The Choice of Acupuncture Points for AP Therapy
Philip A.M. Rogers MRCVS
1980, re-edited 1995
Postgraduate Course in Veterinary AP, Dublin, 1996
1980, re-edited 1995
Postgraduate Course in Veterinary AP, Dublin, 1996
This paper was written in 1980. For an update, see the attached paper on the Choice of AP points for particular conditions
INTRODUCTION
One may use veterinary acupuncture (AP) by the transposition method (from human to animal) or by the traditional vet method. It follows that the choice of points for therapy can be based on either or both of these methods.
Some of the AP textbooks on man and animals have therapeutic indices (point prescriptions) for specific disease conditions or symptoms. Other texts have not this facility. We have also seen that many different combinations of points may be used in any one clinical condition.
The student is advised to study only a few AP texts initially. However, she/he should know that one text (or even 3-4 texts) does not cover all conditions which may respond to AP. Therefore, over a period of years, the serious student can expect to accumulate and study dozens of different texts. Each of these texts will have to be integrated with material from earlier texts. Therefore the student will need to make out personal prescription lists, using data from many sources.
This paper discusses the choice of AP points based on the human transposition system but first we must consider some differences between orthodox and unorthodox concepts of disease.
DIFFERENCES BETWEEN ORTHODOX AND UNORTHODOX CONCEPTS OF DISEASE
AP is frequently of great value in treating the pain and lameness associated with x-ray evidence of severe osteoarthritis or "intervertebral disc prolapse syndrome", despite the persistence of the lesion. Orthodox practitioners would suggest that this is impossible because they assume that the pain and lameness primarily is caused initially by nerve stimulation from the lesion, but which soon becomes a self-perpetuating system, (i.e., a vicious circle). They claim that if the muscle spasm and tissue oedema is relieved, the locomotor function may be restored despite the persistence of the x-ray lesion.
Severe gastric ulcers, even bleeding ulcers, may respond rapidly to AP, with no change in dietary habits. Orthodox concepts would prescribe change of diet, drug therapy with antacids, gastric sedatives, antispasmodics, Zantac or Cimetidine, etc. However, stimulation of certain AP points, especially NeiKuan (PC06); TsuSanLi (ST36), ChungWan (CV12) and WeiShu (BL21) has powerful effects on the autonomic nervous system (anti-nauseous effects), acid secretion and regenerative power of the gastric mucosa. Thus, AP can combat the symptoms of gastric ulcer and promote the ideal environment for self-healing, by reducing acid-secretion and stimulating the defence systems of the body.
Similarly, AP can help patients who have lost motor function of an arm or leg following a cerebrovascular accident, encephalitis etc. Orthodox medical concepts claim that damaged neurons cannot regenerate. Acupuncturists agree with this but they claim that many types of paralysis are due to functional rather than organic damage, (i.e.) that the motor-neurons are "asleep but not dead", due to inadequate oxygen or blood supply. AP at certain points has marked effect on brain microcirculation and, thus, can restore nerve function in such cases. Also, the nervous system itself has considerable "plasticity" and new circuits can be established to replace the functions of damaged circuits.
Another difference between orthodox and unorthodox concepts is in the importance of the nature of the lesion. Orthodox clinicians would set great importance on the nature of a toe pain (for example). Is it arthritis, sprain, gout, subluxation etc? To an acupuncturist, such questions are of minor importance, as the point combination used covers all responsive conditions of the toe and the Channel-Organ System (COS) related to the toes. For pragmatic purposes, however, it is helpful to establish a firm diagnosis before attempting to treat the condition.
Thus, AP claims to treat or help many conditions which, according to our western training, should be difficult or impossible to treat successfully. How, then, do we go about choosing the best points for therapy?
CONSTRUCTION OF AP POINT PRESCRIPTIONS
As one accumulates textbooks one may wish to construct a cumulative index of the points recommended by the various authors for each condition. Each reference should be coded, in order to avoid confusion as to the source and to avoid mistakes in the location of the points.
As new texts are studied, data can be added to the index, under a new reference code. For example, suppose one were studying Klide and Kung in relation to AP in horses and one were using the Sobin data (p 69 of Klide and Kung), one would find the following data under the various points:
Point Indication
Head & Neck01 Tetanus, encephalitis, encephalomyelitis, encephaloedema
02 Purulent frontal sinusitis, cerebral hyperaemia
03 Cerebral hyperaemia, cerebral anaemia, neck rheumatism
04 Same as HN03
. .
Tail 114 Over-exertion, heat stroke, common cold, bowel spasm
First, one would go through the data and pick out the complete list of key-words or pathological conditions, mentioned in the text:
Tetanus, Encephalitis, Encephalomyelitis, Encephaloedema, Sinusitis (frontal, purulent), Cerebral hyperaemia, Cerebral anaemia, Neck rheumatism, Overexertion, Heatstroke, Common cold, Bowel spasm etc.
One would then go through the data again and enter the identity of each point under the relevant conditions, giving a code (say) (K-S (for Klide/Kung-Sobin) before each point combination and giving an appropriate alphanumeric code to each point, for example HN01 for Head and Neck 1, T114 for Tail 114.
Bowel spasm (K-S) T114 (T= Tail)
Cerebral hyperaemia (K-S) HN02,03,04
Encephalitis (K-S) HN01
Encephaloedema (K-S) HN01
Encephalomyelitis (K-S) HN01
Tetanus (K-S) HN01
.
.
.
.
etc
If a new reference, for example author X, had points under these headings, they would be added later. For example:
Cerebral hyperaemia (K-S) HN02,03,04....
(X) 99, 112, 115...
Tetanus (K-S) HN01...
(X) 115, 119, 126...
etc
The problem with this system (traditional vet AP) is that there is no standard chart for any one species. It is not possible to relate (K-S) HN02 with (X) 99 etc on the standard chart. Therefore some major integration (referring back to the individual source charts) is necessary either before the cumulative index is attempted or after it is done. Either way, it becomes very time-consuming for the individual practitioner. However, one would expect that research workers interested in vet AP will integrate all existing vet traditional texts into one "standard" text for each species within the next few years.
Meanwhile, integration of human texts is much easier, as they are normally based on a standard chart of the AP points (except for a few instances in which points such as BL36-54 and ST01-8 may have different alphanumeric coding in some texts:
Outer BL Points (IVAS BL40=WeiZhong, mid-popliteal crease)
IVAS 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54
Other 50 51 52 53 54 36 37 38 39 40 41 42 43 44 45 46 47 48 49
Inner line - - - - - --12 13 14 15 16 17 18 19 20 21 22 23 28 30
Codes for ST01-08
(IVAS ST08=TouWei, on temple)
IVAS 01 02 03 04 05 06 07 08
Other 08 07 06 05 04 03 02 01
These differences should be noted and adjusted by the student on the first comparison of his/her "new" text with the reference text.
