)(+)(-) represents kan, water. The late Hisao Imaizumi, a retired Japanese business executive, studied the Yi Jing and left a treatise, Ekikyo no Nazo (The Mystery of the Yi Jing).3 In this text he drew many parallels between the trigrams and hexagrams and the DNA code.4
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~ile this is a vast, unexplored territory requiring careful investigation to substantiate the correlations, some of Mr. Imaizumi's ideas are important regarding the nature of the trigram codes. He noted for example, that kan : : signals "start" while gen ==signals "stop."
I tried these sequences on the first and last points of various channels and palpated reflex points to see if they responded to the signals. For example, (-) (+) (-) (kan) to LI-1 and(+)(-)(-) (gen) to LI-20 causes LI-4 pressure pain to decrease. The reverse,(+)(-)(-) to LI-1, (-) (+)(-)to Ll-20, causes pressure pain at LI-4 to increase. Having tried this on a number of different channels and having observed the same responses, I then started trying different sequences on different points and also tried coding the sequences differently. For example, since the color red is exciting (+) while the color green is sedating (-), I had a light instrument built that used three bi-color LED's to project light into three fiber optic cables, arranged so that the colored lights could be projected in sequence (see figure 17.1). Thus the kan trigram is green-red-green, the gen trigram is red-green-green. This method works well, giving rapid responses. My current investigations, using the same methodologies as those described above, have shown the following correspondences so far: wood xi-cleft points wood xi-cleft points fire source points of yang channels earth source points of yin channels earth last point on channel; source points of yin channels jing points of yang channels metal jing points of yang channels metal water first point on channel; luo points I am still investigating these correspondences and exploring methods of utilizing them clinically. In particular I have focused on certain biorhythmic cycles and correspondences and devised some simple general treatment methods. I have also investigated other methods of coding the trigram signals. These signals are usually of very low energy content and seem to be specific in their action to specific classes of acupoints. Thus these signals describe further isophasal characteristics of the different classes of acupoint; further, they seem to be good candidates for our more general X-signal system theory. These codes and signals and their correspondences are almost beyond our comprehension; it is quite astounding that ancient Chinese philosophical and divinatory speculations such as these Yi Jing ideas could match specific signal or bioregulatory systems in the human body.
BIORHYTHMIC USES OF THE YI ]INC SIGNALS Based on Jing Fang's interpretation of the trigrams and hexagrams, coupled with Shao Yang's tenth century arrangement of the sixty-four hexagrams, it is possible to arrange the sixty-four hexagrams according to the time of day and ascribe phasal correspondences for each (see Figure 17.2). Allotting each hexagram a time period of 22.5 minutes (1/64th of a day) and looking at the phasal value for both the lower and upper trigrams in each hexagram, interpreted through the table above, we can construct the following table showing the hexagram and phasal correspondences for each time of day. The numbers on the left are the numbers of the hexagrams, the middle column lists the 22.5 minute intervals for each hexagram, the right column lists the phasal correspondences of the upper and then lower trigrams that comprise each hexagram.
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For example, hexagram number 2 has kan over kun, which is water over earth. I have determined that the phasal correspondence of the upper trigram, here kan, signifies treating a water point on a channel on the superior half of the body, i.e., an arm channel. The phasal correspondence of the lower trigram, here kun, signifies treating an earth point on a channel on the inferior half of the body, i.e., a leg channel. Hexagram 0, 1 2 3, 4 5 6, 7 8, 9 10 11, 12 13 14, 15 16, 17 18 19,20 21 22,23 24,25 26 27,28 29 30,31 62,63 61 59,60 58 56,57 54,55 53 51,52 50 48,49 46,47 45 43,44 42 40,41 38,39 37 35,36 34 32,33
Phasal/Time Correspondences for the Hexagrams Time Period Arm - Leg Phasal Correspondences 0:00-0:45 earth - earth 0:45- 1:7.5 water - earth 1:7.5 - 1:52.5 wood- earth 1:52.5- 2:15 fire- earth 2:15-3:00 metal - earth 3:00-3:45 earth - earth 3:45-4:7.5 water - earth 4:7.5 - 4:52.5 wood-earth 4:52.5- 5:15 fire- earth 5:15-6:00 metal - earth 6:00-6:45 earth - water 6:45-7:7.5 water - water 7:7.5 - 7:52.5 wood -water 7:52.5- 8:15 fire- water 8:15-9:00 metal - water 9:00-9:45 earth-wood 9:45 - 10:7.5 water-wood 10:7.5 - 10:52.5 wood-wood 10:52.5- 11:15 fire- wood 11:15 - 12:00 metal-wood 12:00 - 12:45 metal - metal 12:45 - 13:7.5 fire- metal 13:7.5 - 13:52.5 wood-metal 13:52.5- 14:15 water - metal 14:15- 15:00 earth - metal 15:00 - 15:45 metal - metal 15:45 - 16:7.5 fire- metal 16:7.5 - 16:52.5 wood -metal 16:52.5 - 17:15 water - metal 17:15 - 18:00 earth - metal 18:00 - 18:45 metal- fire 18:45- 19:7.5 fire- fire 19:7.5- 19:52.5 earth- fire 19:52.5- 20:15 water- fire 20:15- 21:00 earth- fire 21:00- 21:45 metal-wood 21:45 - 22:7.5 fire- wood 22:7.5 - 22:52.5 wood-wood 22:52.5- 23:15 water-wood 23:15 - 24:00 earth-wood
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Figure 17.2. ba gua signals This phasal/ time correspondences table is a little difficult to use because one must know the precise time and the exact location within the time zone. Without this precision, this table is probably best not used for treatment. A simpler table is listed below, which gives only the phasal correspondences for two consecutive time periods (what I have called "knots") that share the same phasal value for the lower trigrams. It is merely a shorter version of the above tables, listing only these knots. The same arm-leg channel correspondences as above also apply here. Phasalffime Correspondences for the Hexagrams Phasal Correspondences Time Phasal Correspondences Time wood-earth 13- 14 wood-metal 1-2 metal-earth 14-15 earth-metal 2-3 earth-earth 15 -16 metal-metal 3-4 16 17 wood-metal wood-earth 4-5 1718 earth-metal metal-earth 5-6 18 - 19 metal-fire earth-water 6-7 19-20 wood-fire wood-water 7-8 20 - 21 earth-fire metal-water 8-9 earth-wood 21 - 22 metal-wood 9-10 22 - 23 wood-wood wood-wood 10-11 metal-wood 23 24 earth-wood 11-12 24-1 earth-earth metal-metal 12-13
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I have devised a simple method of using these correspondences as a new kind of liu zhu zhen fa, or open point treatment method. To undertake this in a clinical setting, start by performing the diagnosis. Note the time of day you are ready to treat. Once you have determined which channel is problematic, for example, the spleen channel, select the corresponding phase point for the leg channel from the table above, based on the time of day of the treatment. For example, if you were treating at 2:30 pm, you would select the metal point, SP-5, and apply one of the metal trigram signals - qian (red-red-red) or dui (green-red-red) to this point. Next you would select a related arm channel, which for the spleen would be the lung (tai yin), the triple burner (polar opposite) or the large intestine (tai yin-yang ming), and treat the earth point of one of these, using one of the earth signals, either kun (greengreen-green) or gen (red-green-green). Thus the treatment might be to apply the qian signal to left SP-5 and the gen signal to left TB-10. Frequently quite wonderful effects can be observed when using this simple methodology. It is sufficient to be used as a Step One procedure in the root or general treatment program, substituting for the methods described in chapter 9. Based on our experience, the following stepby-step approach to using these ideas will help reinforce the effects of the treatment. 1. Make sure of the exact time of day, taking into account the exact time plus daylight savings. If daylight savings is in effect (between the spring and fall), subtract 1 hour. Thus 2:30pm in August is really 1:30pm. 2:30 pm in January is 2:30pm. 2. Apply the diagnostic techniques described in this text and determine which leg channel should be the focus of the treatment. If the most remarkable diagnostic signs are that left KI-16 is tight and has pressure pain, and the kidney pulse is very weak, then the leg channel that should be focused on would be the kidney channel. 3. Determine which associated arm channel would be best to treat in conjunction with the kidney channel. For example, does pressure pain or tightness show at ST-27 and on the kidney-large intestine reflex area on the gastrocnemius? If so, then the large intestine channel would be a good choice. If not, does the heart channel (both heart and kidney are shao yin channels) show any reactiveness (pressure pain or tightness at the CV-14 area, or at KI-23)? Or, does the small intestine channel show reaction (the kidney channel is shao yin, the small intestine channel is tai yang), e.g., pressure pain at ST-26? Depending on which was clearly reactive, treatment would focus on that arm channel. 4. After determining which leg channels and which arm channels to select for therapy, choose the appropriate phasal point for each- from the table above, according to the time - and apply the corresponding phasal trigram signal to each. Thus, at 2:30 pm, during the winter, having chosen to treat the kidney and large intestine channels, one would perform the following treatment: a) Since 2:30 pm has the phasal correspondences of earth-metal, the metal signal red-red-red or green-red-red would be applied to left KI-7. b) Next, the earth signal, green-green-green or red-green-green, would be applied to right LI-11. c) KI-7 would be treated on the left because it is the metal point and because KI-16 showed reactiveness on the left. d) LI-11 would be treated on the right because LI-11 is the earth point, and because generally it is better to treat the arm channel point located on the opposite side of the body from the leg channel point (to take advantage of the yin-yang octahedral characteristics).
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5. Reassess the effectiveness of the treatment on the reactive points. If the effects obtained so far are not sufficient, that is, the reactions have not changed enough, then consider applying a signal to a relevant source point, for example, the earth signal to right LI-4 or left KI-3. This is usually enough to reinforce the treatment and produce the correct changes sufficient for the completion of the first step of treatment. The biorhythm treatments described in chapter 9 use the daily, ten-day, and sixty-day cycles of open points. These treatments, traditionally called the liu zhu zhen fa, are useful for their general effects on the body. We postulated that they probably work by producing a kind of homeostatic reaction or effect at the signal system level, thus regulating all kinds of imbalances in the body. The method described above, using Yi Jing signals to stimulate the phase points on specific pairs of channels, seems to have similar effects as the liu zhu zhen fa treatments. They are able to adjust the whole body, not just the channels that are the focus of treatment. We believe that there is a signalling system in nature that corresponds to the Yi ]ing concepts and signals. A broader understanding of this signalling system can be seen when we look at the possible correlations of the Yi Jing signals, the trigrams and hexagrams, to the DNA code.
YI /ING SIGNALS AND THE DNA CODE Information is coded in the DNA molecules in the form of triplets of bases or codons. These codons are composed of three pairings of the four fundamental molecular bases, adenine (A), cytosine (C), guanine (G) and thymine (T). The bases are paired, A to T and C to G. According to the sequence of the codons in a specific gene, very specific information is coded in the DNA that has relevance to the exact molecular productions and activities of each cell of the body. A particular codon, e.g., A-C-G, codes for a specific amino acid in the complex process of protein synthesis. Given that there are four bases arranged in triplets, there will thus be four to the power of three possible combinations of bases, therefore sixty four codons. In the Yi Jing, there are sixty four hexagrams, leading some to speculate on a possible correspondence between the two different schemes.S If we see T and C corresponding to the yang (unbroken) line of the trigrams, with A and G corresponding to the yin (broken) line, then the sixty-four bases yield the following trigram correspondences: TGT li TAT li TTT qian TCT qian li TGC TAC li TTC qian qian TCC TGA xun TAA gen gen TTA xun TCA TGG TAG gen xun gen TTG xun TCG li CGT CTT qian qian CAT li CCT li CAC qian li CGC CCC CTC qian CTA xun xun gen gen CAA CGA CCA xun gen gen CTG xun CAG CGG CCG zhen ATT dui dui AAT zhen AGT ACT zhen zhen ATC dui AAC dui AGC ACC ATA kan kan kun AAA kun AGA ACA ATG kan kan kun kun AAG AGG ACG GTT dui GCT dui GAT zhen zhen GGT dui GTC dui zhen zhen GCC GAC GGC GTA kan kan GAA kun kun GGA GCA kan GTG kan kun kun GCG GAG GGG
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As scientists explore the genetic code, it has been discovered that certain codons code for the starting point and stopping point of a specific gene. The genes are "read off" and a specific codon, A-T-G, codes for the point at which the reading of a specific gene should begin. At the end of a gene's codon sequence, one of three codons is found which signifies that the specific gene has now been completely read, i.e., a "stop reading the codon" sequence. These codons are T-A-A, T-A-G and T-G-A. Looking at our table of possible correspondences above, we can see that the "start" codon would correspond to kan, which has the extended meaning of to start, while the "stop" codons would all correspond to gen, which has the extended meaning of to stop. These correlations may only be coincidental, but they do correspond nicely with the kan-gen correspondences and phenomenon described above. It remains for further research to discover and comprehend further correlations and possible consequences of these Yi Jing signal-DNA correspondences. In my mind, part of the body's signalling system clearly correlates to Yi Jing symbols. Specific acupoints seem able to respond in specific ways to these symbols when coded as low energy signals. Perhaps, if the DNA correlations are truly valid, it might be possible in the future to regulate DNA and therefore fundamental biological activity through this signalling system. I leave it to future generations to pick up and continue my work in this area. The possible results are truly marvelous.6
YIN-YANG SYMBOLISM IN CHINESE MEDICINE We have described the use of the biphasic three-channel fiber optic instrument as a simple and effective method of stimulating the acupoints with Yi Jing signals. According to our research, many other methods can be used to code the specific signals. The following is a list of equivalent methods by which the signals can be given to the acupoints. We list them and encourage the reader to test them out, using the same methodologies for testing which are described throughout this book. We also encourage readers to try other appropriate methods of measurement as well. 1. Provided the lettering is small enough, it is possible to write the Chinese character or ideograph for the appropriate trigram directly on the acupoint and observe similar responses to the fiber optic delivery method. 2. Instead of writing the character directly on the skin, it is possible to paste an appropriately sized printed form of the character on the acupoint and observe the same effect. 3. Drawing the equivalent trigram on the acupoint will also produce the same effect. This is reinforced by using a red pen for the yang (unbroken) lines and a black pen for the yin (broken) lines. 4. The trigram figures can be delivered to the acupoint by pasting a small printed version of the trigram to the acupoint, in the same method as 2, above. 5. Traditional theory states that odd numbers are yang in nature and even numbers yin. Our research has shown that applying a stimulation such as light pressure an odd number of times has opposite effects to applying the same stimulation an even number of times. From our research of this phenomenon, we have found concurrence between the traditional idea that odd numbers are yang and even yin. These findings can be used as a simple method of stimulating the acupoints with Yi Jing signals. For example, applying the following sequence of stimuli to an acupoint, ** * ** (e. g., 2- 1 - 2), is the same as the kan signal. There are several possible methods by which such a signal sequence can be given: using light pressure, the wooden hammer and needle, applying a pulsed small electrical signal, a pulsed fiber optic light source, etc.
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Many other yin-yang symbols can be substituted to deliver yin and yang signals to the body. What is significant about written forms or drawn forms on the skin or on paper? What is significant about even and odd numbers? We leave these and quite likely many other questions for the reader to ponder.
CONCLUSIONS We have found that each of the five phases has characteristic signals associated with it that relate to its isophasal nature. We have further found that the ba gua (eight trigram) symbols of the Yi Jing have characteristic signals associated with them. It is possible to use and observe these different signal systems experimentally and take advantage of them clinically. By coding each signal with tiny energy content, we can produce strong effects in the body. We believe that this is due to the effects of these signals on the regulatory systems of the body, rather than on the physiological systems themselves. We further think, following traditional descriptions, that each signal system has extended applications in nature and that the signal systems relate to more general rules of nature. Many rules that operate generally in nature will operate in the body as well. This is a consequence of the fact that we are open systems; we are the product of the complex activities both within and without the body. If certain rules operate generally in nature, it is very likely that they will manifest inside the body as well.
ENDNOTES 1 For those not versed in the Yi Jing or its symbols and correspondences, we refer the reader to Lynn, R., The Classic of Changes, A New Translation of the I Ching as Interpreted by Wang Bi, New York: Columbia University Press, 1994; or Hacker, E., I Ching Handbook, Brookline, MA: Paradigm Publications, 1993. 2 S.B.: Descriptions of these alternate ideas of the channels and their apparent contradictory natures can be found in e.g., Unschuld, P., Medicine in China: The Nan Ching Classic of Difficult Issues, pp. 298-299. 3 Imaizumi, Hisao, Eikkyo n Nazo (Mysteries of the Yi Jing), Tokyo: Kobunsha, 1988. 4 S.B.: This has been noted by other authors, see for example: Schonberger, M., The I Ching and the Genetic Code: The Hidden Key to Life, New York: ASI Publishers, 1979, originally published in German by O.W. Barth Verlag of Munchen, 1973. 5 S.B.: See for example: Imaizumi, H., Ekikyo no Nazo (Mysteries of the Yi Jing). See also Schonberger, M., The I Ching and the Genetic Code: The Hidden Key to Life, New York: ASI Publishers, 1979. 6 S.B.: Research has shown that DNA activity is controlled at least in part by signals that arise from outside the body. For example, mitosis, normal cell division, has been correlated to circadian rhythms, as has protein synthesis: See for example Luce, Gay G., Biological Rhythms in Human and Animal Physiology, New York: Dover Publications, 1971, pp. 62 passim. Thus it is reasonable to speculate on the role of other signalling systems operating in nature that affect and regulate the body such as the Yi Jing signals.
1{2~ APPENDIX FOUR
ON THE SAYOSHI AGENT- CERTAIN UNKNOWN FACTORS WHICH AFFECT THE LIVING BODY BY YASUMASA l
Editor's introduction: The following paper, written by Yasumasa Katsumata, a physicist- acupuncturist, with comments by and translated by Yoshio Manaka, explores the concept sayoshi. It describes possible relationships of sayoshi to some of the known effects of a needle and possible relationships of sayoshi to the Chinese concept of qi. The language and concepts presented in the following paper are almost entirely new, both in the field of acupuncture, and in the fields of physics and biology. Sayoshi may be defined experimentally and clinically as describing a series of functional relationships and properties that cannot be attributed (clearly) to either the physical object from which it derives - needle, medication, human body etc. [known as the "generator")- or the energetic fields- electrical, magnetic, gravitational, etc. -associated with the object. It thus is a seemingly new theory of matter. Dr. Manaka considered Katsumata's ideas important, seeing their validity in their ability to explain some of the signals and signal effects observed by Manaka in his research of the X-signal system. PREFACE
The human being reacts to direct contact with the outer world through the sense organs such as the eyes, ears, nose, mouth, and skin. It has also been observed that some indirect effects from the outer world can affect the organic system of the human being. For example, in therapy using qigong (a traditional Chinese medical practice), the patient is treated without being touched by the practitioner who stands a distance from the patient with hands directed at the patient. Effects such as these, occurring from a distance without direct involvement of the sensory organs, have been observed and experimentally investigated before.l It is further true that the effects of acupuncture are not attributable solely to the actual insertion of the acupuncture needles. Some effects are obtained merely from the proximity of the needle to the patient's skin. No clear scientific explanations have yet been formulated to account for these observed phenomena. They appear weird or unusual to us because they do not fit common sense, but this is no reason to treat these matters as pure mystery and ignore them. We should try to arrive at an explanation through close observation and examination. At present, one usually finds the functions of acupuncture explained through recourse to the theory that it is a form of stimulation therapy. I
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have long been skeptical of that. Through my experiments, I believe that I have demonstrated the existence of a factor currently unknown to today's natural science. I have named this factor the sayoshi agent. The sayoshi agent is an unknown quantity of state in space which is described in the language of anti-symmetrical tensors (axial vectors). In this paper the term "sayoshi agent" is written simply as sayoshi.
I. THE FUNCTION OF ACUPUNCTURE 1. The function of acupuncture depends on the directions of the needles. The therapeutic effects of acupuncture contain a factor that depends partly upon the angle and direction of the inserted needle. For example, in the traditional literature, needles inserted along (ying) the channel, that is in the direction of channel flow, are described as constituting a supplementing or "tonifying" technique. Needles inserted against (sui) the flow of the channel, constitute a draining or "dispersing" technique. When one puts a needle along the circulation of energy in the channel, it is supplementing, while directed against the circulation it is draining. This is especially clear if one uses the hinaishin (intradermal needle) or other very fine, shallowly inserted needles, where the direction of needle insertion is essential. In clinical practice, clinical experience determines for each practitioner the directions of needle insertion, but generally this is done without any knowledge of how these effects are obtained. 2. Acupuncture needles affect the body without being inserted.
Acupuncture needles can be effective even if not actually inserted, but instead held near the surface of the skin. Nowadays, there is a general belief that the effects of acupuncture are brought about purely through stimulation effects. However, the above-mentioned directional factor has nothing to do with stimulation effects, because the factor can be recognized even when the needle is not inserted into the skin. Needles as they approach the skin surface (generally up to Smm and especially within 1-2 mm) can give such influences. The directional effects are the same as when inserted. In the case of the non-inserted needle, its actions cannot be through the nervous system, since no stimulation of nerve receptors is given. Thus when we discuss the effects of acupuncture, we should pay attention to these kinds of agents as well as the stimulation effects. There must be several non-stimulation agents. Manaka has named their effects "signal effects." The directional effects are one group of these effects.
II. THE VECTOR OF AN AcuPUNCTURE NEEDLE When one says that an acupuncture needle has a "vector," this can be understood to say that it has power and direction. One can apply the techniques of vector analysis to handle and describe this vector and the effects of the needle. For example: a) In general vector analysis, two parallel vectors lose power. b) Two incident vectors gain power at an angle to the original vectors. c) Two vectors on a straight line in the same direction add their powers. d) Two vectors arranged against each other on a line lose power.
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1. Vector analysis of two vectors: If one takes two vectors, A and B, which are presented as:
A
= (a1, a2, a3)
B = (b1, b 2, b 3) and if these two vectors are incident upon a point, the product of the two vectors is given by:
Ax B =
J
I
K ----(1)
I, J, K present vector units in the axes x, y, z. If two vectors cross at an angle Q, (1) can be seen as follows:
J
I
AxB=
K
a1 0 0 b*cosQ b*sinQ 0
=I I. I I.
therefore A X B A B sinQ . K - - - - (2) Thus the combined vector is as large as the parallelogram with the sides of vector A and B, and it is normal to the plane of A and B. Accordingly: [a] In the case of two parallel vectors:
Q = 0 and so sinQ = 0
I I. I I.
formula (2) is A X B = A B 0 . K = 0, meaning that the combined veetor disappears. [b] When two vectors cross at right angles: (i) divergently A= (a1, 0, 0) so,
B
= (0, b 2, 0)
AxB
=
I
J
K Figure 18.1
So the combined vector is as large as the parallelogram with the sides of vector A and B. The direction is upward. (ii) convergently
A= (a1, 0, 0) so,
B
= (0, -b 2, 0)
AxB =
I J K a1 0 0 0- b2 0
Figure18.2
So the combined vector is like the above mentioned with its direction downward.
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Appendix Four: On the Sayoshi Agent
[c] Two vectors of the same direction on the same line, have as their combined vector: V = A + B. If A = B, then V A + A 2A that is to say that two vectors of the same size arranged on one line make a vector twice as large. [d] Two vectors on the same line but in reciprocal directions, makes the reduction V A - B. And if B A, then V A - A = 0. The effects of the two vectors disappear. 2. Demonstration of the effects of two needles on the body surface It has been possible to demonstrate the effects of two needles applied simultaneously to the skin surface. Generally speaking, these effects are dependent upon the part of the body at which these polarities of needle direction are applied. Thus the sites of application were selected on the palms of the hand or the lateral aspects of the legs, where the reaction patterns are already known. (a) These reaction patterns in response to the needle on a normal body are in accord with Manaka's octahedral theory. The same polarity causes antagonistic reactions from left to right, yin to yang channel, even if the same points were selected. With these experiments, the following results were obtained:
=
=
=
=
=
(i) on the right palm, a vertical needle causes positive resonance (see the physiological reaction of sayoshi described below). A horizontal needle directed from the thumb side to the small finger side causes positive resonance. In both cases, if the directions of the needles are reversed, they cause negative resonance. (ii) On the left palm, the reactions are exactly the opposite to those of the right palm.
(iii) At right ST-36, positive resonance is caused by vertical needle application as well as centrifugal needle application. Reversing the directions of the needles gave negative resonance, opposite effects.
(iv) At left ST-36, the reactions are exactly opposite those of right ST-36. (b) How to apply the two needles. (i) First the two needles are fixed in different positions on paper with tape. One then puts the paper on the above points and checks the effect. First put two needles parallel with a 3 mm gap on the paper (stainless steel number 1 or 2, 1.3 cun). With this application, no effects were observed in any direction (figure 18-3). (ii) Next fix two needles at a right angle to each other with tape, and place them over the points at different angles. In this manner, one can observe effects similar as to when one needles perpendicular to the paper (see figures 18.4 and 18.5).
Figure 18.3
Figure 18.4
Figure 18.5
Appendix Four: On the Sayoshi Agent
379
(iii) Next place two needles on the same line pointing in the same direction. One can observe the same effects as a single needle, but stronger (see figure 18.6). (iv) If the needles are then placed so that they point towards each other or away from each other (see figures 18.7 and 18.8) the effects are lost.
~---t>
I I ---t>
Figure 18.6
Figure 18.8
Figure 18.7
The results of the above studies lead us to conclude: (i) One of the functions in acupuncture is vector related. (ii) Acupuncture needles can interfere with each other. (iii) The combined function of two needles follows the rules of vector analysis. This is especially clear when the two needles are applied to the same point on the body surface, where a vector product is established.
III. NEEDLES GENERATE SAYOSHI 1. The vector field generated by needles arranged in a ring.
If vector B satisfies the following relation,
div B = 0 .... (a), B surely has vector A which is expressed by the following formula: B =rot A .... (b). The converse is also true because the differential operator div.
rot is always 0.
The proof of this is seen in the following equation:
div. rot A=
~dx fda3_ da2) +~ fda dadx3)+~dz (dadx2 _dady1 ) \dy dz dy \dz 1_
= O.
If one considers needles arranged in a ring as vector A, the needles generate without fail vector B, which satisfies formula (b). Vector A (the needles arranged in a ring) is expressed by formula (c) as follows. Vector Pis a position vector of a point p(x,y,O) on the ring: ~--------~------------~ z
Figure 18.9
A=a·K·P = a
I J K 0 0 1 0 X y
=
-ayl + axJ ................ (c)
Appendix Four: On the Sayoshi Agent
380
Where the plane of the ring would be defined by the x-y coordinates, the center is defined as an origin, and each fundamental vector of axis x,y,z is I, J, K. By putting formula (c) into (b),
B
= rot
(-ayl + axJ)
I J K g g g
dx dy dz
-ay ax
0
= 2aK The result B
= 2aK, is satisfied with formula (a), divB
=
d2a
dz
= 0.
Thus the fact that the needles arranged in a ring generate one vector field with length 2a which is normal to the plane of the ring is derived from vector analysis. 2. Confirmation of the vector field by experiments The above mentioned theory indicates that needles arranged in a ring are equivalent to one needle which is vertical to the plane of the ring. I arranged needles in a ring and examined their function. To make a ring of needles, I arranged six silver needles of 10 mm length on a circle and then fixed them on a sheet of paper. The ring was placed on various parts of the body surface and its function examined. To detect the function, I examined the reaction of the body, explained below. The results of the experiment were that the ring of needles placed at several parts of the body at random had the same effects as one needle placed vertically at the same parts. The needles in the ring had the same function as one needle, following the rule of the right-handed screw. Thus the results of this experiment turned out to be exactly what was theoretically predicted. rotA
Figure 18.10
GENERATION OF SAYOSHI The needles arranged in a ring functioned like a needle vertical to the plane of the ring. It is obvious that the needles in the ring do not produce a needle. Instead what has happened is that the needles arranged in the ring produced a vector field having the same function as the needle vertical to the plane of the ring. In other words, the ring produced a state of space which functioned like a needle. I named this vector field, which has physiological functions, the "sayoshi vector," or simply sayoshi.
Appendix Four: On the Sayoshi Agent
381
[Sayo in Chinese or Japanese means a function, and shi a particle or something. Manaka proposes translating the term sayoshi in English as "phantom factors" (1988).]
IV.
PHYSICAL CHARACTERISTICS OF SAYOSHI
In my experiments, the vector field named sayoshi showed the following characteristics:
1. It remains in the space even after its generator (source) is removed, continuing to maintain its functions; thus we can say that sayoshi is independent.2 2. It can stay still in the space.3
3. When objects with the exception of an electric insulator, pass through the same space where a sayoshi exists, the sayoshi disappears.4 4. Sayoshi can pass through the boundaries of objects with the exception of electric conductors. 5 5. Sayoshi interacts with electromagnetic fields. 6
(i) It functions mutually with electromagnetic waves and forms waves carrying sayoshi. (ii) These waves leave the sayoshi in the direction through which they pass and at the surfaces where they arrive. (iii) Consequently sayoshi can be transmitted to distant places by electromagnetic waves (or electric current or high frequency). (iv) The molecular emission spectrum that a substance generates carries the sayoshi of the substance. I call this spectrum "molecular waves." 6. Sayoshi produces an "identical wave effect."7
(i) Two different things placed closely together obtain the sayoshi of the other. (ii). The newly obtained sayoshi did not diminish for three days throughout the course of my experiment. (iii) I named this phenomenon of one object picking up the sayoshi of the other, the "identical wave effect." 7. The "accompanying phenomenon" of sayoshi.B
(i) Sayoshi can travel along with the secondary object that has picked up the sayoshi, by accompanying the object. (ii) The "identical wave effect" is the phenomenon of sayoshi accompanying other objects. (iii) The "accompanying phenomenon" is quite peculiar to sayoshi. I believe that it is possible to explain it by the relativity of space.
382
Appendix Four: On the Sayoshi Agent
V. WHAT GENERATES
SAYOSHI?
