CMAC111 Acupuncture Channel Theory Session 9 Four Examination Methods in Channel Diagnosis Channels & Collaterals of the Kidney Chinese Medicine Department All channel diagrams used with permission. Deadman, P., Al-Khafaji, M., & Baker, K. (2007). A manual of acupuncture (2nd ed.). Hove, East Sussex: Journal of Chinese Medicine Publications. Endeavour College of Natural Health endeavour.edu.au 1
Four Examinations o Inspection o Listening & Smelling o Enquiry o Palpation Qiao (2008, p.3) Endeavour College of Natural Health endeavour.edu.au 2
Application of Four Examinations Which of the four examinations would be most relevant to channel diagnosis? Endeavour College of Natural Health endeavour.edu.au 3
Application of Four Examinations owe will incorporate inspection & palpation of channels into our practical sessions. oenquiry, listening & smelling are important diagnostic tools that are covered in detail in Foundations of TCM. Endeavour College of Natural Health endeavour.edu.au 4
Channel Palpation Methods o Touching o Stroking o Pressing Maciocia (2006, p. 67) Examining the knee (Wendorf, Kohls & Ulrich, 1960) Endeavour College of Natural Health endeavour.edu.au 5
Channel Palpation Methods Which of these palpation methods would be most appropriate for the following channel portions? Primary Luo-connecting Sinew Cutaneous Endeavour College of Natural Health endeavour.edu.au 6
Pressure Which channels would be diagnosed using light pressure? Which would be diagnosed by pressing more deeply? Endeavour College of Natural Health endeavour.edu.au 7
Channel Palpation Signs & Symptoms Temperature Texture Thermometer (Menchi, 2005) Sandpaper (Woodsurfsc, 2016) Moisture Tender Glass of Water (Petts 2013) Maciocia (2006, p. 68) Endeavour College of Natural Health endeavour.edu.au 8
Cautions When is palpation not appropriate or extreme caution required? Endeavour College of Natural Health endeavour.edu.au 9
Palpation Incorporate some palpation into your practical work today. With permission of your fellow student. If you notice anything unusual present it to your lecturer for discussion. What could be the consequences of using an inappropriate amount of pressure when palpating channels? Endeavour College of Natural Health endeavour.edu.au 10
The Kidney (KI) Foot Shao Yin Channels & Collaterals Deadman, Al-Khafaji & Baker (2007, pp. 331-363) Endeavour College of Natural Health endeavour.edu.au 11
Kidney (Foot Shao Yin) Channel System o The Kidney (Foot Shao Yin) Primary channel o The Kidney Divergent channel o The Kidney Luo-connecting collateral o The Kidney Sinew channel o The Kidney Cutaneous region Endeavour College of Natural Health endeavour.edu.au 12
The Kidney (KI) Foot Shao Yin Primary Channel Regular Points 27 points Connecting Zang Fu Kidney Bladder Liver Lung Heart Main Channel Connections with other channels Spleen Governor Conception Endeavour College of Natural Health endeavour.edu.au 13
Pathway of the Kidney Channel KI-27 KI-21 KI-22 KI-11 KI-10 KI-3 to 6 KI-7 & 8 KI-1 Kidney Channel (Deadman et al., 2007, p. 331) Endeavour College of Natural Health endeavour.edu.au 14
Internal Pathway of the Kidney Channel Deviates from main channel in groin Connects with GV-1 Enters lumbar spine & kidneys BL fu & CV LR Diaphragm LU HT zang PC channel & CV-17 Throat & Root of Tongue Kidney Channel (Deadman et al., 2007, p. 331) Endeavour College of Natural Health endeavour.edu.au Endeavour College of Natural Health endeavour.edu.au 15
External Pathway of the Kidney Channel From the sole of the foot at KD-1 Kidney Channel (Deadman et al., 2007, p. 331) KI 1 (Deadman et al., 2007) Endeavour College of Natural Health endeavour.edu.au 16
External Pathway of the Kidney Channel The channel moves upward to the medial malleolus to form a loop formation Kidney Channel (Deadman et al., 2007, p. 331) KI-3 KI-4 KI-6 KI-5 Kidney Points (Deadman et al., 2007, p. 331) Endeavour College of Natural Health endeavour.edu.au 17
