A Practical Guide to Acu-points Chris Jarmey and Ilaira Bouratinos
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Copyright © 2008 by Chris Jarmey and Ilaira Bouratinos. All rights reserved. No portion of this book, except for brief review, may be reproduced, stored in a retrieval system, or transmitted in any form or by any means – electronic, mechanical, photocopying, recording, or otherwise – without the written permission of the publisher. For information, contact Lotus Publishing or North Atlantic Books. First published in 2008 by Lotus Publishing 3. Chapel Street, Chichester, PO19 1BU and North Atlantic Books P O Box 12327 Berkeley, California 94712
Contents Introduction How to Use This Book
5 7
Chapter 1 Needling Considerations Precautions to be Taken Before Needling Needling Depth Needling Angles Needle Sizes Needle Quality Needling Contraindications Dangerous Areas for Needling Dangerous Points for Puncture Untoward Reactions and Accidents
11 11 11 12 12 12 12 13 13 14
Chapter 2 Manual Techniques Considerations Pressure Techniques Friction Techniques Stretching and Opening Techniques Other Manual Techniques Manual Techniques Contraindications
15 15 15 15 15 16
British Library Cataloguing in Publication Data A CIP record for this book is available from the British Library ISBN 978 0 9543188 4 0 (Lotus Publishing) ISBN 978 1 55643 696 3 (North Atlantic Books)
Chapter 3 Moxibustion Considerations General Cautions Points Contraindicated for Moxibustion First Aid for Burns
17 17 18 18
Library of Congress Cataloguing-in-Publication Data
Chapter 4 Cupping Considerations Functions of Cupping Guidelines and Precautions After Cupping Methods of Cupping
19 19 19 20 20
Chapter 5 Deqi The Importance of Deqi Specic Therapeutic Deqi
21 21 22
Illustrations John Tyropolis, Michael Evdemon and Ilaira Bouratinos Text Design Wendy Craig, Michael Evdemon and Ilaira Bouratinos Cover Design Jim Wilkie Printed and Bound in Singapore by Tien Wah Press Acknowledgements The authors would like to thank the teaching staff of the European Shiatsu School and the European Institute of Oriental Medicine, and also the following persons, without whose valuable input and support this project would not have been possible: Vassilis Basios, Emilios Bouratinos, Katia Boustani, Tew Bunnag, George Dellar, Julie Holland, Jonathan Hutchings, Christos Kondis, Christina Kouli, Giorgio Maioletti, Tim Mulvagh, Andrew Partt, Vita Revelli, and Peggy Zarrou. A Practical Guide to Acu-points is sponsored by the Society for the Study of Native Arts and Sciences, a nonprot educational corporation whose goals are to develop an educational and cross-cultural perspective linking various scientic, social, and artistic elds; to nurture a holistic view of arts, sciences, humanities, and healing; and to publish and distribute literature on the relationship of mind, body, and nature.