Sayoshi can be generated not merely by acupuncture needles. The vector of acupuncture functions when needles are brought only to the body surface. There are various other cases in which the body is affected from the exterior. In these cases physiological functions are caused by the functions of a vector, as in the case of acupuncture, for these things react mutually with the sayoshi vector of needles. 1. CONCERNING THE PHYSIOLOGICAL FUNCTIONS CAUSED BY THINGS OUTSIDE THE BODY:
a) Things placed close to the surface of the body have physiological effects on the body. Examples of physiological functions caused from the outside: (i) Substance. The effect of moxa applied to the body surface is the same as that when a needle is applied vertically to the same point. Placement of potassium chromate instead of moxa gives an effect that is the same as when a needle is applied vertically, but with handle instead of point down, that is, it is the reverse of applying moxa. The direction of the needle having the same effect as substances applied to the body surface depends on the substances themselves. (ii) Magnet. The south pole (S) has the same effect as moxa, whereas the north pole (N) has the same effect as the potassium chromate. (iii) Electric charge. The positive charge has the same effect as moxa, the negative charge has the same effect as potassium chromate. b) Physiological functions of objects interact with the sayoshi of acupuncture. The physiological functions of the combination of two needles applied to a point on the body surface (within a 10 mm diameter circle) follows the vector analysis above. When one of the two needles is replaced by another thing, the combination of the needle and object together follows the same vector analysis as the effect of the two needles. If, for example, the needle and other object are applied in parallel, they lose their effects. Example 1: We described above how moxa placed on the body surface has the same effect as a needle applied vertically to the point. But if the needle is placed in the center of the piece of moxa, and one allows both the needle and moxa to function at the same time, they lose their effects. Example 2: The south facing pole of a magnet has the same effect as a needle held vertically to the point. But if the needle is applied parallel to the center axis of the magnet (either south or north facing), the magnet loses its physiological effect, even though the magnetic field is still present. This shows that the physiological effect of the magnet is the effect of the sayoshi of the magnet. c) Physiological functions of two things interact mutually following vector analysis. The effect of two things placed on the body surface follows the vector analysis which two needles follow. Consequently if two things are placed in parallel on the body surface, they lose their effect. (i) Things of the same kind. If a ball of moxa about 4mm diameter is placed randomly on the body surface, it has the same effect as a needle placed vertically to the same spot. If another ball of moxa of the same size is placed simultaneously at a distance of Smm from the original ball, the two balls lose their effects on the body. If the two balls are placed more than 1 em apart, they do not share the same
Appendix Four: On the Sayoshi Agent
383
point of function. If the two are placed in contact with each other, they function as one ball of moxa. (ii) Things of different kind.
Example 1: A sheet of paper cannot block a magnetic field. Nevertheless, if a sheet of paper in the shape of a cone is placed on a magnet so that the axis of the magnet and that of the cone correspond to each other, the magnet loses its physiological effect. Cones made of plastic, stone, glass, and so on show the same result. This means that a cone and a magnet have the same sayoshi vector. Example 2: If a ball of moxa is placed on the axis of a cone (either inside the cone or on the top of the cone), both the cone and moxa ball lose their effects. As described above, the result is the same whatever the material of the cone. Therefore the form of a cone and the moxa interact mutually as two vectors. This shows that in general a "form," "shape" also has a sayoshi vector. Example 3: If a ball of moxa and a magnet are placed simultaneously on the same point on the body surface, both the moxa and the magnet lose their physiological effects. The result is the same if the ball of moxa is replaced by another substance, therefore the magnet and other substances generate sayoshi vectors. In this manner it is possible to show that everything generates sayoshi and that this sayoshi has physiological effects on the body from the exterior. Sayoshi can be described as a kind of condition or state in space; thus everything can generate sayoshi by its existence in space. This sayoshi has characteristics depending on the generator (object). (i) Form: All kinds of form generate sayoshi, i.e., a spiral produces a vector tangential to the spiral. (ii) Substance: All substances generate sayoshi with convergent or divergent vectors which have antagonistic effects on the living body. Substances with divergent vectors are: moxa, cheese, various herbs, benzene, etc. Substances with convergent vectors are: chocolate, NaF, toluene, etc. Each substance has a sayoshi peculiar to it. Sayoshi does not have chemical reactions; thus substances can function physiologically beyond the realm of chemical reactions. (iii) Electric charge: positive
=divergent, negative =convergent.
(iv) Magnet: south pole= divergent, north pole= convergent. (v) Semiconductor: N-type =divergent, P-type =convergent. (vi) Movement: Movements of objects generate sayoshi which is opposite to the velocity of the vector. For example, if one crosses oneself, the hand movement generates sayoshi which has certain physiological effects. Human beings, animals, plants, the sun,9 sound, voice, mind,10 place, etc., all generate different kinds of sayoshi.
VI. How THE LIVING BODY REACTS TO
SAYOSHI
Substances react with other substances. We react with medications; both our bodies and medications have substance. When two things contain elements in common, reactions occur. Two sayoshi also react. A reaction of the body to a sayoshi is a mutual function of two sayoshi. In other words, when the sayoshi of the body reacts with a sayoshi of external origins, the reaction causes changes that manifest in the body. Each individual has his or her own sayoshi and he or she shows various conditions of his or her own sayoshi according to his or her inner and outer conditions.
384
Appendix Four: On the Sayoshi Agent
1. REACTIONS OF THE LIVING BODY As mentioned above, characteristics of sayoshi vary with its source. However, as far as the effect of one physiological function of the living body is concerned, sayoshi causes only two changes, either activation or suppression. These physiological changes are shown in the following table:
Physiological function
Positive response
Negative response
Respiration Sensory system
deep sharp comfort
shallow
Primitive feeling* Endurance against pain Muscle tension
much increase
dull discomfort little decrease
*As described by Dr. Keizo Hashimotoll The effect of activation and suppression varies with the source of sayoshi. A source which activates one of the above mentioned physiological functions of the body activates the other physiological functions. Likewise, a source which suppresses one of the physiological functions suppresses the others. Since these physiological changes occur simultaneously, sayoshi must be associated with each physiological function at a very fundamental level. An activated condition of physiological response is called a "positive response," a suppressed one, a "negative response." 2. THE
LAW OF POLARITY REACTION
The physiological response of the body caused by sayoshi depends on the parts of the body where the sayoshi functions. In other words, to elicit an expected response, both the source of the sayoshi and the target area of the body are important and need to be considered. In order to avoid inconvenience and treat uniquely the function of sayoshi, I define the polarity of sayoshi as follows: a) Definition of the polarity of sayoshi. If sayoshi applied on one part of the body causes the same reaction as that caused by the application of positive electric charge, that sayoshi is defined as having positive polarity. One which produces the same response as a negative electric charge is one with a negative polarity. b) The law of polarity reaction. Following the above definition, it is necessary to clarify the reaction of the body and types of sayoshi, and the relation between the polarity of the sayoshi and the observed changes in the body. In the relation of the sayoshi possessed by the body and that which affects the body, there are two laws:
Law 1. When these two sayoshi have the same polarity, the body responds positively, but if the two sayoshi have opposite polarity, the body responds negatively.12 Law 2. When the body responds negatively, the polarity of each part of the body reverses. 3. POLARITY AND DIRECTION
a) The direction of sayoshi and polarity of the source. I experimented on the polarity of various sources and the direction of their sayoshi. As a result, I found the following relation between the polarity of source and direction of its sayoshi vector. In the area close to the source (first domain):
Appendix Four: On the Sayoshi Agent
385
(i) a source with a centrifugal sayoshi vector bears positive polarity. (ii) a source with a centripetal sayoshi vector bears negative polarity. b) Domain: The direction of sayoshi reverses according to the distance from the source. The closest area from the source of sayoshi is named the first domain, and the more distant area, where the direction of sayoshi reverses, is named the second domain. There exist more domains farther than the second where the direction of the sayoshi changes reciprocally.
c) Polarity and the direction of sayoshi. The above results lead us to the following conclusions: (i) a vector of sayoshi facing vertically to the body surface shows positive polarity. (ii) a vector of sayoshi turning upside down and facing away from the body shows negative polarity. d) The dipole moment of sayoshi. The above relation between polarity and direction indicates that a sayoshi vector is equivalent to a dipole moment with negative polarity on its origin, positive polarity on its head. For example, a needle (ordinary, of stainless steel) is a dipole moment with positive polarity at the tip of the needle, and a negative polarity at the handle end of the needle. Likewise, a magnet is a dipole moment with positive polarity on the south pole and negative polarity on the north pole. A diode is a dipole moment with positive polarity on the cathode and a negative polarity on the anode. When two things having different polarities of sayoshi are placed on the body surface, the things function as a vector of sayoshi combining these two points.
VII. WHAT IS
SAYOSHI?
1. SAYOSHI IS A TENSOR Sayoshi is an unknown state of space which has a physiological function in the body. Let this unknown state quantity of space produced by objects be S. As described above, when sayoshi S interacts with sayoshi S2, a new sayoshi, S3 is produced. In the relations between S, S2, S3, the product of the vector should hold. There, the state quantity S, functions as an element which makes the vector X of sayoshi correspond to vector T of another sayoshi. The formula describing this is as follows: T = (X) = X X ••••• (1). Now introduce two systems of orthogonal coordinates, 0 and 0 2, into the space. Define S, in the form of matrix as (Sij) in the 0 system and as (Sij 2) in the 02 system. The formula (1) is expressed as follows for the 0 system.
s
s
=
T (Sij) X ..•••. (2). For the 02 system, T2 (Sij2) X2 •.•.•• (3). Both X and Tare transformable between the systems of the formula, (4). X2 AX I T2 AT .•..••• (4). Here, A is the linear transformation from the orthogonal coordinate 0 to 02.
= =
=
3
Ai
= I, j=l
aij
(i
= 1, 2, 3)
386
Appendix Four: On the Sayoshi Agent
In the process of the coordinate transformation, system to the 02 system.
S is transformed from the 0
(Sij2) =A (Sij) A-1 ....... (5). Since A is an orthogonal matrix, the components of S can be expressed as follows, by using the formula:
A-1
=
tA ....... (6)
This expression of the component transformation is exactly the same as the definition formula of the tensor. Therefore, S, a state quantity of the space, is a tensor. Now find Sij' the components of S. Let e 1, e 2, e 3 be the fundamental vectors of the orthogonal coordinate system
0.
sij can be expressed by the fundamental vectors. Sij = ei . S(ej) (i, j = 1, 2, 3)
=ei
. S x ej 3
I
=
sk ei . ek
X
ej
k=1
Accordingly, the components of tensor S are: (S··) 1)
=
This result leads to the fact that Sij = Sij, for the components of S, which means that Sis an antisymmetric tensor (axial vector). Dr. Anton Mesmer noticed that a certain therapeutic effect could be obtained when two individuals affected each other. His assumption was that a certain magnetism, called "animal magnetism," caused this effect. Although it is not clearly known why he fixed on the magnetic field as being responsible for this phenomenon, the magnetic field is an antisymmetric tensor like sayoshi. Because of this, sayoshi and magnetic fields behave similarly. For example, a magnet is a dipole moment which always has north and south poles. A needle is also a dipole moment with positive polarity at its tip and negative polarity at its handle. Since both the magnetic field and sayoshi are antisymmetric tensors, then I imagine that what Dr. Mesmer was trying to explain with his animal magnetism theory were indeed the effects of sayoshi. In ancient Chinese medicine, there was also a belief in something which affects and controls the health of human beings. It is not possible to see or feel it; it is called qi. Both the magnetic field and sayoshi are the state of space. They cannot be seen or felt by us. We notice their existence only by the results brought about by their functions. I believe that sayoshi is one of the factors which the ancient Chinese called qi.
Appendix Four: On the Sayoshi Agent
2.
387
DOES SAYOSHI HAVE ENERGY?
Acc_ording to Einstein's ~heory of relativity, energy and mass are equivalent. The relation between the ~o 1s expressed by the following equation:
E = mC2 ....... (7) E is energy, m is mass and C is the velocity of light. . Sayoshi can stay still in the space it occupies. If sayoshi has energy, sayoshi has static mass as expressed by formula (7). If an object with static mass, m, moves at velocity V, the mass, m, in the motion is expressed by the following formula:
m
=
mo
..... (8)
[1- ( Vfc)2 ]lh
According to the formula, if an object with static mass moves at the speed of light, the mass is infinitely divergent. Therefore what can move at the speed of light cannot have static mass. Sayoshi is transmittable by electromagnetic waves or electric current of high frequency, i.e., sayoshi has neither static mass nor energy. Furthermore, molecular waves (molecular spectrum carrying sayoshi) travel in space and leave sayoshi where they pass. If sayoshi has energy, molecular waves keep losing energy, because molecular waves generate sayoshi while they travel in space. As a result, the wavelength of molecular waves must shift. The phenomenon in which the wavelength of the molecular spectrum shifts is called "red shift." It is mostly known by i) the Doppler effect, caused by the expansion of the universe, ii) relative effects at a field of gravity, iii) solvent effect in the absorption spectrum. If we assume that this red shift occurs with sayoshi, it would be that phenomenon in which the spectrum radiating from a substance at a static state loses its energy while travelling. No such phenomenon has yet been observed. No energy is used in the radiation of sayoshi from the molecular spectrum. Even if sayoshi is transmitted by electromagnetic waves because of the locomotion of sayoshi itself, or by generation from magnetic waves, energy does not take part in either case. Because of the above reasoning, I am led to the conclusion that sayoshi does not have energy. 3. SAYOSHI IS AN UNKNOWN FACTOR Sayoshi is a quantity of state in space like the electromagnetic field or the gravity field. In the cases of the gravitational and electromagnetic fields, the fields are totally dependent upon their source, the fields disappear if the source is removed. But sayoshi remains in the space where the source was, even after removal of the source. Therefore sayoshi is different from the so called "field" in this aspect, it has an existence independent of the source from which it originated. According to Einstein's theory, that which is transmitted at the velocity of light has no static mass or has no energy at static state. That is to say, a substance with mass cannot be transmitted to distant places by electromagnetic waves. Since sayoshi is transmittable to distant places by electromagnetic waves, it therefore cannot be a substance. In modern science it is thought that the natural world is composed of substances and fields and that no phenomena can possibly occur without being affected by either of these. As we have seen, sayoshi is neither substance nor field, it has an unknown nature. 4. A
MODEL OF SAYOSHI
If sayoshi does not have energy, it cannot have physical changes or chemical reactions. That is, sayoshi cannot stimulate any system of the living body.
388
Appendix Four: On the Sayoshi Agent
However, it does cause physiological changes in the living body. In order to explain the function of sayoshi, I devised the following "blank sheet" model:
Blank sheet model. Suppose that space (vacuum) is a blank sheet of paper or a canvas, and that substances are the picture painted onto the blank sheet of paper or blank canvas. If we imagine that the painted part of the paper is "distorted" by the paint, sayoshi can be compared to the distortion that occurred on this part of the paper. In other words, sayoshi is the distortion in space caused by the very existence of substances. This distortion remains there even after the painted picture is removed. Sayoshi is transmittable to remote places by electromagnetic waves or accompanying phenomena; it distorts both the blank sheet of paper and the painted picture at the point of contact. Sayoshi does not affect things directly, but it affects them by causing changes in the state of space where the things are placed, and these changes affect the nature of those things. The change made in the picture by the distortion of the paper is the function of sayoshi. Once the distortion of the paper is cleared away, nothing remains there as sayoshi. Sayoshi is the space (vacuum) itself and we recognize the existence of sayoshi only by its function. I conclude that sayoshi is of an unknown nature and that it is an operation but has no substance behind its functions.
COMMENTARY BY YOSHIO MANAKA In the classical textbooks of acupuncture, one can find the idea that for supplementation and draining, it is essential to consider the direction of the needle along the channel. Recently an author of a Chinese textbook openly opposed the clinical law of ying-sui, saying that ancient people mixed up the circulation of blood and qi of the body and thus proposed such a foolish law. This foolish author seems to have no idea about sayoshi, just as the majority of acupuncturists do not. Some probable reasons for the ignorance of the sayoshi-like factor can be proposed. First, in modern times one forgets about the use of the various types of fine needles used superficially, some of which were described in the Nei Jing. Second, one cannot understand the fact that the effects of acupuncture do not depend exclusively on stimulation of the nervous system; they also depend on what I have called the X-signal system, where minute factors like sayoshi play an important role. Unfortunately even acupuncturists and scientific researchers pay no attention to this basic issue.
Any generator of sayoshi (if one is able to design such a bipolar moment) can substitute for the needle function, maybe not entirely, but at least partially so, if one says nothing of the stimulation effects. A magnet can be applied to an acupuncture point instead of a needle. Its north pole - south pole polarity is just like the polarity of handle to point of the needle.13 Likewise, a diode is similar to a needle, from anode to cathode. Two substances of negative and positive polarity, if positioned on two points in series, have effects like a needle with regards to the sayoshi vector. POSTSCRIPT
The author has discussed an unknown factor which affects the living body and has named it sayoshi. Sayoshi is both a kind of space which has function, and a kind of vector. The biological reaction of sayoshi is the interaction of the original sayoshi of the body with the sayoshi of various origins. Any individual has particular sayoshi structure. Changes of the individual sayoshi condition cause changes of the physiological functions.
Appendix Four: On the Sayoshi Agent
389
Acupuncture is deeply concerned with sayoshi; it is an operation that changes the sayoshi state of the body by the use of needles. However, any generator of sayoshi can be used to this end. So far as sayoshi is concerned, especially in the case of superficial sayoshi, one can expect effects without the insertion of needles, from contact only. Most things, including living bodies, emit sayoshi. Only approaching them can cause sayoshi reactions. One can transfer a medication's sayoshi to other indifferent substances. Thus it might be possible to reasonably explain the effects of homeopathic preparations in terms of the mechanisms of sayoshi. Moxa generally has positive sayoshi. The movement of any substance generates sayoshi. Any form can generate a particular sayoshi. This may be why qigong exercise can control the body and mind, by means of the sayoshi procedure. Even if the term qi in Chinese medicine and acupuncture is difficult to define, because it is ambiguous and has multiple descriptions, it is certain that sayoshi plays an important role in it. In studying qigong scientifically, there should be an appropriate scientific methodology. Perhaps our study of the sayoshi problem could be an initial step in breaking the barrier. BIBLIOGRAPHY
1. Katsumata, Yasumasa, "Physiological Reaction to substances placed outside of the body and its cause," first report on his studies (in Japanese), unpublished report. 2. Akabane, Kobei, Hinaishin Ho (Method of Hinaishin), Yokosuka: Ido no Nippon Sha, 1964. 3. Manaka, Yoshio, Ika no Tameno Shinjutsu Nyumon Kuoza (Introduction to Acupuncture), Yokosuka: Ido no Nippon Sha, 1980. 4. Katsumata, Yasumasa, "Applications of Sayoshi," third report on his studies (in Japanese), unpublished report. 5. Hashimoto, Keizoh, Sotai-ho (in Japanese). ENDNOTES
1 See for example: Yasumasa Katsumata, "Physiological reactions to substances placed outside of the body and their causes," first report on his studies (in Japanese), unpublished report. 2 Yasumasa Katsumata, first report, op. cit. 3 Yasumasa Katsumata, "Applications of Sayoshi," third report on his studies (in Japanese), unpublished report. 4 Ibid. 5 Ibid. 6 Yasumasa Katsumata, first report, op. cit. 7 Ibid. 8 Yashumasa Katsumata, third report, op.cit. 9 Ibid. 10 Ibid. 11 See his Sotai Ho (in Japanese). 12 S.B.: This is like+ X+=+,- X-=+, but+ X- or- X+=-. 13 In Japan, Tada Kono efficiently systematized magnet treatment on the acupoints, receiving the 1987 Manaka prize for his work.
APPENDIX FIVE
ON THE DEVELOPMENT OF A MATHEMATICAL MODEL FOR THE ''LAWS" OF THE FIVE PHASES* *FIRST PUBLISHED IN THE AMERICAN JOURNAL OF ACUPUNCTURE
(1)
17:4, PP 261-6, 1989
STEPHEN BIRCH, SociETY FOR ACUPUNCTURE RESEARCH
(2) MARK FRIEDMAN, PH.D., DEPT. OF MATHEMATICS AND STATISTICS, UNIVERSITY OF ALABAMA AT HUNTSVILLE
INTRODUCTION The wu xing lun, the "five phase" theory, has notable significance in acupuncture and Chinese traditional medical theory. It has appeared in medical literature from the earliest texts - Huang Di Nei Jing Su Wen Ling Shu and the Nan Jing, circa 300 BC- 100 AD, to present-day professional literature. Almost all introductory texts on acupuncture in use today describe five-phase theory; indeed, several examine it in great depth. Some schools of thought view it as nothing more than protoscientific speculation, with no physiological basis, and make little attempt to use it clinically. Others view it as essential to their clinical practice of acupuncture. For those able to use the theory successfully, its physiological basis remains unclear, yet it manifests and is used in an exact manner. So precise are some of these manifestations that some have speculated on the need to formulate mathematical models and from there to search for appropriate physiological models [1]. It is our intention in this introductory paper to outline a basic mathematical model capable of explaining the "laws" of the five phases. An important advantage of using a mathematical model is that the unambiguous language of mathematics makes it possible to ask precise questions and formulate precisely the hypotheses to be tested. While this is our goal, we recognize the limitations of this first model and speculate on further developments and refinements that we think will allow the model to cope with more complex clinical situations and from which predictions and measurements can be made. We think that it is important to assess each step carefully with tests and measurements. Only thus can we construct a scientific model of this ancient theory. The five phases are: wood, fire, earth, metal and water. These terms are used in a number of related ways, only some of which will be explored in this paper. The phases are central to the Medicine of Systematic Correspondences. All things in nature may be categorized within one of the five phases. Each of the seasons, directions, climatic patterns, body organs, colors, tones, odors, emotions, body tissues, body types, disease patterns, pulses, palpatory reflex areas, etc.,
392
Appendix Five: A Mathematical Model for the Five Phases
have correspondences [2]. Many of them predate the early Chinese medical texts by at least several hundred years and hence come from more theoretical and philosophical backgrounds. Thus some scholars argue that the theory of the five phases is just ancient philosophical speculation. The phases were also described in their relationship to each other. In the engendering cycle, e.g., wood => fire => earth => metal => water => wood, etc., each phase is engendered by (is the child of) the previous phase in the cycle and engenders (is the mother of) the next phase in the cycle. In the restraining pattern, each phase is restrained or controlled by another phase and restrains or controls yet another phase, e.g., wood => earth => water => fire => metal => wood, etc. Diagrammatically these two are shown as:
Figure 19.1: The Engendering Cycle
Figure 19.2: The Restraining Cycle
Aside from these two, their opposites are also described, the counter-engendering and counter-restraining cycles, allowing for interaction of each phase with all others such that they completely regulate each other. Reference to these patterns is commonly made, though often they are seen as mere speculation, without physiological basis. Another important function of the five-phase theory lies in its facility for explaining various biorhythms. Early descriptions of five-phase theory focused on yearly and sixty-year patterns, examining the influences of climate and season. Later descriptions (circa 1400) focused on daily, ten-day, and sixty-day biorhythms. These descriptions are very exact and can still be found in modem literature and practice. Five-phase theory lies at the heart of the theoretical explanations of these rhythms. In this paper we will focus on the second general use that describes phase interactions: the engendering, restraining, counter-engendering, and counterrestraining patterns of the phases. In future papers we hope to explore in more detail the first and third uses of five phase theory. To construct an appropriate model for these, we have had to make the assumption that it is possible to consider all phenomena in the body categorized within one phase as representing a single united energy state. For example, the liver, gallbladder, liver and gallbladder channels, the tendons and muscles, etc. all belong to wood; the total physiological activity of all these create the wood energy state. At this level of description we use the term "energy" in a broad sense. In the discussion at the end of this paper, we speculate briefly on the possible physiological basis of this energy. Note also that the energy transfers between the phases that
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occur in the four restraining patterns, e.g., wood engenders fire, wood restrains earth, etc., have very low level energy contents. By simple addition or subtraction they neither increase nor decrease significantly the energy content of the phases. Rather, they are "information" transfers (see the discussion at the end of the paper).
ANALYSIS The patterns of interaction describe how the change of energy of a particular phase is affected by the energy changes in itself and other phases. We first will formulate precisely our assumptions, then derive an appropriate mathematical model that describes the evolution in time of the energy of each phase, using a system of five ordinary differential equations. Then we will analyze this system. The main idea is that each phase has its "normal" steady state energy. We are interested in determining under what conditions the system is stable under small perturbations, i.e., if we slightly change the energies of different phases, will the energies return to the steady states? This is important since the five phase "laws" predict that they should return to the steady states. 1) For simplicity of mathematical analysis, we assume that all five phases are identical in the sense below. 2) Denote by [ wi (t), i = 1, 2, .... , 5 ] with [ wi = wi ± 5 ] the energy of each of the five phases, considered as a function of time [ t ]. By subtracting the "normal" steady states, we can assume (without loss of generality) that all the five steady states are zero; thus [ wi (t) ] is the difference between the energy at time [ t] and the "normal" energy for a phase [ i ]. 3) We assume that when [ wi = 0, i = 1, .... , 5 ] (i.e., each phase is in the steady state), the sum of the influences on each phase is zero (i.e., the whole system is in equilibrium). 4) We assume that the rate of change in time of energy of the phase i, dwi , i = 1, .... , 5
at
is the sum of the quantities proportional to the energies of phases, j 1 j = 1, •••••1 5. More specifically, we postulate the following system of five linear ordinary differential equations: (1) dwi = awi-1 - bwi-2 - cwi- dwi+1- ewi+2 , i = 1, ..... , 5. dt To understand what system (1) says, assume for example that wi is the energy of wood. 4.1) (Engendering) The rate of change of wi(wood) is proportional to awi-1 (water), a> 0. This means that if wi-1 > 0 (the energy wi-1 of water is above the "normal") then the energy wi of wood increases; if wi-1 < 0 (the energy of water is below "normal") then the energy wi of wood decreases. 4.2) (Restraining) Similarly, the rate of change of wi (wood) is proportional to - bwi-2 (metal), i.e., if the energy wi-2 of metal is above (below) normal, the energy wi of wood decreases (increases). 4.3) wi (wood) affects itself homeostatically, proportional to - cwi. If wi > 0 it decreases itself; if wi< 0 it increases itself, c > 0. 4.4) (Counter-engendering) If wi+ 1 (fire) is above normal, it decreases wi (wood); if it is below normal it increases wi proportionally to- dwi+ 1 , d > 0.
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4.5) (Counter-restraining) If wi+2 (earth) is above (below) normal, it increases (decreases) wi (wood), proportionally to- ewi+2, e > 0. Expect a> b > e > d. The
m:~xoffulesy:r~r~r=~ :~ -e -c
-b -e
a -b
-c a
I
-d -c
This is a circular matrix [3]. The stability condition is that all eigenvalues of A should have a negative real part. The eigenvalues are [4]: (2) ~ = - c + apj - bp2j - ep3j - dp4j , j = 1, ..... , n, (3)
"-1 = "-2 = A-3 = "-4 = "-s=
p = p2vt/5 ' t = v--:r - c + ap - bp2 - ep3 - dp4 , - c + ap 2 - bp4 - ep - dp3 , - c + ap3 - bp - ep 4 - dp2 , - c + ap 4 - bp3 - ep2 - dp , -c+a-b-e-d.
Note that ReA-1 = ReA-4 ReA-2 = ReA-3 . Denote Rep = Rep4 = :os 27t/5 = .309 = y> 0, Rep2 = Rep3 =cos 47t/5 = -.809 = -P < 0, From ReA-1 , ReA-2 , ReA-5 < 0, we have: (4) { - c + (a-d) y+ (b +e) p < 0. - c - ( a - d ) p - ( b + e ) y < 0. - c + ( a - d ) - ( b + e ) < 0. Under the assumption a> d the system (4) reduces to the first and third equations: (5) {
(a-d) y + ( b +e) P < c, - a - d - ( b + e ) < c.
Denote a-d= x, b + e = y. Then (5) is satisfied for (x,y) in the region R.
y .::::
1.24 c l+P 1-y ) ( --C --C r+P 'y+P
-
(1.53 c, .57 C)
R
c
X
Figure 19.3 This tells us for which values of the parameters the zero steady state of the system (1) is stable, in particular, if c = 0 (i.e., there is no homeostatic effect of a phase on itself), then it is always unstable.
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DISCUSSION Perhaps the most significant theoretical aspect of the above model concerns the assumption that the energy transferred between the phases is of a qualitative, informational nature and not a quantitative physiological nature. The various control parameters- engendering (a), restraining (b), counter-engendering (d) and counter-restraining (e)- are concerned solely with physiological regulation and not physiological process or exchange. As the model evolved, we found that were the parameters of a physiological and not an informational nature, i.e., by simple addition or subtraction were they to increase or decrease the energy content of the phase, the system would always break down. We thus concluded that they must be informational. This outcome resolves some apparent conflicts between different schools of thought in acupuncture. Schools adhering to the descriptions of organ theory (zang-Ju theory) as the sole basis of acupuncture have always found that the fivephase parameters (a, b, d, and e) are unable to describe the physiological functions and interactions of the zang-fu. However, when we take the view that these parameters are concerned solely with the interactive regulation of the zang-fu, the channels, and the related phase-sets, and are not the physiologic interactions themselves, then the conflict is resolved. Clinically this implies, at the very least, two different types of acupuncture practice. One is concerned solely with the regulation of the control parameters. Since these are of an informational nature, i.e., they have tiny energy content, they require only tiny stimulation to achieve this regulation. This supposition is supported both by clinical practice and results and clinical research and investigations [5]. The second type of practice is more explicitly concerned with the physiological activities of the zang-Ju, and thus concentrates on the physiological energies themselves. Consequently treatment tends to use stronger stimulation to achieve such effects. This, too, is supported by clinical practice and results and clinical research. The method of treatment seems closely tied to the theoretical basis of the treatment. In a future work we hope to investigate these relationships and differences. For the model to create a stable interaction between the phases, we found it necessary to add a fifth parameter, (c). This is the "intra-phase homeostatic" parameter. Increase or decrease of this only speeds up or slows down the return to normal. We hope to investigate this parameter in further papers. It is possible that it relates, at least in part, to the "ten stern" expanded model of the five phases [6]. To date our attempts to apply this model in treatment have found that it fails to adequately explain the following: (i). How do the parameters a, b, d, and e actually increase or decrease physiological activity within a phase and thus either increase or decrease the energy state of the phase? (ii). This model is a linear approximation, but in practice we will need nonlinear models to explain non-linear phenomena. For example, when a phase is vacuous (vacant, deficient, depleted), we can interpret this as an imbalance of a parameter that changes and resets the steady state of the phase. In such a case, traditional theory tells us to "supplement the mother." For a wood vacuity, we therefore supplement water. This improves the "child" phase, wood, while the "mother" phase, water, returns to normal. This sequence of events must be interpreted as a non-linear phenomenon, requiring changes in parameters, energy states and steady states.
