Course: Energetics Date: 11-6-07 Class #: Class 7: LI 5 through LI 20 LI 4 is used a LOT. LI 4 and LI 11 used heavily. Other points from here besides these are mostly used for local problems. Test next week! Will ask all pt categories! Fill in blanks write about diff pt categories. I.e., which is the Yuan source for, what is the window of sky, what is the ghost, etc. Know the category and it will be easier to recognize the indications. Many questions about LI 1-LI 11 re indications Wind invasion: LU 7 (wind invasion) and LI 4 (expel wind) LU 5 is the child point excess type LU problems. LI 4 notes: face and mouth command point. (Can be used to sub for anesthesia for dental and for general dental pain. Can use an ear tack here. Helps both during and after dental work.) Large Intestine 5 Category(s) Jing river Fire point of LI Location Puncture Indications 1. Clear heat along LI channel a. Along LI channel heat flaring up b. Clear yangming fire which transmits to the heart and spirit psycho emo problems. Often used for stop smoking. Best point located on line between LU 7 and LI 5. Palpate for tenderness. Best when combined with other not-smoking points such as those on the ear. Mostly we can help control side effects. Pt must be ready to stop smoking!!! 2. Cough and dyspnea, fever and chills, cold with cough, fever with no sweating. Not often used. Page 1 of 9
3. Diseases manifesting pt s voice mania with raving and propensity to laughter. Not often used. 4. Local problems, wrist pain with limited movement, paralysis, muscle atrophy. Helps a lot with local problems, regardless of injury or CTS. Pain opening jars, etc, can use this point. Any wrist pain, esp when along the Yangming channel (LI) of hand. Re paralysis after stroke for muscle atrophy. Note re carpal tunnel syndrome: LI channel rich in Qi and blood best to circulate Qi. You usually choose Peri channel and add LI points. Large Intestine 6 Category(s) Luo connecting point of the Large Intestine Channel (so good for LU + LI problems) Location Puncture Indications 1. Luo connecting point a. Treating disorders of their int-ext related channel or zangfu (own channel LI and paired channel LU) i. Lung meridian related problem 1. Acute edema, esp upper part of the body. And specifically edema on the face. This is generally a wind invasion problem. (Edema on legs = spleen and kidney) Symptoms: allergies, puffiness on the face like with mold and wind sensitivities. Also, acute nephritis with puffy face, scanty urination, etc. Don t treat via Kidney, but via Lung as a wind cold invasion all tech and herbs will be expel wind. ii. LI meridian 1. Shoulder, arm, finger problems, usually as an Ashi point. 2. Treat disorders in regions reached by the Luo connecting channel. Where Luo connecting channel passes thru. This is the only Luo that passes thru the ear, fyi, so can treat deafness, tinnitus, ear disorders. There are other better points for this, however: SJ 3, 21, 17; SI 19; GB 2; +LI 6. LU 9 + LI 6. Host/guest combination opens and regulates water passage, acute edema, upper part of body, no sweating, diff urination. While technically all points of LI from 5 up can treat local problems, not all of them are actually used for this. Page 2 of 9
Large Intestine 7 Category(s) Xi Cleft point Location Indications 1. Xi Cleft points of LI channel a. Acute disorders and pain affecting the LI channel. All Xi clefts are used for acute problems. Example: tooth problems such as toothache and puffy face, acute swelling and pain along the arms. b. Clear toxic heat and detox poisons (skin/face). Clove sores, carbuncle, furuncle, throat painful obstruction, heat and swelling of face. Mumps can express this way. Add herbs for best results! From staph infection for instance. c. Skin: carbuncle, furuncle, from toxic heat. Often from infection, might be pus deep d. Psycho-emo problems (manic, not depressive). Manic because related to heat and excess (depression related to deficiency). e. LI organ problems. Constipation, ab pain. Not good alone: add local pts, ab pts, pts on legs. f. Local problems. Large Intestine 8-10 Talk about these in a group as far as indications. Location: LI 8 about 4 cun below LI 11, LI 9 is about 3 cun below, LI 10 is about 2 cun below. These are similar in location to correspondent points on the Stomach channel. Compare below. LI LI 10 = Shou (hand) San Li LI 10 2 cun below the elbow LI 9 = 1 cun below LI 10 and 3 cun below elbow LI 8 = 1 cun below LI 9 and 4 cun below the elbow ST ST 36 = Zu (foot) San Li ST 36 is 3 cun below the knee ST 37 = 3 cun below ST 36 or 6 cun below knee Lower He-sea point of the Large Intestine ST 39 = 3 cun below ST 37 and 9 cun below the knee. Lower He-sea point of the Small Intestine However, points on the arms not so great for digestive problems. Clinically, don t use much, but in theory still, ZZ is emphasizing because of probably board exams. LI 8 Indications Page 3 of 9