External Pathway of the Kidney Channel The channel moves upward to the medial malleolus to form a loop formation Kidney Channel (Deadman et al., 2007, p. 331) KI Points (Deadman et al., 2007, p. 331) Endeavour College of Natural Health endeavour.edu.au 18
External Pathway of the Kidney Channel cont d Continues up the medial leg Connecting with SP-6 KI 10 (WHO, 2008) Liver Channel Human (Lian, Chen Hammes & Kolster, 2005, p.171) To the popliteal fossa (knee) at KI-10 Endeavour College of Natural Health endeavour.edu.au 19
External Pathway of the Kidney Channel cont d Continues upward along the postero- medial aspect of the thigh To the tip of the coccyx where it heads internally Kidney Channel (Deadman et al., 2007, p. 331) Endeavour College of Natural Health endeavour.edu.au 20
External Pathway of the Kidney Channel cont d Re-emerges to the exterior above the pubic bone at KI-11 Travels superiorly 0.5 cun from the midline intersecting CV-3, CV-4 & CV-7 to KI-21 KI 11 & 21 (Deadman et al., 2007) Kidney Channel (Deadman et al., 2007, p. 331) Endeavour College of Natural Health endeavour.edu.au 21
External Pathway of the Kidney Channel cont d Travels 2 cun from the midline on the chest from KI-22 in the 5 th intercostal space To KI-27, just inferior to the clavicle Kidney Channel (Deadman et al., 2007, p. 331) KI 22 & 27 (Deadman et al., 2007, p. 331) Endeavour College of Natural Health endeavour.edu.au 22
Actions & Indications of the Kidney Channel o Nourish yin, clearing empty heat and grounding heat, qi, yang and wind o Nourish Liver Yin o Nourish water and balance fire (heart) o Grasping of qi in relation to the lungs o Tonify kidney yang (oedema, urinary dysfunction, sexual disorders, warm the body) o Benefit dry throat o Strengthen lumbar spine o Benefit the ears o Regulate the CV and TV (menstrual/fertility pathologies) o Drain damp-heat from the lower jiao o Nourish kidney yin (constipation) Endeavour College of Natural Health endeavour.edu.au 23
Luo-Connecting Channel of the Kidney o Separates at KI-4 posterior to the medial malleolus o Connects with the bladder channel on the lateral heel o Ascends to below the pericardium o Unites with the lumbar vertebrae Kidney Luo (Deadman et al., 2007) Endeavour College of Natural Health endeavour.edu.au 24
Indications of the Luo-connecting channel of the Kidney o Restlessness o Urine retention o Lumbago When pathogens invade the collateral of the Foot Shaoyin channel, it will cause fulminating cardiac pain and distending sensation, fullness in the hypochondrium unable to eat due to severe pain, unreasonable anger and reversing of Qi against the diaphragm (Chapter 63 Simple Questions, Huang Di Nei Jing) Endeavour College of Natural Health endeavour.edu.au 25
Divergent Channel of the Kidney o Separates from the primary Kidney Channel in the popliteal fossa o Converges with the Bladder channel on the posterior thigh Kidney Divergent (Deadman et al., 2007) Endeavour College of Natural Health endeavour.edu.au 26
Divergent Channel of the Kidney (cont d) o Connects with the kidneys o Intersects the Belt vessel at the second lumbar vertebrae (L2) o Connects with the tongue root o Emerges of the nape of the neck, uniting with the Bladder channel Kidney Divergent cont d. (Deadman et al., 2007, p. 331) Endeavour College of Natural Health endeavour.edu.au 27
Sinew Channel of the Kidney Travels superiorly to the occiput, meeting with the bladder sinew channel Connects with the inner aspect of the spinal vertebrae Connects with the Spleen sinew channel at the medial heel Connects with the Spleen sinew channel. Ascends the medial thigh to bind at the genital Meets the Bladder sinew channel then ascends to bind with the medial condyle of the tibia Starts at the 5 th metatarsal Kidney Sinew (Deadman et al., 2007) Endeavour College of Natural Health endeavour.edu.au 28