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It is necessary to expand the model to include more parameters. This will be the basis for a further paper. We think for example that adding a sixth parameter, cl, is necessary. If it is caused to increase, it will increase the physiologic activity and thus the energy state of its related phase. If it decreases, it decreases physiologic activity and thus the energy state of the phase. Introduction of such a parameter allows for an explanation of how the shu acupoints, the five-phase acupoints on each channel, might bring about their specific effects. It also allows for an explanation of the yuan (source) acupoints and their effects. If it is necessary to introduce this parameter, then it is possible that we have uncovered a necessary relationship between the five phases and the source-triple burner/pericardium functions. Based on translations of original texts, arguments have been made that such a necessary relationship exists [7]. In a future work, we hope to examine these relationships. Since five-phase treatments typically use the phase acupoints on each channel and each channel has a phasal correspondence, then it will be necessary in future work to develop a model of the channel systems, to be able to fully explain how treatments work. Our next paper will focus on this problem, as the current model is clearly inadequate to deal with it. It may also be necessary to develop a ten-stem model as part of the channel model to explain some of the relationships. A final word on the biological basis of these descriptions is necessary. In research and in practical utilization of the phase acupoints on the channels, it is clear that they have the phasal characteristics described by the traditional literature. The methods by which these acupoints have been explored suggests that the control parameters they affect - the flow of interactive regulatory information or signals - have electrical, magnetic, electromagnetic, and possibly other characteristics. Information may be encoded by frequency, wavelength, amplitude and other properties [8]. There is ample evidence of the existence and role of weak electric currents, ionic currents, electric fields, magnetic fields, electromagnetic radiation, coherent light waves, etc., as the carriers of biological information in the body [9]. In future works, as we develop the model, we will test it using computers to simulate the development of a disease, its diagnosis and treatment, and make measurements on the body to see if we find or measure the predicted outcomes. Measurements must be of specific events and will probably be of electrical parameters like voltage and resistance, since adequate equipment exists for this. It is our hope that by evolving a mathematical model that is tested at each step, we will be able to demonstrate that theories from acupuncture and Chinese traditional medicine have a firm scientific and biological basis. Further, we hope that the model will have practical applications that enable acupuncturists to take advantage of these theories.
GLOSSARY Five phases: This concept is sometimes called the five elements. The term refers not to concrete things, rather to methods of categorizing and describing relationships and correspondences in nature. They have superficial similarity to the Greek four elements. Channels: This refers to pathways or trajectories of qi energy flow in the body. There are a number of different channels that criss-cross the body surface and interior. The major channels have relationships to specific internal organs. As yet the channels have not been clearly described anatomically, but have been measured electrically and observed using other specific techniques.
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Zang-fu: These are the internal organs. However, the Chinese reference to the zang organ, xin (heart) refers to more than the simple physical structure, but involves a series of other functions as well. The "triple burner" and "pericardium" are two unusual zang-fu that have unclear anatomical correspondences and phasal correspondences. Acupoints: These are discrete sites at the body surface, usually located on the channel trajectories. They are the points into which needles are usually inserted to produce the healing effects of acupuncture. Like the channels or meridians, these have been measured electrically.
NOTES [1] Dr. Yoshio Manaka is one such practitioner. [2] See Matsumoto, K. and S. Birch, Five Elements and Ten Stems, Brookline, MA: Paradigm Publications, 1983. [3] Lancaster, B., Theory of Matrices, New York: Academic Press, 1969.
[4]Ibid. [5] See for example: Matsumoto, K. and S. Birch, Five Elements and Ten Stems; Manaka, Y. and K. Itaya, "Acupuncture as Intervention in the Biological Information System," an address given at the annual assembly of the Japan Meridian Treatment Association, Tokyo, March 1986; and Manaka, Y., K. Itaya and S. Birch, Chasing the Dragon's Tail, Brookline, MA: Paradigm Publications, 1995. [6] See Matsumoto, K. and S. Birch, Five Elements and Ten Stems for a description of this. [7] See Matsumoto, K. and S. Birch, Five Elements and Ten Stems, and Matsumoto, K. and S. Birch, Hara Diagnosis: Reflections on the Sea, Brookline, MA: Paradigm Publications, 1988. [8] See Manaka, Y. and K. Itaya, "Acupuncture as Intervention in the Biological Information System;" Manaka, Y. and K. Itaya, "Biasology applied in acupuncture," unpublished manuscript, 1987; Manaka, Y., K. Itaya, and S. Birch, Chasing the Dragon's Tail; and Paul Nogier, From Auriculotherapy to Auriculomedicine, St. Ruffine, France: Maisonneuve, 1983. [9] As examples see the following: Burr, H.S., The Fields of Life, New York: Ballantine Books, 1972; Becker, R.O. and G. Selden, The Body Electric, New York: William Morrow, 1985; Taubes, G., "An Electrifying Possibility," Discover, April 1986; Sedlak, W., Bioelektronika 1967-1977 with English summaries, Poland Instytut: Wyadawniczy Pax, 1979; Callahan, P., Tuning into Nature, Old Greenwich, CT: Devin-Adair, 1975.
TOWARDS 1HE DEVELOPMENT OF A MA1HEMATICAL MODEL FOR ACUPUNCfURE CHANNELs* *FIRST PUBLISHED IN ACUP. &ELEC. THER.RES.[NT.fOUR
14, PP 217-226, 1989
[1] MARK J. FRIEDMAN, PH.D., ASSOC. PROFESSOR, DEPT OF MATHEMATICS AND STATISTICS, UNIV. OF ALABAMA AT HUNTSVILLE, ALABAMA, 35899, [2] STEPHEN BIRCH, LIC.AC., B.A., SOCIETY FOR ACUPUNCTURE RESEARCH, P.O. Box 33, NEW TOWN BRANCH, BOSTON, MA. 02258, [3] WILLIAM A. TILLER, PH.D., PROFESSOR DEPT OF MATERIAL SCIENCE & ENGINEERING, STANFORD UNIVERSITY, STANFORD, CALIFORNIA, 94305.
ABSTRACT Traditional concepts of classical acupuncture and Chinese medicine come from a culture which is very different from ours, and there have been considerable problems in their accurate presentation. Our approach is to attempt the development of a mathematical language that links these traditional concepts theoretically to models that can be tested experimentally.
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We will first review some of Manaka's findings, confirmed also by our results, having to do with low-intensity stimuli. In particular, Manaka applied polarized agents such as Cu (+) and Zn (-) to non-acupuncture points on a channel and to the so-called "mother" and "child" points on a channel. In both cases he observed the pressure-pain reaction which increased for one orientation of Cu and Zn on the channel and decreased for the opposite orientation. Note that in the case of mother and child points the observed reaction was in agreement with the "five phase" (five element) theory. Also, in the case of the mother and child points, the effect usually lasted considerably longer than in the case of non-acupuncture points on a channel. We will describe several case histories supporting the latter observation. We have interpreted Manaka's clinical findings in terms of a three-level model: 1) a low-intensity signalling system 2) a channel system 3) an anatomophysiological system Taking into account the connection between Manaka's results and skin electrical measurements by some electrodermal diagnostic instruments such as Motoyama' s AMI, we discuss some equivalent electric circuits for a single channel and relate them to the nervous system response. In particular, an electrical circuit model similar to a synapse membrane with two ionic channels (note that we are not talking here about real membranes which have more than two channels) seems especially useful when we try to explain Manaka's clinical results and Motoyama's results on the velocity of propagation of electrical impulses along channels. We develop a mathematical model in the form of a linear five-dimensional dynamic system of the five-phase laws such as the engendering cycle, restraining cycle, etc., in the case of a single channel. We connect this model with the membrane type model above by assuming a simple mass action law (which says that the closed pores in a channel open at a rate proportional to their number and to the input signal) for the dependence of the conductances in the ionic channels on inputs. This combined model is used to describe the development of a disease and its treatment according to the "five phase" theory. Here we interpret "disease" as a blockage in a channel, while a treatment initiates the unblocking process.
INTRODUCTION There have been substantial problems in the accurate presentation of traditional concepts from acupuncture and Chinese medicine. For too long poor philological and scholarly standards have been applied and it is only recently that appropriate standards have begun to appear (see Unschuld) [1 & 2]. This has been compounded by a tendency to try to westernize these concepts by reducing them to concepts that typically do not address the traditional theoretical concepts themselves. This is like trying to relate concepts from one culture to concepts in another culture without having found a language that bridges the two cultures. The result is a mass of contradictory information that often seems irreconcilable. In a simple attempt that pays attention to the traditional concepts themselves, the authors propose the development of a mathematical language that tries to link these concepts theoretically to models that can be experimentally tested. To our knowledge, this is the first attempt to build such a bridge and should be recognized as being only a working model in its infancy. Our use of mathematics here is in the spirit of the development of dynamic system models of complex neural phenomena (see e.g., Carpenter and Grossberg [3]). The mathematical models we derive here draw from three sources:
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(i) knowledge (very limited) of the underlying physical mechanisms (ii) observed clinical phenomena (iii) the translation of the traditional theoretical concepts into their minimal realizations as mathematical laws. Experimental evidence supports a connection between the results of classical acupuncture diagnostic procedures and the results of some electrodermal diagnostic instruments such as Motoyama's AMI and Nakatani's Neurometer. Such measurements lead to simple electrical equivalent circuits of the skin discussed recently in Tiller [4]. In section 2 we first review these circuits and then try to relate them to clinical practice by examining the clinical findings and clinical results of Yoshio Manaka, which investigate the validity and applicability of certain traditional ideas. Exploration of these clinical findings and results show the need to extend the simple model to be able to explain the observed clinical phenomena. Such an extension is explored mathematically with suggestions for further clinical experiments to establish its validity and further extension. In particular, Manaka applied copper and zinc to non-acupuncture points on a channel and to the "five phase" (five element) points and observed the channel responses. To explain his results we introduce an electric circuit model similar to synapse membranes with two ionic channels. Section 3 contains case histories that support the mathematical model developed in section 2. In section 4 we assume an interpretation of disease as a blockage in a channel and assume that treatment initiates an unblocking process. We hypothesize an appropriate dependence of the conductances in ionic channels on inputs and consider a simple dynamic systems model to account for the development of disease and its treatment according to the five-phase laws. The channel is an important concept in acupuncture. It is described as having several functions, probably the most important of which is the distribution of a kind of energy, called qi. The treatment loci of acupuncture lie mostly on these channels. Considerable efforts have been made to understand, measure, and demonstrate the existence of the channels. Measurements made by many researchers have shown that the channels have electrical characteristics (see e.g., [4] and especially [5], which has an extensive bibliography). A certain number of people are ultra-sensitive and are able to describe the movement of sensations following insertions of needles into the channels. These propagated sensations tend to follow channel pathways and have been investigated extensively in China and elsewhere (see e.g., [6]). Dermatological diseases have sometimes been observed to produce lesions and eruptions that lie along the channel trajectories (see e.g., [7]). Attempts have been made to visualize the channels by injecting radioactive isotopes and observing their migrations with a scintillation camera (see e.g., [8]). More recently, using a "bidigital 0-ring test," Omura has provided striking evidence for the existence of "meridian-like networks," which show some correspondence to the channel systems (see e.g., [9]). While the exact nature of these channels is not clear, there is more than clinical evidence to support the premise that they exist.
EQUIVALENT ELECTRICAL CIRCUITS FOR A SINGLE CHANNEL The simplest electrical equivalent circuit corresponding to a single channel used for skin measurement analyzed in Tiller [4] has the form:
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R,
c Figure 19.4
Here R 2 and C correspond to the epidermic layer of the skin and Rt corresponds to the dermic layer. Note that the parameters of the circuit depend in general on the voltage. The Motoyama AMI instrument applies a DC potential of V 0 = 3 volts between a number of channel terminal points and a large indifferent electrode on the wrist and measures the short-time current response (1-100 microsec). In what follows we use the term channel as the corresponding electrical circuit pathway. Clinical evidence of Manaka [12] and others suggests the possibility that the initial electric current BP = V0 I Rt is a parameter corresponding to traditional acupuncture diagnostic measurements (such as radial pulse palpation, abdominal palpation, visual inspection, etc.), though we are not aware of rigorous research that confirms this suggestion. More precisely, for a particular channel, a high BP compared to the average taken over all the channels corresponds to repletion. In traditional terms, repletion (shi) is a condition of too much qi from various causes. A low BP compared to this average corresponds to vacuity. In traditional terms, vacuity (xu) is a condition of insufficient qi from various causes. Here, BP refers to the initial current response at time t = 0 before any polarization has occurred. Because of the known occurrence of circadian rhythms (see e.g. Manaka [12]), where current readings have been found to fluctuate according to the time of day, we feel that further experimental evaluation is required to validate these definitions. The acupuncture points are known to have a positive potential of several millivolts (see e.g., Tiller [4] and the discussion there). To account for this we add a battery E to the circuit of Figure 19.4.
-cJ---1 R, c Figure 19.5
Manaka' s clinical practice and experimental research in acupuncture has led him to suggest the existence of a biological signalling system which has the following characteristics: 1. The biological system works at the level of low intensity signals and responds to low-strength stimuli. 2. The biological system is able to detect and discriminate both internal and external changes, and plays a role in regulating the body by transmitting this information to other parts of the system. 3. As part of the signalling system, certain components of traditional acupuncture practice can be used clinically to regulate the body as indicated below. It was suggested that this signalling system has embryological and evolutionary roots and functioned to regulate the body prior to the development of the neurological, endocrinological, etc. systems. Generally, acupuncture activates both the
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simple signalling system and the more advanced regulatory systems. In such cases, both effects occur together and need to be clinically discriminated since the effects of the signalling system are generally masked by the more evident anatomophysiological system effects. The following diagram illustrates the interaction of the signalling system, our electrical model of the channel system and the anatomophysiological system: ~
Ievetone
~signaling
system
t ~level two ~channeling
system
l
~level three ~anatamophysiologic
level Figure 19.6
The channel system at level two, the electrical circuits in our model, interface between the signalling system at level one and the anatomophysiological system of level three. Regulation at level one produces lasting changes at level two and level three. Most forms of acupuncture work at levels one through three, but only showing the clearer and more easily measured responses from level three. Working from the premise that traditional concepts function at level one, Manaka began exploring the properties of the signalling system to see if this were so. His experiments utilized tiny small-intensity stimuli such as the application of copper and zinc plates, north and south poles of a magnet, and colors in the form of light and ink to acupoints and channels. The use of such polarized agents, in particular, allow for observation of their repeatable and reversible effects [10 & 11]. Assessment of these effects was made through observation of pressure pain and muscle tonus at acupoints on the channels investigated and on related reflex points. If the application is favorable to the channel under investigation, pressure pain and muscle tonus will decrease. If unfavorable, pressure pain and muscle tonus will increase. We have repeated his simple tests and experiments and have obtained the same results. According to traditional theory the channel qi flows in a particular direction. In an effort to relate this concept to the electrical model of the channel and to determine if there is an electric current flowing in one direction, he applied copper and zinc plates to non-acupuncture points on a channel and observed the channel responses. For example, for pressure pain and tension at right LI-4, on the flesh in the center of the web between the first and second metacarpals, placing copper upstream and zinc downstream, proximal to the wrist on the large intestine channel, decreases these reactions. Reversing the copper and zinc causes the reactions to return. Epidermis
Dermis
Figure 19.7
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Manaka interprets his findings as describing a current flow in the channel which agrees with the traditional description of the flow of qi. In our electrical model, high BP relates to repletion and low BP to vacuity of the channel. However, it is known that pressure pain can arise from both repletion and vacuity (in the traditional sense of these terms). From a simple electrochemical viewpoint, copper is electropositive relative to zinc so that the application of copper upstream and zinc downstream should increase BP. Hence we assume that this adds a voltage and thus is able to describe what happens in the case of vacuity. But in the case where BP is already high, repletion-pressure pain should only increase when we do this. However for this case, clinically the pressure pain decreases, which would indicate a contradiction to our model. Consider next two possible mechanisms of the observed phenomena. The first is that the pressurepain response arises from an influence of the treatment on the neural response in the vicinity of a particular point. The chain of effects for this would be as follows: (i) surface treatment leading to (ii) changes in the local channel that ultimately manifest as electrical changes in the equivalent circuit which lead to (iii) electrolyte and voltage changes in the vicinity of the key neural channels leading to (iv) excitatory or inhibitory response in the neural fibers leading to (v) pressure pain response at the point. The second possibility is that we need to change the channel model, specifically to change R by a circuit similar to one that describes the excitatory and inhibitory responses of a neural fiber. In both possibilities we choose the same model to resolve the contradiction. Release of pressure pain from repletion or vacuity can be explained in either case by the effect of stimulation on the inhibitory and/ or excitatory channels of either the neural membrane, the equivalent channel channels or possibly both. In the first case, where treatment influences the two channels of the neural fibers, the effects on the pressure pain are relatively straightforward. In the second case where treatment influences the two pathways of the channel to effect pressure pain changes, the following are evidence in support of this model: a) pressure pain responses do not arise solely from neurological causes and therefore do not necessarily require a model of the neurological effects (see e.g., Melzack [13]). b) Motoyama's results regarding the velocity of qi support this model (see page 75 especially of [14]). He found the velocity of propagation of electrical impulses along the channels to be in the range 4 em/ sec - 50 em/ sec, which is considerably smaller than the velocity of propagation of nervous impulses which are in the range 50 em/sec-100m/sec. It appears that the propagating impulses measured by Motoyama are travelling waves; the mathematical equations which have as their solution, travelling waves, are of the form similar to equation (1) below. We therefore feel justified in the use of this model and equation (1) for the channel. c) our analysis below shows that the use of this two ionic channel model for the channel is able to resolve the above contradiction and describe qualitatively many other phenomena. To be specific, assume that a channel is described by the equation of the type used in the neurophysiological model for synapse membranes with two ionic channels: (1) C0 ~; = (v+ - v) g+ + (v- - v) g- , where v+ and v- are excitatory and inhibitory saturation points, respectively: v+ > v-; g+ > 0 and g- > 0 are the corresponding conductances of the two ionic channels, while C 0 is the
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capacitance which we can assume to be unity for simplicity. Thus, depending on the values of g+ and g-, v can take any value between v+ and v-, which we interpret as being related to the most replete and most vacuous states of the channel, correspondingly. When the channel becomes vacuous, let us presume that the resistance of the excitatory channel becomes large (the excitatory channel closes) so that g+ becomes small and v+ is close to v-; i.e., we have blockage in the excitatory channel. Similarly, if g- becomes very small, we presume that it is due to the channel being replete and vis close to v+. This we interpret as blockage of the inhibitory channel (the inhibitory channel closes). Thus for the case of copper and zinc application as indicated in figure 19.7, the homeostatic effect of reduction of the pressure pain can be explained as follows:
In the case of vacuity, g+ is increased which makes the channel more replete. In the case of repletion, g- is increased so that the channel becomes more vacuous. These simple copper and zinc tests developed by Manaka appear to demonstrate that the channels have direction of flow. The north and south pole magnets of 600-800 gauss strength have also been used to check channel flow and the results are essentially the same as found for copper and zinc. The pressure pain responses are qualitatively similar when the north pole replaces the copper and the south pole replaces the zinc. Omura [15] has shown that low-energy signals can change body musculature, but they cannot create such changes by introducing voltage to neuronal membranes. Low-energy signals cannot create a sufficient voltage to cause nerve impulses. Our model describes such signals as effecting changes in conductances and not voltages. This is similar to the negative resistance circuit suggested by Omura [15] as a possible mechanism of the above effects. These experiments have so far used non-acupuncture points on a channel. Next Manaka applied these same polarities to certain acupoints, in particular the "mother" or supplementing (tonifying) and "child" or draining (dispersing) points [10 & 11]. These acupoints are important in traditional practice. Their names derive from their association with the wu xing (five phases). We have done some exploration of the five-phase model mathematically, and formulated mathematical models which match traditional descriptions of their interactions [16]. Looking only at the interaction of the supplementing and draining points, we see that they can be modeled according to the five-phase model by the following equation, which is a simplification of equation (9) below: dsi = asj-l - dsj+l dt
Here sj is the amount of stimulation of the j-th point on the channel under investigation where this point belongs to the same phase as the channel and a > 0, d > 0 are coefficients. sj-1 is the amount of stimulation of the supplementing ("mother") phase. Accoraing to traditional concepts, we treat the mother in cases of vacuity. s·+1 is the amount of stimulation of the draining ("child") phase. According to lraditional concepts we treat the child in cases of repletion (excess). Note that Sj-1 has a positive value and sj+1 a negative value. We assume that stimulation of the channel is proportional to sj. Manaka observed polarity-dependent reversible changes associated with these points. Repeating his experiments, we have been able to confirm his findings. Placing copper to the mother point and zinc to the child point reduces pressure pain on the channel or at associated channel points. Reversing these so that zinc is on the mother points with copper on the child points causes the pressure pain to
404
Appendix Five: A Mathematical Model for the Five Phases
return. Replacing the copper with the north pole of a magnet and zinc with the south pole has the same effect on the pressure pain. In general, applying a positive electrical polarity to the mother point and negative to the child point has the same effects. Thus other polarity agents such as Manaka's ion-pumping cords (I.P.) can be used to treat these points with the same effects. The ion-pumping cord is essentially a wire with a germanium or silicone diode in it. It has clips on either end for attachment to needles (see Manaka [11 & 17]). It allows for unidirectional flow of current from the black to the red clip. Thus the black clip is negative and the red positive. Clinical usefulness of the ion-pumping cords can be seen in the case histories below. Note that they are used with great efficacy on the "extraordinary vessels" as well as on the channels. The following is a clinical demonstration of the applications of these various polarity agents to mother and child points. For pressure pain at KI-16, located approximately one centimeter on either side of the navel and associated with the kidney channel on which it lies, the following results are obtained using polarity agents on the KI-7, the mother, and on KI-1, the child points: Agent
Point
Agent
Point
Pressure Pain
copper(+)
Kl-7
zinc(-)
KI-1
KI-16 decrease
zinc(-)
KI-7
copper(+)
Kl-1
KI-16 increase
north(+)
south(-)
KI-1
KI-16 decrease
south(-)
KI-7 KI-7
north(+)
KI-1
KI-16 increase
I.P. red(+)
KI-7
I.P.black (-)
Kl-1
KI-16 decrease
I.P.black (-)
KI-7
I.P.red (+)
KI-1
KI-16 increase
These observations can be explained using the above model of the channel. The positive agent applied to the mother point and the negative agent applied to the child point opens the ionic channel pores as described above. In cases of repletion, this opens the inhibitory channel pores which will improve current flow through the channel and release pressure pain. In cases of vacuity, this opens the excitatory channel pores which will improve current flow through the channel and release pressure pain. Reversing the polarity agents closes the pores, reversing the changes in current flow and causing the pressure pain to return. These effects of the polarity applications to the mother and child points can be seen in the phase model equation above. (See section 4 for a more detailed mathematical model of this.) It is also important to notice that in eight out of twelve of the channels, the order of application of the polarities to the mother and child points is the reverse of that when applied to non-acupuncture points on a channel. In this latter case, we have postulated that part of the effect is due to the addition of voltage to the circuit, but in the former, since in most of the applications the polarity order is reversed, the action of the polarity agents on the mother and child points must be other than simple addition of voltage to the circuit. The mother and child points must have special properties not directly related to the flow of current in the channels. They regulate the channels by increasing or decreasing conductances (opening or closing the ionic channel pores). This and other of Manaka's research- for example, application of colored light and ink to these acupoints [11, 18 & 19] - supports the interpretation that these categories of acupoints do correlate to what the Chinese called the five phases. In our model their total interaction serves to regulate channel conductance. However, more rigorous clinical research is required to investigate this.
Appendix Five: A Mathematical Model for the Five Phases
405
An important point to notice in the above experiments is that in the first clinical demonstration, when applying copper and zinc to non-acupuncture points on a channel, _the effects are shortlasting. We postulate that their effects occur partially through addmg voltage to the channel and partially by opening the channel pores. Once the voltage is removed, the channel returns to its original state. In our model of Manaka's ideas above, this works at level two. We think though that this requires experimental confirmation. Applying polarities to the mother and child points works primarily at level one by changing the conductance of the channels and thus has longer lasting effects than in the other case. Rigorous experiments are required to verify this, but it at least has clinical confirmation. Manaka takes advantage of these changes clinically by applying I.P. to the mother-child points of the channels found to be problematic by his methods of diagnosis. These involve palpation of pressure pain and tension, use of the Omura hi-digital 0-ring test, pulse palpation, visual inspection, etc. Our own clinical utilization of these ideas shows their clinical application. This can be seen in the following case histories taken from Manaka and our own case loads. These case histories are essentially anecdotal, intended only to illustrate that long-term effects can be obtained with these treatments, as our model predicts. Until now, with the development of a model to describe these clinical concepts, we have had no need to do rigorous clinical studies. We recognize the need for such studies. We also recognize that our model is only for application to a single channel. Clinical reality is more complex than this. Actual treatment in these case histories is applied to two channels, often with supplementary points. Further, in the first case study, the extraordinary vessels were used on the first visit. We include this to illustrate the clinical effectiveness of the ion-pumping cords. In the future we will develop models for all the channels and their various interactions, including the extraordinary vessels. Experimental protocol requires us to start with the simple models and build on these. CASE STUDIES Case One: Female, age 53 Main complaints: Severe lumbar pain and pain of the right upper arm and shoulder. History: These problems were of nine years duration. The patient had tried the following therapies unsuccessfully during this time: traction of the spine; wearing a support brace while taking pain medications; surgery for a herniated disc; and traditional herbal therapy for one year. She was now pessimistic and depressed about her condition. Diagnostic findings: Dark facial color with pigmentation of the skin on the face and over areas of the upper back and chest. Pressure pain and tension in the right subcostal and lower left quadrant regions of the abdomen. Positive 0-ring tests at right LR-14, left ST-27, and CV-4. Tension and swelling at right BL-18. Weakness of the left radial pulse, especially in the second position at the radial notch. Poor flexion of the lumbar region. Poor flexion of the legs. Pain with abduction and rotation of the right arm. Diagnosis in this case was a problem of the liver channel. Treatment: On this first visit we used shallowly inserted needles with I.P. on the extraordinary vessels at right PC-6, SP-4 and left TB-5, GB-41 for fifteen minutes. This released the abdominal reactions and improved the 0-ring tests. Hashimoto's extension exercise for the leg was applied three times. Subsequent flexion of the legs and lumbar region showed great improvement with considerable improvement in the lumbar pain.
406
Appendix Five: A Mathematical Model for the Five Phases
At the second visit seven days later, the patient's range of lumbar flexion was still at the improved level and the patient reported having had almost no lumbar pain. However there had been no real improvement of the pain in the right upper arm and shoulder. Diagnosis revealed a slightly different pattern of abdominal reactions. Pressure pain and tension was found in the right subcostal region and to the left of the navel focusing around ST-26. Positive 0-ring tests were found at right LR-14, left ST-26 and CV-4. Diagnosis in this case was of the liver and small intestine channels. Treatment involved the use of shallowly inserted needles with J.P. to the mother and child points of these two channels for fifteen minutes in the following pattern:
right SI-3 red - SI-8 black left LR-2 black- LR-8 red
This released the abdominal reactions and improved the 0-ring tests. Range of motion of the right arm was examined. Abduction and rotation showed improvement with greatly reduced pain. Associated back points BL-18 and BL-27 were then needled and warmed with moxa to reinforce the J.P. treatment. The patient was then sent home with recommendations for dietary changes and instructions not to worry about her problems since they had responded so well to treatment. On subsequent visits over the next few weeks, the lumbar and arm and shoulder pain did not return.
Case 2: Male, age 38. Main complaints: Reiter's syndrome with arthritic pain and poor mobility of the spine and both hips joints. History: The problems began five years before with an acute onset of arthritis in the left hip joint only days after an attack of urethritis and conjunctivitis. Indomethacin and aspirin were used to treat this. Three and a half years later, the spine began showing signs of arthritis with pain, stiffness and poor mobility. 600 mg per day of Clinoril was then used in place of the previous medications with some success and partial relief of symptoms. But in the last few weeks the patient had suffered a worsening of the condition with increased severity and frequency of pain and signs that it had started in the right hip joint. The patient was sleeping very badly. He was unable to lie on his back without muscle spasms and great pain. This disturbed his sleep considerably. Diagnostic findings: The musculature of the upper body and back was swollen and tight with pressure pain in the cervical, thoracic, and lumbar regions. Pressure pain and tension was found in the right subcostal region of the abdomen. But more severe pressure pain was found at left LU-1 and at both Kl-11. Positive 0-ring tests showed at left LU-1 and both KI-11. Weakness was found in the right radial pulse at the cun position and left radial pulse at the chi position. Poor mobility of the spine and hip joints was found. Diagnosis was of the lung and bladder channels. Treatment: We applied shallowly inserted needles with J.P. to the mother and child points of the left lung channel and the bladder channel for fifteen minutes in the following pattern: left LU-5 black- LU-9 red left BL-65 black - BL-67 red The patient, lying supine with knees raised, reported a relaxing of the back muscles. The abdominal reactions and 0-ring tests improved. Range of motion of the spine was examined. The patient had greatly increased range of motion and reported a significant reduction in pain and stiffness. Needles were then inserted to BL-18
Appendix Five: A Mathematical Model for the Five Phases
407
and BL-28 and warmed with moxa. Hashimoto's sotai leg extension exercise was applied three times. Hinaishin (subcutaneous needles) were then applied to ear points for the spine and hips. One week later, the patient reported having maintained the improvements in the spine and having been able to sleep on his back with no discomfort or spasm. Treatment continued successfully over the next few weeks with improvement in the hips and a slow reduction of Clinoril until zero intake was achieved. Except for minor flare ups requiring further treatment over the last two years, this patient has maintained these improvements and now is able to lead a normal, active life.