Thus, studying four texts, such as the Beijing text (2), Hongkong text (3), Taipei text (4) and Barefoot Doctor's Manual (5), the student would prepare a therapeutic index in the same way as above. Then, on checking the points listed for gastritis/gastric ulcer; toothache; sciatica/lumbosacral pain, sprain, etc (for example) he/she would find:
Gastritis/Gastric ulcer
(Pek) ST20,21,25; SP05; CV12,13 (plus Earpoints and other points)
(Hkx) ST21,28,36; SP05; NL20,21; CV12,13 (plus earpoints and other points)
(TX) ST36,44; SP04; BL21; CV12; local points
(Bdm) ST25,36; BL20,21; PC06; CV06,08,12,13
Toothache
(Pek) LI02,03,04,05; ST03,05,06,07,42,44; SI18; Kl03; TH09,20; GB03,05,06,10,12,17; CV24; GV27 (plus earpoints and other points)
(Hkx) LU02; LI01,02,04,05; ST03,05,06,07,42,44,45; SI18; TH09,20,21; GB02,03,05,06,10,12,17; CV24; GV27,28 (plus earpoints and other points)
(TX) LI04,11; ST06,44; TH17
(Bdm) LU09; LI04; ST06,07; SI03; TH17,20
Sciatica, lumbosacral pain, sprain etc
(Pek) BL22,23,24,25,26,27,28,29,30,31,32,33,34,37,39,40,52,53,54,55,
57,59,60,63,64; GB30,31,34,39; GV02,03,04; AhShi, (plus earpoints and other points)
(Hkx) BL27,28,29,30,31,32,33,34,37,39,40,52,54,58,60; GB30,31,32,34,35,40; GV02,03 (plus earpoints and other points)
(TX) BL23,30,40,60; GB34; AhShi
(Bdm) BL23,37,40,52,60; GB30,34; AhShi (plus other points)
In the above examples (Pek), (Hkx), (TX) and (Bdm) refer to the Beijing, Hongkong, Taipei and Barefoot Doctor's Manual Sources respectively.
Glancing down through the points listed under each condition, one could see some agreement and some alternative point combinations. In choosing points for therapy, the student could pick those which showed the greatest measure of agreement, for example:
Gastritis/gastric ulcer: Choose from CV12,13; ST36; BL21 (listed in 3-4/4 of the texts)
Toothache: Choose from LI04; ST06,07,44; TH20 (listed in 3-4/4 of the texts)
Sciatica/lumbosacral pain: Choose from AhShi; BL23,30,40,60; GB30,34 (listed in 3-4/4 of the texts)
The therapeutic index is obviously a dynamic system, which is extended each time new references are studied. Also, one may add data from the clinical experience of colleagues, articles in the journals etc, as it becomes available.
The above approach is often called "Cookbook AP" by the purists and is regarded (especially by classically trained members) as inferior AP. However, Cookbook AP works very well in clinical situations with only one or a small number of signs or symptoms. Many recent textbooks from China, Taiwan, Hongkong etc make no mention of classic AP in the old sense and they rely very heavily on the Cookbook approach themselves. The Laws of the Five Phases, the classic use of the Phase Points, Yuan-Source, Luo-Passage, Hour Points, the Chinese Pulse Diagnosis etc are not mentioned in detail (if at all) in most of the modern texts from China and its neighbouring countries.
Even if one has access to a comprehensive therapeutic index, one still needs a way to reduce the number of points to a minimum. This is because many comprehensive prescriptions list far more points than are needed to treat the case. In the final choice of points, one usually relies on a few ancient Laws, choosing combinations from the following:
1. Sensitive points
2. TianYing points
3. Local points along affected and nearby Channels
4. Points along the affected Channels
5. Distant points on Channels through the affected area
6. Points on related Channels
7. Master points, including the Five Phase points, Mu/Shu points, Yuan/Luo points and Xi-Cleft points
8. Combination of local and distant points
9. Selection of points according to the symptoms
10. Selection of points according to the innervation
11. Fore and Aft points
12. Earpoints
Cookbook AP can be improved greatly by choosing points from an extensive list (based on many, if not dozens of, authoritative texts) so that at least 2 of the basic Laws of choosing points are fulfilled (see example re elbow pain etc later in this paper).
DIAGNOSTIC, THERAPEUTIC AND PROGNOSTIC VALUE OF SENSITIVE POINTS AND THE CHOICE OF POINTS FOR THERAPY
1. SENSITIVE POINTS
It is important to search for sensitive points. Sensitive points include the AhShi, Trigger Points, motor points and any other points which show abnormal tenderness to palpation-probing. After taking the case history, the acupuncturist usually palpates the entire body, probing the muscles, especially in those areas which the case history may suggest as likely to be sensitive. In musculoskeletal conditions of the upper limb and neck one probes especially the muscles of the upper limb, neck and thorax. In conditions of the lumbosacral area and lower limb, these areas will be probed carefully. Occasionally, sensitive points may be found far away from the problem area and a careful examination would include probing of the whole body, irrespective of the more obvious areas likely to be affected. For example, SP06 may be sensitive in menstrual disorder in women; KI03 may be sensitive in renal disorders; GB34 may be sensitive in cholecystitis; L 13 (LanWei = "Appendix Tail") may be sensitive in appendicitis.
Wherever sensitive points are found, their locations are noted carefully for future reference. These points may or may not be codified AP points. Their location can help in the diagnosis and they are also useful in therapy and prognosis. Their disappearance, i.e. return to normal sensitivity, during a course of treatment is taken as a good prognosis.
Sensitive points, when present, are always included in the point prescription. However, occasionally a whole area, such as the rectus abdominis, gastrocnemius or gluteal muscles may be sensitive and to needle all of this would require too many needles. In such cases, one or two of the most sensitive areas in the muscle are chosen. If ultrasound or electrostimulation equipment with a roller-electrode is available, the entire muscle can be treated.
One also probes scar tissue carefully. Wherever scar tissue is found, great care is taken to check whether or not it may be associated with the symptoms (by reflex effects or by blocking the flow of Qi in one or more Channels). Treatment of problem scars is very important. It is discussed in the paper on "Techniques of stimulation of the AP points".
Other areas important to probe include the 66 Command Points (the 60 Phase Points + the 6 Yuan points of the Yang Channels (the Yuan points of the Yin Channels are the same as the Yu points), see paper on the Study of Points and Channels), the front Mu points, the paravertebral Shu Points" (BL13-30), also the outer line of the BL Channel (BL36-40, 41-54)).
Sensitive points excluded from needling treatment include cancers, joint cavities, abscesses, infected wounds, parasitized skin areas and ulcers. In the latter case, the use of TianYing points is permitted in certain conditions (see next section).
In humans, practitioners who use the Earpoints pay particular attention to those points which show abnormal sensitivity.