Jarmey, Chris. A practical guide to acu-points / by Chris Jarmey and Ilaira Bouratinos. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-1-55643-696-3 (pbk. : North Atlantic Books) ISBN-10: 1-55643-696-3 (pbk. : North Atlantic Books) ISBN-10: 0-9543188-4-6 (pbk. : Lotus Publishing) 1. Acupuncture points. I. Bouratinos, Ilaira. II. Title. [DNLM: 1. Acupuncture Points. 2. Acupressure. 3. Acupuncture Therapy. 4. Meridians. WB 369.5.M5 J37c 2006] RM184.5.J372 2006 615.8’92--dc22 2006031085
Chapter 6 Classification of Points The Top Most Commonly Used Points The Back-Shu and Front-Mu Points The Source-Yuan Points The Accumulation Cleft-Xi Points The Connecting-Luo Points The Four and Six Command Points The Eight Gathering Hui Points The Five Transporting Shu Points Five Phase Point Selection The Window of Heaven Points The Nine Points for Returning Yang The Thirteen Ghost Points The Twelve Heavenly Star Points The Points of the Four Seas The Eight Extraordin ary Vessels The Eight Opening and Coupled Points The Six Divisions The Chinese Clock
25 25 26 26 26 26 27 27 27 29 30 30 30 30 30 30 31 32 32
Chapter 7 Principles of Point Selection How to Choose Points Selecting Points According to Area (Local and Distal Points) Selecting Points According to Syndromes Selecting Points According to Diseases and Conditions from Empirical Knowledge and Clinical Practice
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Chapter 8 Cun Measurements General Guidelines Cun Measurements According to Body Area
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Chapter 9 Considerations, Cautions and Contraindications General Contraindications Considering Sensitive, Dangerous and Contraindicated Points
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G A L L B L A D D E R C H A N N E L
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A Practical Guide to Acu-points
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Chapter 10 Points of the Lung Channel
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Chapter 11 Points of the Large Intestine Channel
59
Chapter 12 Points of the Stomach Channel
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Chapter 13 Points of the Spleen Channel
115
Chapter 14 Points of the Heart Channel
135
Chapter 15 Points of the Small Intestine Channel
145
Chapter 16 Points of the Bladder Channel
159
Chapter 17 Points of the Kidney Channel
201
Chapter 18 Points of the Pericardium Channel
215
Chapter 19 Points of the Sanjiao (Triple Burner) Channel
225
Chapter 20 Points of the Gallbladder Channel
239
Chapter 21 Points of the Liver Channel
271
Chapter 22 Points of the Ren Mai (Conception Vessel) Channel
287
Chapter 23 Points of the Du Mai (Governing Vessel) Channel
303
Chapter 24 Extraordinary (Miscellaneous) Non-channel Points
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Resources Index of Points
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Introduction Stimulation of specic points on the body surface with the intention of obtaining particular/specic therapeutic effects has been used for thousands of years in many traditional healing systems. There are numerous ancient and modern techniques that have been applied to these points for the purpose of inuencing the functional capacity of the body to correct physical and energetic dysfunctions. The application of physical pressure (acupressure), the insertion of needles (acupuncture) and the use of suction cups, magnets, or special herbs and oils, are all traditional methods commonly employed in Eastern therapeutic systems. This text presents clinically useful, practical information for a wide range of specialists including acupuncturists, shiatsu practitioners, physiotherapists and massage therapists. It describes the common techniques that can be applied to the major acu-points, such as acupuncture, moxibustion, guasha, cupping, magnet therapy and manually applied techniques, as well as describing the different therapeutic effects that can be achieved via those treatment methods. The various techniques are clearly delineated in headed subsections. It is recommended that all the sections on the different modes of treatment are studied, even if the intention is to use some, but not all, of those methods. This will facilitate a deeper understanding of each point. For example, shiatsu practitioners, tuina practitioners and other bodywork therapists will improve their understanding of the different layers and depths associated with pressure by studying the needling section. Acupuncturists will greatly benet from using manual techniques, either in the clinic or as self-treatment recommendations for their patients. Most practitioners of Eastern healing systems will benet from the moxibustion, cupping, guasha and magnet therapy guidelines offered in the text. Furthermore, physiotherapists, nurses and many medical specialists will benet from the manual techniques section. Chris Jarmey and Ilaira Bouratinos, 2008
G A L L B L A D D E R C H A N N E L
How to Use This Book Introduction to the Text Format
Main Text Format
The text for each point begins with a clear title giving its name and number, followed by a calligraphic image of the Chinese ideogram. Below the title, the classication of the point is mentioned (where relevant). The main text outlines a comprehensive description of the location of the point.
Classification Classication terms are given in English, followed by the Chinese term. For example, Source- Yuan point. For more details, see Chapter 6. For points of the Five Phase categories, the Tonication, Sedation and Horary nature is mentioned in brackets.
The remaining text is presented in different sections, discussing the treatment and applications. They include the following:
Location description Classical Chinese locations have been used throughout the text. Where there are in effect two or more locations for a point, this is clearly described in the text. Variations of location according to other systems and the authors’ own experiences are also mentioned where relevant.