Case 3: Female, age 75 Main complaints: Pain, stiffness and restricted motion of the left elbow, wrist and fingers following a lower left humeral fracture ten months before. Right sided sciatica with ankle pain. History: Following the injury a cast was applied. After removal of the cast, physical therapy was given twice a week for six months. During this time the patient put on weight, which irritated an old sciatic problem on the right side with pain also at the ankle. Diagnostic findings: The left arm could not be abducted beyond shoulder level. The left hand had very poor grip, and the left wrist had restricted rotation. Swelling and pressure pain was noted on the left triple burner channel from elbow to wrist. The patient was obese, and the musculature of the lumbar region was swollen and tight. Pressure pain and tension was found in the right subcostal region of the abdomen with pressure pain and tension at right ST-25 and GB-26. The right radial pulse was weaker than the left radial pulse, especially at the middle position. Diagnosis was of the spleen and triple burner channels. Treatment: We applied shallowly inserted needles and I.P. to the mother and child points of the right spleen and triple burner channels for fifteen minutes in the following pattern: right SP-2 red- SP-5 black right TB-3 red - TB-10 black The abdominal reactions improved. Abduction of the left arm was tested showing some improvement. The wrist rotation also showed some improvement. Two hinaishin were inserted to the Korean arm reflex points on the left fourth finger. Further hinaishin were placed at left LI-14 and in the right ear at the ankle and sciatic points. Finally needles were shallowly inserted at right GB-39 and GB-41 for five minutes. Abduction and rotation were retested showing further improvements. Upon stepping off the treatment bed, the patient reported almost no sciatic pain with only a little discomfort at the right ankle. One week later abduction and rotation of the left arm was still improved though some pain persisted. The sciatica had improved to a dull pain in the right buttock.
In these case studies, we can see long-term changes resulting from treatment. Our model predicted that regulation at level one should produce lasting effects. We think that this is at least demonstrated in these case studies. Below are more developments of the mathematical model which describe a possible mechanism for these treatments. Rigorous experiments will be required to validate the model.
408
Appendix Five: A Mathematical Model for the Five Phases
A MATHEMATICAL MODEL FOR THE FIVE PHASE LAWS IN THE CASE OF A SINGLE CHANNEL We consider the effects of different signals on the excitatory conductance g+ (for g- the analysis is similar). We use a simple mass action law. To be specific, assume that (1) describes a wood (liver) channel. Let T 1 be a signal leading to vacuity of the liver channel, i.e., decreasing g+, say, due to emotional and dietary factors, acting for a long time (i.e., several years) from time to to t1. At time t1 the diet was changed and treatment using needles, electrical polarities or light (according to the five phase laws) was administered for a short time from t1 to t2 by a signal T2. We thus have: (2)
(3)
T 1 (t)
=
{
0. const, t 0 t
{
0.
t < tl• s t2•
T2 = const, t1
s
0,
> tz.
t
t
The simplest mass action law is defined by: (4) gg+ = ( H + JT2 (t) ) ( g 0 - g+) - JT1 (t) g+ , t ~ t 0 , dt Where go is the maximal number of open pores (when T1 (t) = 0). Equation (4) says that closed pores, which number g 0 - g+ , open at a rate H + JT2 (t) (when T 2 (t) = 0 then the rate is H); and that the signal T1 (t) closes open pores, which number g+ at a rate J. We also assume that at timet= t0 all pores are open, i.e., no blockages: (5) g+ = go Solving (4), (5) for different time intervals gives: (6)
g+ (t) = _!L g 0, H+JT1 for timet "long enough";
• t0 << t
s
t1 •
(7)
g+(t)= g 0 - g 0 (J~e) -(H+JT2 )(t-t1), tl H+JT1
(8)
g+ (t) = g 0 - ( g 0 - g+ (t2 >) e -H (t- t2), t ~ t2 .
s
t
s
t2;
Equation (6) shows that the excitation channel of the liver channel is now partially blocked (the conductance g decreased). Equation (7) models the unblocking process (increase of g) due to the treatment. Equation (8) says that the unblocking process continues after the treatment stopped, but with a slower rate than during the treatment. Substitution of (6), (7), and (8) into (1) and solving it will show how the voltage v changes in time. Clinical experiments are required to test this model. We next look more closely at the treatment process, e.g., how T2 (t) can be obtained. Clinical experiments performed by Manaka and ourselves seem to agree with the traditional five-phase theory. The following example with colors shows this [11]. To reduce pressure pain on LI-4, a metal channel point, applying red to LU10, a fire point on a metal channel, will reduce the LI-4 pressure pain. Here, fire restrains metal, red on a metal channel restrains the channel. Applying black to LU-10 will cause the LI-4 pressure pain to return. Here water restrains fire. Black on a fire point reduces the restraining effect of fire on the metal channel.
Appendix Five: A Mathematical Model for the Five Phases
409
The simplest conceptual model of the classical five-phase theory in the case of one channel can be formulated as follows. Given a stimulation of one or several of the five acupoints corresponding to different phases, on the channel under consideration, these five acupoints stimulate each other according to what the traditional theory calls engendering and restraining cycles. Then the stimulation of the channel is proportional to the resulting stimulation of the acupoint that belongs to the same phase as the channel. The simplest mathematical interpretation of this model gives a linear five-dimensional dynamical system. We illustrate our approach in the case of our example of the wood (liver) channel. Let Sj (t), j = 1 ....,5 (assume j = 1 for water, j = 2 for wood etc.) denote the amount of stimulation of j-th point on the wood channel. Suppose our treatment was to supplement the water point by signal R. Then the simplest mathematical model describing the effects of this treatment is given by the system of five linear differential equations (see also [16]).
(9)
dS1
-
dt
= aS 5 - aS4 - cS1 - ds2 -eS 3 + R(t), t
~
t1 ,
~ = aSj-1 -bSj-2- cSj- dsj+l -eSj+2, j = 2, 3, 4, 5, where R(t) = R = const > 0 for t1 ditions:
~
t
~
t2 , R(t) = 0 otherwise; with the initial con-
sj = o, j = 1, ...., 5. Here a, b, c, d, e > 0. The first equation in (9), for example, says that the rate (10)
of change of stimulation of the water acupoint is proportional to the stimulation Ss (engendering) of the metal point, to the negative stimulation S4 (restraining) of the earth acupoint, to the negative stimulation S1 (homeostatic) of the water acupoint, to the negative stimulation S2 (counter-engendering) of the wood acupoint, to the negative stimulation s3 (counter-restraining) of the fire acupoint, to the stimulation R(t) from the treatment.
Liver (wood) channel
Figure 19.8
410
Appendix Five: A Mathematical Model for the Five Phases
Solving (9), (10) we obtain in particular S 2 (t) which gives us the resulting effect of the treatment on the wood acupoint on the (wood) liver channel, we next set T2(t) = S2 (t), i.e., we assume that the stimulation of the liver (wood) channel equals the stimulation of the wood acupoint.
CONCLUSIONS We have explored mathematically some concepts and clinical data from classical acupuncture. We have attempted to convince the reader that a shift in attitude is possible so that questions of the type "what does all this mean?" are replaced by questions, "How accurate is a particular model?" and "What are the appropriate experiments to verify it?" Though we are not aware of any rigorous experiments to support our analysis, still the abundance of anecdotal data convinced us that our attempt was worthwhile. We have started with a simple electric circuit model of the skin, which accounts for the measurements of some of the electrodermal instruments such as Motoyama's AMI. The initial electric current BP is interpreted as an indication of the condition (as determined by traditional acupuncture procedures) of a channel. High BP corresponds to repletion, low BP corresponds to vacuity, in traditional terms. Rigorous experiments are required to verify this correspondence. Manaka's clinical results (confirmed by our own) show that application of a small voltage to non-acupuncture points on a channel and to the mother and child points reduced pressure pain independent of whether the channel was vacuous or replete. In view of the importance of this homeostatic mechanism, we intend to conduct triple-blind experiments to verify this. To account for these results, we introduce a mathematical model similar to that of a synapse membrane with two ionic channels and assume that the applied voltage affects the conductances of the ionic channels. Further research is required to determine actual mechanisms. In figure 19.6, we develop Manaka's idea showing how treatment regulates at the signal level which alters channel conductances, which in tum creates anatomophysiological changes. We corroborate Manaka's suggestion that the five phases and their acupoints belong to the signal level as regulatory mechanisms. Next, we develop a phenomenological model of the five-phase laws in the case of a single channel and use it to describe in real time the development of a disease (which we interpret as blockage in a channel) and its treatment (which we interpret as the corresponding unblocking process). Again, we plan to conduct clinical experiments and monitor them by using AMI or other related equipment. We also intend to examine detailed parametric properties of solutions of our differential equation models, both analytically and numerically, and compare the mathematical predictions with related data. An extension of equation (1) will replace it by an appropriate partial differential equation to account for the travelling wave fronts measured by Motoyama [20]. We also plan to develop a mathematical model for the complete channel system.
REFERENCES [1] Unschuld, P., Medicine in China: A History of Ideas, Berkeley, CA: University of California Press, 1985. [2] Unschuld, P., Medicine in China: Nan Ching, The Classic of Difficult Issues, Berkeley, CA: University of California Press, 1986.
Appendix Five: A Mathematical Model for the Five Phases
411
[3] Carpenter, G. and S. Grossberg, "Dynamic Models of Neural Systems," "Oscillations in Mathematical Biology," Springer-Verlag Lectures in Biomathematics pp. 102-196, Secaucus, NJ: SpringerVerlag, 1983. [4] Tiller, W.A., "On the evolution of electrodermal diagnostic instruments," Journal of
Advancement in Medicine 1:1, Spring 1988. [5] Zhu, Zong-Xiang, "Research Advances in the Electrical Specificity of Meridians and Acupuncture Points," American Journal or Acupuncture 9 (3):203-216, 1981. [6] Li, Ding-Zhong, Jing Luo Phenomenon II, Kyoto: Yukonsha, 1985. [7] Li, Ding-Zhong, Jing Luo Phenomenon I, Kyoto: Yukonsha, 1984. [8] Tiberiu, R., G. Gheorghe and I. Popescu, "Do Meridians of Acupuncture Exist? A Radioactive Tracer Study of the Bladder Meridian," American Journal of Acupuncture 9 (3):251-256, 1981. [9] Omura, Y., "The bidigital 0-ring test and its use for imaging the internal organs and their corresponding meridians." Symposium paper. [10] Manaka, Y. and K. Itaya, "Acupuncture as intervention in the biological information system (Meridian treatment and the X-signal system)," Annual Assembly of the Japan Meridian Treatment Association address, March, 1986. [11] Manaka, Y., K. Itaya and S. Birch, Chasing the Dragon's Tail, Brookline, MA: Paradigm Publications, 1995. [12] Manaka, Y. and K. Itaya, "Thoughts about Ryodoraku total regulation therapy," Nihon
Ryodoraku Jiritsushinkei Gakkai Journal, March, 1986. [13] Melzack, R. eta!., "Trigger Points and Acupuncture Points for Pain," Pain 3:3-23, 1977. [14] Motoyama, H., "A Biophysical Elucidation of the Meridian and Ki-Energy," Inti. Assoc. Relig. & Parapsychol. (1981) 7:1, p.1-78, 1981. [15] Omura, Y., "Effects of an electrical field and its polarity on an abnormal part of the body or organ representation point associated with a diseased internal organ, and its influence on the bi-digital 0-ring test (simple, non-invasive dysfunction localization method) and drug compatibility test - part 1," Acupuncture and Electrother. Res. Int. J. 7, pp.209-246, 1982. [16] Birch, S. and M. Friedman, "On the development of a mathematical model for the 'laws' of the five phases," American Journal of Acupuncture, 17, 4, 361-6, 1989. [17] Manaka, Y., K. Itaya K. and S. Brown," Abdominal diagnosis and indications in traditional Chinese medicine," American Journal of Acupuncture 13:3, p.223-234, 1985. [18] Manaka, Y., "The skin distinguishes color and sound!? An approach to qi, the origin of Oriental medicine," Ida no Nippon magazine, May, 1987, p. 91-98. [19] Manaka, Y., "Speculation on 'qi' in Chinese medicine as media in the signal system," Japan
Shinkyu Topology Conference, Kyoto, July, 1988. [20] Motoyama, H., "Electrophysiological and preliminary biochemical studies of skin properties in relation to the acupuncture meridian," Inti. Assoc. Relig. & Parapsychol. 6, p.1-36, 1980.
FURTHER THOUGHTS ABOUT THE POSSIBLE NATURE OF THE X-SIGNALS BY STEPHEN BIRCH
It is useful to speculate on the possible nature of the signals involved in Manaka's X-signalling system. Ultimately it may be impossible to designate one or a class of possible candidates as exact signals. One is reminded of Lao Zi's famous saying: "The dao that can be spoken of is not the eternal dao." But it is useful from the point of view of potential scientific research to identify potential candidates. When we think about or study these issues we should reject seeing one or more as "correct" and the rest as "wrong" or irrelevant. For all we know, the signalling system is like a large orchestra with each member playing a different instrument in a seamless musical whole. As long as the methodologies employed are appropriate, it will be possible to explore many models. However, beginning where Manaka left off will not be easy. Manaka' s signal system model of acupuncture was discovered through the use of inquiry methods appropriate to the subjects investigated. It fits the criteria for a developed theoretical model and avoids the problems that plague both the integrationist and strictly scientific approaches to acupuncture. It avoids paradigmatic contradictions as well. As a logical description of acupuncture and as a biological model, it neither contradicts the traditional theories (where they have held up to experimental analysis) nor the principles of biology. Essentially, Manaka has proposed that these theories describe how very small signals, produced both within and without the body, are transformed at specific loci and amplified to produce physiological changes of greater extent. I Manaka's theories describe how the material of physiology- all the electronic, protonic, atomic, molecular, and cellular events that are the mainstay of physiology, are regulated by an underlying information system. The theories of yin-yang and five phases describe how aspects of this system work and can be controlled. They describe a kind of subphysiological system, perhaps one that lies in the infinitely complex realm of microenergetic events: the electrical currents, fields, magnetic fields, electromagnetic fields and waves, that are the products of physiology, but which are the matrix within which physiological phenomena occur and are regulated. Thus the language of acupuncture, the theories of yin-yang, do not describe physiological processes, rather they describe the microenergetic phenomena that regulate those processes. This is the essential nature of qi and the channels.
414
Appendix Six: Thoughts About the Nature of the X-Signals
These Chinese words describe the actions of a complex, interconnected, information-regulatory system. They describe the communicational, informational, and regulatory events that support physiology. 2 There exist few references in the literature to ideas such as these. The following makes a clear statement that parallels Manaka's ideas: The comprehensive understanding of the lesser-differentiated states which underlie all the psychologic, physiologic, and structural manifestations of illness - the understanding of energetic states in living systems - is the great gift that Chinese medicine gives to the West. We have no counterpart to this system in Western medicine.3
There exist discoveries - often ignored by the general scientific community which also parallel these ideas. For example, the late Albert Szent-Gyorgyi, twice Nobel Laureate, discoverer of many aspects of energetic physiology, discovered a primitive, less efficient energy production system. While mostly replaced by later, more efficient systems, it is still present in living organisms, hidden or masked by these systems.4 This protometabolism is significant because it is an example of a lower order system that retains functions in the midst of greatly superior systems. Manaka's information system, the Chinese system of qi, is similar. It is a less differentiated, lower order energy system that maintains its functions in the midst of a veritable symphony of higher-order functions. Perhaps what the Chinese have called qi is an undifferentiated energy, the matrix of all derivative forms of energy. In acupuncture and Chinese medicine, differentiated forms are labeled as a specific qi, for example, the ying qi, wei qi, gu qi, etc. In physical, chemical, or biological terms it might be characterized by, exhibit properties of, or propagate signals via many different mechanisms, routes, and forms of energy. The following is a list of possible routes or mechanisms that may participate in such a system. It comprises a compilation of concepts, models, and mechanisms from a wide variety of sources. Rigorous research needs to identify which, if any, of these participate in the signal system and under what circumstances. It is not improbable that many of these phenomena are characteristics of the signal system. The inquiry methodologies were quite different, but often the perspectives are similar. Included in this list are more general discussions of models and concepts that might describe, or lead to a description of, the underlying mechanism that unites these as a whole. Theoretically such a level exists, a very primitive, basic energy form, from which other forms are derived. It is hard to describe. The term qi is much more convenient!
MODELS OF POSSIBLE PARTICIPANTS IN THE SIGNAL SYSTEM The very nature of the subject suggests that there are many models. It is impossible to review them all or to discuss them in detail. We list good candidates. According to traditional Chinese ideas, there would be a primitive or primordial field phenomenon from which all of the following would be derivative forms. Thus, it is also useful to speculate on the nature of this general field. Researchers will need to map what occurs in the context of each phenomenon. In scientific terms, we are only at the point of discussing appropriate means and methods of inquiry. The following is thus speculation. ELECTRICAL POSSIBILITIES:
There are many renowned and respectable studies on the electrical characteristics and properties of the body, some of which have already adopted perspectives
Appendix Six: Thoughts About the Nature of the X-Signals
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similar to those Dr. Manaka proposed. Many come from diverse fields, often without knowledge of the others:
- The electro-dynamic field theory of Harold Saxton Burr of Yale.s All events in the body generate fields which interact as a whole field. This field determines the activities of its parts and in turn is determined by those parts. - The semi-conductor system of interconnected molecular systems and the quantum considerations of Albert Szent-Gyorgyi.6 Oschman extends SzentGyorgyi's model to include the connective tissues and in particular the planes of fasciae, allowing communication between every cell and every other cell, every organelle, and all other organelles? - The DC current system described by Robert Becker, which is associated with growth, healing, and regeneration and which is thought to correlate to the acupuncture channels and their points.B - The various currents which have been found associated with embryological development, orientation of neurones, muscle cells, the prediction of the sites of limb bud formation, etc.9 - The battery properties of the epidermis and the current of injury in relation to piercing the skin.10 - The ionic currents of the body which compose the biologically closed electric circuits of Bjorn Nordenstrom.11 - The electrical fields associated with neural and muscular activities which communicate throughout the body, triggering responses in cells tuned to the frequencies of associated cells, the window effects of Adey (the signatures associated with the temporal features of the fields accompanying the contraction of muscle tissues).12 - The contracting muscles that generate sounds which move within the body. In the correct medium, such as water, these sounds can be communicated between organisms. Research has shown that these sounds sometimes encode information.13 - The sensitivity of the body surface to very weak electrical fields, both close and distal- projected- fields, as described by Yoshiaki Omura.l4 - Possible antenna properties of a needle inserted through the skin and its electrical effects upon the body.15 - Possible piezoelectric effects of needle insertion.16 - The correlations of frequency-dependent relationships that exist between particular organs, tissues, the body surface and electrical fields. In 1974, Arthur Pilla described models of how electrochemical information can be transferred across cell membranes, how a cell can be stimulated, inhibited, or exhibit passive response depending upon the frequencies and amplitudes of the signals employed.1 7 - The quantum studies and speculations on bioelectrical functions of Wlodzimierz Sedlak of Poland. He has theorized on the integrated functions of the bioelectrical systems, for example, that of electrostasis, and the flow of electrons to the body surface with the role of protection and shielding of the body interior.lB He has further speculated on the possible magneto-hydrodynamic effects occurring in biological structures and their importance in both the generation of electrical signals in the body and the maintenance of the bioelectrical environment inside the body.19
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- Bioelectrical homeostasis and its possible relationship to acupuncture. 20 - The electrical characteristics of the channels and their acupoints, measured by many different devices and means, and speculations on the role of this electrical system relative to body functions.21 - Hiroshi Motoyama's electrical studies of the channel systems and his speculations on the nature of qi.22 - The superconductive properties of specific tissues, cell structures, and molecules, and their possible role in living processes.23 Biological superconductivity is seen as an important mechanism for allowing organisms to maintain homeostasis. Some authors have even speculated on the roles of this relative to the acupuncture points and channels.24 MAGNETIC POSSIBILITIES
It is difficult separating magnetic properties from electrical properties because wherever we have a moving electric charge- electrons, protons, ions, etc. we also have magnetic fields. Since research has shown that electrical fields and currents are generated at all levels of physiological activity, then in all likelihood so too are magnetic fields. Specific measurements of these magnetic fields have been made using sensitive equipment. The magnetic fields represent another set of information carriers concomitant with the electrical carriers. The following is a list of some of the measured fields and their proposed properties:25 - John Zimmerman has done considerable research into the magnetic fields of the body, in particular the brain and its responses to varied perceptive stimuli, the magnetic fields associated with palm healing or therapeutic touch. He has also speculated on the general functions of these fields, particularly in healing.26
- The earth's magnetic field has been shown to be very important to life, to the timing and integration of normal physiology, and to be related to various disorders including psychiatric disturbances and possibly even cancerP Some authors have speculated on the roles of biomagnetic homeostasis relative to the actions of the geomagnetic field.28 - William Tiller has proposed that part of the nature and origin of the electrical potential in the channels, in particular the battery-like effect of the acupoints, is generated by the magnetic vector potential field. Such a proposal accounts for phenomena observed in the acupoints.29 - In his studies of the bi-digital 0-ring test, Omura has speculated on the possibility that electromagnetic resonance phenomena participate in the use of the test for localizing and identifying molecules in the body. In general, the phenomenon of electromagnetic resonance can be said to also carry information between like substances that resonate.30 - Molecular mechanisms may be involved in a variety of magnetic field phenomena.31 ELECTROMAGNETIC POSSIBILITIES
Just as cinematic images appear to be real but are only combinations of light and shade, so is the universal variety as delusive seeming. The planetary spheres, with their countless forms of life, are naught but figures in a cosmic motion picture. Temporarily true to man's five sense perceptions, the transitory scenes are cast on the screen of human consciousness by the infinite creative beam. 32
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As well as the electrical and magnetic fields, currents that can act as carriers of signals or information, there are more diverse electromagnetic fields and waves: light in all of its various forms, both visible and non-visible, coherent and noncoherent. Sedlak has measured this extensively in his research and has proposed models of how the living organism creates and utilizes such energies: The evolutionary mechanisms sought in the relation to environment can be solved by reducing both sides to a common nature. The author conceives the organism and environment in terms of electromagnetic fields. At every level of complexity the organism emits electromagnetic radiations. This applies to individual cells (mitogenetic radiation) as well as to organs and to the whole complex organism. Human brain radiations have been best studied so far. The '"metabolism'" of electromagnetic energy is a manifestation of life as much as the transformation of matter. The biological field with its electromagnetic qualities is a universal manifestation of life. The organism may be considered as an oscillator emitting biological field with large band spectrum. 33
All molecular changes, interactions, etc., produce electromagnetic radiations that travel away from their origin. Different tissues, different molecules, and atoms, are tuned to radiations of specific wavelengths and frequencies. Frequently biological organisms even project coherent light in the form of laser-like light.34 Throughout evolution all levels of organization seem to have taken advantage of this production of energy and sensitivity to specific energies. Several authors have developed theories of how these energies are utilized. For example, Philip Callahan, in his studies of insect communication systems, found that such sensitivities exist and are very much exploited.35 He has further postulated that molecules and atoms emit "inversional and rotational emission waves" that are particular to an atom or molecule, have "signatures," that hold information about the state of the molecules and atoms, and can be read by molecules and atoms elsewhere which are tuned to those waves. This system of molecular emissions exists throughout nature in all living things and in the environment. There exist an almost infinite number of signal carriers, of information in the environment and within and between all living things. Concepts such as these have been discussed by a variety of authors. In a related theory, Herbert Weaver, a telegraph company worker from England, devoted his retirement to the study of the phenomenon of divining. He researched the mechanisms of this ancient art, proposing that it uses the radiations naturally emitted by all objects. He provided evidence showing that natural systems are tuned to these radiations as a kind of "primary sense," a very ancient method of sensing things in the environment. He further argued that living things developed geometrical forms and shapes that served to disguise their radiations so that their predators could not find them. He also proposed that primitive man's writings and drawings used forms and figures which could elicit similar responses.36 Weaver's theories resonate with Manaka's discussions about the possible origins of acupuncture, as a kind of primitive sense that has been lost to more modem civilized man. Similar discussions have also been initiated by physicist and acupuncturist Yasumasa Katsumata, a colleague of Dr. Manaka. In particular, Katsumata arrived at the concept of sayoshi, a phantom function or effect that can be transferred between objects, that is not itself material, and that can even be left in the place or space which an object formerly occupied. He first began studying the mechanisms of the bi-digital 0-ring test and through extensive research arrived at this more general theory. He proposed that it is the emission of "molecular waves," in the ultra-infrared or microwave range, which produces the effect. This
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is similar to the concepts described by Callahan and Weaver.3 7 His general theory is discussed in appendix 4 of this text. His findings and speculations are not dissimilar to research findings in the study of qigong, where many research groups have identified low frequency infrared radiation as a factor.3 8 The findings of lkuro Suehara, a Japanese physicist and acupuncturist, may also be relevant here. Through his research using pure samples of individual chemical elements and muscle testing, he has found correlations between the effects of pure elements from within a vertical column of the periodic table of elements and a single channel. He has reportedly mapped these correlations for all the channels. These possible correlations need more rigorous investigations, but if correct, they reveal some significant bioenergetic correlates to the theories of acupuncture which could potentially be "signal" mechanisms in Manaka's more general theory.39 It is clear from these discussions that there may be many mechanisms involved in acupuncture, at many levels of electrical, magnetic, and electromagnetic activities, all of which may act as carriers of the signals described by Dr. Manaka. It is helpful to look further at proposals of a more global nature that try to explain the whole field in simpler terms. If only a few of the above mechanisms participate in the signal system, it is indeed a very complex and powerful system. To grasp it, a simpler, more encompassing theory would be helpful. William Tiller has proposed a sophisticated and far-reaching model that is not only able to explain the effects of acupuncture, but many other healing disciplines, ancient practices, etc. This model has come from his many years researching acupuncture, meditation, and paranormal phenomena. Though his work is as yet unpublished, his many papers outline the basic theory.40 He has proposed the existence of "positive space-time," the realm most easily accessible to our senses, and "negative spacetime," a more subtle world that coexists with the positive: Whereas positive space/time matter is associated with the forces of electricity and electromagnetic (EM) radiation, negative space/time matter is associated primarily with magnetism and a force which Tiller describes as magnetoelectric (ME) radiation. 41 In negative space/time, energy is magnetoelectric and negatively entropic and substance is of a subtle magnetic character.42
It is possible that this theory, worked out in some detail by Tiller and already correlated to acupuncture and the energy fields of the body, especially the "subtle bodies," may be able to explain many of the phenomena observed by Dr. Manaka and describe the general nature of the signals. The holographic paradigm is another possible global model of how signals may be produced, propagated, and received. David Bohm's theory of implicate order and holographic nature is pertinent.43 In such a universe, higher levels of order and information may be holographically enfolded in the fabric of space and matter/energy. Because what happens in just a small fragment of the holographic energy interference pattern affects the entire structure simultaneously, there is a tremendous connectivity between all parts of the holographic universe.44
Aside from the obvious correlations of this model to the model described above (i.e., the connectivity of all parts to each other), the storage and transfer of information between all parts of the system, it can also be seen as a good candidate for describing some of the signals that participate in Manaka's signal system. There have been other speculations on the role of the holographic paradigm in acupuncture.45
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Rupert Sheldrake's theory of the morphogenetic field may also be relevant. Sheldrake, a biologist, postulated a theory that has weathered scientific scrutiny. He proposed that non-physical, morphogenetic fields exist. They guide morphological development, activity of forms, etc. This represents another candidate for describing the global regulation of information storage, transfer, and activity.46 In a more limited biological model, we can postulate that the global regulation mechanisms, which function to allocate energy within species and individual organisms, may also be relevant. This is sometimes called "the principle of allocation."47 On a larger scale, but still in a limited biological sense, the Gaia hypothesis of James Lovelock may also be relevant. This states that the earth itself functions to globally regulate life and energy distribution.48 It is possible that regulatory mechanisms operate at many levels of organization in nature. These last two models describe how underlying principles in nature can regulate higher-order activities and functions such as the general distribution of energy and information. Order is an important function of living things; any system which can create order may be useful to life. We saw in Tiller's model that the more subtle energies of the negative space-time are negatively entropic; they create order. This seems similar to the models described above, specifically that chaotic systems seem to spontaneously give rise to order. Recent studies have unravelled exquisite mathematical principles operating throughout nature, at all levels, which give rise to order. Deep within chaotic systems are layers of hidden order.49 These are properties of whole systems and not parts of systems, and are important here because they too describe how information can be stored, transferred, and regulated. They provide further potential global descriptions of Manaka's signal system. Physiological integration is essential to life. Without ordered, well-timed, and integrated systems at all levels of activity within an organism, life would slowly begin to degenerate. This is probably the simplest way of describing how disease develops. The mechanisms of physiological integration are complex and varied, but somehow remain an integrated whole for maximal activity.SO It is probable that the systems which serve to regulate the organism are not describable solely by the normal physiological languages of molecular, atomic, and cellular interactions. There are many principles operating, many at very low energy content. If Dr. Manaka's hypothesis is correct regarding the role of acupuncture relative to this signal system, then this is indeed significant.Sl In a way, much of what Dr. Manaka has said can be seen in a simple analogy. When one walks into a factory that has been idle for the weekend, it may take only the flick of a few switches to engage the factory's equipment and machines in production again. Here, only a tiny amount of energy, - the flick of a few switches - activates many processes creating and expending huge amounts of energy. In the body, only a tiny stimulus at the skin surface can activate a multitude of processes in the body, creating and expending large amounts of energy. When the factory is already in full operation, it is regulated and controlled by similar small amounts of energy applied to appropriate leverage points: switches, buttons, dials, etc. To regulate the body's activities (within at least a physiological range), only small amounts of energy need be applied at key leverage points. In the factory, the languages describing the energies of general activity will be electrical, magnetic, thermal, etc. In the body, the Chinese described energy as qi in a variety of forms, and, using yin-yang, five phase, and channel theories, they described how one is able to choose the appropriate leverage points to create change. In modem biological language, the inner workings of the body are complex and enmeshed. Possibly all of the mechanisms discussed here participate in the regulation of physiological activity. The Chinese descriptions of these concepts are difficult at best.