Point sensitivity can be detected objectively by electronic detectors, as mentioned in an earlier paper.
2. TIANYING POINTS
In certain cases it is permissible to needle abnormal masses, such as goitre, synovial cysts, indurated masses in muscle following intramuscular injections etc. The TianYing point is the point of greatest sensitivity in the mass, cyst etc, It is focus of the problem a swollen or enlarged area such as an inflamed muscle or joint or periosteum. One needle is put into the TianYing point and occasionally, 3 or 4 more needles are placed around this one, from the periphery, as in the diagram (a) and (b) below.
Cyst diagrams (a) and (b):
In the case of varicose leg ulcers, 3-5 needles are sometimes advanced underneath the base of the ulcer as in diagram (c) below. Ulcer diagram (c):
In hip arthritis, for example, point GB30 (HuanTiao) is needled but the needle may also be advanced to peck the periosteum of the femoral neck. The intramuscular lump which sometimes follows injection in the biceps brachii or gluteal muscles can be dispersed quickly by dry-needling the centre of the lump. In "Tennis elbow", the lateral epicondyle of the humerus is often pecked with a needle.
In headache following epidural injection or lumbar puncture, the pain can be relieved by injecting a needle into the original needle track. (A recent paper in a medical journal reported extraordinary success in such cases by injection of 10 ml of the patient's blood back into the puncture site. The author did not acknowledge the Chinese discovered that simple needling of the same area could get the same result).
In general, however, cancer masses, joint cavities, infected wounds and infected abscesses (non-sterile) and parasitised skin areas should not be needled except for biopsy or drainage purposes.
3. LOCAL POINTS
In local problems, such as elbow pain, gastritis, tenesmus etc, one or two local points are included in the prescription. For example, include:
neck pain: GB20; BL10; X 35 (HuaToChiaChi points);
shoulder pain: LI15; TH14;
elbow pain: LI11; HT03;
carpal (wrist) pain: LI05; HT07;
lumbosacral pain: BL23,25; GV03;
hip pain: GB30;
knee (stifle) pain: BL40; GB34; L 16 (HsiYen);
tarsal (hock) pain: BL60 penetrating to KI03;
gastritis: CV12 (CV12 is also the Mu point-for ST);
intestinal disease: ST25, CV04 (these are both local and Mu points for the large and small intestine respectively);
bronchitis: BL13; CV17;
tracheitis: CV22,23.
Other examples of local points are in Table 1 (at the end of the paper).
4. POINTS ON THE AFFECTED CHANNEL
Where an organ or function controlled by a Channel is disturbed, one or more points on that Channel are chosen. For example, ST36 in gastritis; LI04 in ulcerative colitis; LU09 in pneumonia; SP06 in diabetes (Spleen- pancreas); HT07 in tachycardia; BL23,28 in bladder disorders (these are also the Shu points for KI and BL respectively); KI points in KI disorders; PC points in PC disorders etc.
Similarly, where aches or pains are located on or near the course of a Channel, points are chosen on the Channel. For example in pain along the lateral thigh, points GB31 or 32 could be included; for pain along the lateral chest, points GB22 or 25; SP17 or 18 or 19 or 20 or 21 could be included; for pain on the inner aspect of the leg, one might include one or two points from: SP05,06,07,08,09; LV05,06,07; KI08,09,10.
5. DISTANT POINTS ON CHANNELS THROUGH THE AFFECTED AREA
In general, the most effective AP points are below the elbow and knee (the areas in which the 66 Command Points lie.
Problems at one end of the body may be treated by points at the other end. For example, disorders of the head and its organs may be helped by points below the elbow or below the knee (stifle). Points on the head may help problems below the waist.
Also, a local problem may be helped by needling a point above or below it on its Channel. For example GB34 in hip, flank or lateral, thoracic pain; TH05 in elbow, shoulder and side of neck pain; BL40 or 60 in lumbar pain; SP04 in genital pain etc.
A variation of this "Law" is that pain or other disorders at one end of a Channel may be treated by points at the opposite end of the Channel. Examples are: GV20 in haemorrhoids, tenesmus or rectal prolapse; GV26 in low back pain; KI01 in cerebral vascular accident, apoplexy; LI04 in rhinitis, sinusitis, toothache of lower jaw; ST44 in toothache of upper jaw or temporal headache; BL67 or GB37 in eye pain; LU01, HT01 or PC01 in pain in the palm of the hand; TH23, LI20 or SI19 in pain in the dorsum of the hand; SI03, 04 or 05 in tinnitus aurium; LI04, TH05 or SI03 in neck pain.
A Beijing text (9) advises that needles or moxa should not be applied to a wound, an ulcer or scar. The nearest local points should be used instead. This is at variance with two well established techniques: the treatment varicose leg ulcers (in Section 2 above) and the treatment of scar tissue in the paper on "Techniques of stimulation of the AP points").
6. POINTS ON RELATED CHANNELS
The Phase-Mate Channels (Husband-Wife pairs, or Linked Pairs in the same Phase) are: LU-LI; ST-SP; HT-SI; BL-KI; PC-TH; GB-LV. One member of each pair influences the other. Disease along one member of a pair or of the main organ of a pair may be helped by points on the other member of the pair. For example, gastric upsets or pain along the ST Channel may be helped by needling points on the SP Channel. LI points influence LU disorders. LV points are used in GB disorders (see below).
Also, points on nearby (anatomically related) Channels (for example SP, KI, LV in the leg and thigh area; TH, LI, SI on the forearm etc) influence pain etc in the area. Example, pain along LI Channel in the forearm should be helped by local or distal points TH or SI Channels.
7. MASTER POINTS
In Classic AP the Five Phase Points (60 points in total) are very important but these are often ignored in western and modern Chinese AP. They are discussed elsewhere, as are the Master Points of AP.
The most important of the Master Points for therapy are the Shu-Back Association points, Mu-Front Alarm points, Yuan-Source, Luo-Passage and Xi-Cleft points. Whether or not these points are sensitive when their respective organs are upset), these points often are used in therapy.
