FUNDAMENTAL TREATMENT

Transcription

1 CHAPTER 5 FUNDAMENTAL TREATMENT In this chapter we finally reach the heart of the treatment process. In the treatment procedure from here onward, we must especially keep in mind vacuity of the jīng qì. We must pay close attention to complaints directly caused by jīng qì vacuity and closely observe the changes in response to treatment by supplementation of jīng qì. Always keep in mind the continuity of these treatment procedures and how they build on previous procedures. CONTACT NEEDLING Contact needling is the first step of the fundamental treatment method. The posture for contact needling depends on correct positioning of the hand. The oshide (pushing hand) refers to the ring formed by joining the pads of the thumb and forefinger at the treatment point. For a right-handed person, the left hand is the oshide. The oshide locates the point, guides the needle and securely holds it as the needling hand makes the insertion. Since no guide tube is used in shakujyū therapy, the oshide technique is important. It should not be too tight a grip, but not too relaxed. The grip should have enough tone to be sensitive to subtle energy and to reactions of the skin, yet firm enough to guide and hold the needle securely. Clenching and unnecessary tension in either hand is counterproductive to a gentle and effective stimulus.

2 104 Acupuncture Core Therapy 5.1: The Oshide Hand In contact needling, rather than locating a single point and inserting the needle, the oshide is moved from point to point on the surface of the abdomen or back. There are a number of necessary hand position techniques, sequenced as follows: 1. Bring the needle from above to direct contact with the skin at an angle of about degrees at the space where the thumb and forefinger of the oshide hand form a triangle with the surface of the skin. 2. Briefly place the needle where the thumb and forefinger have formed a triangular space with the skin surface. The point is opened by slightly stretching the skin. The needle is immediately and briefly placed. When well practiced, the technique gives the impression that the needle and the oshide arrive at the point simultaneously, with a space of about 1 cm. between the tips of the thumb and forefinger. The oshide applies tension to the skin surface. Stretching the skin opens the point. If the right amount of tension is applied, the patient will feel no pain. If more force than necessary is applied by the oshide, it will cause discomfort. The base of the thumb and forefinger of the oshide hand are slightly apart, to open the area around the point, but they are in contact at the upper angle of the triangle. Figure 5-2 shows the relationship of the thumb and forefinger in the oshide. The thumb and forefinger form a space the shape of a triangle with the skin as the triangle base. At the same time, the other three fingers are in contact with the skin, but naturally spread out to place the little finger at a distance from the thumb. During initial practice, this may seem difficult. As you acquire skill the correct contact needling technique will become easier. Ultimately it will be possible to enhance the technique further with directed consciousness.

3 Chapter 5: Fundamental Treatment 105 Figure 5-2: Placement and Application of the Thumb and Forefinger in the Oshide 3. Contact the skin with the ring finger and little finger of the needling hand to stabilize the oshide. Sometimes the middle finger and ring finger touch the skin surface, but depending on the location of the acupoint, the thumb and little finger are apart from each other. Figure 5-3: The Oshide in Contact Needling 4. Arrive at each acupoint with both hands simultaneously. When the point of the needle is in contact with the skin, the needling hand pushes against the skin surface to some degree and applies slight pressure. Since the needle is flexible the needle body will bend as it is pushed against the skin surface. When the force on the needle is relieved it will spring back into shape. The amount of force and the degree to which it causes the needle to bend is very important in contact needling. If the needle is applied without sufficient force to bend, the

4 106 Acupuncture Core Therapy patient s qì can get trapped, with a negative effect. If the needle should penetrate the skin during this point of contact, do not be concerned, but have no mistake about the meaning of contact needling. The needle should only make contact at the treatment point and not slide over the skin. Figure 5-4: Hand Position in Contact Needling 5. After making contact draw the needle away from the skin and immediately close the point with the forefinger of the oshide hand. Closing the point is a supplementation technique in acupuncture. Because this procedure is done as successive movements, the timing is essential, and the needling hand is not removed completely until the point is closed with the oshide hand. Figure 5-5: Closing the Treatment Point When first practicing this technique, begin with one point. Gradually expand the range to two points, three points, and onward. As you develop skill, the patient will feel hardly any sensation. They will have the impression that the finger alone is moving along the skin.