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Modem physiological descriptions are also complex, and may best be simplified, at least while the full model is being researched, in appropriate general languages. In addition to describing this unbelievably complex interpenetrating regulatory system in the technical languages of systems and information theory, we may also use the language of mathematics. In particular, the language of topology, three dimensional geometry, and the use of more recent mathematical ideas developed in the studies of chaos, may be useful. Finding an appropriate language for describing certain characteristics that arise from global interactions and not local properties can be difficult. Dr. Manaka frequently referred to the language of three-dimensional geometry, or topology, as a valid manner of describing some of the theories of acupuncture. He founded and was president of the Shinkyu Topology Group (the Acupuncture and Moxibustion Topology Group), holding yearly meetings in Kyoto. This group has shown how the language of topology can be useful in describing complex phenomena in acupuncture. The term "connectedness" is important for modern views of nature; if all things are inseparable and non-reducible, then they are all connected. "At all levels, from atoms to persons, connection is a requirement for life."52 Cunningham proposes that: Health depends on a property which may be called "connectedness," an optimal passage of information between the levels of the organism and its environment. The right kind and amount of information must be transmitted to maintain health. 53
Disease is the reverse, what he calls "disconnectedness." If these views are correct, and commonsense interpretation of the information and systems theory models of life suggest that they may be, then connectedness is an important property of living things. We find the property of connectedness in the study of topology. Connectedness is a topological property; thus the use of the language of topology for describing connectedness in the living body may be useful. Dr. Manaka takes advantage of this with his sophisticated theories regarding structure-function relationships, especially those inherent in octahedral theory. Mathematics can also be used to describe yin-yang and the five phases phenomenologically. The behavior of the body's yin-yang and five-phase systems seem to have such precision that it is not unreasonable to suggest that the language and descriptions of these theories may be referring to mathematical rather than merely philosophical concepts. In appendix 5, two papers are presented that develop such phenomenological models, providing a minimal mathematical description of the five phases and their various interactions. Important parallels to Manaka's information model derive from these descriptions. In particular, we found that for the system of five interacting phases to remain in balance, which is the essential nature of the system according to traditional descriptions, what passes between each phase must have a qualitative and not a quantitative nature. That is, the five-phase interactions must be informational in nature. For example, if we think of what is passing between the water and wood phases in the sheng cycle, as quantities of stuff (i.e., xue, gu qi, ying qi, zong qi, etc.), then the system of five phases cannot maintain balance. Only when we reduce the amount to near zero, i.e., to a qualitative entity such as information, can the system work as described. Working in consultation with William Tiller, we developed a mathematical model that bridges the gap between traditional descriptions of a channel and the simplest electrical model of a channel- based on electrical measurements -the five
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phases, the actions of the five-phase points, observed clinical findings, and clinical applications. In short, we have the beginnings of a mathematical model that is able to describe research findings, traditional descriptions, and clinical practice. This particular model is important because it interfaces traditional concepts with scientific measurements and tests using a "neutral language." If we are to develop a full scientific model of acupuncture, we must first develop a precise idea of what is testable with rigorous scientific methodology. Only thus may the theory be raised to the standard of science. It is our intention to rigorously investigate the specific findings of Dr. Manaka which have led to the formation of the signal system model. Mathematical models are the starting point for this research. It will take much careful work to unravel the traditional theories and mechanisms of acupuncture and Manaka's X-signal system. We hope this work will contribute to that process.
NOTES 1 The idea that tiny stimuli or signals produce therapeutic effects is similar to one expressed by Speransky: "Hence we obtain the rule that only weak degrees of irritation can have a useful significance, strong ones inevitably do damage." A Basis for the Theory of Medicine, quoted from Chaitow, L., Soft-Tissue Manipulation, p. 66. 2 In Hara Diagnosis: Reflections on the Sea, we develop an argument that shows the parallels between traditional Chinese descriptions and modem scientific discoveries, specifically the observed field and energetic phenomena. See chapters eight and nine. 3 Kobrin, L.E., "The role of Chinese medicine in modem medicine," Jefferson Alumni Bulletin, pp. 12-18, Winter 1988. 4 Szent-Gyorgyi, A., "Protometabolism," Int. Jour. Quant. Chern., "Quant. Bio. Symp. 11," pp. 6367,1984. 5 Burr, H.S. and F.S.C. Northrop, "An electro-dynamic theory of life," Quart. Rev. Bioi. 10:3, pp.322-333, 1935; and Burr, H.S., The Fields of Life, New York: Ballantine Books, 1972. 6 Szent-Gyorgyi published many books and papers on this subject. The following is a good example of his work: Szent-Gyorgyi, A., Introduction to a Submolecular Biology, New York: Academic Press, 1960. 7 Oschman, J.L., "The connective tissues and myofascial systems," paper presented at the Rolfing '81 conference in Los Angeles; Oschman, J.L., "The structure and properties of ground substance," Amer. Zoo!. 24:1, pp. 199-215, 1984. See also Matsumoto, K. and S. Birch, Hara Diagnosis: Reflections on the Sea, chapters seven, eight and nine, where this concept is explored and correlated to traditional Chinese and Japanese medical texts and theories. See also the more recent text, Oschman, J.L., "A biophysical basis for acupuncture," The Proceedings of the First Symposium of the Society For Acupuncture Research, Boston, MA, Society for Acupuncture Research, 1994. 8 Becker, R.O. and A.A. Marino, Electromagnetism and Life, Albany: State University of New York Press, 1982; Becker, R.O. and G. Selden, The Body Electric, New York: William Morrow, 1985; Becker, R.O., "Electromagnetic controls over biological growth processes, Jour. Bioelect. 3:162, pp. 105-118, 1984. 9 For discussion see: Jaffe, L.F., "Developmental currents, voltages and gradients," in Subtelny, S. and P.B. Green, Developmental Order: Its Origin and Regulation, New York: A.R. Liss Inc., 1982, pp. 183-215. 10 Barker, A.T. et al., "The glabrous epidermis of cavies contains a powerful battery," Amer. Jour. Physiol. R358-366, 1982. The "current of injury" is discussed in many places. See for example, Becker, R.O., "The basic biological data transmission and control system influenced by electrical forces," Ann. N. Y. Acad. Sci. 238, p. 236, 1974; Becker, R.O. and A.A. Marino, Electromagnetism and Life, pp. 14-16. Both of these are discussed in Stux, G. and B. Pomerantz, Acupuncture Textbook and Atlas, Berlin: Springer-Verlag, 1987, pp. 23-24. 11 Nordenstrom, B., Biologically Closed Electric Circuits, Sweden: Nordic Medical Publications, 1983. 12 Adey, W.R., "Tissue interactions with nonionizing electromagnetic fields," Physiol. Rev. 61:2, pp. 435-514, 1981; Sawin, S.W. eta!., "Ionic factors in release of 45 Ca2+ from chicken cerebral tissue by electromagnetic fields," Proc. Nat!. Acad. Sci. USA 75:12, pp. 6314-6318, 1978; Williamson, S.J. and L. Kaufman, "Biomagnetism," Jour. Mag. and Mag. Mater. 22, pp. 129-201, 1981.
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13 Oster, G., "Muscle sounds," Scientific American, p. 108-114, March 1984. 14 Omura, Y., "Effects of an electrical field and its polarity on an abnormal part of the body or organ representation point associated with a diseased internal organ, and its influence on the bi-digital 0-ring test (simple, non-invasive dysfunction localization method) & drug compatibility test - Part 1," Acup. & Electrother. Res. Int. J. 7, pp. 209-246, 1982. 15 Romodanov, A.P. et al., "Antenna properties of acupuncture needles," Vrachebnoe Delo 8, pp. 93-96, 1984; abstract in Amer. Jour. Acup. 13:1, p. 74, 1985. 16 Oschman, J., op.cit., discusses the piezoelectric properties of the connective tissues, and thus skin. See "The connective tissue and myofascial systems." paper presented at the Rolfing '81 conference in Los Angeles. See also, Lipinski, B., "Biological significance of piezoelectricity in relation to acupuncture," Medical Hypotheses 3:1, pp. 9-12, 1977. 17 Presman, A.S., Electromagnetic Fields and Life, New York: Plenum Press, 1970. See pp. 52 and following for examples of tissue frequencies. Pilla, A.A., "Electrochemical information transfer at living cell membranes, Ann. N. Y. Acad. Sci. 238, p. 149, 1974. William Tiller describes the possibility that the channels and their acupoints represent the surface flows of energy associated with the functioning state of the internal organs. The characteristics of these energy flows relate to specific pathways, etc. See Tiller, W.A., "On the evolution of electrodermal diagnostic instruments," Jour. Advancement in Med. 1:1, pp. 41-72, 1988. He further describes different effects that result from at least two frequencies of stimulation at the skin. See Tiller, W.A., "What do electrodermal diagnostic acupuncture instruments really measure," Amer. Jour. Acup. 15:1, pp. 15-23, 1987. 18 Sedlak, W., Bioelektronika, 1967-1977, Poland: Instytut Wyadawniczy, 1979. On pages 82-85 is a good summary in English of his concept of electrostasis, its origins, nature and functions. 19 Ibid., pp. 203-205. 20 Zukauskas, G. et a!., "Quantitative analysis of bioelectrical potentials for the diagnosis of internal organ pathology and theoretical speculations concerning electrical circulation in the organism," Acup. & Electro-ther. Res. Int. J. 13, pp. 119-130, 1988. See also Nordenstrom, B., Biologically Closed Electric Circuits, and Sedlak, W., Bioelektronika 1967-1977. 21 For good reviews of the literature and the specifics of what the measurements really measure, see: Zhu Zong-Xiang, "Research advances in the electrical specificity of channels and acupuncture points," Amer. Jour. Acup. 9:3, pp. 203-216, 1981; Tiller, W.A., "On the evolution of electrodermal diagnostic instruments," Jour. Advancement in Med. 1:1, pp. 41-72, 1988; Tiller, W.A., "On the evolution and future development of electrodermal diagnostic instruments," in Energy Fields in Medicine, Kalamazoo, Michigan, John E. Fetzer Foundation, 1989, pp. 257-328. 22 See for example, Motoyama, H., "Electrophysiological and preliminary biochemical studies of skin properties in relation to the acupuncture meridian," Research Relig. & Parapsych. 9, 1980. Also, Motoyama, H., "A biophysical elucidation of the meridian and ki energy. What is ki energy and how does it flow?" Research Relig. & Parapsych. 7, p 1, 1981. 23 See for example, Cope, F.W., "Evidence from activation energies for superconductive tunneling at physiological temperatures," Physiol. Chern. Phys. 5:3, pp. 173-176, 1971; Cope, F.W., "Biological sensitivity to weak magnetic fields due to biological superconductive junctions," Physiol. Chern. Phys. 5, pp. 173-176, 1973. 24 See for example, Dubrov, A.P., The Geomagnetic Field and Life: Geomagnetobiology, pp. 152-153. 25 For a good review of the general literature in this area, see Williamson, S.J. and L. Kaufman "Biomagnetism," op.cit. 26 See for example, Reite, M and J.T. Zimmerman, "Magnetic phenomena of the central nervous system," Ann. Rev. Biophys. Bioeng. 7, pp. 167-188, 1978; Zimmerman, J.T. et al., "Auditory evoked magnetic fields: A replication with comments on the PSO analog," II Nuovo Climento 2D:2, pp. 460-470, 1983; True, B., "Professor tunes in on touch healers," Up the Creek 4:56, February 14-20, 1986; Zimmerman J.T.; Laying-on-of-hands and therapeutic touch: a testable theory," Newsletter of the Bio-Electro-Magnetics Institute 2, 1, 8-17, 1990. 27 There is considerable literature in this area. The most comprehensive is perhaps A.P. Dubrov's work, The Geomagnetic Field and Life: Geomagnetobiology. This text is a landmark in the field. Many other authors have researched and speculated on the significance of the geomagnetic field. Robert Becker has speculated on the role of the channels relative to the varying geomagnetic field. See Becker, R.O., "Electromagnetic controls over growth processes," op.cit. Kyoichi Nakagawa, a Japanese physician, has uncovered a variety of disorders which result from underexposure to the geomagnetic field; see Nakagawa, K., "Magnetic field deficiency syndrome and magnetic treatment," Japan Medical Jour. 2745, 1976. Other literature of interest relates to studies of specific disease entities. See Friedman,
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H. et al., "Psychiatric ward behavior and geophysical parameters," Nature 205, pp. 1050-1052, 1965; Marton, J.P., "Conjectures on superconductivity and cancer," Physiol. Chern. Phys. 5, pp. 259-270, 1973. Elsewhere, we discussed some of the roles of the geomagnetic field and explored possible correlations to Chinese biorhythm ideas; see Hara Diagnosis: Reflections on the Sea, pp. 74-75,216-221. 28 Dubrov, A.P., op.cit., p.152. 29 On the evolution of electrodermal diagnostic instruments; op.cit. 30 For further discussions, see: Omura, Y., "Electromagnetic resonance phenomenon as a possible mechanism related to the 'hi-digital 0-ring test molecular identification and localization method'," Acup. & Electrother. Res. Int. J. 11, pp. 127-145, 1986. 31 For a good summary of the possible see Surgalla, L.A., "Molecular mechanisms of magnetic medicine," Magnets; 3:4, p. 14, April1988. 32 Paramahansa Yogananda, Autobiography of a Yogi, pp. 318-319. 33 Sedlak, W., Bioelektronika 1967-1977, pp. 82-83. 34 Ibid. 35 Callahan, P.S., Tuning into Nature: Solar Energy, Infrared Radiation and the Insect Communication System, Old Greenwich, CT: Devin-Adair, 1975. 36 Weaver, H., Divining the Primary Sense: Unfamiliar Radiation in Nature, Art and Science, London: Routledge and Kegan Paul, 1978. 37 See: Katsumata, Y., "Fundamental studies of the 0-ring test," Ida no Nippon Sha, 504, August 1986; 505, September 1986. See also Katsumata, Y. with comments by Y. Manaka, "On certain unknown factors, hypothetically named 'sayoshi' by Y. Katsumata, which affect the living body," Unpublished manuscript, December 1988. 38 Qian Cun-Ze et al., "Simulated human-body information in bio-medical therapy," unpublished manuscript; Shen, G.J., "Study of mind-body effects and qigong in China;" Advances; 3, 4, 134142, 1986; Sampson, R., "A survey of qi related research- East and West," paper presented in conjunction with the Sino-U.S. Qigong health sciences exchange program, first U.S. symposia series, September 14-26, 1985, Beijing. 39 See for example, Suehara, I., Genso Keiraku Ho (Fundamental Channel Therapy), p. 11, Onso Shindangaku Kenkyujo Research Institute, 1985. 40 See for example Tiller's Introduction to Motoyama, H., Science and the Evolution of Consciousness: Chakras, Ki and Psi, Cambridge, MA: Autumn Press, 1978, pp. 9-19. One of the better summaries and descriptions of his ideas can be found in Gerber, R., Vibrational Medicine, Santa Fe: Bear and Company, 1988, pp. 143-153 and 503-507. 41 Gerber, R., Vibrational Medicine, op.cit., p. 147. 42 Ibid., p. 506. 43 See Bohm, D., Wholeness and the Implicate Order; Wilber, K., The Holographic Paradigm and Other Paradoxes. 44 Gerber, R., Vibrational Medicine, op.cit., p. 61. 45 See for example, Hameroff, S.R., "Ch'i a neural hologram? Microtubules, bioholography and acupuncture," Amer. Jour. Chin. Med. 2:2, pp. 163-170, 1974. 46 Sheldrake, R., A New Science of Life: the Hypothesis of Causative Formation, Los Angeles: J.P. Tarcher, 1981. 47 This is an attempt to describe global energy regulation. See for example, Campbell, N.A., Biology, Menlo Park, CA.: Benjamin Cummings Publishing, 1987, p. 1004. 48 Lovelock, J., Gaia: A New Look at Life on Earth, Oxford: Oxford University Press, 1979. 49 See for example, James Gleick, Chaos, Making a New Science; Ira Prigogine and I. Stengers, Order Out of Chaos; and Benoit Mandelbrot, The Fractal Geometry of Nature. 50 A good description of physiological integration and the views afforded by such a model are given in Adolph, E.F., "Physiological integrations in action, Physiologist 25 (supplement), p. 2, April 1982. 51 Dr. Manaka has speculated in several recent papers about the possible nature and roles of qi in this signal system. See for example, Manaka, Y., "Speculations on the media of qigong," paper presented at the National Congress of Qigong in China, fall of 1988. See also Manaka, Y., "Speculation on qi in Chinese medicine as the media in the signal system," Text of the 18th annual convention of the Shinkyu topology group, Nippon Shinkyu Topology Gakkujutsu Taikai, July 1988, pp. 6-21. 52 Larry Dossey, Space, Time and Medicine, p. 76. 53 A.J. Cunningham, "Information and health in the many levels of man."
APPENDIX SEVEN BIOGRAPHY OF YOSHIO MANAKA M.D., PHD. BORN: April23, 1911, in Odawara, Japan. DIED: November 20, 1989, in Odawara, Japan. FAMILY ADDRESS: Odawara-shi, Minami-cho, 3-4-31. EDUCATION: Graduated Kyoto Imperial University Medical School, 1935. PhD in physiology from the Kyoto Imperial University Medical School, 1957. WoRK EXPERIENCE: 1935-37, surgical department of Tokyo Imperial University. 1939-45, military service as army surgeon. 1945-1989, director of Manaka Hospital, Odawara. 1950-1989, active member of Japanese Association of Oriental Medicine. 1952-56, elected to Municipal Commitee of education in Odawara. 1957-58, elected President of Odawara Medical Association. 1974-1989, Director emeritus of Oriental Medical Research Center affiliated with the Kitasato Institute, Tokyo. 1973-83, President of M.D. Society of Oriental Medicine. 1981, Chairman of 1981 Congress of Japanese association of Oriental Medicine. 1971-83, Director of Financial Foundation for Oriental Medicine. 1978-1989, President of the Topology Acupuncture Group in Kyoto. 1968-1989, Lecturer of the Annual Summer Seminar on Acupuncture. 1975-85, Editorial staff of the Medical Encyclopedia of Kodansha in Tokyo. 1980-81, Editorial staff of the Annual reports of basic and clinical researches on acupuncture in Japan. 1960-70, President of the Toyo Shinkyu Senmon Gakko (East Asian Acupuncture and Moxibustion School) in Tokyo. Dr. Manaka taught at many international congresses and seminars in countries, including: Canada, the United States, Mexico, Uruguay, Brazil, Argentina, Spain, China, Korea, France, Germany, Holland, Egypt, Phillipines, Hong Kong, etc. Later visits to China included, for example, October, 1987: Tianjin, International Symposium on the therapeutic principle of Huo xue Hua yu, where he presented a paper entitled " Acupuncture applied for Huo xue Hua yu," November, 1986: Beijing, International Symposium on the Regulating Function of Acupuncture, where he presented a paper entitled " Acupuncture's effects on the microcirculation, especially its activation of vasomotion."
426
Biography of Yoshio Manaka
MOST RECENT AREAS OF STUDY:
1. -Speculation on "qi" in Chinese Medicine, as the media of the signal system. 2. - "Biasology" applied in acupuncture. 3. - Abdominal diagnosis in Chinese Medicine. 4. - Acupuncture as intervention in the biological information system. 5. - Placebo effects and bias effects. 6. - The Yi Jing in the field of acupuncture. PUBLICATIONS IN jAPANESE:
Kappa Zuihitsu (Kappa Essays), Ido no Nippon Sha, 1955. Byoki no Jikoshindan no Tebiki (A guide to disease self-diagnosis), Kubo Sha, 1960. Kyu to Hari (Moxibustion and Acupuncture), Shufu no Torno Sha, 1961. PW Doktor Okinawa Horyoki (POW Doctor- An Okinawan prisoner's account), Kongo Sha, 1962. Hari Kyu Kanpo (Acupuncture, Moxibustion & Herbal Medicine), Ido no Nippon Sha, 1962. Muntera- lsha to Kanja (Muntera- Doctors and Patients), Sogen Sha, 1963. Kappa Zuihitsu (Kappa Essays [letters from the spiritual world]), Ido no Nippon Sha, 1970. Shinkyu Rinsho Iten (Dictionary of Clinical Acupuncture and Moxibustion), Ido no Nippon Sha, 1970. Katakori to Yotsu (Shoulder pain and stiffness and lumbar pain), Sogen Sha, 1971. Shinkyu no Riron to Kangaekata (Thoughts and Theories of Acupuncture and Moxibustion), Sogen Sha, 1973. Okyu no Kenkyu (Studies in Moxibustion), Goma Sha, 1976. Translated into Chinese as Jiu Xue Zhi Liao Fa, Si Li Publishing Company, Taiwan. lka no Tameno Shinjutsu Nyumon Kuowa (Introductory Lectures on Acupuncture for Medical Doctors), Ido no Nippon Sha, 1980. Co-authored with Dr. Herbert Schmidt. Translated into Chinese and Korean. Hiratashi Junnihanotai Nesshin Shigeki Ryoho (Hirata-style Hot Needle Therapy), Ido no Nippon Sha, 1982. Chiguan Zuihitsu; Soroban no Mudadama (Essays to Chiguan; Playing with the Beads of the Abacus), Ido no Nippon Sha, 1988. Manaka Yoshio Ronbunshu (Collected Essays of Yoshio Manaka), Shinkyu Topology Gakkai, 15th anniversary issue, 1988. Karada no Naka no Genshi Shingo (Primordial signals inside the body: Chinese medicine and the X-signal system), co-authored with K. Itaya, Tokyo, Chiyu Publishing Co, 1990. PUBLISHED TRANSLATIONS:
Chiropractic, by W. Pepper, Ido no Nippon Sha, 1952. Tsuina Ryoho, Chugoku Anma Ryoho (Tuina Therapy, Chinese massage therapy), Ido no Nippon Sha, 1961. Naikateki Shikkan no Shinkei Ryotai Ryoho, a translation of Die neurotopische diagnose und Therapie innerer Krankheiten (Neural Dermatome Therapy for the Treatment of Internal Diseases), by Dittmar F. and E. Dohner, ldo no Nippon Sha, 1965. Kiketsu Zufu (An Illustrated Guide to the Extra Points), Ido no Nippon Sha, 1971, from the Chinese Qi Xue Tu.
Biography of Yoshio Manaka
427
FOREIGN LANGUAGE PUBLICATIONS:
L'Acupuncture, "a val d'oiseau" (Acupuncture, "as the crow flies"), Co-authored with Marc Siegel, Yokohama, General Printing Company, 1960. The Layman's Guide to Acupuncture, Co-authored with Ian A. Urquhart, Rutland, VT: John Weatherhill, 1972. Quick and Easy Chinese Massage, Co-authored with Ian A. Urquhart, Japan Publications Trading Company, 1973. Translated to Dutch, Snelle Destrijding Van Pijn, 1984. Translated to Finnish, Kiinalainen Hieronta, 1984. PAPERS:
Too numerous to mention. Hundreds of "Essays to Chiguan" in the Ida no Nippon magazine. Publication of many articles and research papers in many languages in many countries, especially journals specializing in acupuncture, herbal medicine, and Western medicine. Most recently authored the landmark paper, co-authored with Kazuko Itaya, "Acupuncture as Intervention in the Biological Information System (Meridian Treatment and the X-Signal System)," presented at the annual assembly of the Japan Meridian Treatment Association in Tokyo on March 1986, subsequently translated and published in Chinese, German, French, English, Swedish, and Spanish. Yoshio Manaka was also an accomplished poet, artist, and sculptor; there have been several exhibitions of his work over the years.
BIOGRAPHY OF KAZUKO ITAYA EDUCATION:
1968- Graduated the Toyo Shinkyu Senmon Gakko, Tokyo. 1978 - Educational certificate in a special course designated by the Minister of Public Welfare, Japan. 1980- California acupuncture and herbal medical licensure. WORK EXPERIENCE:
1974-1989 - Research fellow at the Oriental Medical research center of the Kitasato Institute, Tokyo. Her work here has been in numerous areas of research and the preparation of many papers, presented at conferences around Japan, in China and other countries. 1987-present- Councillor of the Nippon Toyo Igakukai. PUBLICATIONS:
Author and co-author of numerous papers on acupuncture published in Japan.
~~ ~ BIBLIOGRAPHY BOOKS IN ORIENTAL LANGUAGES:
Akabane, K., Hinaishin Ho [Method ofHinaishin], Yokosuka: Ido no Nippon Sha, 1964. Fujita, R., Meridian-phenomena, myogen circulatory membrane system, Yokosuka: Ido no Nippon Sha, 1964.
Ida no Nippon Journal of Japanese Acupuncture and Moxibustion, 45:4 (SOOth special issue), April1986. Ikegarni, S. (trans.), Tianjin Chinese Medical College, Shinkyu Rinsho no Riron to Jisai [Theory and Practice of Acupuncture and Moxibustion], vol. 2, Tokyo: Kokusho Publishing Association, 1988. Imaizumi, H., Ekikyo no Nazo [Mysteries of the Yi Jing], Tokyo: Kobun Sha, 1988. Irie, S., Fukaya Kyu Ho [Fukaya's Moxibustion Therapy], Tokyo: Shizensha, 1980. Kobayashi, Y., Chugoku no Atarashi Chiryooten [New Chinese Treatment Points], Osaka: Osaka Kobayashi Ryodoraku Institute, 1972. Kono, T. Kin Shin Dan Ho [Muscle Diagnosis Method], Tokyo: JICC Publishing Company, 1986. Li Ding Zhong, The Jing Luo Phenomena vols. I & II, Kyoto: Yukonsha, 1984,1985. Li Shi Zhen, Qi Jing Ba Mai Kao [An Examination of the Extraordinary Vessels], from the Tu Zhu Nan Jing Mai Jue [Discriminating Pulses from the Classic of Difficult Issues with Illustrations], Taipei: Shui Cheng Shu Ju Publishing Company, 1970. Manaka Y., Kyu to Hari [Moxibustion and Acupuncture], Tokyo: Shufu no Torno Sha, 1961. _ _, Shinkyu Rinsho Iten [Dictionary of Clinical Acupuncture and Moxibustion], Yokosuka: Ido no Nippon Sha, 1970. _ __, Katakori to Yotsu [Shoulder Pain and Stiffness and Lumbar Pain], Osaka: Sagen Sha, 1971. _ _, Shinkyu no Riron to Kangaekata [Thoughts and Theories of Acupuncture and Moxibustion), Osaka: Sagen Sha, 1973. _ __, Okyu no Kenkyu [Moxibustion Studies], Tokyo: Goma Sha, 1976. _ __, Hiratashi Junnihanotai Nesshin Shigeki Ryoho [Hirata-style Hot Needle Therapy], Yokosuka: Ido no Nippon Sha, 1982. _____ , Manaka Yoshio Ronbunshu [Collected Essays of Yoshio Manaka], Kyoto: Shinkyu Topology Gakkai, 1988. _ _, Kiketsu Zufu [An Illustrated Guide to the Extra Points], Yokosuka: Ido no Nippon Sha, 1971, translated from the Chinese Qi Xue Tu.
430
Bibliography
Manaka, Y., and Herbert Schmidt, Ika no Tameno Shinjutsu Nyumon Kuowa [Introductory Lectures on Acupuncture for Medical Doctors], Yokosuka: Ido no Nippon Sha, 1980. Miyawaki, K., Yin Yo Rokugyo Setsu no Shinjutsu [Yin Yang Six Phase Acupuncture Treatments], Tokyo: Soikai Sha, 1976. Nagahama, Y., Shinkyu Chiryo no Shinkenkyu [New Studies in Acupuncture and Moxibustion Therapies], Osaka: Sogen Sha, 1959. _ __, Shinkyu no Igaku [Western Studies of Acupuncture and Moxibustion], Osaka: Sogen Sha, 1956. _ __, Toyo Igaku Gaisetsu [Outline of Oriental Medicine], Osaka: Sogen Sha, 1961. Nagatomo, T., Nagatomo M.P. Shinkyu Kuowa Hachiju Hachisyu [Mr. Nagatomo's 88 Lectures on the Minus Plus Needle Therapy], Kyoto: Shinkyu Shinkuokai Sha, 1976. Omura, Y., Illustrated Lectures on the Bi-digital 0-ring Test, Yokosuka: Ido no Nippon Sha, 1986. Shiroda, B., Shinkyu Chiryo Kisogaku [Fundamentals of Acupuncture and Moxibustion Therapy], Yokosuka: Ido no Nippon Sha, 1978. _ __, Shinkyu Shinzui, The Basics of Acupuncture and Moxibustion, Yokosuka: Ido no Nippon Sha, 1977. Takagi, K., Seitai no Chosetsukino [The Control Systems of the Biological Organism], Tokyo: Chuokoron Publishing Company, 1972. Yanagiya, S., Shinkyu Ijutsu no Man [An Introduction to the Medical Arts of Acupuncture and Moxibustion], Yokosuka: Ido no Nippon Sha, 1948.