Combinations of Shu and Mu Points are prescribed frequently when an organ (or its functions/correspondences) is abnormal:
Shu and Mu
BL13 and LU01 in disorders of the Lung
BL25 and ST25 in disorders of the Colon
BL21 and CV12 in disorders of the Stomach
BL20 and LV13 in disorders of the Spleen-pancreas
BL15 and CV14 in disorders of the Heart
BL27 and CV04 in disorders of the Small Intestine
BL28 and CV03 in disorders of the Bladder
BL23 and GB25 in disorders of the Kidney
BL14 and CV17 in disorders of the Pericardium, Circulation-Sex
BL22 and CV05 in disorders of the Triple Heater
BL19 and GB24 in disorders of the Gallbladder
BL18 and LV14 in disorders of the Liver
Combinations of Yuan-Source and Luo-Passage points. In disease of an organ or its Channel, the Yuan point of the affected Channel is used with the Luo point of its Phase-Mate Channel, for example in LU disorders (or disorders of the LU Channel), LU09 (Yuan of LU) and LI06 (Luo of LI) could he used:
affected Yuan and Luo of Mate
in LU disorders: LU09 and LI06
in LI disorders: LI04 and LU07
in ST disorders: ST42 and SP04
in SP disorders: SP03 and ST40
in HT disorders: HT07 and SI07
in SI disorders: SI04 and HT05
in BL disorders: BL64 and KI04
in KI disorders: KI03 and BL58
in PC disorders: PC07 and TH05
in TH disorders: TH04 and PC06
in GB disorders: GB40 and LV05
in LV disorders: LV03 and GB37
The Xi-Cleft points are indicated mainly in acute diseases of their respective Channels or organs. In haemoptysis: LU06 (Xi of LU); in acute colitis: LI07 (Xi of LI); in epigastric pain: ST34 (Xi of ST); in acute lower abdominal pain at menstruation: SP08 (Xi of SP).
Various combinations of Master Points are possible. For example, in liver disease, or in problems of the eyes or nails (which are controlled by LV), the LV Shu point (BL18, KanShu), the LV Mu point (LV14, ChiMen), the LV Yuan point (LV03, TaiChung) and the LV Xi-Cleft point (LV06 ChungTo) might be combined. In liver and gallbladder disease (or in problems controlled by LV and GB Channels), the Luo points LV05 (LiKou) and GB37 (KuangMing) might be combined with the Mu, Shu and/or Xi-Cleft points for liver and gallbladder (LV14, GB24; BL18, BL19; LV06, GB36).
8. COMBINATION OF LOCAL AND DISTANT POINTS
This is one of the most common methods of choosing points. Examples are:
Face and cheek disorders: local points (ST04,06) plus distant points on Channels to the area (e.g.) LI04, ST44.
Eye disease: BL01; ST01 (local) plus SI06; GB37 (distant).
Ear disease: GB02; SI19; TH17 (local) plus SI03, GB43.
Hip arthritis: GB30 (local) plus GB34 (distant).
Other examples are shown in Table 1 (below).
The "Adjacent" point is another type of point, recommended in recent Chinese texts. This is a powerful point, located 1-20 tsun from the local disorder or problem area. Examples are, GB20 for head and eye; GV20 for forehead; GB25 for lower dorsal area and lumbar area; LV13 in gastric pain. Other examples are given in Table 1 (below).
For best results, "Adjacent" points usually are combined with local and distant points as in Table 1. Example: acute gastritis with gastric pain: ST36; PC06 (remote points on the leg and arm) plus CV12 (local point plus Mu point) plus LV13 ("Adjacent point" and Mu of SP).
9. SELECTION OF POINTS ACCORDING TO SYMPTOMS
Symptomatic points: Certain points are known to be highly effective for common symptoms, such as vomiting, nausea, fever etc. In treating a clinical syndrome, points are chosen for the main problem and others may be added for the symptoms. For example, in gastritis: CV12 and ST36 might be chosen as the main points. If symptoms of nausea and fever were also present, points PC06 and GV14 might be added. The Beijing text (2) lists the following points for the common symptoms:
Cough; CV22; LU07; SP06
Diarrhoea: ST25,36; SP04; CV06
Difficulty swallowing: CV22,23; PC06
Dreams, nightmares: BL15; HT07; LV03
Excess mucus, cough: ST40.
Excessive-perspiration: HT06; KI07
Fever: LI04,11; GV14.
Hiccough, diaphragmatic spasm: BL17; ST36
Insomnia: HT07; SP06; KI03; CV24.
Nausea, vomiting: PC06; ST36.
Night sweats: SI03; HT06; Z 01
Pain in the cardiac area: PC06; CV17
Palpitation: PC06,04
Salivation: ST04; CV24,23
Shock: GV26; CV08,04; PC06,09
Other examples of points specific for symptoms are:
GB34 in acute, traumatic or muscular pain. (This is the pain point par excellence. It is usually combined with one of two local points for the affected area).
ST36 in upper abdominal disorders;
SP06 in lower abdominal disorders;
GV26; KI01 in anaesthetic emergencies (collapse, apnoea, cardiac arrest);
PC06 in disorders of the heart, lungs, thorax;
Earpoint Lung in relieving the symptoms of narcotic or alcohol withdrawal.
10. SELECTION OF POINTS ACCORDING TO NERVE SUPPLY
For diseases in any region (head, neck, limbs, internal organs), one may select points from areas supplied by the same spinal nerves, nerve plexus or nerve trunks as supply the problem area. Often, direct needling of the nerve trunk or plexus is used. In this respect, the paravertebral BL points and the paravertebral X 35 (HuaToChiaChi) points are especially useful for many conditions which do not appear (on casual examination to have anything to do with the back. This may be the explanation for the success of chiropractic and other manipulative systems which concentrate on spinal massage and pressure manipulation. These systems would concentrate on the same areas as the BL and X 35 paravertebral points.
11. SELECTION OF FORE AND AFT POINTS
In local disorders, such as knee pain, arm trauma etc, a combination of Fore and Aft points (in front of and behind) are used. These are almost always local points. Examples are: Knee pain: L 16 (HsiYen) and BL40; Forearm pain: PC06 and TH05. The Mu/Shu combination is also an example.
12. EARPOINTS
Sensitive earpoints, plus other earpoints known to be related to the affected areas or functions are used in Ear AP. The system is highly effective in man but needs much more development before it can be recommended for routine use in animals.
INTRODUCTION
One may use veterinary acupuncture (AP) by the transposition method (from human to animal) or by the traditional vet method. It follows that the choice of points for therapy can be based on either or both of these methods.
Some of the AP textbooks on man and animals have therapeutic indices (point prescriptions) for specific disease conditions or symptoms. Other texts have not this facility. We have also seen that many different combinations of points may be used in any one clinical condition.
The student is advised to study only a few AP texts initially. However, she/he should know that one text (or even 3-4 texts) does not cover all conditions which may respond to AP. Therefore, over a period of years, the serious student can expect to accumulate and study dozens of different texts. Each of these texts will have to be integrated with material from earlier texts. Therefore the student will need to make out personal prescription lists, using data from many sources.
This paper discusses the choice of AP points based on the human transposition system but first we must consider some differences between orthodox and unorthodox concepts of disease.
DIFFERENCES BETWEEN ORTHODOX AND UNORTHODOX CONCEPTS OF DISEASE
AP is frequently of great value in treating the pain and lameness associated with x-ray evidence of severe osteoarthritis or "intervertebral disc prolapse syndrome", despite the persistence of the lesion. Orthodox practitioners would suggest that this is impossible because they assume that the pain and lameness primarily is caused initially by nerve stimulation from the lesion, but which soon becomes a self-perpetuating system, (i.e., a vicious circle). They claim that if the muscle spasm and tissue oedema is relieved, the locomotor function may be restored despite the persistence of the x-ray lesion.