5 Chapter 5: Fundamental Treatment 107 Remember not to bend the needle out of shape such that there is a crease or such that it remains bent and does not return to a straight configuration. Do not prick the oshide fingers; do not hold the needle shaft with the needling finger and do not use a needle that is too thick or too hard. CONTACT NEEDLING PROCEDURE Contact needling is mostly performed on the abdomen and back, from superior to inferior in a zigzag fashion without regard for point names or channels. Figure 5-6: Contact Needling the Abdominal Area In the first step of the treatment, the abdomen is needled. In the second step of treatment, the patient turns over and the back is treated. Sometimes the lateral head area is also treated with this technique. It is not necessary to focus your awareness on specific points or channels; it is preferable to proceed at random. It is important to think in terms of planes rather than lines on the surface of the skin as represented by the channels. The interval between the points treated, the speed of movement from point to point and the range of points treated, and the number of repetitions from superior to inferior, all depend on the patient s condition. The interval of space between points should not be too narrow but it is not something that is measured. There is a tendency for the interval to widen as the practitioner s consciousness and technical skill increase. The range of influence of a needle contacting a point varies as much as 1 cm, 5 cm, or 10 cm in diameter. However, even when the range of influence is small, contact needling at the outer borders of the abdominal region in any direction is not necessary.

6 108 Acupuncture Core Therapy Figure 5-7: Narrow Range of Influence of Contact Needling For contact needling to be effective, you must project consciousness while applying the needle. There is no specific rhythm for moving the needle along, but when the needle is in contact with the skin it should be placed there briefly and your consciousness should be projected as if a long needle were shooting through the skin to the other side. When you are accustomed to treating this way, it is important to widen the range of consciousness projected in all directions from the treatment point through the body with a ripple-like effect. Figure 5-8: Wide Range of Influence of Contact Needling The duration of contact needling depends on changes in the indications. Among these, perspiration is particularly important. A slight moistening of the skin occurs as a parasympathetic response to needling and is a sign that the jīng qì vacuity is being supplemented. When you observe the appearance of moistening or perspiration, drainage methods should not be used. We can verify this supplementing effect when we observe phenomena such as the disappearance of pain around the knee or another area simultaneous with the appearance of perspiration. Always keep a small towel or cloth at hand to wipe the patient s skin in the treatment area, should it be necessary. Depending on the patient s condition, discontinue contact needling when the force of the perspiration settles down or when you notice any other significant change in indications or reference points.

7 Chapter 5: Fundamental Treatment 109 Be sure to distinguish contact needling from sanshin, a touchingneedle technique used for drainage rather than supplementation. In the sanshin technique, the practitioner directly holds the needle while moving across the skin, but does not use the oshide hand. THE EFFICACY OF CONTACT NEEDLING The efficacy of contact needling relates to the practitioner s skill of application and power of consciousness projection. If you are strong, the effect will be great. In contact needling, contact of the needle to the skin is important, but with patients with low sensitivity the needle may sometimes slightly penetrate the skin. On older patients with looser skin the needle tip may even penetrate fairly deeply. With regard to the rate of movement from point to point, a needle moved too quickly tends to create a shallow stimulation. Further, undue haste may cause the qì at the skin surface to become congested, giving the patient a mild fever with discomfort. The body may even become chilled and tinged with fever. In short, since the yīn qì of the body is always a matter of concern, we must strive to execute the technique such that the needling hand seems to stop for a moment at each point. It is also important to maintain the sense that you are supplementing the jīng qì vacuity and extending your consciousness along the line of the needle body. As you proceed from superior to inferior, if no special circumstances are noted and the indications and responses are as anticipated, working two or three times over the abdomen (or the back) is usually sufficient. In special circumstances, such as an abdomen with no power, a cold body, a heat condition, or a sensitive patient, proceed gently and slowly, starting with a single pass and gradually increasing to two or three on subsequent visits. There are situations when contact needling should not be used, for example in emergency circumstances such as subsequent to an injury, or whenever a patient cannot freely stretch out. THE SIGNIFICANCE OF CONTACT NEEDLING Why do we use contact needling? We use contact needling as the first step of Acupuncture Core Therapy because it effectively moves the most superficial layer of qì. Yet it not only moves the most superficial layer of qì; with projection of consciousness it also influences deep levels of yīn qì. The movement of the most superficial layer of qì affects the qì of the entire body and should be constantly in our awareness. Contact needling changes the condition of the abdominal and dorsal regions, and as well the pulse and many other indications.