• Best treatment positions • Needling • Manual techniques and shiatsu • Moxibustion • Cupping • Guasha
Magnets
This section also mentions useful tips for locating the point. Every effort has been made to be as anatomically precise as possible and thus resolve the contradictions
A Practical Guide to Acu-points
How to Use This Book
Cautionary notes are marked with an exclamation mark [!]. Text marked with a double exclamation mark [!!] denotes potentially dangerous techniques and contraindications.
Magnets This section mentions basic usage of magnets and certain point combinations.
Needling This section details the main needling techniques, including the minimum and maximum depths, angles and directions for insertion.
Although there are many different points of view on the subject of magnet usage, it is important to understand that the mechanism via which they work is still not fully understood.
The text marked with an exclamation mark [!] cautions the acupuncturist to avoid the blood vessels, nerves and other sensitive structures found at the needling site. Furthermore, text marked with a double exclamation mark [!!] denotes dangerous techniques and contraindications. For more details, see Chapter 1.
Although there are differing opinions on which pole of the magnet is more tonifying or sedating, it is taken in this text that the North Pole is more tonifying and the South more dispersing, when in the Earth’s Northern Hemisphere (the opposite applies in the Southern Hemisphere). Throughout the text, it is taken that the treatment is applied in the Northern Hemisphere.
Manual techniques and shiatsu Most points can be treated by manual techniques, whether it is sustained or moving pressure, supercial or deep friction, oil massage or other useful physical manipulation methods such as stretching and mobilisation.
This section details the most effective ways to apply a choice of manual techniques to points where these methods are applicable. Variations and different techniques are discussed in relation to their therapeutic effect and the desired outcome. The text marked with an exclamation mark [!] mentions the relevant cautions, whereas a double exclamation mark [!!] indicates dangerous techniques and contraindications, accordingly. For more details, see Chapter 2. Moxibustion This section details the points indicated for moxibustion and those contraindicated. As a general rule, where there is no mention of it at all, moxibustion should not be used. The times, quantities and types of moxa mentioned are based mainly on Chinese recommendations. Where ‘indirect’ moxa is mentioned, both traditional moxa poles and other more modern methods of moxa application are intended for use. For more details, see Chapter 3. Cupping Cupping is mentioned only where applicable. Where it is not mentioned, it should not be used. For more details, see Chapter 4. Guasha The basic guasha method is mentioned where considered most useful and applicable. Where it is not mentioned, it should not generally be used.
Stimulation sensation This section discusses the most common manifestations of deqi acquired from stimulating the point. It details the quality, intensity, direction and areas the sensation should reach depending on the required therapeutic results. It also mentions other manifestations of deqi such as changes in the pulse, or breathing rate.
Although deqi is mostly relevant to the application of acupuncture and manual techniques such as massage and shiatsu, it may also apply to magnet therapy and moxibustion. This section is based on the major acupuncture texts as well as the authors’ experience. For more details, see Chapter 5. Actions and indications This section discusses the applications for each point. It requires that the reader have an understanding of Traditional Chinese Medicine (TCM) diagnosis and differentiationof syndromes.Themain actions(functions) are clearly presented and accompanied by the relevant indications (including signs, symptoms and diseases). The major functions are emphasised in italic text. They are based mainly, but not exclusively, on classical Chinese medical theory. Furthermore, there are numerous comments mentioning various interesting and important facts relating to the point.
At the end of the text for each point* there is a quick reference section (synopsis), clearly dened in a text box, highlighting the body areas, organs and functions that are deemed of most use in the clinic.
* Except for a small number of less commonly used points.
About the Illustrations Main Areas: Mentions the main body areas, tissues, organs, systems and Zangfu affected by the point. Main Functions: Mentions the main functions of the point to complement and re-emphasise the italicised functions in the actions and indications section.