Severe gastric ulcers, even bleeding ulcers, may respond rapidly to AP, with no change in dietary habits. Orthodox concepts would prescribe change of diet, drug therapy with antacids, gastric sedatives, antispasmodics, Zantac or Cimetidine, etc. However, stimulation of certain AP points, especially NeiKuan (PC06); TsuSanLi (ST36), ChungWan (CV12) and WeiShu (BL21) has powerful effects on the autonomic nervous system (anti-nauseous effects), acid secretion and regenerative power of the gastric mucosa. Thus, AP can combat the symptoms of gastric ulcer and promote the ideal environment for self-healing, by reducing acid-secretion and stimulating the defence systems of the body.
Similarly, AP can help patients who have lost motor function of an arm or leg following a cerebrovascular accident, encephalitis etc. Orthodox medical concepts claim that damaged neurons cannot regenerate. Acupuncturists agree with this but they claim that many types of paralysis are due to functional rather than organic damage, (i.e.) that the motor-neurons are "asleep but not dead", due to inadequate oxygen or blood supply. AP at certain points has marked effect on brain microcirculation and, thus, can restore nerve function in such cases. Also, the nervous system itself has considerable "plasticity" and new circuits can be established to replace the functions of damaged circuits.
Another difference between orthodox and unorthodox concepts is in the importance of the nature of the lesion. Orthodox clinicians would set great importance on the nature of a toe pain (for example). Is it arthritis, sprain, gout, subluxation etc? To an acupuncturist, such questions are of minor importance, as the point combination used covers all responsive conditions of the toe and the Channel-Organ System (COS) related to the toes. For pragmatic purposes, however, it is helpful to establish a firm diagnosis before attempting to treat the condition.
Thus, AP claims to treat or help many conditions which, according to our western training, should be difficult or impossible to treat successfully. How, then, do we go about choosing the best points for therapy?
CONSTRUCTION OF AP POINT PRESCRIPTIONS
As one accumulates textbooks one may wish to construct a cumulative index of the points recommended by the various authors for each condition. Each reference should be coded, in order to avoid confusion as to the source and to avoid mistakes in the location of the points.
As new texts are studied, data can be added to the index, under a new reference code. For example, suppose one were studying Klide and Kung in relation to AP in horses and one were using the Sobin data (p 69 of Klide and Kung), one would find the following data under the various points:
Point Indication
Head & Neck01 Tetanus, encephalitis, encephalomyelitis, encephaloedema
02 Purulent frontal sinusitis, cerebral hyperaemia
03 Cerebral hyperaemia, cerebral anaemia, neck rheumatism
04 Same as HN03
. .
Tail 114 Over-exertion, heat stroke, common cold, bowel spasm
First, one would go through the data and pick out the complete list of key-words or pathological conditions, mentioned in the text:
Tetanus, Encephalitis, Encephalomyelitis, Encephaloedema, Sinusitis (frontal, purulent), Cerebral hyperaemia, Cerebral anaemia, Neck rheumatism, Overexertion, Heatstroke, Common cold, Bowel spasm etc.
One would then go through the data again and enter the identity of each point under the relevant conditions, giving a code (say) (K-S (for Klide/Kung-Sobin) before each point combination and giving an appropriate alphanumeric code to each point, for example HN01 for Head and Neck 1, T114 for Tail 114.
Bowel spasm (K-S) T114 (T= Tail)
Cerebral hyperaemia (K-S) HN02,03,04
Encephalitis (K-S) HN01
Encephaloedema (K-S) HN01
Encephalomyelitis (K-S) HN01
Tetanus (K-S) HN01
.
.
.
.
etc
If a new reference, for example author X, had points under these headings, they would be added later. For example:
Cerebral hyperaemia (K-S) HN02,03,04....
(X) 99, 112, 115...
Tetanus (K-S) HN01...
(X) 115, 119, 126...
etc
The problem with this system (traditional vet AP) is that there is no standard chart for any one species. It is not possible to relate (K-S) HN02 with (X) 99 etc on the standard chart. Therefore some major integration (referring back to the individual source charts) is necessary either before the cumulative index is attempted or after it is done. Either way, it becomes very time-consuming for the individual practitioner. However, one would expect that research workers interested in vet AP will integrate all existing vet traditional texts into one "standard" text for each species within the next few years.
Meanwhile, integration of human texts is much easier, as they are normally based on a standard chart of the AP points (except for a few instances in which points such as BL36-54 and ST01-8 may have different alphanumeric coding in some texts:
Outer BL Points (IVAS BL40=WeiZhong, mid-popliteal crease)
IVAS 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54
Other 50 51 52 53 54 36 37 38 39 40 41 42 43 44 45 46 47 48 49
Inner line - - - - - --12 13 14 15 16 17 18 19 20 21 22 23 28 30
Codes for ST01-08
(IVAS ST08=TouWei, on temple)
IVAS 01 02 03 04 05 06 07 08
Other 08 07 06 05 04 03 02 01
These differences should be noted and adjusted by the student on the first comparison of his/her "new" text with the reference text.
Thus, studying four texts, such as the Beijing text (2), Hongkong text (3), Taipei text (4) and Barefoot Doctor's Manual (5), the student would prepare a therapeutic index in the same way as above. Then, on checking the points listed for gastritis/gastric ulcer; toothache; sciatica/lumbosacral pain, sprain, etc (for example) he/she would find:
Gastritis/Gastric ulcer
(Pek) ST20,21,25; SP05; CV12,13 (plus Earpoints and other points)
(Hkx) ST21,28,36; SP05; NL20,21; CV12,13 (plus earpoints and other points)
(TX) ST36,44; SP04; BL21; CV12; local points
(Bdm) ST25,36; BL20,21; PC06; CV06,08,12,13
Toothache
(Pek) LI02,03,04,05; ST03,05,06,07,42,44; SI18; Kl03; TH09,20; GB03,05,06,10,12,17; CV24; GV27 (plus earpoints and other points)
(Hkx) LU02; LI01,02,04,05; ST03,05,06,07,42,44,45; SI18; TH09,20,21; GB02,03,05,06,10,12,17; CV24; GV27,28 (plus earpoints and other points)
(TX) LI04,11; ST06,44; TH17
(Bdm) LU09; LI04; ST06,07; SI03; TH17,20
Sciatica, lumbosacral pain, sprain etc
(Pek) BL22,23,24,25,26,27,28,29,30,31,32,33,34,37,39,40,52,53,54,55,
57,59,60,63,64; GB30,31,34,39; GV02,03,04; AhShi, (plus earpoints and other points)
(Hkx) BL27,28,29,30,31,32,33,34,37,39,40,52,54,58,60; GB30,31,32,34,35,40; GV02,03 (plus earpoints and other points)
(TX) BL23,30,40,60; GB34; AhShi
(Bdm) BL23,37,40,52,60; GB30,34; AhShi (plus other points)
In the above examples (Pek), (Hkx), (TX) and (Bdm) refer to the Beijing, Hongkong, Taipei and Barefoot Doctor's Manual Sources respectively.