8 110 Acupuncture Core Therapy We can say that this movement of superficial qì is a yáng phenomenon and that it corresponds to the concept of jyū in the abdomen. When jyū in the abdomen are eliminated, the result is not just a change in the abdomen but a change in the entire body. Even though contact needling is the first step of treatment in Acupuncture Core Therapy, it is also a treatment method in its own right. We can expect significant changes in qì movement with contact needling. A typical example is using contact needling to treat children, called shōnibari or shōnishin. Usually a teishin needle is used, and this alone can considerably improve the condition. THE PRESSURE TECHNIQUE OF NEEDLE INSERTION Needle insertion using the pressure technique does not require a needle guide tube, nor is the needle twisted when inserted to allow penetration of the skin. By pushing the needle using only intermittent downward pressure, the needle enters the skin only if the skin opens up to receive it. Manipulating the needle using the pressure technique allows you to evaluate the condition of the skin and the qì at the acupoint. Thus the needle can be used not only as a therapeutic instrument but also as an evaluation tool. Furthermore, since the same needle is used at each point, the entire treatment can be carried out with only a single needle. Needles that are too flexible or too rigid will not help in this process. A 40mm. No.3 silver needle, the needle that has been developed for use in Acupuncture Core Therapy, has a slightly rounded tip so that the needle will not penetrate unless the receptivity of the skin allows it. Silver is useful for feeling the condition of the skin through the needle. It is also a better conductor of electricity and heat than gold or steel. Thus, it is the best material for accelerating the circulation of qì. With the aim of achieving an optimally painless insertion, most practitioners use stainless steel needles having a sharp tip. However, in the Acupuncture Core Therapy model, a sharper needle is not necessarily a more effective treatment if it penetrates the skin when insertion is not desirable, and doing so does not always give good results. The needle is not inserted when the skin resists. Furthermore, the needle need not be inserted in order to obtain an effect teishin, for example, is exclusively used at the skin surface. The skin and body tissue determine the appropriate depth of insertion through their readiness to receive the external influence. Using the pressure technique allows for painless insertion, and painless needling sensations that may follow insertion.

9 Chapter 5: Fundamental Treatment 111 A good practice point is BL-40, at the back of the knee. This is an area where there is little muscle tissue and low reactivity. As a beginner, if you can insert a 40mm needle in 30 seconds it is a milestone of progress. When your technique is more developed, insertion to a back point can be performed in around 15 seconds. When first applying the needle to the skin, hold the needle halfway up the handle and angle the needle in the direction of the insertion. Figure 5-9: Pressure Technique Position for Holding the Needle Slide the thumb of the oshide hand down the needle shaft against the forefinger. With the sashide needling hand, slide the thumb and forefinger down the handle toward the body of the needle. Figure 5-10: Applying the Needle to the Skin At first, refrain from causing the needle to bend. Gradually apply enough pressure to make use of the needle shaft s flexibility to exert force on the point. Repeat this process several times to see if the needle will enter the skin and if so, to what depth. When the needle enters the skin, more force can be added to effect the insertion of the needle. Once the needle enters the skin, pull back and continue to use an up-and-down motion rather than simply pushing the needle further in a linear fashion. Try to cause the patient as little pain as possible. Sensations of pain can mean a technique that is too forceful or a speed of insertion that is too rapid.