The main functions listed in the synopsis text box are often the same as the major functions that are italicised in the section on actions and indications. This means that these repeated functions are of most clinical relevance. In some cases, the synopsis of functions differs from the italicised text. This means that those functions mentioned in the text box are the most clinically relevant. The reason for this is that the italicised functions in the main text are mostly major traditional Chinese functions. For example, regulating qi and Blood is a traditional function, whereas lowering blood pressure is not (see St-9). Therefore, the italicised functions in the main text and synopsis box must be compared. The reader must note, however, that because Eastern medicine is an ‘art’ rather than a precise ‘science’, there is immense variation in the actions of the points, both in terms of the different traditional schools of thought and the individual practitioner. Therefore, the synopsis of main functions and italicised text serves as a general guide only. Furthermore, the functions that are emphasised, have been chosen as those deemed most clinically applicable according to the authors’ own experience and understanding. In this sense, they can be altered or substituted by each practitioner, as he/she considers most appropriate. Every effort has been made to include the most accurate information from principal traditional and contemporary sources. For example, the synopsis for point Lu-9:
Main Areas: Chest. Lungs. Blood vessels. Main Functions: Tonies chest qi. Strengthens the breath and voice. Nourishes Lung yin. Transforms phlegm. Benets the vessels and improves circulation.
These illustrations aim to be as anatomically precise as possible and to show the relevant structures. The needle insertion site is illustrated with a dot. A broader area around this dot is illustrated with light blue shading. This area displays the site where manual techniques, moxibustion, guasha and cupping can be applied (where relevant). Most of the point illustrations have the shaded area, except where, for reasons of clarity, it was excluded. Also, where there is more than one illustration for any given point, the shaded area is not always repeated. These shaded areas may also illustrate other possible sites for needling, acupressure and other treatment methods. Possible reasons for treating outside the main point as illustrated with the dot include: • If
deqi cannot be achieved at the specied point, the practitioner must palpate this area carefully to ascertain a more reactive location to insert the needle or apply the pressure, magnet, moxibustion, etc.
•
If there is distortion of the main needling site (for example: swelling, skin eruptions, scar tissue, extreme tightness, distended blood vessels), then the practitioner must insert the needle at a different site.
Also, the shaded area may illustrate the area the needle shaft may reach at a deeper level, particularly when applying oblique or transverse needling. For example, the large shaded area between the middle and anterior bres of the deltoid muscle for the point LI-15 not only illustrates the manual techniques region, but also the area where the needle will be located when using the second needling method mentioned (i.e. needle up to 2 cun at a transverse angle distally, between the anterior and medial bres of the muscle). The reader may also notice that some of the dots illustrating a point appear to be slightly smaller (or larger) than others. This is because points do vary somewhat in size. For example, the Well-Jing points at the tips of the ngers are smaller than large eshy points such as Sp-6 or GB-30.
A Practical Guide to Acu-points
GB-25
Points of the Gallbladder Channel
Jingmen Capital Gate
Alarm Mu point of the Kidney On the lower back, at the free end of the twelfth rib. To aid location, it is usually tender on light palpation because it is a very sensitive location. Alternative location At the inferior border of the free end of the twelfth rib. Best treatment positions This location is best treated with the patient in a prone or side position. However, manual techniques can also be applied with the patient sitting up. Needling • 0.3 to 1 cun oblique or transverse insertion, medially along lower border of twelfth rib. • 0.3 to 0.5 cun perpendicular insertion.
!! Do not needle deeply. Do not puncture the peritoneum. Deep needling may puncture the colon, liver, spleen or kidney.
Manual techniques and shiatsu Gently applied sustained perpendicular pressure can be applied with the ngertips onto the tip of the twelfth rib, and directly below it.
GB-26
! Only apply very gentle pressure to the false ribs. This location is very sensitive and can be very painful if pressed carelessly.