Glancing down through the points listed under each condition, one could see some agreement and some alternative point combinations. In choosing points for therapy, the student could pick those which showed the greatest measure of agreement, for example:
Gastritis/gastric ulcer: Choose from CV12,13; ST36; BL21 (listed in 3-4/4 of the texts)
Toothache: Choose from LI04; ST06,07,44; TH20 (listed in 3-4/4 of the texts)
Sciatica/lumbosacral pain: Choose from AhShi; BL23,30,40,60; GB30,34 (listed in 3-4/4 of the texts)
The therapeutic index is obviously a dynamic system, which is extended each time new references are studied. Also, one may add data from the clinical experience of colleagues, articles in the journals etc, as it becomes available.
The above approach is often called "Cookbook AP" by the purists and is regarded (especially by classically trained members) as inferior AP. However, Cookbook AP works very well in clinical situations with only one or a small number of signs or symptoms. Many recent textbooks from China, Taiwan, Hongkong etc make no mention of classic AP in the old sense and they rely very heavily on the Cookbook approach themselves. The Laws of the Five Phases, the classic use of the Phase Points, Yuan-Source, Luo-Passage, Hour Points, the Chinese Pulse Diagnosis etc are not mentioned in detail (if at all) in most of the modern texts from China and its neighbouring countries.
Even if one has access to a comprehensive therapeutic index, one still needs a way to reduce the number of points to a minimum. This is because many comprehensive prescriptions list far more points than are needed to treat the case. In the final choice of points, one usually relies on a few ancient Laws, choosing combinations from the following:
1. Sensitive points
2. TianYing points
3. Local points along affected and nearby Channels
4. Points along the affected Channels
5. Distant points on Channels through the affected area
6. Points on related Channels
7. Master points, including the Five Phase points, Mu/Shu points, Yuan/Luo points and Xi-Cleft points
8. Combination of local and distant points
9. Selection of points according to the symptoms
10. Selection of points according to the innervation
11. Fore and Aft points
12. Earpoints
Cookbook AP can be improved greatly by choosing points from an extensive list (based on many, if not dozens of, authoritative texts) so that at least 2 of the basic Laws of choosing points are fulfilled (see example re elbow pain etc later in this paper).
DIAGNOSTIC, THERAPEUTIC AND PROGNOSTIC VALUE OF SENSITIVE POINTS AND THE CHOICE OF POINTS FOR THERAPY
1. SENSITIVE POINTS
It is important to search for sensitive points. Sensitive points include the AhShi, Trigger Points, motor points and any other points which show abnormal tenderness to palpation-probing. After taking the case history, the acupuncturist usually palpates the entire body, probing the muscles, especially in those areas which the case history may suggest as likely to be sensitive. In musculoskeletal conditions of the upper limb and neck one probes especially the muscles of the upper limb, neck and thorax. In conditions of the lumbosacral area and lower limb, these areas will be probed carefully. Occasionally, sensitive points may be found far away from the problem area and a careful examination would include probing of the whole body, irrespective of the more obvious areas likely to be affected. For example, SP06 may be sensitive in menstrual disorder in women; KI03 may be sensitive in renal disorders; GB34 may be sensitive in cholecystitis; L 13 (LanWei = "Appendix Tail") may be sensitive in appendicitis.
Wherever sensitive points are found, their locations are noted carefully for future reference. These points may or may not be codified AP points. Their location can help in the diagnosis and they are also useful in therapy and prognosis. Their disappearance, i.e. return to normal sensitivity, during a course of treatment is taken as a good prognosis.
Sensitive points, when present, are always included in the point prescription. However, occasionally a whole area, such as the rectus abdominis, gastrocnemius or gluteal muscles may be sensitive and to needle all of this would require too many needles. In such cases, one or two of the most sensitive areas in the muscle are chosen. If ultrasound or electrostimulation equipment with a roller-electrode is available, the entire muscle can be treated.
One also probes scar tissue carefully. Wherever scar tissue is found, great care is taken to check whether or not it may be associated with the symptoms (by reflex effects or by blocking the flow of Qi in one or more Channels). Treatment of problem scars is very important. It is discussed in the paper on "Techniques of stimulation of the AP points".
Other areas important to probe include the 66 Command Points (the 60 Phase Points + the 6 Yuan points of the Yang Channels (the Yuan points of the Yin Channels are the same as the Yu points), see paper on the Study of Points and Channels), the front Mu points, the paravertebral Shu Points" (BL13-30), also the outer line of the BL Channel (BL36-40, 41-54)).
Sensitive points excluded from needling treatment include cancers, joint cavities, abscesses, infected wounds, parasitized skin areas and ulcers. In the latter case, the use of TianYing points is permitted in certain conditions (see next section).
In humans, practitioners who use the Earpoints pay particular attention to those points which show abnormal sensitivity.
Point sensitivity can be detected objectively by electronic detectors, as mentioned in an earlier paper.
2. TIANYING POINTS
In certain cases it is permissible to needle abnormal masses, such as goitre, synovial cysts, indurated masses in muscle following intramuscular injections etc. The TianYing point is the point of greatest sensitivity in the mass, cyst etc, It is focus of the problem a swollen or enlarged area such as an inflamed muscle or joint or periosteum. One needle is put into the TianYing point and occasionally, 3 or 4 more needles are placed around this one, from the periphery, as in the diagram (a) and (b) below.
Cyst diagrams (a) and (b):
In the case of varicose leg ulcers, 3-5 needles are sometimes advanced underneath the base of the ulcer as in diagram (c) below. Ulcer diagram (c):
In hip arthritis, for example, point GB30 (HuanTiao) is needled but the needle may also be advanced to peck the periosteum of the femoral neck. The intramuscular lump which sometimes follows injection in the biceps brachii or gluteal muscles can be dispersed quickly by dry-needling the centre of the lump. In "Tennis elbow", the lateral epicondyle of the humerus is often pecked with a needle.
In headache following epidural injection or lumbar puncture, the pain can be relieved by injecting a needle into the original needle track. (A recent paper in a medical journal reported extraordinary success in such cases by injection of 10 ml of the patient's blood back into the puncture site. The author did not acknowledge the Chinese discovered that simple needling of the same area could get the same result).
In general, however, cancer masses, joint cavities, infected wounds and infected abscesses (non-sterile) and parasitised skin areas should not be needled except for biopsy or drainage purposes.