Indications of the Sinew Channel of the Kidney o Cramp on the sole of the foot o Pain and muscular spasm on the channel o External/Internal diseases will present with the inability to bend the lumbar spine forwards/backwards respectively Endeavour College of Natural Health endeavour.edu.au 29
Group Discussion o Compare (discuss similarities) and contrast (discuss) differences in Sinew channels of the three leg yin. You may wish to view the following link in your own time. http://peterborten.com/wp-content/uploads/2013/02/sinew-composite2.pdf Endeavour College of Natural Health endeavour.edu.au 30
Cutaneous Regions of the Shao Yin Shaoyin Cutaneous (Deadman et al., 2007) Endeavour College of Natural Health endeavour.edu.au 31
Palpation Case Study Lecturer demonstrates palpation of leg yin channels on a student volunteer. Perhaps someone with knee, ankle or other leg problems may be willing to participate. Lecturer describes what is felt on palpation. With your patient s permission students can feel for abnormal findings on channel. Discuss what these might mean clinically. Endeavour College of Natural Health endeavour.edu.au 32
Group Work - Palpation Case Study After gathering information from palpation, break into small groups. Determine which channel/s are affected. What treatment strategy will you use? o Affected primary channel or sinew o Interior/exterior related channel o Luo connecting channel Why have you chosen this strategy? (i.e. Give rationale) Report back to the class as a whole. Endeavour College of Natural Health endeavour.edu.au 33
Essential Reading Deadman, P., Al-Khafaji, M., & Baker, K. (2007). A manual of acupuncture (2nd ed.). Hove, East Sussex: Journal of Chinese Medicine Publications. [Available as web app 2013, mobile app 2009 or text 2007] Maciocia, G. (2015). The foundations of Chinese medicine, (3rd ed.). Churchill Livingstone, Edinburgh. pp. 795-805. (Scanned copy provided on LMS session 10). Endeavour College of Natural Health endeavour.edu.au 34
Group Work o Divide into groups of 2 o Using a chinagraph pencil or eyeliner, locate the pathway of Kidney, Spleen and Liver channels using main points as landmarks. o Be very clear about where the Kidney Channel runs in relation to Spleen and Liver channels in the lower leg. Endeavour College of Natural Health endeavour.edu.au 35
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References Deadman, P., Al-Khafaji, M., & Baker, K. (2007). A manual of acupuncture (2nd ed.). Hove, East Sussex: Journal of Chinese Medicine Publications. [Available as web app 2013, mobile app 2009 or text 2007] Lian, Y., Chen, C., Hammes, M. & Kolster, B. (2005). Pictorial Atlas of Acupuncture, H.H.Ullmann, Marburg. Maciocia, G. (2006). The channels of acupuncture: clinical use of the secondary channels and eight extraordinary vessels, Churchill Livingstone, Edinburgh. Maciocia, G. (2015). The foundations of Chinese medicine, (3rd ed.). Churchill Livingstone, Edinburgh. Menchi. (2005). A medical/clinical thermometer showing the temperature of 38.7 [Image]. Retrieved February 22, 2016, from https://commons.wikimedia.org/wiki/file:clinical_thermometer_38.7.jpg Petts, J. (2013). Glass of Water [Image]. Retrieved February 22, 2016, from https://commons.wikimedia.org/wiki/file:glass_of_water_(8467149239).jpg Qiao, Y., (2008). Traditional Chinese Medicine Diagnosis Study Guide, Eastland Press, Inc. Seattle. Wendorf, Kohls & Ulrich. (1960). Leipzig, DHfK, Äztliche Untersuchung [Image]. Retrieved February 19, 2016, from https://commons.wikimedia.org/wiki/file:bundesarchiv_bild_183-76942-0023,_leipzig,_dhfk,_%c3%84ztliche_untersuchung.jpg Woodsurfsc. (2016). Macro photo of a 120 grit sandpaper made of aluminum oxide [Image]. Retrieved February 22, 2016, from https://commons.wikimedia.org/wiki/file:120_grit_(scale).jpg World Health Organisation. (2008). WHO standard acupuncture point locations in the Western Pacific Region. Manila, Philippines: World Health Organization. Endeavour College of Natural Health endeavour.edu.au 37