Intersection of the Dai Mai and Gallbladder
Moxibustion Cones: 3–10. Pole: 10–30 minutes. Cupping Cupping with medium or light suction or empty cupping can be very benecial for kidney disorders and lumbar pain. Use a medium or large cup size. Guasha Gently applied guasha is applicable. Magnets Stick-on magnets are helpful for kidney disorders. Apply south pole to GB-25 and north to Bl-23 for lumbar pain and kidney disorders including colic and haematuria. Stimulation sensation Local ache, distension, tingling or numbness radiating across the lumbar area, possibly extending toward the groin or into the kidneys. Actions and indications Although GB-25 is not as commonly used as other Alarm-Mu points, it can be effective to tonify the Kidneys and strengthen the lumbar area, dispel dampness from the lower jiao and open the water passages as well as regulate the intestines. It also activates qi and Blood circulation and alleviates pain.
Indications include acute or chronic lumbar pain, renal colic, frequent urination, dysuria, haematuria, lumbar pain, cold lower back, hip pain, abdominal rumbling, diarrhoea, vomiting, intercostal neuralgia, hypochondrial or abdominal distension and pain. Spontaneous pain at this location on one or both sides may be a diagnostic indication of kidney disease.
Main Areas: Kidneys. Lumbar area. Flank. Main Functions: Benets the Kidneys. GB-25
Transforms dampness and heat. Regulates qi and blood. Alleviates pain.
Daimai Girdle Vessel
e n i l y r a l l i x a d i M
On the lateral aspect of the abdomen, level with the umbilicus, below the free end of the eleventh rib, approximately on the mid-axillary line. Best treatment positions This location is best treated with the patient in a supine or side-lying position. However, prone or sitting up may also be employed.
Umbilicus
Needling • 0.5 to 1 cun perpendicular insertion.
GB-26
!! Do not needle deeply. Do not puncture the peritoneum. Deep needling may puncture the colon, liver, spleen or kidney. Moxibustion Cones: 3–5. Pole: 10–20 minutes. Rice-grain moxa is also useful. Magnets Small stick-on magnets can be effective. For weight loss and harmonising or tonifying the abdomen, alternate north and south poles on points level with the umbilicus including GB-26, Sp-15, St-25, Ren-8, Bl-23 and Du-4. Manual techniques and shiatsu It is generally not so easy to stimulate this location by pressure and massage because of the soft nature of the underlying tissues. However, it can be effective to press both sides simultaneously (this is not so easy to achieve on overweight patients) or one side only in a side-lying position.
An effective shiatsu technique is to open this area by stretching the space between the pelvis and rib cage. This is achieved either in a side-lying position (grasp the iliac crest and stretch the pelvis down toward the feet, or apply crossed arm diagonal stretch with one palm resting on the pelvis and the other on the lower ribs), or, in a sitting position (side ex the torso toward the opposite side, while stabilising the pelvis). ! Only apply very light pressure to the oating ribs. Stimulation sensation Local distension, dull ache or tingling spreading across the abdomen and lower back, or down toward the hip on the side that is being treated.
Actions and indications GB-26 is an important point to activate qi and Blood circulation in the lower jiao and regulate the Dai Mai (Girdle Vessel), from which it takes its name.
It is useful to clear dampness and heat from the abdomen, harmonise the lower jiao and regulate menstruation. Indications include pain, distension, swelling or accidity of the abdomen, lumbus and girdle area, lower abdominal pain in women, irregular menstruation, amenorrhoea, chronic leucorrhoea, blood-stained discharge, hernia, diarrhoea and abdominal rumbling. Treatment at GB-26 is useful in weight loss programmes because it helps tonify the intestines and strengthen the abdominal wall , helping to lose inches around the waist. In such cases it is most effective to combine treatment with embedding needles or stick-on magnets. Furthermore, self-moxibustion, applied daily for a few minutes, is helpful to tonify the Kidneys and Spleen in such cases.
Main Areas: Abdomen. Sides. Lumbar area. Uterus. Girdle Vessel. Main Functions: Clears dampness and heat. Benets the lower jiao. Regulates menstruation.