3. LOCAL POINTS
In local problems, such as elbow pain, gastritis, tenesmus etc, one or two local points are included in the prescription. For example, include:
neck pain: GB20; BL10; X 35 (HuaToChiaChi points);
shoulder pain: LI15; TH14;
elbow pain: LI11; HT03;
carpal (wrist) pain: LI05; HT07;
lumbosacral pain: BL23,25; GV03;
hip pain: GB30;
knee (stifle) pain: BL40; GB34; L 16 (HsiYen);
tarsal (hock) pain: BL60 penetrating to KI03;
gastritis: CV12 (CV12 is also the Mu point-for ST);
intestinal disease: ST25, CV04 (these are both local and Mu points for the large and small intestine respectively);
bronchitis: BL13; CV17;
tracheitis: CV22,23.
Other examples of local points are in Table 1 (at the end of the paper).
4. POINTS ON THE AFFECTED CHANNEL
Where an organ or function controlled by a Channel is disturbed, one or more points on that Channel are chosen. For example, ST36 in gastritis; LI04 in ulcerative colitis; LU09 in pneumonia; SP06 in diabetes (Spleen- pancreas); HT07 in tachycardia; BL23,28 in bladder disorders (these are also the Shu points for KI and BL respectively); KI points in KI disorders; PC points in PC disorders etc.
Similarly, where aches or pains are located on or near the course of a Channel, points are chosen on the Channel. For example in pain along the lateral thigh, points GB31 or 32 could be included; for pain along the lateral chest, points GB22 or 25; SP17 or 18 or 19 or 20 or 21 could be included; for pain on the inner aspect of the leg, one might include one or two points from: SP05,06,07,08,09; LV05,06,07; KI08,09,10.
5. DISTANT POINTS ON CHANNELS THROUGH THE AFFECTED AREA
In general, the most effective AP points are below the elbow and knee (the areas in which the 66 Command Points lie.
Problems at one end of the body may be treated by points at the other end. For example, disorders of the head and its organs may be helped by points below the elbow or below the knee (stifle). Points on the head may help problems below the waist.
Also, a local problem may be helped by needling a point above or below it on its Channel. For example GB34 in hip, flank or lateral, thoracic pain; TH05 in elbow, shoulder and side of neck pain; BL40 or 60 in lumbar pain; SP04 in genital pain etc.
A variation of this "Law" is that pain or other disorders at one end of a Channel may be treated by points at the opposite end of the Channel. Examples are: GV20 in haemorrhoids, tenesmus or rectal prolapse; GV26 in low back pain; KI01 in cerebral vascular accident, apoplexy; LI04 in rhinitis, sinusitis, toothache of lower jaw; ST44 in toothache of upper jaw or temporal headache; BL67 or GB37 in eye pain; LU01, HT01 or PC01 in pain in the palm of the hand; TH23, LI20 or SI19 in pain in the dorsum of the hand; SI03, 04 or 05 in tinnitus aurium; LI04, TH05 or SI03 in neck pain.
A Beijing text (9) advises that needles or moxa should not be applied to a wound, an ulcer or scar. The nearest local points should be used instead. This is at variance with two well established techniques: the treatment varicose leg ulcers (in Section 2 above) and the treatment of scar tissue in the paper on "Techniques of stimulation of the AP points").
6. POINTS ON RELATED CHANNELS
The Phase-Mate Channels (Husband-Wife pairs, or Linked Pairs in the same Phase) are: LU-LI; ST-SP; HT-SI; BL-KI; PC-TH; GB-LV. One member of each pair influences the other. Disease along one member of a pair or of the main organ of a pair may be helped by points on the other member of the pair. For example, gastric upsets or pain along the ST Channel may be helped by needling points on the SP Channel. LI points influence LU disorders. LV points are used in GB disorders (see below).
Also, points on nearby (anatomically related) Channels (for example SP, KI, LV in the leg and thigh area; TH, LI, SI on the forearm etc) influence pain etc in the area. Example, pain along LI Channel in the forearm should be helped by local or distal points TH or SI Channels.
7. MASTER POINTS
In Classic AP the Five Phase Points (60 points in total) are very important but these are often ignored in western and modern Chinese AP. They are discussed elsewhere, as are the Master Points of AP.
The most important of the Master Points for therapy are the Shu-Back Association points, Mu-Front Alarm points, Yuan-Source, Luo-Passage and Xi-Cleft points. Whether or not these points are sensitive when their respective organs are upset), these points often are used in therapy.
Combinations of Shu and Mu Points are prescribed frequently when an organ (or its functions/correspondences) is abnormal:
Shu and Mu
BL13 and LU01 in disorders of the Lung
BL25 and ST25 in disorders of the Colon
BL21 and CV12 in disorders of the Stomach
BL20 and LV13 in disorders of the Spleen-pancreas
BL15 and CV14 in disorders of the Heart
BL27 and CV04 in disorders of the Small Intestine
BL28 and CV03 in disorders of the Bladder
BL23 and GB25 in disorders of the Kidney
BL14 and CV17 in disorders of the Pericardium, Circulation-Sex
BL22 and CV05 in disorders of the Triple Heater
BL19 and GB24 in disorders of the Gallbladder
BL18 and LV14 in disorders of the Liver
Combinations of Yuan-Source and Luo-Passage points. In disease of an organ or its Channel, the Yuan point of the affected Channel is used with the Luo point of its Phase-Mate Channel, for example in LU disorders (or disorders of the LU Channel), LU09 (Yuan of LU) and LI06 (Luo of LI) could he used:
affected Yuan and Luo of Mate
in LU disorders: LU09 and LI06
in LI disorders: LI04 and LU07
in ST disorders: ST42 and SP04
in SP disorders: SP03 and ST40
in HT disorders: HT07 and SI07
in SI disorders: SI04 and HT05
in BL disorders: BL64 and KI04
in KI disorders: KI03 and BL58
in PC disorders: PC07 and TH05
in TH disorders: TH04 and PC06
in GB disorders: GB40 and LV05
in LV disorders: LV03 and GB37
The Xi-Cleft points are indicated mainly in acute diseases of their respective Channels or organs. In haemoptysis: LU06 (Xi of LU); in acute colitis: LI07 (Xi of LI); in epigastric pain: ST34 (Xi of ST); in acute lower abdominal pain at menstruation: SP08 (Xi of SP).
Various combinations of Master Points are possible. For example, in liver disease, or in problems of the eyes or nails (which are controlled by LV), the LV Shu point (BL18, KanShu), the LV Mu point (LV14, ChiMen), the LV Yuan point (LV03, TaiChung) and the LV Xi-Cleft point (LV06 ChungTo) might be combined. In liver and gallbladder disease (or in problems controlled by LV and GB Channels), the Luo points LV05 (LiKou) and GB37 (KuangMing) might be combined with the Mu, Shu and/or Xi-Cleft points for liver and gallbladder (LV14, GB24; BL18, BL19; LV06, GB36).