10 112 Acupuncture Core Therapy MORE ON POINT SELECTION In Acupuncture Core Therapy, the treatment rule is to first treat one point. Then, after observing changes, choose the second point. Apart from the governing vessel and the conception vessel, all channels are symmetrical, having a left and right side. When you select LU-9 (tài yuān), for example, there are two choices, the left and the right. The problem is which side you should choose, or if you should choose both sides. The criteria for this decision come from the reference points and zones. Naturally you customize treatment for each person based on the indications from these points and zones. If you are treating a hand point, you should find a reference point or indication in the forearm. If you are treating a leg point, you should find a reference point or indication in the leg. Points LU-6 (kǒng zuì) and PC-6 (nèi guān) and the brachioradial muscle can be found on the forearm. SP-6 (sān yīn jiāo), SP-9 (yīn líng quán), and the medial epicondyle of the femur just superior to LR-8 (qū quán) can be found on the leg. Compare hardness, pain, and reactivity between the left and right. The side where the pain or hardness is conspicuous is the afflicted side. Where it is less apparent is the healthy side. Select and treat the point on the healthy side and, while checking the afflicted side for change, determine the degree and duration of stimulation. The changes in the reference points and the pulse are in alignment. When you achieve a feel for it, it is possible to complete the treatment based on changes in the reference points alone without even checking the pulse. It is also possible to evaluate the changes in reference points or indications through pulse evaluation. With these findings you can measure the stimulation level and determine how long to stimulate with the needle, how deeply the needle should be allowed to penetrate, and which point should be used. The stimulation lasts until the afflicted side reference point improves, and the depth of insertion is determined by how the skin responds to the needle at the treatment point. Changes in the reference points also determine how many points are used. Remember, it is not necessary to insert a needle for it to be effective. The use of the teishin is an adequate level of stimulation in many cases. When applying the needle, do not forget to direct your consciousness toward the reference point. When using a teishin, this is even more important. Direct your consciousness from the point along the course of the channel towards the same point on the opposite side. Directing consciousness is something each individual can put into practice and perform according to their own capacity. Once you have developed greater proficiency, you can direct consciousness in an instant.

11 Chapter 5: Fundamental Treatment 113 MONITORING CHANGES IN THE PULSE Since the pulse is more or less at the pulsating point of the lung channel, LU-9 (tài yuān) is thought to exert a particularly strong influence on the channels and network vessels. Since the channels and network vessels extend throughout the entire organism, treating the reference points and thereby adjusting the pulse has an influence throughout the entire system. You can evaluate whether this influence is sufficient by observing the degree of change at the reference points. If there are only symptoms of a slight deviation of qì, you may be able to complete treatment simply by treating the reference points. In such cases, you can understand the degree to which the pulse influences the whole body. However, the most important reference points are the locations of shaku and jyū in the abdomen. As previously mentioned, pulse adjustment achieved by treating the reference points can also influence abdominal shaku and jyū. In Acupuncture Core Therapy, abdominal symptoms that clear with this method are considered tentative jyū. Depending on the power of the practitioner s qì, the reading of the abdomen and condition of the entire body may change following contact needling or adjusting the pulse. Shaku and jyū are primal abdominal symptoms and are intermixed and to some degree overlap, hence you cannot decide in advance if an abdominal sign is absolutely a shaku or a jyū. TREATMENT OF THE DORSAL REGION Treatment of the dorsal region involves treatment of the back shū points. The back shū points are divided into zones according to the five phase dorsal lateral zones. Treatment procedure follows five basic steps. Figure 5.11: The Five Phase Dorsal Lateral Zones