BOOKS IN WESTERN LANGUAGES:
Anon., Symposia Proceedings of the National Symposia of Acupuncture and Moxibustion and Acupuncture Anesthesia, June 1979. Baldry, P.E., Acupuncture, Trigger Points and Musculoskeletal Pain, Edinburgh: Churchill Livingstone, 1989. Barral, J.P., and P. Mercier, Visceral Manipulation, Seattle: Eastland Press, 1988. Becker, R.O. and A.A. Marino, Electromagnetism and Life, Albany: State University of New York Press, 1982. Becker, R.O. and G. Selden, The Body Electric, New York: William Morrow Company, 1985. Bischko, J., An Introduction to Acupuncture, Heidelberg: Haug Publishers, 1985. Bohm, D., Wholeness and the Implicate Order, London: Ark Paperbacks, 1980. Bourdiol, R.J., Auriculosomatology, Paris: Maisonneuve, 1983. Capra, Fri~of, The Turning Point, New York: Bantam Books, 1982. Chaitow, L., Soft Tissue Manipulation, Wellingborough, England: Thorsons Publishing Group, 1987. Davies, P., The Cosmic Blueprint, New York: Simon and Schuster, 1988. Diamond, J., Life Energy: Unlocking the Hidden Power of Your Emotions to Achieve Total Well-being, New York: Dodd, Mead and Company, 1985. Dossey, L., Space, Time, and Medicine, Boulder: Shambhala Publications, 1982.
Bibliography
431
Ellis, A. et al., The Fundamentals of Chinese Acupuncture, Brookline, MA.: Paradigm Publications, 1988. Foss, L., and K. Rothenberg, Second Medical Revolution, Boston: Shambhala Publications, 1987. Gleick, J., Chaos, Making a New Science, New York: Viking Penguin Inc., 1987. Harding Rains, A.J. et al., Bailey and Love's Short Practice of Surgery, London: H.K. Lewis and Co. Ltd., 1971. Hashimoto, K., and Y. Kawakami, Sotai: Balance and Health Through Natural Movement, Tokyo: Japan Publications, 1983. Kapel, P., The Body Says Yes, San Diego: A.C.S. Publications, 1981. Kapit, W., and L. Elson, The Anatomy Coloring book, New York: Harper & Row, 1977. Kinoshita, H., Illustration of Acupoints, Yokosuka: Ido no Nippon Sha, 1970. Lau, D.C., Lao Tzu: Tao Te Ching, London: Penguin Books, 1963. Lovelock, J., Gaia: A New Look at Life on Earth, Oxford: Oxford University Press, 1979. Lu Gwei Djen and J. Needham, Celestial Lancets: A History and Rationale of Acupuncture and Moxibustion, Cambridge: Cambridge University Press, 1980. Manaka, Y. and I. Urquhart, The Layman's Guide to Acupuncture, New York: John Weatherhill Inc., 1972. Mann, W.E., Orgone, Reich and Eros: Wilhelm Reich's Theory of Life Energy, New York: Simon and Schuster, 1972. Matsumoto, K. and S. Birch, Extraordinary Vessels, Brookline, MA.: Paradigm Publications, 1986. Hara Diagnosis: Reflections on the Sea, Brookline, MA.: Paradigm Publications, 1988. Nakatani, Y. and K. Yamashita, Ryodoraku Acupuncture, Tokyo: Ryodoraku Research Institute, 1977. Needham, J., Science and Civilization in China vol. 2, Cambridge: Cambridge University Press, 1956. Nogier, P., Handbook to Auriculotherapy, Sainte-Ruffine: Maisonneuve, 1981. _ __J
Nogier, P., From Auriculotherapy to Auriculomedicine, Sainte-Ruffine: Maisonneuve, 1983. Nordenstrom, B., Biologically Closed Electric Circuits, Sweden: Nordic Medical Publications, 1983. Prigogine,l. and I. Stengers, Order Out of Chaos, New York: Bantam Books, 1984. Requena, Y., Terrains and Pathology in Acupuncture, Brookline, MA.: Paradigm Publications, 1986.
Character and Health, Brookline, MA.: Paradigm Publications, 1989. Reich, W., The Function of the Orgasm, New York: Meridian Books, 1971. Rolf, I. P., Rolfing: The Integration of Human Structures, New York: Harper and Row,
---J
1977. Schoffeniels, E., Anti-Chance, New York: Pergammon Press, 1976. Schonberger, M., The I Ching and the Genetic Code: The Hidden Key to Life, New York: ASI Publishers, 1979.
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Bibliography
Tae Woo Yoo, Koryo Sooji Chim: Korean Hand Acupuncture, vol. 1, Seoul: Eum Yang Mek Jin Publishing Company, 1988. Ulett, G. A., Principles and Practice of Physiologic Acupuncture, St. Louis: Warren H. Green, 1982. Unschuld, P., Medicine in China: Nan Ching, the Classic of Difficult Issues, Berkeley: University of California Press, 1986. Voll, R., Kopfherde Diagnotik und Therapie mittels Elektroakupunktur und Medikamentestung (Diagnosis and Therapy with Electroacupuncture and Medication Testing), Mediz. Liter, Verlag-gesellschaft, 1974. Walther, D. S., Applied Kinesiology, Pueblo, CA: Systems D.C., 1976. Wilber, K. (ed.), The Holographic Paradigm and other Paradoxes, Boulder: Shambhala Publications, 1982. Worsley, J.R., Traditional Chinese Acupuncture, Vol. 1: Meridians and Points, Tisbury, England: Element Books, 1982. PAPERS
Anon, "Xue Wei Ya Tong Bian Bing Zhen Duan Fa," compiled by the Chinese Scientific and Technological Information and Research Institute, Beijing: Science and Technology Document Publishing Company, 1978. Becker, R.O., "Electromagnetic controls over biological growth processes," Jour. Bioelect. 3:162, pp. 105-118,1984. Birdsong, M. and J.E. Edmunds, "Harlequin colour change in the newborn: Report of a case,"Ob. + Gyn. 7, p. 518-521, 1956. Bossy, J., "Morphological data concerning the acupuncture points and channel network," Acup. & Electro-Ther. Res. Int. Jour. 9, pp. 79-106, 1984. Chai Wenju, "Researches on diagnosed method at points (a review)," Journal of Chinese Acupuncture and Moxibustion 1, pp. 1-2,1987. Chen Weichang et al., "The determination of the depth of puncture for the development of needling sensation," National Symposia of Acupuncture and Moxibustion and Acupuncture Anesthesia, June 1-5, pp. 113-114., 1979. Davenas, E. et al., "Human basophil degranulation triggered by very dilute antiserum against IgE," Nature 333, pp. 816-818, 30 June, 1988. Diggle, J.H., "Familial proctalgia with painful harlequin flushing," unpublished manuscript. Dung, H.C., "Anatomical features that contribute to the formation of acupuncture points," Amer. Jour. Acup. 12:2, pp. 139-143, 1984. Dung, R.E., "Familial rectal pain," Lancet, April15, 1972, p. 854. Edisen, et al., "Regional and lateral specificity of acupuncture induced action of blood-factor effects inhibiting flexor reflex in the rabbit," Physiol. Chern & Phys. & Med. NMR 15, pp. 189-199,1983. Furukawa, R., "Kukakuseijotai joho no sonzai to sono teigen (A proposal for the existence of an information system across the epithelial systems)," Unpublished manuscript, Kyushu: Kagoshima University. Gunn, C.C. et al., "Acupuncture locii, a proposal for their classification according to known neurological structures," Amer. Jour. Chin. Med. 4, pp. 183-195, 1976.
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Hayden, R. and M. Grossman, "Rectal, ocular and submaxillary pain," Amer. Jour. Diseases Childhood 97, pp. 479-482, 1959. Head, H., "On disturbances of sensation with special reference to pain of visceral disease," Brain 1:16, pp. 1-133, 1893; 2:17, pp. 339-480, 1894; 3:19, pp. 153-276,1896. Hori, S. et al., "Objective consideration of the correspondence between pulse diagnosis and quadridemarkation of the body," abstract, Amer. Jour. Acup. 13:1, p. 80, 1985. From Jour. Jap. Soc. Acup. 33:4, pp. 420-426, 1984. Illingworth, C.M., and AT. Barker, "Measurement of electrical currents emerging during the regeneration of amputated finger tips in children," Clin. Phys. Physiol. Meas. 1:1, pp. 87-89, 1980. Ionescu-Tirgoviste, C. and E. Papa, "Tonification and dispersion effect of an acupuncture needle obliquely introduced into an electric field," Amer. Jour. Acup. 144:4, pp. 339-343, 1986. Itaya, K., "Essays on the history, nature, functions, methods and research of moxibustion in Japan," Medical Encyclopedia of Kodansha, 1985. _____ , "An historical compilation of acupoint contraindications," Medical Encyclopedia of Kodansha, 1985. Itaya, K. et al., "Effects of acupuncture needle application on the cutaneous microcirculation of rabbit ear lobe," Paper presented at the Symposium on Traditional Oriental Medicine, Science and Technology Agency, Tokyo. Itaya, K. et al., "Effects of Acupuncture Needle Application upon the Cutaneous Microcirculation of Rabbit Ear Lobe, Acup. & Electro- Ther. Res. Int. Jour. 12, pp. 4551,1987. Itaya, K. et al., "Microcirculation: An update: vol. 2; proceedings of the fourth world congress for microcirculation, Tokyo, July 1987," Excerpta Medica, Amsterdam, New York, London, 1987. Itaya, K. et al., "On the efficacy of acupuncture treatment for decubital ulcer formation during dietary-induced hyperlipidemia in the male rabbit," (in press). Itaya K. andY. Manaka, "The M.l. Diagram as a supplement to the classical diagnosis of acupuncture," Paper presented at the First International Congress of the Acupuncture-Anesthesia Association, Beijing, 1979. _ __, "The M.l. Diagram and clinical findings, Jour. Jap. Assoc. Clin. Acup. 1:27, p. 1,1977. ___,"A summary of research findings based on twenty years of study related to the abnormalities of sensitivity of the acupoints, both in disease and health," The Kitasato Institute of Tokyo. _ __,"Observation of temperature differences in each body part, using a deep body thermometer," Clinical body temperature, vol. 3, supplemental issue, July 1983. Also in Manaka Yoshio Ronbunshu, (Collected essays ofYoshio Manaka), 15th anniversary issue of the Shinkyu Topology Gakkai, Kyoto, 1988, pp. 230-243. ____ , "Fundamental studies of the auricular acupoints using an electrical probe," Presented at the 29th Nihon Toyoigakkai Gakujutsu Sokai, May 1978. Katsumata, Y., "Fundamental researches of the 0-ring test," Ido no Nippon magazine no. 504, August 1986; no. 505, September 1986. Katsumata, Y., with comments by Y. Manaka, "On the 'Sayoshi agent', a certain . unknown factor which affects the living body," Unpublished manuscript, December 1988. Translated into English by Y. Manaka.
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Khoe, W.H., "Referred pain: A holistic approach in acupuncture," Amer. Jour. Acup. 5:4, pp. 323-328, 1977. Liao, S.J., "Acupuncture points, concordance with motor points of skeletal muscles," Arch. Phys. Med. Rehab. 56, p. 550, 1975. Manaka, Y., "Shinkyu igaku kara mita oketsu," Oketsu Kenkyu 6, pp. 1-9, 1987. ___,"Acupuncture, a therapeutic method of modifying the biological information system," Excerpta Medica, International Congress Series 693, pp. 344-349, 1984. ______ , "Bishona shigeki moshiku eikyo o mochite a konau chiryo hono ko osatsu (Thoughts about treatment using tiny, tiny stimulation,)" Seminar pamphlet at the Nippon Shika Toyo Igakkai seminar, Tokyo, June 1983. Published in: Manaka Yoshio Ronbunshu, Collected essays of Yoshio Manaka, 15th anniversary issue of the Shinkyu Topology Gakkai, Kyoto, 1988, pp. 110-129. _ ___,"Reflections on abdominal diagnosis," Ida no Nippon Journal 45:4, pp. 115120, April1986. ___, "Speculations on the media of qigong," paper presented at a National Congress of Qigong in China, 1988. ___, "Speculation on qi in Chinese medicine as the media in the signal system," Nippon Shinkyu topology Gakkujutsu Taikai, Text of the 18th annual convention of the Shinkyu topology group, July 1988, pp. 6-21. ___, "Biasology as it is applied in acupuncture and moxibustion therapies," published by the Kitasato Institute of Tokyo and in Manaka Yoshio Ronbunshu (Collected essays of Yoshio Manaka), 15th anniversary issue of the Shinkyu Topology Gakkai, Kyoto, 1988, pp. 14-32. _ __, "Papers on the nature, signs and treatment of oketsu (blood stasis) from 1941 to the present," originally published seperately in many journals but now collected in Manaka Yoshio Ronbunshu (Collected essays ofYoshio Manaka), 15th anniversary issue of the Shinkyu Topology Gakkai, Kyoto, 1988, pp. 54-101. _ ___, "Meridian-phenomenon and its paradoxical phenomena," Nippon Shinkyu Gakkaishi 17, p. 1, 1968. ___, "Johokei Nitaisuru Kanshoho Toshite Usa Shinjutsu," presented at the 17th International satellite symposium of Internal Medicine, October 17, 1984. _ ___, "Shin to Ekikyo," Kanpo no Rinsho 35:9, pp. 230-247, 1989. _ ___, "The skin distinguishes color and sound!? An approach to qi, the origin of Oriental medicine," Ida no Nippon magazine 46:5, pp. 91-98, May 1986. Also in the Nippon Kanpo Kyokai Dairokkai Kanpo Gakujutsu Taikainite Hapyo (Aikido Journal) 20, Nov. 1986, and in Manaka Yoshio Ronbunshu (Collected essays ofYoshio Manaka), 15th anniversary issue of the Shinkyu Topology Gakkai, Kyoto, 1988, pp. 34-40. Manaka, Y. et al., "Abdominal diagnosis and indications in traditional Chinese medicine," Amer. Jour. Acup., July-Sept, 13:3, 223-234, 1984. Manaka, Y. and K. Itaya, "In yo ron tekini kumitateta keiketsu system shian (The basic procedure of acupuncture, equilibration of yin yang balance, Manaka's system," paper presented at the Keiraku Chiryo Gakkaishi, 1982 and published in Manaka Yoshio Ronbunshu (Collected essays of Yoshio Manaka), 15th anniversary issue of the Shinkyu Topology Gakkai, Kyoto, 1988, pp. 164-177. ___, "Shinkyu Kenkyu ni oyoshita jiki kotoni sana keiketsu sessyoku koka ni tsuite (Research into the effects of magnets and specifically the effects on certain acupoints)," Lecture pamphlet, Kitasato Institute of Tokyo, 1982.
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Manaka, Y. and K. Itaya, "Zen Ryodoraku chosei ni tsuite," Nippon Ryodoraku Jiritsu Shinkei Gakkai Zasshi 31:3, pp. 61-79, 1986. Manaka, Y. and K. Itaya, "Acupuncture as intervention in the biological information system (Meridian treatment and the X-signal system)," address given at the annual assembly of the Japan Meridian Treatment Association, Tokyo, March 2930, 1986. Also published in Manaka Yoshio Ronbunshu (Collected essays of Yoshio Manaka), 15th anniversary issue of the Shinkyu Topology Gakkai, Kyoto, 1988, pp. 132-146, published in English in Journal of The Acupuncture Society of New York 1:324, pp. 9-18,1994.. Mann, T.P. and J.E. Cree, "Familial rectal pain," Lancet, May 6, 1972, pp. 1016-1017. Matsui, H., "Fukudaidomyaku no Atsu ni tsuite (Tender points on the abdominal artery)," Nippon Iji Shinpo 3075, April1973. Melzack, R. et al., "Trigger points and acupuncture points for pain: correlations and implications," Pain 3, pp. 23, 1977. Melzack, R., "Myofascial trigger points, relation to acupuncture and mechanisms of pain," Arch. Phys. Med. Rehab. 62:3, pp.l14-117, 1981. Mortensen, 0. and P. Stougard-Andresen, "Harlequin colour change in the newborn," Acta Obst. et Gynec. Scandinav. 38, pp. 352-359, 1959. Motoyama, H., "A biophysical elucidation of the meridian and ki energy, what is ki energy and how does it flow?" Research for Religion and Parapsychology 7:1, August 1981. Nathan, P.W., "The gate control theory of pain, a critical review," Brain 99:1, pp. 123-158, 1976. Neligan, G.A. and L.B. Strang, "A 'harlequin' colour change in the newborn," Lancet, Nov. 22, pp.lOOS-1007, 1952. Oda, I., "Chiryo no Jisai," Nihon Shinkyu Topology Gakkujutsu Taikai, July 1988, pp. 55-60. Oleson, T. D. et al., An experimental evaluation of auricular diagnosis: the somatotropic mapping of musculoskeletal pain at ear acupuncture points," Pain 8, pp. 217-229, 1980. Omura, Y., "The bidigital 0-ring test: Critical evaluation of its abnormal responses with laboratory tests including 'blood pressure and blood flow method,' 'blood chemistry' and 'neurological method'," Acup. and Electro-Ther. Res. Int. Jour. 8:1, pp. 37-43, 1983. - - - ' " 'Bi-digital 0-ring test molecular identification and localization method' and its application in imaging of internal organs and malignant tumors as well as identification and localization of neurotransmitters and microorganisms - Part I," Acup. & Electro-Ther. Res. Int. Jour. 11, pp. 65-100, 1986. - - - ' "Electromagnetic resonance phenomenon as a possible mechanism related to the 'hi-digital 0-ring test molecular identification and localization method'," Acup. & Electro-Ther. Res. Int. J. 11, pp. 127-145, 1986. _ __, "Meridian-like networks of the internal organs, corresponding to traditional Chinese 12 main meridians and their acupuncture points as detected by the 'hidigital 0-ring test imaging method': Search for the corresponding internal organ of Western medicing for each meridian- part 1," Acup. & Electr-Ther. Res. Int. Jour. 12, pp. 53-70, 1987. Oschman, J.L., "The connective tissue and myofascial system," paper presented at the Rolfing 1981 conference.
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INDEX A abdominal aorta: 134 abdominal distension: 230 abdominal pain: 45, 99, 134, 149, 167, 230, 267, 269, 279280, 282, 318-319, 321, 406407 abdominal palpation: 89, 120, 127, 131, 133-134, 136, 141, 143-144, 159, 162, 319, 400 abdomen, healthy: 136 abdomen, thin: 128 acne:232 Acrasiales amoeba: 20 acupoint: 6, 10, 14-15, 19, 25, 28, 31, 36-37, 43, 49-53, 5661, 63-66, 71-75, 77-78, 82, 84, 87-95, 101, 103, 105-107, 111, 118, 160, 223, 233, 235, 252,254-256,311,314,318319, 323, 325, 328-329, 331333, 344-345, 348, 350-352, 355, 363, 366-367, 372, 389, 396-397, 401, 403-404, 409410,416,422 acute conditions: 148, 155, 160, 235, 242 Akabane testing: 329
akashi-based diagnosis: 114, 152 allergic rhinitis: 220, 232, 317 allergic skin conditions: 254 alopecia: 232, 270, 344 alternating hot and cold: 160 amenorrhea: 54, 239, 332, 343-344 analgesics: 136 anemia:245,259,269 angina:213,268,271,315 anosmia: 216 anti-bias: 32-33 appetite, poor: 195, 209 apoplexy: 129, 259, 316 appendicitis: 141, 214, 280, 311-312, 316
arm jue yin channel sinew: 150 arm shao yin channel sinew: 150 arm tai yang channel sinew: 150 arm tai yin channel sinew: 76, 150 arm yang ming channel sinew: 150
hi-digital 0-ring test: 25, 93, 128, 134-135, 141-142, 144145, 151-153, 166-167, 181, 189,212,243,265-266,272273,278-283,288-289,291293, 295-296, 306, 324, 326, 399, 405-406, 411, 416-417, 422-423 bihourly supplementation: 132, 167
arrhythmia: 230, 315
biliary tract ascariasis: 315
arthritis: 144, 147, 193, 211, 216, 231, 240, 272, 276, 290, 317,406
biliary tract infection: 315
ASIS region: 137, 161, 171, 268
biometeorology: 33
biological system: 18-19, 30, 112,400
associated-shu points: 183184, 266, 273 asthma: 10-11, 145, 150,209, 212-213, 221, 230, 236, 244, 259,285-288,312,351 astigmatism: 215 auriculomedicine: 12 16 79 244,397 I
I
I
auriculotherapy: 11-12, 16, 73, 79,90,117,244,344,397 autonomic nervous system: 221,254,257,332
ba gang bian zheng: 10, 115, 176,309
B back-shu points: 137, 142-
biorhythms: 10, 19, 28, 58, 66, 68-69, 87, 89, 99-101, 103106, 112-113, 116-117, 151, 159, 166-168, 180,367, 371, 392,423 biorhythmic treatment: 99, 103-106,116-117, 159,166, 168,371 biorhythms and five phases: 99 Bischko: 79 bitter taste in the mouth: 167 BL-1: 85, 233-235, 240, 359, 365 BL-2:188,234,238,240,359 BL-4: 234-235 BL-5: 234, 359
143,147,158,166,223,311
BL-6: 173, 234, 359
bacterial infections: 129
BL-7: 188, 234, 316
Baldry: 326
BL-8: 234, 359
Becker: 31, 37, 52, 79, 397, 415, 421-422
BL-9: 188,234,359
Bell's palsy: 149, 217, 231 Benoit: 28, 423 beri-beri: 216 bias: 7, 12, 27, 29, 32-34, 43, 84-85, 124, 130, 132, 157, 165, 179, 181, 196, 205, 218, 228, 245, 261, 306, 324, 339-340, 397
BL-10: 188-189, 193, 209-210, 213-217, 233-234, 236, 239240, 255-256, 359 BL-11: 50, 188,213-214,216217,237,317,359 BL-12: 85, 188,209, 213-217, 237-238, 253 BL-13: 94, 142, 184, 212-213, 215, 234, 237, 240, 253, 266, 285-288, 314
438
Index
BL-14: 142, 184,213-214, 234, 253,297
BL-34: 187, 194, 352
blackbox: 55, 79
BL-35: 50
BL-15: 142, 184, 213-217, 234, 240,253,289,315,359
BL-36: 50, 359
BL-17: 177, 184, 194-195, 212-216, 237, 239-240, 285286, 305, 333-334, 337-338
BL-38: 295
bladder channel: 7, 50, 53, 60, 67, 73, 76, 78, 93-94, 97, 100, 104-105, 168, 225, 235, 272-273,277,281-282, 301, 359, 406, 411
BL-18: 72, 137, 142, 177-178, 184, 186-187, 189, 194-195, 200, 203, 206-210, 213-217, 234-235,237,239,253,255257, 266, 273, 283, 291-295, 297, 303-304, 307, 315, 317, 405-406 BL-19: 142, 184, 187, 214, 216, 234, 237, 289-290, 303, 305,315 BL-20: 142, 177-178, 184, 187, 194-195, 207, 209-210, 212216,228,234-240,253,256257, 269, 287-288, 292, 303, 315,317 BL-21: 142, 184, 187, 214-215, 236-238,240,291-294, 303305,311 BL-22: 142, 184, 187, 210, 214-216, 235, 237, 239, 256; 292-293, 303, 305 BL-23:94, 139,142,161,176178, 184, 187, 189, 193, 200, 207-210, 213-216, 234-240, 253, 256-257, 266, 269-270, 273, 276, 283, 285-288, 293294, 316-317 BL-25: 142, 184, 187, 189, 193, 208, 210, 212, 214-216, 234-236, 238-240, 253, 256, 265-266,269-271, 273, 289, 293-294
BL-37: 208, 216, 314, 359 BL-40: 89, 97-98, 100, 103, 187,194,206,211,234,236, 238-240, 256-257, 314, 359 BL-42:94,142, 184,215,300 BL-43: 142, 184, 207, 209-210, 212, 235-236, 256 BL-44: 142,184,315 BL-45: 315 BL-47: 142,184,186-187,295 BL-48: 142, 184 BL-49: 142, 184 BL-50:50, 142,184,214,315 BL-51: 142, 184, 187, 214, 235,268 BL-52: 94, 142, 177-178, 184, 187, 210, 212, 215, 234-236, 239,253,256,265-266 BL-53: 142,184,214,216,235 BL-54: 168,234,240 BL-55: 187, 240 BL-56: 140, 187, 359 BL-57: 140, 187, 234, 239-240, 288 BL-58: 140, 187, 190, 194, 200,208,210,256-257 BL-59: 85, 215-216
bladder problem: 253, 272, 277,281,295,354 bladder tuberculosis: 214 blockages of the blood vessels: 13 blood: 13, 42, 49, 65-66, 70, 82, 85, 87, 118, 128-130, 137, 143, 150, 153, 162, 179-180, 182,203,209,221,228,237242, 246, 261, 267, 279, 298, 305, 307, 315-316, 324, 333341,344,349-354,388 blood coagulation: 129, 351, 354 blood pressure: 42, 153, 162, 209, 221, 238, 240-241, 279, 315-316 blood stasis: 128-130, 137, 153,179-180,182,203,228, 237-239, 241-242, 246, 261, 267,298,305,339-341 blood transfusion: 129 blood-clearing medicinals: 246 bloodletting: 3, 116-117, 129, 148, 158, 168, 203, 206, 240242,246,307 blue-colored superficial veins: 129
BL-60: 89, 97, 103, 169, 214, 216, 238-240
body organs: 391
BL-26: 240
BL-61: 85
body palpation: 133
BL-27: 142, 184, 186-187, 189, 215-218, 234-235, 240, 273, 290,305,315,317,406
BL-62: 11, 85, 159-161, 171175, 240, 268-269, 290, 292, 294, 3001 359
body structure: 18, 34, 82, 84, 106, 111, 118
BL-28: 142, 184, 186-187, 228, 239,291,407
BL-63: 85
body types: 391
BL-64:92, 168,171,175,190
Bohm:24,37,418,423
BL-30: 240, 359
BL-65: 89, 94, 97, 100-101, 103,164,168,181,233,238, 272,277,291,406
bonesetting: 197
BL-31:215,287,352 BL-32: 176-178, 187, 194, 210, 213-216, 219, 234, 237, 239, 253-254,257,317,352 \L-33: 176, 187, 214-216, 257, 352
BL-66: 89,97, 103,168,180 BL-67:89,94,97, 101,103, 164, 168-169, 215, 257, 272, 277,291,365,406
body tissues: 65, 125, 391
Bourdiol: 79 Boyd:21 bradycardia: 315 brain point: 219, 221, 257, 307
Index
breast pain: 215 broken bones: 231, 254, 256
channel therapy: 10, 114, 116-117, 156, 423
bronchiecstasis: 167, 314
channel trajectory on the hands: 225-226
bronchitis: 145,209,213,230, 237, 312-314
chaos:28,37,419-420,423
439
common cold: 209, 213 comparison of the abdominal quadrants: 136 conception vessel: 82
chest pain: 230
confluence-jiaohui points: 10, 68, 82, 99, 105, 112, 120, 138, 159,161,171,256-257,324
Chiba: 15
congestive heart failure: 129
child: 5, 9, 94-98, 102, 140, 144,163,215,282,285,306, 366,392,395,398,403-407, 410 childbirth: 179-180
conjunctivitis: 206, 215, 232, 406 constipation: 195, 210, 214, 230, 236, 254, 256, 260-261, 268, 302, 315
Capra: 17
childhood pertussis: 215
constitution: 178,332
cardiovascular system: 31
childhood polio: 215