1. SI problems Needs to be combined with local points an lower extrem points ST 39 and RN 4 Digestive ab distention, pain around umbilicus, indigestion Urinary probs. 2. Mostly as Ashi point for Arm. LI 9 LI 10 1. Large Intestine problems theoretically. Constipation, diarrhea, combine w/st 25 and ST 37. 2. Arm numbness, tennis elbow, etc. 1. Tonifies Qi and Blood defic s Combine it with ST 36. Increase white blood cells: LI 10 + ST 36. If too high is due to infections, but some ppl have low wbc count which = bld deficiency. Use this for chemo patients. Esp good to tonify Wei Qi, so can use for allergies. Can use before and during the season! Will not tonify the pathogens either. Hurray! 2. Move Qi and Blood Painful problems due to Qi and blood stagnation a. Local tennis elbow. Really helps. Ask your patient not to play tennis or whatever caused the problem during treatment as this will cause the problem all over again. Also, gradually increase exercise after treatment. Put needle in, add heat lamp treatment. Can use liquid moxa or spray herbs around painful area. Needle and heat are the most important part of this treatment. If you don t have a heat lamp, add moxa. You could have pt use a heating pad on their own also. b. Acute lumbar muscle injuries/strain. Not sciatica, not herniated disc, not spinal problems. Usually due to Qi stagnation. Can make a huge difference with a max of 3 treatments. Give pt exam, while lying on table, legs straight, move up. If they can move up 70 degrees, they prob don t have spinal problem. Do this treatment. If they have spinal problems, this won t help much. Combine this with Du 20 punctured forward, threaded to Du 21. MS 6 + 7. Put needle in LI 10, add scalp points. Critical step: Once needled, have patient start moving in light movement. Basically, have them do whatever it is that hurts (?) 5 to 10 minutes. Page 4 of 9
May add ashi pts and or follow with local massage, cupping. c. Digestive Problems d. Head sore throat, toothache, swelling. LI 11 Categories: He-Sea point of LI Earth point of LI Ghost Point Sun Simiao 1. One of foremost points to clear Heat and fire from yang ming channel and also from the whole body clear heat/fire. No matter what organ or channel. Includes deficient heat. Any heat diagnosis (i.e., insomnia, dream disturbed sleeping, heavy menstruation due to heat, etc.) a. Heat: rapid pulse, red tongue b. Shen: psycho-emo probs, mostly of manic type w/irrit, insomnia, hyperactive. Also considered Ghost Pt. Not used for depressive symptoms. c. Hypertension Esp related to heat flaring up and raising BP. d. Mastitis. This is an infection and has heat signs. 2. He-Sea point a. Counterflow of Qi/diarrhea plus nausea, vomiting, etc. Comparatively, however, lower he-seas work far better for this purpose. b. Diseases of the skin with heat/fire. Any kind of skin disease with redness visible. Toxic heat and infections (bacterial, viral) as well, but not exclusively. c. Mother point of the LI channel (earth point). Affects flow of qi and blood in the upper limb: LI channel shoulder pain, face/head problems. 3. Local problems. esp elbow pain, most important is tennis elbow. LI 12 20 Group Primarily for local problems. Easier now! Nausea, maybe vomitting, some chills w/o fever or much fever. Tongue normal, pink w/red tip, thin yellow coating. Pulse: slippery, rapid. Symptoms = upper back pain. DX: wind, damp, heat. Points: ST 36. For fu organs: front mu point = Ren 12. For expel wind: LI 4, LU 7. Clr heat: LI 11. (and I d add LI 10 I think) Page 5 of 9
LI 13-18 all can be used for goiter/scrofula. LI 12 Indication: Local problems. Elbow pain. Use it as an Ashi point OK, technically, lift Yang Qi. But not often used. LI 13 local problems, Ashi. Could be used for SOB, but not often used. Scofula/goiter LI 13-18-- older application. Lymph swelling on neck, armpit. LI 14 Local problems. Shoulder pain, arm pain. Pts with shoulder joint pain will often be sensitive at LI 14. Palpate around LI 14 if complains of this. Some ppl use this for eye problems, vision related headaches. (This is the pt at the deltoid muscle Deadman pg 115.) ZZ says not really good for this. LI 15 Categories: Meeting point of LI channel and Yang Motility vessel. Very good for shoulder pain. Used as Ashi. Any kind of shoulder pain, whether deficient or excess. LI 16 Use in conjuction with SJ 14 which is