12 114 Acupuncture Core Therapy (1) CONFIRMING A REFERENCE POINT OR POINTS FOR THE BACK This means checking the back on both the left and right sides for an imbalance of qì. The first place to check is BL-52 (zhì shì). Subsequently, check locations in the lumbar and pelvic area, such as the attachments of the gluteus maximus and gluteus minimus, the margins of the posterior superior iliac spine, the sacroiliac joint, and the sacrum. Then check the posterior neck and shoulder areas including both sides of the neck, the suboccipital area, the posterior margin of the mandible, the posterior surface of the shoulder joint, and the superior and lateral margins of the scapula. With the patient still lying prone, identify reference points by checking for reactive points in the popliteal fossa, BL-39 (wěi yáng), and BL-40 (wěi zhōng), or points on the medial and lateral sides of the knee. Among these BL-52 is the most important. Check for spontaneous pain, pressure pain, or hardness, in that order of importance. The side with the stronger reaction is the afflicted side. The other side is the healthy one, and where treatment is performed. For treatment purposes, spontaneous pain is the preferred indication. Tenderness is the indication next in priority. For example, if left BL-52 is more tender than right BL-52, then the left side is the afflicted side and the right side is the healthy side where treatment should be performed. If right BL-52 has only hardness and the left BL-52 shows nothing, the right side of the back is the afflicted side and the left side is the healthy side. If there is no reaction at all at BL-52, look for reactions at BL-39, at the hip, or at the sacrum. If there is no reaction in the lumbosacral region, check the upper back. This is how we use the rule of establishing the afflicted side and treating the healthy side. The strategy is to commence treatment from the healthy side and, if necessary, move to the afflicted side. If the responses of the reference points of the left and right sides are equal in magnitude, or if there are no reference point responses at all, choose either side for treatment. If responses appear at BL-52 or if any other reference point becomes apparent during treatment, select the next treatment point on the healthy side. (2) PERFORMING CONTACT NEEDLING ON THE BACK Performing contact needling on the back brings about the same bodily changes as described in the prior section on the abdomen. There should be subtle changes in the pain and tightness at BL-52, in the degree of tenderness between the vertebrae, in the reactions at BL-39 and BL-40, and in skin luster, skin moisture, and itching. All the reference points must be rechecked after contact needling. At points where the reaction was particularly painful, check the degree of change.

13 Chapter 5: Fundamental Treatment 115 Contact needling on the back is performed just as on the abdomen. Begin from the superior area and place the needle at appropriate intervals from side to side in a zig-zag pattern in the superior to inferior direction. Do not simply stroke the surface with the needle, but project consciousness through it downwards in the direction of the abdomen and hold the awareness that the needle is extending toward the skin of the abdomen. If possible, it is beneficial to project the focus of consciousness from the head downward to the feet. Watch the patient for signs of skin moisture or perspiration during this process. Wipe with a towel if perspiration is observed. Generally the procedure goes from top to bottom two or three times. Figure 5-12: Direction of Contact Needling on the Back When you reach the lowest point needled on the back, leave the oshide hand stationary and bring the needling hand up to contact the upper back. Then lift the oshide hand upward into position with the needling hand to give the patient an impression of continuity. If there is abundant perspiration, you should slow down the rate of contact needling. (3) CONFIRMING A TREATMENT PROTOCOL The selection of the treatment zones depends foremost on the abdominal evaluation. For example, if there is a heart shaku and a consequent evaluation of heart vacuity, points in the zones for wood, fire, metal, and water are selected for treatment. The relationships for each of the phases are as follows: Heart vacuity: Wood Fire Metal Water (Earth) Spleen vacuity: Fire Earth Water Wood (Metal) Kidney vacuity: Metal Water Fire Earth (Wood) Lung vacuity: Earth Metal Wood Fire (Water) Liver vacuity: Water Wood Earth Metal (Fire)

14 116 Acupuncture Core Therapy The selection of these zones and their sequence correspond to a yīn vacuity condition. This pattern is the fundamental treatment pattern. This pattern is the standard for selecting the zones on the back. Four zones are chosen for a single abdominal pattern. The one in parentheses is supplemental and seldom used. However, with five zones on the back, the number of possible sequence combinations that can be expressed mathematically is 120 (a factor of five). With the above sequence as one, the number of combinations becomes 24 groups (120/5=24). Presently we use four combinations that can be expressed as follows. We will call the four zones A, B, C, and D and we will express the fundamental pattern for the yīn vacuity condition as A B C D. We will call this sequence the Standard Sequence. The sequences of treatment protocols gleaned from experience are as follows: Standard Sequence: A B C D Sequence Two: C D A B Sequence Three: B A D C Reverse Sequence: D C B A Figure 5-13: Heart Vacuity Standard Sequence: Wood Fire Metal Water Figure 5-14: Heart Vacuity Sequence Two: Metal Water Wood Fire