carotid pulses: 131
chong mai: 83-85, 138, 146,
contracted feeling in the center of the chest: 150
bruising: 129, 253 bursitis: 218
c callus: 130 cancer: 130,141,302,314315, 317, 352, 416, 423
carriers of biological information: 396 central nervous system: 76, 245,422 central nervous system, severe damage: 245 cerebral apoplexy: 316 channel acupoints: 14, 57, 59, 71, 73, 77, 84, 91, 100, 103, 106, 158, 188-191, 195, 282,311,331,370,403,408 channel biorhythm: 69, 99101, 103, 106, 168 channel clock: 66, 71, 99, 111 channel frequency relationships: 73 channel palpation: 89 channel pathway: 50, 61, 69, 87, 157, 225-226
Cheng: 11, 50, 58, 86
159, 162, 187, 265, 268-271, 275, 277, 295, 318 chronic gastroenteritis: 214 chronic shoulder and low back pain: 32
circulation, poor: 129, 179, 210,241
correct qi: 5 corrective exercises: 246 correspondences: 41, 43, 7172, 75, 87-94, 97, 100, 105, 107, 134, 143, 153, 157, 165166,184, 224-225, 258, 273, 318, 324-325, 363-364, 367373, 391-392,396-397
climatic patterns: 391
costal arch, narrow: 128
closed circuits: 18, 126
cough: 160,230,236,259
coherent light waves: 396
counter-bias: 33-34
cold: 5, 134, 145-150, 153, 160, 176, 183, 209-210, 213, 236-241, 257, 266, 285-286, 309,343,349,351-352,354
counter-engendering: 392393,395,409
cold feet: 145-146,257
counter-restraining: 392, 394-395, 409
circadian: 66, 71, 100-101, 111-112, 181, 373, 400 circuit flow: 60, 65-66
channel sensitivity: 193
cold in the cheek muscles: 149
channel sinew symptomologies: 145, 148
coldness or achiness in the lower back: 146
channel sinews: 49, 58, 73, 75-78, 116-117, 145, 148-150, 183-184, 197
colitis: 171
channel software: 54-55, 5859, 61,79 channel stretching: 75, 191, 205,212,219,243,307 channel system: 10, 12, 18, 43, 49-80, 88, 106, 118, 156, 323, 398, 401, 410
contusions: 206, 208, 227228, 231, 242-243, 253, 256, 298
color: 47, 54, 87, 91-93, 119, 128, 130, 136, 150, 158, 161163, 165-166, 182, 241-242, 257, 261, 277-279, 363, 367, 391,401,404-405,408,411 color-phase correspondences: 91 combinations of points and colors: 92
counterflow qi: 160, 194
cramping: 148-150 cramping and epilepsy: 149 cramping and pain of the sexual organs: 149 cramping at the little finger: 150 cramping at the top of the big toe with pain: 149 cramping below the navel: 149 cramping between ST-12 and the cheek: 149
/
440
Index
cramping in chest: 149-150 cramping in knee region: 148 cramping in the neck musdes: 150 cramping of the abdominal muscles: 149 cramping of the lateral knee muscles: 148 cramping on the medial side of the thigh: 149 cramping on top of the big toe: 149 cross syndrome: 137-139, 146, 152, 161, 167, 180, 187, 223, 266-270, 273, 275-276, 279-280, 305, 325
C"-13: 181,214,216,234235,237,239
diagnostic methods: 114, 118, 127, 329, 332-333
C"-14: 74, 102, 134-135, 137, 164, 181, 209-210, 212-214, 216-217, 280,291-292,306307,370
diagnostic palpation: 89, 114, 127, 132-134, 136, 138, 142-143,151,153,161,195, 405
C"-15: 102,105,181,302, 360
diagnostic points: 11, 31, 52, 62-64, 74, 92-93, 96, 100-101, 104-105, 115-117, 125, 134, 140,142,144,151,157,161, 163-164, 166, 168, 171, 181, 184, 188, 311-313, 318, 325, 328,333
C"-17: 9, 74, 134-135, 137, 139,153,161,164,181,208210, 212-216, 234-236, 267, 270, 289, 360, 365 C"-21: 181, 281-283 C"-22: 10-11, 85, 142, 161, 216,233-237,243-244,318 C"-23:85,233-234,365
diarrhea: 160, 210, 214-215, 230,236,302,305,351-352 diarrhea in nursing child: 215
cupping: 3, 116-117, 148, 203, 241-242,246
C"-24:83,85,234,365
dietary problems: 157,237, 246,256,261
curvature of the spinal vertebrae: 148
cycle: 87-88, 91, 93-94, 96, 98, 101, 111, 392, 420
difficult labor: 215
C"-1: 71, 83-85, 234, 360
cystitis: 176, 215, 227, 231, 267,316
C"-2: 78, 181, 215, 235, 253, 257, 306-307 C"-3:74,78, 134,176,181, 210, 214-216, 234-236, 239, 253,281-283,316,360 C"-4: 74, 78, 134-135, 166, 178, 181, 194-195, 208-210, 212, 234-237, 239-240, 253, 257,278,342,405-406
D dai mai: 29, 68, 81-83, 85, 120, 139, 146, 159, 161, 187, 228, 270-271,275,279,290 daily branch method: 101 daily rhythm: 99-100, 102103, 168, 180
difficult menses: 215 difficulty bending and straightening the knee.: 148 difficulty breathing: 150 difficulty moving: 150, 217 difficulty moving the shoulder: 148 difficulty turning the head to right and left.: 150 digestive problems: 130, 146, 194,243,256,274
C"-5: 74-75, 78, 134-135, 181, 360 C"-6:61,78, 177,181,214216, 235-237, 239, 281-282, 289, 302, 315, 360 C"-7: 78, 178, 181, 194-195, 214-215, 235, 253, 279-280, 317,360 C"-8: 78, 236-237, 239, 352, 360
de qi: 185, 218
direct moxa: 72, 148, 166, 176-177, 181, 184, 187-188, 203,227,252,286-290,293, 303-304, 307, 351
deep body temperature: 328-329,341-344
direction of flow: 49, 55, 6063, 111, 365, 403
deformity at the side of the mouth, sudden: 149
directional polarities: 60 discoloration of an area: 129
C"-9: 78, 181, 213-215, 234235,237,282,360
degenerative diseases: 130, 227
disease patterns: 137, 159, 254, 341, 391
C"-10: 78, 153, 181, 234, 237, 253, 265, 292
degranulation: 37
diverticulitis: 141
dermatitis:232,240,279,307
dizziness: 146
C"-11:181,237,315
dermatome: 34, 117, 143, 240,323-324,331,351
D.N.A.: 5, 23, 112, 364, 366, 371-373
C"-12: 74, 78, 134-135, 137, 164, 166, 177-178, 181, 194, 207,209-210,212-216,234240, 253, 257, 274, 279, 281, 288, 294, 297, 302-303, 305, 315, 365-366
danokyu:203,242 daoyin: 75, 78 Davenas: 37
diabetes: 216, 231, 240, 259, 274,316,353 diagnostic confirmation: 132, 143, 159
drainage: 7-8, 43, 60-61, 6364, 79, 94-98, 100-102, 111, 115, 140, 145, 159-160, 163164, 166-168, 241, 366,376, 388,403
Index
dreams: 231 drllikll1g:59, 155,352 dryness: 5, 129 du mai: 29, 49, 64, 71-72, 81-
electrostatic adsorbers: 19, 31, 102-103, 113, 119-120, 122, 125, 132, 136, 144-145, 159, 161-164, 265-266,272273,277,279,288-292
441
five-phase theory: 2, 18, 30, 87-91, 93-94, 97, 105-106, 114, 365, 391-392, 408-409 flaccid muscles: 128, 134, 162, 267, 308
82, 85, 146, 148, 159, 185, 193, 228, 242, 255, 259-260, 268-269, 295, 361
embryogenesis: 18,27-29, 44,81,83,346,400,415
duodenal ulcer: 214, 230, 312-313, 315
emotions: 5, 32, 87, 129, 158, 194,232,257,324,326,391, 408
dysentery: 315
endometritis:215,317
folliculitis: 232
dysmenorrhea: 115, 195, 259, 317
engenderillg cycle: 88, 92, 94-96,111,392,398
food allergies: 256
dyspepsia: 230, 315
enteritis: 210, 230, 237, 259, 306,315
four examinations: 127
.E ear and eye problems: 146 ear, nose, and throat problems: 145 ear pain: 150 early stages of catching cold: 146 earth phase: 28, 87, 89, 9192,97,363,391-392 eczema:210,217,232,240 edema: 129, 143, 183-184, 237,340 Eigen: 23 ejaculatio praecox: 230 electrical fields: 79, 396 electrical characteristics of the channels: 52, 55, 416
flat wart: 232 flow of qi: 10, 65, 84, 96, 365, 402 flu:5, 147-148,241,307
formulating a diagnosis: 127
enuresis: 215
fretful child: 215
epilepsy: 146, 149, 209, 216, 316
Fujita: 53, 73-75
epistaxis: 206, 232 esophagealspasms:214 evolution: 14, 18, 23, 26-30, 53, 55-56, 79, 85, 106, 112, 344,393,411,417,422-423 extraordillary vessels: 10-11, 18, 36, 49, 57-58,61, 79, 8186, 89, 99, 105-106, 111-112, 114, 116-117, 120, 122, 128, 130, 137-138, 141-142, 145, 153, 156, 159, 161-163, 166167, 169, 171, 178, 182, 187, 223,259,269-270,404-405 eyes, illability to close: 149
E
Fukaya: 205-206, 244, 253, 303 functional diseases: 33, 76, 113, 130, 332-333 functional hyperesthesia: 141-142 functional hyposensitivity: 142 functional muscle groups: 75-77 functional uterine bleedillg: 231 Furukawa: 65-66
G
face problems: 146, 217, 236, 253
gallbladder channel: 53, 66, 69, 71, 78, 84, 128, 235, 273, 290,360
electrical moxa devices: 252
fatigue: 115, 119, 146, 194, 253-254, 280, 352
gallbladder problem: 146147,194,290,315
electrical potential: 121, 329, 416
febrile condition: 7, 129, 146148,242
gallstone: 168, 214, 231, 267, 270, 276, 313
electrical resistance: 25, 219, 325,329,345
fire needle: 3, 76, 143, 183184, 191-192, 195, 197-202, 212,219,243,307
gastric spasms: 214
electrical current: 121-122, 124,126,366,381,387,396, 400-401, 410
electrodermal: 79, 97, 117, 219, 222, 227, 271, 328, 345, 366,398-399,410-411,422423 electromagnetic: 30, 37, 53, 71, 120-121, 153, 324, 326, 381, 387-388, 396, 413, 416418, 421-423
five phases: 4, 19, 28, 36, 87108, 111-112, 117, 133, 159, 168,188,223,324,327,339, 363-366, 373, 391-413,419420 five-phase points: 64, 71, 82, 88-89, 91-93,95, 98, 106, 111, 117,156,165,396,421
gastric ulcer: 114, 230, 311313, 315 gastritis: 153,167,210,230, 237, 259, 315 gastrocnemius palpation: 140 gastroenteritis: 214 gastroilltestinal problems: 147,230
442
Index
gastroptosis: 210, 214, 230, 237,256,315
GB-31: 64, 84, 178, 208, 216, 253,255
GV-3: 214-216, 235-236, 239240, 287-288
gastrospasm: 315
GB-32: 360
GV-4:214-215,235-236,239
GB-1: 234-235, 360, 365
GB-33: 240, 360
GV-5: 235
GB-2: 188, 206, 216-217, 233, 237-238 GB-3:215,234,360
GB-34: 89, 103, 168, 178, 194, 198, 206-208, 211, 213-217, 234, 237-240, 253, 255-257, 298,315
GV-6: 361
GB-4: 235 GB-5: 215 GB-6: 235 GB-7: 188, 235 GB-8: 234-235 GB-9: 235 GB-10: 234-235
GB-35: 64, 84-85, 232-233, 243,257,301 GB-36: 213, 315 GB-37: 140 GB-38: 89, 94, 101, 103, 164, 168-169,237-238, 289, 300
GB-11: 234-235
GB-39: 194, 234, 238, 243, 253, 257, 299-300, 407
GB-12: 188,206-207,216-217, 235-236
GB-40: 92, 169, 178, 194, 208, 235,240,253,257
GB-13: 85, 235
GB-16: 215, 235
GB-41: 11, 68, 82, 89, 103, 105, 159-161, 168, 171-175, 206, 209, 214, 216, 233, 237, 240,266-271, 279, 291-294, 299-301, 304, 315-316, 405, 407
GB-17: 72,213, 216, 235
GB-42: 105, 360
GB-18: 235, 360
GB-43: 89, 94, 101, 103-104, 164,168,289,300
GB-14: 188,219,234-235, 238,240 GB-15: 235, 360
GB-19: 235 GB-20: 71-72, 188, 193, 207, 209, 212, 215-216, 233-238, 240,255,289,291
GB-44: 89, 103, 168, 257, 365
GV-8: 201, 216-217, 292-294 GV-9: 213-214, 216 GV-10: 188,201,213-214,361 GV-11: 316, 361 GV-12: 177-178, 185, 187-188, 190, 194, 201, 206-207, 209210, 212-217, 235, 253, 257, 287 GV-13: 234 GV-14: 53, 61, 72, 188-190, 193, 209, 213, 215-216, 234238,240,244,286-287,289, 291,294,314 GV-15:85, 188,361 GV-16: 85, 216-217, 234, 236, 238,361 GV-17: 234,361 GV-18: 361 GV-20: 71-72, 136, 178, 188, 194,207-210, 212-214, 216217, 233-238, 253, 255-257, 365
GB-22: 360
general treatment: 113, 115118, 137, 143, 145, 148, 151, 153, 156, 158-159, 161-162, 165-167, 176-177, 179-183, 193, 203, 205-206, 223, 227, 233, 244-245, 255-257, 265283,285-308,367,370
GB-24: 74, 134-135, 137, 139, 161, 164, 289
genetic information: 23, 30, 112
GB-25: 74-75, 134-135, 214215,235
geomagnetic field: 33, 104, 416, 422-423
GB-26: 64, 85, 135, 137, 139, 145,161,164,167,171,239, 266, 269-270, 274-276, 279, 299, 317, 319, 407
geometry: 19,28,37,98,420, 423 glaucoma:232,270,317
GB-27: 85
Gleick: 37, 423
GB-28: 85
gonorrhea: 215
Hashimoto: 85, 195, 197, 203,326,389,405,407
GB-29: 85, 135, 137, 164, 209, 318-319
governing vessel: 82
headache and vertigo: 231
GV-1: 85,234-235, 240
headache: 71, 74, 231, 238, 296,322,333
GB-21: 85, 188-189, 207-210, 212-213, 217, 235-236, 240, 256,289,295,297,360
GB-30: 210, 216, 234, 238, 240,338
GV-2:214,235,256
GV-22:216,304,361 GV-23: 188,206,212,303 GV-24: 71,234,361 GV-25: 361 GV-26: 234-237, 240 GV-28: 85, 234 . gynecological problems: 145-146,194,243,253
H hara: 47, 79, 126, 133, 153, 182,244,261,325-326,353354,397,421,423
Index
heart attack: 129, 150
homeopathy: 20-21, 25, 3637, 326, 353, 389
443
hot needle: 76, 143, 325
information system: 18, 26, 35, 112-114, 118, 127, 183, 337,397,411,413-414
heart: 221, 397
HT-1: 239, 315
inherited predisposition: 129
heart problem: 70-71, 145146,162,181,213,253,265, 277
HT-2: 356
heart channel: 66, 69-70, 100, 102, 105, 128, 168, 225, 370
heart valve disease: 213 heat: 5, 72, 117, 149-150, 176179, 182, 186, 192, 198, 202, 209, 227, 236-240, 252, 258, 289, 291-294, 329, 340, 348, 350-352
HT-3: 89, 103, 169, 180, 216217, 315, 356 HT-4: 89, 103-104, 168,217, 315 HT-7: 89, 92, 94, 100-101, 103,164,168-169,207,209210, 213-214, 216-217, 234, 237, 240, 289, 315
heat-pain threshold response:329,331,333
HT-8: 89, 100, 103, 169
Heaven and Earth: 5, 87
HT-9: 89, 94, 100-103, 164, 168,289,365
HEENT problems: 146 hematuria: 70 hemiplegia: 129,254,257 hemmorhoids:254 hemolysis: 129 hemoptysis: 213, 312 hemorrhaging: 215 hemorrhoids: 145,210,214, 231,240,256,259,280 hepatitis:210,221,228,230, 276-277, 279, 315 herbal medicine: 13, 15, 176177,203,227,314,339 hernia:214,231,304 herpes zoster: 227-228,232, 240,270 high fever: 242, 352
hinaishin: 61, 205-206, 217218,376,389,407 Hirata: 128, 131, 143, 153, 180,232,235,245,258,260 Hirata Liver Zone: 128, 131, 143,180,232,258,260 holographic paradigm: 16, 24,35,91,418,423 home moxa therapy: 157, 194,245 home therapies: 155-158, 177-178, 180, 206, 245-262, 307
hyperesthesia: 141-142,308 hypertension: 152, 213, 230, 268,315 hypertensive medications: 136, 142 hyperthyroidism: 216, 231 hypertrophic rhinitis: 216 hypoesthesia: 141-142, 308 hyposensitivity: 130, 141142,333 hypotension: 141-142, 230, 269, 308, 315 hypothyroidism: 231
I imbalances of the autonomic nervous system: 254, 332 impotence: 149, 215, 230, 239,257,259 infection: 10, 147-148,213, 216, 230, 241, 307, 315, 350 infectious disease: 147, 230 inflammation of the canthi: 215
insertion of needles: 19, 389 insomnia: 146,195,208,231, 237,257,259,268,278,342, 344 inspection of the skin: 128 intercostal neuralgia: 208, 216, 231, 239, 312, 316 intersection-jiaohui points: 64-65, 71-72, 76,84-85, 112, 178,189, 193,232,~235, 243 intestinal cancer: 141 intestinal hernia: 214 intestinal invaginations: 141 intestinal problems: 145-146, 253 intestinal spasm: 315 intestinal TB: 141 intradermal needle: 61, 117, 158, 193-194, 205-206, 217219, 223, 227-229, 233, 243, 281,286-288,290-305,339, 343-344, 352, 376 intussusception: 214 ion beam device: 19,95-96, 105, 113, 119-120, 122-125, 132,1~145,151,159,161-
164, 268,271,273-277, 281282,306 ion pumping: 18-19,31,95, 102, 113, 119-122, 125-126, 140, 144-145, 158-159, 161165, 167, 171, 190, 193, 212, 227,232-233,244,246,265273, 275, 278, 283, 285-305, 307-308,404-405 ionic currents: 31, 121, 126, 396,415 iritis: 215
inflammation of the shoulder joint: 313
irritability: 257
inflammation of the spinal cord: 216
ischemic angina: 315
inflammation of tissues: 215
irritable bowel: 315 isophasal correspondences: 90,93
444
Index
isophasal relations: 157, 180 isophasality: 18, 28, 37, 8994, 99-100, 107, 111, 116, 156158, 168, 180-181, 183, 188, 190,219,223,244,327,366367,373 Itaya: 54, 130, 138, 153, 194195, 205, 219, 227, 244, 261, 306, 327-362, 397,411
J jaundice: 214 Jia: 103, 168, 355
jing: 3, 5, 7, 9, 14-16,25, 4952, 56-58, 77-82, 86-87, 89, 94, 103, 105, 116, 130-133, 160, 241, 243, 255-257, 307, 325, 328-330, 341, 343, 348, 355,363-374,388,391,411
jing luo: 49-80, 52-76, 116, 239, 325, 328, 411
jing luo theory: 49-51, 77-80 jing mai: 49, 86 jing xue: 14, 57
Kl-7: 67, 89, 94, 96, 98, 101, 103, 164-165, 168-169, 178, 194, 209-210, 238, 253, 257, 269-270, 272-274, 276, 281, 286,288,293-295,297,300, 342-343,358,370,404
194, 265-266, 271, 276, 283, 289-295,303-305,343,352
Kl-10:89, 100,103,168,180, 237 Kl-11: 7, 60, 85, 104-105, 135, 137, 139, 161, 164, 268-269, 272, 277, 281, 291, 318, 358, 406 Kl-12: 176,215,239 KI-16: 62, 64, 67, 72, 83-84, 92,96,98, 100,103-105,135, 137, 139, 141, 144-145, 152, 161, 164-165, 214-216, 235, 265, 267, 269, 271-274,276, 279, 281-282,285-289,291297, 300, 316, 318-319, 370, 404 Kl-21: 85, 358
Kl-25: 213
keiraku chiryo: 10, 35, 89, 116 keratitis: 215 Kl-1: 83-85, 89, 94, 96, 98, 100-101, 103, 164-165, 168169, 181, 214, 257, 272-274, 276, 281, 288, 293-295, 300, 317, 365, 404 Kl-2: 67,85,89, 103,168,358 KI-3: 72, 85, 89, 92, 98, 100, 103, 168-169, 177, 190, 207, 209, 213-214, 216, 234, 237240,316,371 KI-4: 190 Kl-6: 85, 105, 125, 137, 144145, 159-162, 171-175, 177, 240, 265, 267, 269, 271, 282, 285-288,290,304,308
Kyushin, Yurnoto: 7
kyutoshin: 176, 184-191, 193-
jue yin: 7, 56-57, 67-68, 70,
Katsurnata: 21, 375, 389, 417, 423
Kreb's cycle: 90, 99
Kl-9: 85, 216
KI-23: 135, 137, 164, 213, 289,370
K
koryo sooji chim: 223, 244
Kl-8: 85
josen: 219, 240, 295 142, 149-150, 180, 184
Korean hand acupuncture: 90,206
KI-27: 213-214, 216 kidney channel: 50, 57, 62, 67, 70, 72, 83, 92, 94, 96, 100, 102, 104-105, 130, 137, 180, 189-190,270,274,276,280282,311,358,370,404 kidney problem: 147, 180, 187,267,273,281-282, 293, 313 kidney qi vacuity: 238, 314 kidney stones: 141 kidney-large intestine: 103, 105, 137, 140, 152, 165, 187, 193, 265, 271-272, 274, 276, 281, 288-289, 293-295, 299, 302-303, 370 kinesiological: 25, 33, 78, 144, 311, 324 Kinoshita: 15 Kobayashi: 229,244
kong xue: 14
1 lactation, insufficient: 212, 215 large intestine channel: 51, 55, 59, 62, 67, 70, 73, 75, 91, 94, 102, 189-191, 235, 271, 274, 280-282, 297, 363, 365366,370,401 large intestine problem: 67, 189 laryngitis: 317 leg jue yin channel sinew: 149 leg shao yin channel sinew: 149 leg tai yang channel sinew: 76, 148 leg tai yin channel sinew: 149 leg yang ming channel sinew: 149 leg pain: 149 leukorrhea: 210, 231, 239, 317 LI-1: 55, 89, 91, 103, 107, 168, 206,209,356,363,365,367 LI-2: 51, 61, 63-64, 89, 94-95, 97, 101, 103, 164-165, 168, 272-273, 282, 288, 293-295, 297,300 LI-3: 89, 103, 169, 180 LI-4: 25, 31, 37, 44, 59, 61-64, 74-75, 77, 91-92, 95, 97, 104, 152, 168, 188-190,206-207, 209, 212-213, 215-217, 233235, 237-240, 253, 255, 292, 298, 304, 318-319, 342, 356, 365-367, 371, 401, 408 LI-5: 89, 103, 168, 240, 282
Index
LI-6: 61 LI-7: 214, 316 Ll-8: 61
liver-small intestine: 137, 140, 152, 165, 167, 171, 184, 187,273,275, 280,291-292, 296-298,300,302-303,306
445
LU-1: 55, 74, 92, 104, 134135, 137, 139, 141, 144-145, 152, 191, 212-213, 217, 232, 265, 269,271-272, 277,281, 285-287,289,291,318,355, 366,406
Ll-10: 188-190, 210, 212, 214, 216-217, 253, 255-257, 298, 300-301
loca1Urrflammation:147 local swelling: 129, 256
LU-2: 135, 137, 139,236, 355
Ll-11: 61, 63-64, 89-91, 94-95, 97, 101-103, 107, 164-165, 168, 177-178, 188, 190-191, 206-207, 212-217, 234-240, 253, 256, 272-274, 276, 281282,288,293-295, 297-298, 300,370
lordosis: 148
LU-3: 139, 191, 238, 355
Lovelock: 37, 419, 423
LU-4: 139, 191
low back pain: 32, 150,219, 239, 266,269,280-281,290291,295,299,313,317,343, 405-406
LU-5: 51, 89, 94, 101, 103, 164, 168, 213-214, 216, 232, 234, 236-237, 240, 272, 286, 291, 316, 355, 406
LI-13: 296, 300, 314, 356
low back problems: 32, 219, 266,269,300
LU-6: 209-210, 213-214, 216217, 232, 256
lower abdominal problems: 146-147, 288
LU-7: 51, 79, 105, 125, 137, 144-145, 159-162, 171-175, 206, 209, 216-217, 233-238, 240,253,265,267,269,271, 281,285-288,304,308
Ll-14: 85, 191, 296, 299-301, 407 Ll-15: 85, 188, 190-191,208, 212, 214, 217, 234, 236, 239240 LI-16: 85, 188 Ll-18: 188 LI-19: 188, 214, 234-235, 356 Ll-20: 188, 190, 216-217, 233235,238,240,317,356,365, 367 Li Ding Zhong: 52, 79,314, 325
1i Shi Zhen: 86 lifestyle modifications: 245 lifestyle, poor: 157
ling gui ba fa: 105, 171 Ling Shu: 3, 7, 50, 56-57, 75, 78-79, 145, 148, 183, 197, 348, 391
liu zi jue: 97 liver and gallbladder problems: 146 liver cancer: 315 liver channel: 32, 57, 72, 93, 128, 130, 140-142, 1~165, 180-181, 190, 212, 235, 257, 266, 273, 275-278, 280, 298, 301, 306, 308, 405, 408-410 liver problem: 25, 32-33, 57, 76, 128-129, 137, 142, 146147, 152, 165, 179-181,202203,214,218,228,235,244, 261, 265, 272-273, 275, 277278, 293, 298, 306, 314-315, 405
lower ribs and costal border region are distended: 128 LR-1: 89, 93, 103, 168, 180, 365 LR-2: 77, 89,93-94, 101, 103, 164-165, 167-169, 239, 273, 275, 277-278, 292, 296-298, 301,307,406 LR-3: 76-77, 83-85, 89, 92-93, 103, 142, 168-169, 178, 194, 199,208,210,233-234,236240,253-255,257,278,290, 342-343 LR-4: 89, 93, 103, 169, 178, 194, 207-210, 214-215, 235, 237,253-254,257,342-343 LR-5: 239, 287 LR-6: 239 LR-7: 195 LR-8: 89, 93-94, 101, 103, 164-165, 167-169,210-211, 214-216, 237, 239, 273, 275, 277, 292, 296-298, 301,307, 406 LR-10: 193,212 LR-11: 193 LR-13: 74, 85, 134, 180-181, 214,216,237,239,291-292 LR-14: 44, 64, 74, 85, 93, 134135, 137, 139-140, 161, 164, 180-181, 209-210, 212-214, 216, 237, 239, 273, 278, 293, 296,298,306,318-319,405406
LU-8: 89, 103, 169, 355 LU-9: 51, 89-90, 92, 94, 101, 103, 164, 168-169, 236-237, 272,277,291,316,406 LU-10: 37, 89, 92, 103, 168, 181, 236-237, 355, 408 LU-11: 89, 103, 169, 180, 240, 355,365-366 lumbago: 57, 194, 254, 266, 306,318 lumbar pain: 146, 210, 221, 235-236,248,256,405-406 lung channel: 55,59, 62, 76, 78, 92, 94, 101, 104, 115, 137, 160,164,187,191,226,232, 266, 281-282,355, 365-366, 406 lung problem: 145, 253, 277, 281 luo mai: 49-51, 77-80, 159, 189-190,235,328,364,367
luo points: 159, 188-190,235, 364,367
M magnet: 4, 18, 21, 25,31-34, 37, 44-47, 53, 61-65, 75, 77, 91,95-96,99-100, 113, 119, 121-124, 132, 151, 158, 179182, 246, 279-280, 305, 324, 329,345,366,375,382-383, 385-389, 396,401,403-404, 413,415-419,422-423
446
Index
magnet heater: 34, 179-180, 246,279-280, 305 magnetic fields: 21, 121, 324, 329, 386, 396, 413, 416-417, 422
metronome: 71-73, 98, 101, 104-105,182,195,242,245, 255, 268, 277, 282, 288-291, 294
malignant tumors: 153, 245
microcirculation: 129-130, 228,327,333-338,340,361
Manaka mu points: 135, 137138
microsystems: 90-91, 223, 325
Manaka san yin jiao: 99, 178, 181, 275, 279-280
migraine: 216, 231, 255, 260, 285,299,316,318
Mandelbrot: 28, 423
minimal stimulation: 18-19, 33, 43, 59, 65, 93, 107, 118, 121, 123-124, 155, 197, 302, 341-343,395,401,419,421
mapping particular patterns of reactive points: 143 Maruyama:53,244 massage: 7, 13, 196-197, 210211,257,293,349-350 mastitis: 212, 231 mathematical model: 391412, 420-421 Mawangtui: 56, 348
monosyllabic phonemes: 97 morning sickness: 215, 239, 317 mother-child relationship: 5, 9, 94-98, 102, 140, 144, 163, 215, 282, 285, 306-307, 366, 392,395,398,403-407,410
muscle testing: 206, 418 muscle tone: 150, 196-197 muscle-posture-channel relationships: 77 musculoskeletal: 116, 148, 156, 158, 193, 243, 256, 290, 326 musculoskeletal problems: 148,193,243,256,290 myocardial infarction: 315 myocarditis: 315 myopia: 219, 232, 240
N Nagahama: 15
nai jia fa: 103, 168 naizhifa: 101,167-168,171 Nakatani: 52,79,399
maximum-minimum energy relationships: 102
motor points: 311, 323, 326
Nan Jing: 3, 7, 9, 15-16, 57, 86-87, 89, 94, 131-133, 160, 366,391
McBurney's point: 79, 141
movement of qi: 83
nasal bleeding: 317
Medikamententestung:25
moxa, indirect: 183, 287-288, 350-351
neck stiffness: 193
Melzack: 16, 326, 402, 411 memory, poor: 195 menopause: 180, 210, 231, 239,241,317 menorrhagia: 317 menorrhalgia: 231 menses: 180, 210, 215, 227, 239,257,332 menses, irregular: 215, 239 menstrual cycle: 85 menstrual flow, incomplete: 129 menstrual pain: 195, 239 menstrual problems: 129130, 146, 194 mental disorder: 316
motion sickness: 231
moxa on the handle of the needle: 176, 183-185, 188189, 193-194,203,212, 228, 233,288,343,352 moxibustion: 3-5, 7-8, 10-19, 30,32-35,49,51-52, 56-57, 59, 65, 72-73, 77, 87, 106, 111112, 116-117, 121, 136, 143, 146, 148, 155, 157-159, 166167, 176-178, 181-195, 198203, 205-206, 210, 212-217, 219, 227-228, 233, 236-237, 239-240, 243-245, 252-253, 256, 258-259, 265-266, 268269, 271, 273, 276, 278-283, 286-295, 300, 303-305, 307, 314, 325, 327-329, 341-344, 348-355, 361, 382-383, 389, 406-407, 420 moxibustionists: 8, 12, 205