in the depression posterior to this at the top of the shoulder. Know how to find this point without raising the shoulder. Many people come in for shoulder pain! Pt relaxes arms, you find the point. For needling: often oblique needle toward the elbow. Better qi sensation, deeper. Important: pt cannot move!!! Much pain as the needle bends! Sometimes with shoulder pain can increase calcium and decrease shoulder pain. Can also use for scrofula/goiter W/H skin problems such as hives, esp on upper part of body. Not often, however. LI 11 is a better choice. Caution: risk of Lung damage (pneumothorax) with deep medial insertion, esp in thin patients. If you do cupping, deep bruises here. Page 6 of 9
Categories: Meeting point of the LI and Yang Motility vessel. Local problems. Neck: scrofula and goiter Epilepsy, convulsions LI 17 Not on test: Deeper puncture can get carotid artery or vein. But may be on boards. Local problems. More often used with body work than with puncture. Can combine with heat lamp, cupping. In China, often in pediatrics use acupressure, tuina at this point. Throat pain indication, but there are better points in the throat Ren 22-23 as well as distal points. Scrofula, goiter. Hiccups use acupressure during attack. Actually, it s the pain that knocks these out! BL 2 is better result. LI 18 Category: Window of Sky point. Same as 17. Local problems (throat pain, scofula/goiter/thyroid, hiccups). Acupuncture anesthesia for thyroid/chest surgery. Any problems on the meridian pathway - arms. Window of the Sky point for psychoemotional problems: manic depression, hard to calm down. Safer ones like LU 3 would be more suitable. LI 19 Contraindicated with moxa! Why? Because TCM tradition = scarring moxa. Not so great on the face! Local problems: Nose congestion, sores, allergies, small polyps. LI 20 is better indication. You will probably use this point a lot in Austin, allergy cap of world. Mouth bells palsy, facial paralysis, twitching. ST 4 better. More distal points better indications. More proximal points are more local problems. LI 20 Contraindicated with moxa! Category: Meeting point of LI and ST channel. Page 7 of 9
Local problems: Nose: nasal congestion, sores, allergies, profuse dschg., sores in the nose, small nasal polyps. If pt comes to see you for sinus problems with no nasal congestion, don t use this point. Choose others like ST 3 for sinus headache, pain. Mouth: Bell s Palsy patients. Puncture on the flat side with no nasal groove, affected side. Can use with parasites too. Really not great results, however. Needling: Threading between LI 20 and Bitong extrapoint. Single needle inserted at LI 20, insert into Bitong. Often inserted perpendicularly, then angle toward the extra point Bitong toward the root of the nose. (p 568) Needle quickly touches the bone, which is fine even if pt jumps and head goes back a little. Can manipulate a little for stimulation. Nose will clear for about 15 minutes, then clog again. Retain the needle, manipulate again. Use the red Seirin needles for new patients who haven t had acu here. Use regular needle for those who want more stim. Prescribe herbs: Bi Yan Pian or Pi Men Kan Wan. Some of the ingreds have liver tox side fx don t use long term or overdose. Take as needed, only when have symptoms. Used for profuse nasal dschg, sinus infx. Note: acu anesthesia is not like drugs. Stills the pain, but you can still feel the pulling sensations. Most patients still choose drugs for anesthesia. Acu during surgery can help reduce the dosage of the drugs. Allergies to drugs, can t get sedated for whatever reason (like ht attack risk), etc. Notes for next quiz: Point cat s: know categories for all points. Five element theory/pts: know how to choose the 5 element points Know 5 elements related to the points what s an earth point, etc. Will give us the number, not the element. Know mother points, horary, child, etc. Know 5 element each point indications. Ex: jing well is good for what? Etc. Know from LU channel to LI channel, each point indications, categories pts belong to. Pathway of meridians primary channel, not other parts. Know only general info for other channels i.e., divergent is connected with what organ, muscular regions start where. Luo connecting where does it go (thumb/palm, tooth/ear)? Page 8 of 9
From first quiz: stuff she said would always be on it, what do yuan source points do, what the categories do. Horary: LU and LI memorize those numbers!!! She will give us a chart, we ll fill in what the horaries, mothers, child points. Which number is what element. Jing on yin start wood Jing on yang start on metal go from there. Page 9 of 9