meridian imbalance diagram (M.I.D.): 18, 34, 36, 47, 85, 118, 130, 178, 221, 327329,332-333,341,346,361
mu points: 74-75, 133-135, 137-138, 143, 166, 278, 314, 318
metal phase: 67, 87, 89, 92, 94,366,391
Mubunryu hara diagnosis: 133
negative electrode: 102, 105, 136, 164 nephritis: 214-215, 230, 276, 316 nervous gastroenteritis: 230 nervous problems: 136, 146147, 254, 331-332 nervous system: 18,21-22, 25, 31, 43, 60-61, 76, 95, 98, 121, 143, 245, 254, 257, 324, 331-333, 376, 388, 398, 422 nervousness: 146, 268-269 neural dermatomes: 117,323 neuralgia: 10-11, 146,207208, 216-217, 231, 238-239, 306, 312-313, 316 neuralgia of the arm: 217 neuralgia of the inguinal joint: 216 neuralgia of upper arm: 217 neurasthenia: 316 neurological disorders: 196, 316
Index
neurological medications: 136
osteoarthritis: 317
Neurometer: 67, 399
ovarian cystoma: 317
neurophysiology: 18, 25-26
overcontraction and swelling of the neck: 150
neurosis: 145-146, 216
otitis media: 216, 306
neurotransmitters: 153
~
Nogier: 11, 16, 35, 73, 117, 217, 219-220, 222-223, 244, 325,344,348,397
pain and cramping: 149-150 pain, axilla: 148, 150
non-inserted needle: 186, 376
pain, chest: 134, 149, 230, 405
Nordenstrom: 31, 37, 126, 415,421-422
pain, chin: 150
north and south magnets: 44,46,75,91
pain, knee: 211, 232, 283, 288-289
north magnet: 25, 31, 37, 6263, 99-100, 182, 382-383, 385, 388, 403-404
pain, medial malleolus: 149
numbness of the arm: 217 nutrition, poor: 245
0 occipital pain: 217, 267 ocean of the blood: 82 ocean of yang: 82 ocean of yin: 82 octahedral model: 26, 47, 70, 81-86, 103, 189 octahedral relationships: 34, 331 octahedral structure: 81-82, 178 octahedral symmetry: 26, 28, 43,47 octahedral theory: 18-19, 29, 43,4~64,309,327,378,420
Chnura:25,32, 128,142,144, 153,324-326,337,399,403, 405,411,415-416,422-423 open point: 103-106, 159, 161, 166-169, 171, 173, 175, 180,265,267,286,289-290, 292-293,300-301,305,370 open ulcers: 217 organ-channel system: 49, 160 Oschman: 31, 37, 415, 421422
pain killers: 142
447
palpation, gastrocnemius muscles: 127, 137, 139, 143 palpation of abdominal points and areas on the abdomen: 89, 120, 127, 131, 133-134, 136, 141, 143-144, 159,162,319,400 palpation, radial pulse: 89, 127,131-132,137,143,314, 400 palpatory reflex areas: 391 palpitations: 134, 146, 208, 213,253,282 pancreatitis: 231-232, 238, 316 panting: 160
pain, navel: 45, 149, 278
paradigm: 24, 35, 91, 182, 244,326,397,411,418,423
pain, neck: 150, 193, 232, 296
paranasal rhinitis: 317
pain, olecranon process: 150
parotitis: 214
pain: 7, 11-12, 16-17, 31-33, 37, 43-47, 55, 59-64, 67, 7172, 74, 76, 79, 83, 91-93, 96100, 102-105, 107, 114-115, 118, 120, 122, 127, 130, 132, 134-137, 140-146, 148-150, 152, 156, 160, 162, 164, 166168, 176, 178, 180-182, 184, 187, 189-191, 193-198,205, 208-212, 214-215, 217-219, 221-223, 226-228,230-232, 234-236, 239-240, 243, 246, 248,253,255-256,260,265267, 269-270, 272-283, 288291, 295-297, 299-300, 302303, 305, 311-326, 328-329, 331, 333, 340-341, 343, 352, 364-367,370,384,388,401408, 410-411
pathophysiology: 337 pattern: 3, 24, 28, 33-34, 36, 44,63,69,76,87, 104,113114, 117, 127, 131, 135, 137138, 141, 144-145, 151-152, 155, 157, 161-162, 165-167, 171, 179, 184, 186-187, 189, 195,223,239,265-271,275277, 279-280, 282, 285, 306, 318,320-322,325,341,392, 406-407,418 PC-1: 135, 137, 139, 153, 161, 164,266,274 PC-3: 64, 84, 89, 103, 169, 233,253 PC-4: 64, 213, 216-217, 234, 253,315
pain, penis: 149
PC-5: 89, 103, 169, 234
pain, scapular region: 150
PC-6: 82, 120, 159-161, 167, 171-175, 208,210, 217, 234, 236-240, 255, 266-271, 278, 291-293,301-305,308,405
pain, shoulder: 32, 146, 148, 184,190,208,217,219,223, 228, 270, 275-276, 280-281, 283,288-289,296,406 pain, thigh: 149, 193 pain, tibia: 149 palpation: 60, 89, 114, 127, 132-134, 136-137, 139-143, 145, 151, 181, 187, 195, 212, 274,283,311,314-317,400, 405
PC-7: 64, 84, 89, 92, 94, 101, 103, 164, 168-169, 171, 175, 208,210,217,233,240,253, 315 PC-8:89, 103,168,317,356 PC-9: 89, 94, 101, 103-104, 164,168,356,365
448
Index
pelvic inflammatory disease: 147-148
polarities of needle direction: 378
pulse diagnosis: 8, 13, 47, 131-133
pendants: 42, 159
polarity agents: 18-19, 31-33, 54-55, 60-63, 65, 91, 95-96, 102-104, 106-107, 112-113, 119,122,138,144,156,159161,183,325,366,404
pulse,ilTegular:213
periarthritis humeroscapularis: 231 pericarditis: 315 pericardium: 6-7, 56-57, 59, 64, 67-68, 70, 72, 75, 78, 8182, 84, 89, 92, 94, 101-102, 132, 1~135, 142, 146, 153, 164,180,184,187,226,233, 242,255,274,297,301,303, 319,321,356,365,396-397 perineural: 31 peripheral circulating blood: 338 peritonitis:214,312,316 pertussis: 213, 215, 313 phantom function: 21, 417 pharyngitis:214,240,317 phasal characteristics: 89, 92, 107,365,396 phasal correspondence: 97, 368,396 phase cycles: 91, 94 phase, phasal: 24, 28, 49, 67, 70, 87-94, 96-101, 103-104, 106-107, 111-112, 116, 119, 133, 141, 159, 166, 168, 180, 188,223,324,363-371,391399,403-404,408-409,419420
polarity tests: 83
pulses: 8-9, 13, 16, 28, 47, 71, 89, 93, 100, 102, 104, 124, 127, 131-133, 137, 140-141, 143, 145, 150-152, 156, 158, 162, 167, 178, 181, 190, 206, 213,265-267,272-273,275-
positive electrode: 102, 105, 132,164
278,280,282,2~306,314,
postpartum discharge: 317
pulsings: 134
pre-disease conditions: 332
pyelitis: 215
pressure pain: 7, 12, 31, 33, 37,44-46,55,59-64,67,7172, 74, 76, 79, 83, 91-93, 96100, 103-105, 107, 127, 132, 134-137, 141-145, 150, 152, 162, 166-167, 176, 178, 181, 187, 189-191, 193-195, 212, 219, 231-232, 234-236, 240, 253, 278-279,283, 297, 311326, 328, 352, 364-367, 370, 401-408,410
pyelonephritis: 316
370,372,391,400,405-407
Q
pressure perspiration reflex: 26,43
qi: 5-6, 10, 13, 19, 35-36, 41, 43,47,49,58,65456,69,8184, 86, 89, 96, 112, 116, 136, 143, 146, 149, 155, 160, 177, 185, 194, 218, 237-239, 244, 255, 314, 327, 349, 365, 375, 386,388-389,396,399-402, 411, 413-414, 416, 419-420, 423 qi counterflow: 255
Prigogine: 23,423
qi gong: 5, 75, 78, 97-98, 181,
primary channels: 49-50, 57, 61, 66,75 primitive signals: 83 problems that come when sitting from a lying position: 147
197,375,389,418,423
qi jing ba mai: 81, 86, 116 qi jing mai: 49 Qigong: 75, 78, 97-98, 181, 197,375,389,418,423 quadrantality: 26, 43, 85-86, 341
pi: 6-7, 142, 184, 187, 303, 355
problems that come when standing from a sitting position: 147
Pelvic Inflammatory Disease (P.I.D.): 147-148
problems, urination: 145, 316
radial pulse palpation: 89, 132,400
pigmentation: 128-131, 136, 203,290,345,405
propagating sensations: 5253
pimples: 130, 227
prostatitis: 230
radial pulses: 8, 127, 131132,137,141,145,150,156, 158, 167, 314
pleuritis:213,312
psychological counselling: 157
pheromone: 20-21
pneumonia:213,312,314 Po Di Gao: 203 point reactions: 127, 153, 166,318,322 polar agents: 163 polar channel pairs: 83, 102, 122, 158-159, 161-163, 166
psychological problems: 129, 136, 146, 194, 216 psychosomatic disorders: 332 pulling pain at the lateral edges of the chest: 149
R
range of motion: 150, 193, 198-202, 206, 212, 218, 227, 246,272,283,291,297,406 reflex point: 7, 35, 57, 59, 63, 67, 71-72, 75, 77, 79, 90-91, 93, 100, 105, 117, 141-143, 145, 165-166, 180-181, 187, 232, 266, 281-282, 288-289, 302, 319, 324, 365, 367, 401, 407
Index
reflex points, tender: 59 reflexology: 34-35, 90-91 regeneration:22,37,351,415 regulation and distribution of qi: 81
ren mai: 29, 49, 64, 71-72, 8182, 85, 137-139, 141, 145, 148, 159, 161-162, 171, 181-182, 187,193,212,242,255,259260,265-267,269,271,280281,285,287,290,295,302, 318,360 ren mai-du mai axis: 29 renal atrophy: 215 renal calculi: 316 renal disease: 230 renal tuberculosis: 177, 214 Requena:326 respiratory disorders: 243
Sawada: 8, 177, 205-206, 213217
sayoshi: 21, 37, 375-390, 417, 423 scarring moxibustion: 178, 203 scars:27,32, 196,203,206, 228, 296, 350, 353 schizophrenics: 71
rhinitis:206,216,220,232, 240,282,306,317 right-brain pattern recognition:3,36 rings: 159, 196 river-jing points: 104, 160 root treatment: 113, 115-118, 137, 143, 145, 148, 151, 153, 156, 158-159, 161-162, 165167, 176-177, 179-183, 193, 203,205-206,223,227,233, 244-245, 255-257, 265-283, 285-308, 367, 370
Ryodoraku: 52, 79, 117, 244, 411
SI-1: 89, 103, 168, 365-366
scleritis: 215
Sl-2: 67, 89, 103, 169, 180
scoliosis: 148, 196
SI-3: 11, 89, 94, 99, 101, 103, 159-161, 164-165, 167-168, 171-175, 180-181, 188, 213, 233, 237-238, 240, 268-269, 273,275,277,290,292,294, 296-298, 300-301, 307, 406
scrofula: 217, 349 self-massage: 155 semi conductor network: 31 serious conditions: 162
sexual organ: 149 shaking of the leg: 149
san jiao: 6-7, 142, 184, 221
SI-4: 63, 92, 169, 190, 240, 278 SI-5: 89, 103, 168 SI-6: 217 SI-7: 188
shallowly inserted needles: 254, 376, 405-407
SI-8: 89, 94, 100-103, 164-165, 167-169, 240, 273,292, 296298, 300-301, 307, 406
Shang Han Lun: 7,146 shao yang: 7, 56-57, 67-68, 70,
SI-9: 139, 188, 192, 239-240, 289, 296-297, 356
75-76, 148, 150, 180
shao yang-jue yin: 180 shao yin: 7, 57, 67-68, 70, 149-
SI-10: 85, 139, 192, 216-217, 283,297,301
150, 180-181, 370
Sl-11: 188-190, 192,208,212215,217,297,317
shen men: 219, 221, 286, 301,
SI-14: 188, 236, 256
303-305
shi si jing: 49-50, 57-58, 79 Shi Si Jing Fa Hui: 50, 57-58, 79
Shinjutsu: 16, 153, 389 Shinkenkyu: 15 Shinkyu: 15, 79, 146, 213, 236, 244,307,354-355,361,411, 420,423 Shinkyu Rinsho Iten: 146, 244
~
shoulder problems,: 146, 180,189,191,227,236,242, 254,256,271,405
sciatica: 146, 208, 216, 231, 238,273,299,316,407
sexual dysfunction: 257
rheumatoid arthritis: 147, 211, 216, 231, 317
shoulder pain: 32, 146, 148, 184,190,219,223,228,270, 276, 283, 288, 406
shoulder stiffness: 254, 256
restraining cycle: 88, 92, 98, 100, 111, 392, 398
rheumatic heart: 315
shoulder, inability to raise: 148
shu ha ri: 15, 244, 309
restore the balance of qi: 155
retinitis: 216
shou po li: 15
Schoffeniels: 23, 30, 37
severe pain: 205, 227,280, 290
restricted movements of the shoulder: 254
449
Shiroda: 8, 177-178, 205-206, 213-217
Sl-17: 233 Sl-18: 188, 217, 234-235, 356 SI-19: 188, 206, 216,233-234, 237, 240, 365-366 signal: 18-27, 30, 32-33, 3536, 43, 47, 49, 58-60, 65-66, 73, 83,88-89, 96, 102-104, 106-107, 111-114, 117-119, 121, 125, 136, 144, 156, 158, 198, 309, 323, 325, 363-367, 370-373, 375-376, 398, 408411, 413-414, 417-419, 421, 423
450
Index
signal system: 18-20, 22-27, 30, 32-33, 35-36, 43, 47, 49, 58-60, 65-66, 73, 88-89, 96, 102-104, 106-107, 111-114, 117-119, 121, 125, 136, 144, 156, 158, 309, 325, 371, 373, 411, 413-414, 418-419, 421, 423
SP-6: 64, 71, 84-85, 194, 208, 210, 214-216, 232, 234, 236240, 243, 253-254, 256-257, 296-298,317,342-343,357
sprains: 208, 231, 242-243, 254,256
SP-7:210,232,256,357
ST-1: 85, 233-234, 240, 358, 365
single channel problems: 136-137
SP-9: 89, 101, 103, 169, 211, 237, 239-240, 303, 357
ST-3:85, 188,234-235
sinusitis: 216
SP-10: 64, 71, 84, 142, 178, 194, 210, 216, 239-240, 243, 253-254, 257, 283, 315, 317, 342
ST-5: 85, 214, 217
six character method: 97 skin problems: 217, 253 skin temperature: 329 skin texture and color: 150
SP-8: 210, 239, 253, 256, 298, 303-305, 316
ST-4:85,233-235,238
ST-6: 188, 233-234, 237-238 ST-7: 188, 214, 217, 233-234, 237-238, 240, 358
SP-13: 85, 139
ST-8: 188, 234, 238, 358
SP-14: 214
ST-9: 85, 139, 142, 161, 188, 209,213-214,216,358
SP-15:85, 139,279
small intestine problem: 100, 135,189,278,306
SP-21: 135, 137, 139, 145, 161,164,167,303
209-210, 245-251, 256, 288294,307,324,326,389,407
ST-2: 85, 238
SP-11: 316,357
small intestine channel: 53, 57, 67, 69, 78, 99-100, 135, 140-141, 181, 184, 189-190, 192, 218, 225, 275-278, 280, 283, 298, 300-302, 306, 308, 366,370
sotai: 85, 158, 195, 197-203,
spring-ying points: 160
SP-16:85, 139,357 SP-20: 357
spasming of the muscles around ST-32: 149
ST-11: 83, 161, 188, 289, 318319 ST-12:85, 139,142,149,161, 188, 190, 318, 358 ST-14: 314 ST-16: 314
Soulie De Morant: 323, 326
spasming of the muscles of the third toe: 149
ST-17: 358
source points: 82, 90-93, 103, 165-166, 168, 188, 190, 364, 367
spasming of the sole of the foot: 149
ST-19: 214
source-luo points: 189
speech disorders: 146, 307
source-yuan points: 52, 63,
spider veins: 129
ST-21: 135, 164, 214, 216, 232,237,303-304,315
67-68, 72, 75, 92, 160, 324
spinal extension problems: 147
ST-23: 78
south magnet: 25, 31, 63, 113,382-383,385,388,403404
spinal flexion problems: 147, 201,291
SP-1: 89, 103, 168, 180, 357, 365
spine and neck problems: 146
SP-2: 89, 94, 101, 103, 145, 164, 166-168, 171, 274-276, 299,407
spinal problems: 146-147, 216
SP-3: 89-92, 103-104, 166, 168-169, 190, 237, 279 SP-4: 82, 120, 159-161, 167, 171-175,210, 236-237, 239240, 266-271, 278, 291-293, 301-305, 308, 405 SP-5: 89, 94, 98, 101, 103, 145, 164, 167-168, 240, 274276,299,370,407
spiritual turtle eight methods: 105 spleen channel: 84, 100, 128, 130,145,167,189-190,225, 259,274-276,311,357,370 spleen problem: 145, 265, 275,370 spontaneous bleeding: 129 sprained ankle: 243, 256
ST-18: 304-305
ST-20: 315
ST-24:214-216,317 ST-25: 63, 72, 74-75, 78, 134135, 137, 139, 145, 161, 164, 166-167, 171, 178, 194, 207, 210, 234, 236-237, 239, 253, 257, 266-267, 269-270, 274276, 279, 291, 294, 299, 301302, 305, 315-316, 318-319, 407 ST-26: 63, 78, 100-101, 135, 137, 139-140, 152, 161, 164165, 167, 171, 266, 268-269, 273, 277, 280, 285-286, 289, 291-292,294,296-298,300301, 305-306, 317, 366, 370, 406
Index
ST-27: 31, 62-63, 67, 75, 91, 100, 135, 137, 141, 152, 161, 164-165, 167, 171, 194, 210, 214-215, 256, 265-266, 272274,280-282,285,288-289, 291-295,297,300-302, 304, 316,318,370,405 ST-28: 236-237 ST-29: 236 ST-30: 83, 85, 139, 142, 193, 239,358 ST-31: 193,212,358 ST-32: 139,149,290,316,358 ST-33: 358 ST-34: 209-210, 214-216, 283, 297,317 ST-35: 240, 358 ST-36: 89-91, 98, 103, 107, 169, 177-178, 206-210, 212217, 234, 236-240, 253, 256, 290, 297-298, 316, 378 ST-37:214,234,237,255 ST-38:239,256,342,358
stiffness in the back of the neck: 148 stomach atony: 214 stomach cancer: 315 stomach channel: 50-51, 55, 62, 102, 128, 137, 153, 171, 189, 212, 226, 232, 274, 311, 358 stomach hyperacidity: 214 stomach problem: 134, 146147,153,194,210,253-254, 275, 303, 314 stomach ulcer: 194, 214, 304, 314,331 stomatitis: 214
symmetry: 22-23, 25-26, 28, 33, 43, 47, 81, 111, 113 symptom control treatment: 115, 118, 156, 177, 203, 205245,252 symptom patterns: 131, 145146, 153 symptoms in confirming diagnosis: 145
systematic correspondences: 391
stretching exercises: 256
systemic microcirculatory changes: 65
stroke: 216, 219, 241, 257, 349
T
Su Wen: 3, 5, 7, 9, 16, 56-57,
ST-44:89, 103,168,176,232233, 237-238
swelling of the anterior portions of the thigh: 149
stress: 59,136,205,232,253254,256-257,269,285,302304,306,324,326
ST-40: 189, 235-239, 303
ST-43:89, 100,103,169,180, 240
swelling and pain of the fifth toe and heel: 148
systematic and comprehensive treatment plan: 18
structural disorders: 116, 156,183,195-197,246
ST-42: 92, 168, 189-190
sweating problems: 146
stream-shu points: 160
ST-39: 210, 237-238, 255, 315 ST-41: 89, 94, 101, 103, 132, 152, 164, 167-168, 171, 181, 206,235,240,256,276,304
451
tachycardia: 315 tactile examination: 127, 131
343, 348, 391
Tae Woo Yoo: 35, 117, 180, 217,219,223,244,299,325
subcostal reactions: 102, 153, 167,181,268,277
tai ji moxa: 253
subcostal tension: 33, 93, 102, 132, 137, 162, 171, 181, 273, 280, 291-295, 297,299300
tai yang: 7, 56-57, 67-70, 7576, 146, 148, 150, 180-181, 221,370 tai yang disease: 146
subcutaneous tissues: 136
tai yin: 7, 56-57, 67-68, 70, 76,
summerheat: 5
ST-45: 89, 91, 94, 101-103, 107,164,168-169,301,365
Sun Si-Mo: 13
149-150, 180-181, 188-189, 370 taikyoku: 176, 206, 232
stagnant liver qi: 314
sunken appearance: 128
Takagi: 26, 43
Stengers: 423
superficial invasion of cold or external qi: 146
TB-1: 89, 103, 169, 365
supplementation: 7-8, 60-61, 63-64, 79, 94-98, 101-102, 104, 111, 132, 140, 145, 159160, 163, 166-168, 181, 276, 366,388
TB-3: 89, 94, 101, 103, 164, 167-168, 171, 175, 233, 274276,299,407
sterility: 152, 210, 215 sternocleidomastoid musdes: 143 stiffness: 148, 150, 184, 188, 191,193,228,246,254,256, 272,283,289-291,406-407 stiffness and difficulty moving the tongue: 150
surgery: 10, 27, 79, 136, 179, 228,268,270,279,281,302, 306-307,316,331,405
stiffness of the fourth toe: 148
sweat rash: 217
TB-2: 89, 103, 168, 289
TB-4: 63, 72, 92, 166, 168, 171, 175, 177, 207, 214-217, 240,279,357 TB-5: 11, 68, 82, 159-161, 171-175,188,206,209,233, 236-238, 240, 266-271, 279, 291-294,301,304-305,405
452
Index
TB-6: 89, 103, 166, 168, 239240 TB-7: 357 TB-8: 64, 84, 178, 188, 194, 206-208, 213, 232-233, 253, 256, 301, 357 TB-9: 192, 216-217 TB-10: 89, 94, 101, 103, 164, 167-169,240,275, 299,370, 407 TB-13: 85, 188 TB-14: 188, 192, 239-240 TB-15: 85,192,213,216-217, 288-289, 291 TB-16: 235, 357
tetany of the muscles in the pectoral and anterior neck: 148 tetany of the posterior gluteal muscles: 148 thoracic: 53, 221,240, 259, 272,313,316,406 throat infection: 213, 216 thrombophlebitis: 317 thumb: 13, 18, 25, 31, 55, 5960, 95-98, 119, 132, 144, 155, 251,254,266,282,352,378 tilted uterus: 215 tinnitus: 150,216,232,237, 259
tuberculosis: 7-8, 177, 213214,230,312,314,353
tuina: 197 tumors: 130,153,227,245 twelve branches: 169 twelve channels: 7, 36, 50, 67, 69, 74, 81-86, 88, 94, 103, 106, 111-112, 145, 159, 168, 180,234,259 two-metal contact: 31, 83, 119, 122-123 typhoid fever: 242
u ulcer of the oral cavity: 317
TB-17: 188, 213-214, 216-217, 233, 235, 237-238, 240
tiredness: 146,254
ulcers: 130, 217, 237, 338, 351
tones: 97, 391
Ulett: 326
TB-18: 235, 357
tonsillitis: 209, 216, 317
TB-19: 235, 357
tonus, poor: 128
unidirectionality of channel flow: 18
TB-20: 188,235,357
tooth extraction: 221
uniting-he points: 160
TB-21: 188,206,235,230357
toothache: 33, 57, 145, 194, 207,214,221,235,237,253, 255
Unschuld: 14-16, 373,398, 410
temperature differences: 134,341
topology: 18-19, 27-28, 4243, 79, 82, 84, 106, 307, 361, 411, 420, 423
upper limb problem: 220
temporal relationships: 69
trachoma: 215
uranaitei: 176, 209-210, 214, 253, 286-288
ten-day channel biorhythms: 103
tranquilizers: 136, 142
urethral calculi: 316
transporting-shu points: 8889, 92, 94, 111
urethritis:215,316,406
TB-22: 215, 217, 357 TB-23:235,240,357,365
ten-day stem method: 103105 tension: 28, 31, 33-34, 37, 59, 71-72, 74, 76, 84, 93, 96-97, 102,127,132,134,137,141144, 150, 152, 156-158, 162, 171, 176, 181, 183, 187, 189, 191, 193, 195, 197, 203, 205, 212,219,227,236,246,254256, 266, 273, 277, 279-280, 291-295, 297, 299-302, 304306, 323, 325-326, 384, 401, 405-407 tension and pressure pain: 33,37,59, 76,132,162,193 ten-stem: 169, 396 testicular pain: 149 tetany of the muscles anterior to the femoral bone: 148
trauma: 115, 129, 179, 206, 254,256,273,290,296,298, 323 traumatic injuries: 254, 256 trigeminal neuralgia: 10-11, 146,207,217,231,238 trigger points: 16, 219, 311, 323-324, 326, 411 trigrams: 105,363-364,366367,369,371 triple burner: 6, 56-57, 59, 63-64, 67-68, 70-72, 75, 78, 81-82, 84, 89, 92, 94, 97, 101102, 132, 134-135, 142, 145, 164, 166-167, 171, 180, 184, 187,191-193,225,242,274276, 299-300, 303, 319-320, 357,365,370,397,407
unusual sweating: 146
urinary incontinence: 239, 316 urinary retention: 230, 316 urticaria: 221, 232 uterine bleeding: 215, 231 uterine cancer: 317 uterine prolapse: 317
v vacuities: 7, 13,94,96,100101, 113, 128, 141-142, 152, 157, 162, 177, 194, 236-239, 252-253, 269, 271, 273, 282, 290,309,314,348,366,395, 400,402-404,408,410 vaginitis: 285, 287-288 vascular spiders: 128-130, 241-242
Index
yin-yang balancing: 197, 203
vasomotion: 333-338, 340 venesection: 129, 158, 203, 241-242,246 vertical relationships: 18, 73 vesical calculi: 316 viral infections: 148, 242 visible raised venules: 128 visual examination: 127-128, 131,143 Voll: 25, 32, 52, 79, 117, 326 vomiting blood: 150 vomiting milk: 212, 215
w wakakusa: 185 water phase: 87, 89, 92, 94, 101,365-366,392,395,420
xiang: 5, 195
yin-yang channels: 137
xie qi: 5
yin-yang theory: 18, 39-41, 81,328
xin bao: 6-7 xin zhu: 6-7 X-signal system: 17-38, 4344, 47, 49-50, 58-60, 65-66, 73, 88-89, 96, 102-104, 106107, 111-114, 117-119, 121, 125,136,144,156,158,309, 325,339,367,371-373,375, 388,398,400-401,411,413414,418-419,421,423
y Yamashita: 79, 354
yang ming: 7, 56-57, 67-68, 70, 149-150, 180-181, 188-189
yang ming-tai yin: 91, 180
weakness, extreme: 155, 275, 308
yang patient: 128
wei: 11, 13, 49, 57, 65-66, 68,
yang qiao mai: 11, 85, 146,
82, 84-85, 137-138, 141-142, 146, 152-153, 159, 161-162, 167,171,184,187,228,265271, 275, 277, 290, 295, 318, 325,414
159, 161, 228, 268-269, 295, 318
well-jing points: 160
yang wei-dai mai: 137-139,
whiplash: 146, 207, 228, 236, 244
167 Yasumasa:21,375,389,417
wide costal arch: 128
Yi ]ing: 105, 355, 363-374
Wilber: 423
yin qiao mai: 85, 145, 159, 161-162, 187, 193, 265-267, 269,271,290,295,318
wind: 5, 236-238, 240, 285 Wiseman: 15 wood phase: 87, 89, 92, 94, 97, 364, 366, 391-392, 395, 420 wooden hammer and needle: 72-73, 100, 104-105, 192193,195,202,211,242-243, 253-254, 256-258, 282, 372 work habits: 155
453
yang wei mai: 11, 57, 68, 85, 137, 146, 159, 161, 187, 228, 265-267,271,290,318
yin qiao mai-ren mai: 128, 137, 139, 141-142, 144, 152, 162, 223,265,283 yin wei mai: 57, 85, 137, 141, 146, 159, 161-162, 187, 265267,269-271,277,295,318
yin wei mai-chong mai: 128, 137, 139, 142, 153, 162, 167
Yin Yang Shi Yi Mai ]iu ]ing:
Worsley: 79
56,348
wounds: 253-254,256,349, 351
ying: 13, 49-50, 58, 65-66, 69, 82,89, 103,355,365,376, 414,420 ying qi: 69, 365, 414, 420
yin-yang triplets: 146-147 Yoshiaki: 25, 415
yu yao: 219, 240 yuan qi: 5
z zangfu: 6 Zhen ]iu Da Cheng: 11, 50, 58 Zhen ]iu ]u Ying: 50, 58, 355 zhenggu: 197 zi wu: 69 Zi Yun Gao: 203
Yoshio Manaka, MD with Kazuko Itaya and Stephen Birch
Y
oshio Manaka was a poet, artist, scholar, physician, and healer. He lived for and was inspired by ideas and invention. At the pinnacle of his life he reached a level of healing skill that only those who have invested many years of practice, research, and study can achieve. Yet he sought not accolades, but hopeless and puzzling medical cases. He was not content with fame but sought bright young idealists to challenge and inspire. His transformation of East Asian traditional medical theory into a rational scientific model established the foundation for a new explanation of acupuncture, the X-signal system. It explains and explores both traditional and modern theories without trivializing either. He based every aspect of his model on clinical tests, observations, and years of successful clinical practice, both his own and that of a network of skillful and dedicated healers. Chasing the Dragon's Tail assembles the elements of that model, beginning with a clear exploration of the observational evidence. It organizes and presents Manaka's experim~tal and clinical findings, explaining each of the many levels. The system of theoretical explanation and clinical practice he evolved is detailed step-by-step with illustrations and instructions. Manaka's system is proven and practical, and is based on tests and observations every practitioner may confirm for themselves. It is an invitation not only to a new and dynamic understanding of acupuncture but to new levels of clinical skill. Chasing the Dragon's Tail ISBN-13: 978-0-912111·32-2