8. COMBINATION OF LOCAL AND DISTANT POINTS
This is one of the most common methods of choosing points. Examples are:
Face and cheek disorders: local points (ST04,06) plus distant points on Channels to the area (e.g.) LI04, ST44.
Eye disease: BL01; ST01 (local) plus SI06; GB37 (distant).
Ear disease: GB02; SI19; TH17 (local) plus SI03, GB43.
Hip arthritis: GB30 (local) plus GB34 (distant).
Other examples are shown in Table 1 (below).
The "Adjacent" point is another type of point, recommended in recent Chinese texts. This is a powerful point, located 1-20 tsun from the local disorder or problem area. Examples are, GB20 for head and eye; GV20 for forehead; GB25 for lower dorsal area and lumbar area; LV13 in gastric pain. Other examples are given in Table 1 (below).
For best results, "Adjacent" points usually are combined with local and distant points as in Table 1. Example: acute gastritis with gastric pain: ST36; PC06 (remote points on the leg and arm) plus CV12 (local point plus Mu point) plus LV13 ("Adjacent point" and Mu of SP).
9. SELECTION OF POINTS ACCORDING TO SYMPTOMS
Symptomatic points: Certain points are known to be highly effective for common symptoms, such as vomiting, nausea, fever etc. In treating a clinical syndrome, points are chosen for the main problem and others may be added for the symptoms. For example, in gastritis: CV12 and ST36 might be chosen as the main points. If symptoms of nausea and fever were also present, points PC06 and GV14 might be added. The Beijing text (2) lists the following points for the common symptoms:
Cough; CV22; LU07; SP06
Diarrhoea: ST25,36; SP04; CV06
Difficulty swallowing: CV22,23; PC06
Dreams, nightmares: BL15; HT07; LV03
Excess mucus, cough: ST40.
Excessive-perspiration: HT06; KI07
Fever: LI04,11; GV14.
Hiccough, diaphragmatic spasm: BL17; ST36
Insomnia: HT07; SP06; KI03; CV24.
Nausea, vomiting: PC06; ST36.
Night sweats: SI03; HT06; Z 01
Pain in the cardiac area: PC06; CV17
Palpitation: PC06,04
Salivation: ST04; CV24,23
Shock: GV26; CV08,04; PC06,09
Other examples of points specific for symptoms are:
GB34 in acute, traumatic or muscular pain. (This is the pain point par excellence. It is usually combined with one of two local points for the affected area).
ST36 in upper abdominal disorders;
SP06 in lower abdominal disorders;
GV26; KI01 in anaesthetic emergencies (collapse, apnoea, cardiac arrest);
PC06 in disorders of the heart, lungs, thorax;
Earpoint Lung in relieving the symptoms of narcotic or alcohol withdrawal.
10. SELECTION OF POINTS ACCORDING TO NERVE SUPPLY
For diseases in any region (head, neck, limbs, internal organs), one may select points from areas supplied by the same spinal nerves, nerve plexus or nerve trunks as supply the problem area. Often, direct needling of the nerve trunk or plexus is used. In this respect, the paravertebral BL points and the paravertebral X 35 (HuaToChiaChi) points are especially useful for many conditions which do not appear (on casual examination to have anything to do with the back. This may be the explanation for the success of chiropractic and other manipulative systems which concentrate on spinal massage and pressure manipulation. These systems would concentrate on the same areas as the BL and X 35 paravertebral points.
11. SELECTION OF FORE AND AFT POINTS
In local disorders, such as knee pain, arm trauma etc, a combination of Fore and Aft points (in front of and behind) are used. These are almost always local points. Examples are: Knee pain: L 16 (HsiYen) and BL40; Forearm pain: PC06 and TH05. The Mu/Shu combination is also an example.
12. EARPOINTS
Sensitive earpoints, plus other earpoints known to be related to the affected areas or functions are used in Ear AP. The system is highly effective in man but needs much more development before it can be recommended for routine use in animals.
FINAL SELECTION OF POINTSS
In the last two sections, we saw that points can be selected from therapeutic indices (Cookbook Approach) or by reference to the Laws of AP. (There are other Laws not discussed in this seminar). Ideally one should keep the number of points used in any one session to a minimum. In practice, however, western acupuncturists may use up to 10 or often 20 points in certain cases. Usually, the number would be <10; Master acupuncturists usually use <5 points. The ultimate aim of the Master is to cure with only 1 needle: few western-trained practitioners attain that standard.
There is no hard and fast rule as to the choice of points. Various combinations are possible but all combinations use the Sensitive (AhShi, Trigger etc) Points, when these are present. Examples would be:
ORGAN DISEASES:
Sensitive Points (if present) + Mu + Shu points + points for symptoms
(or) Sensitive points + Yuan + Luo + Xi + points for symptoms
(or) Sensitive points + Earpoints
(or) Sensitive points + Local points + Distant points on the affected Channel
(or) many other combinations.
LOCAL DISORDERS (say elbow pain):
Sensitive points (if present) + Local points + Distant points on affected and related Channels
(or) Sensitive Points + Earpoints for Elbow + Earpoint ShenMen
(or) Sensitive Points + TianYing point + Fore and Aft points
(or) other combinations.
As mentioned earlier, the Cookbook approach, especially when it is based on a comprehensive (cumulative) therapeutic index, may suggest dozens of points in specific conditions. One way to make a final selection is to use only those points which are most frequently recommended and to ensure that two or more of the AP Laws mentioned above are included in making that selection. An example of this method is given below.
Example: In my files, based on a large number of textbooks and other sources, the following points are recommended for the treatment of elbow pain, strain, trauma, arthritis, rheumatism, etc. The various authors are coded (1) to (22). For the purpose of this exercise, only the Channel points are noted.
Author Points Recommended as Effective
1 LU05,06; LI08,11,12,13,14,15; HT03; SI07,08,11; PC03; TH05,15; GB21,34; AhShi
2 LI11; HT03
3 LI10,11; HT03; SI09; BL10,20,23,37; GV04,12,14; LI11; TH05
5 LU05; LI11; TH05;
6 LU05; LI08,11,12,13; SI04,07,11; PC04
7 LU05; LI01,04,11; PC03; TH05,10; AhShi
8 LI11
9 LU05,06; LI08,12,13; SI04,07,11; PC03; TH01
10 LI10,11; BL40
11 LI10,11; SP04; HT04; SI04; PC06; TH01,03,05
12 LU05,07; LI04,06,11; HT01; SI08; PC03; TH10
13 LI04,10,11,12; HT03; TH05,10;
14 LI11,12; HT04; SI04; TH03,05,10; GB34; AhShi
15 LI02,04,05,10,11,13; SI04,08,10,11,12,13,14; BL42,43,44,45; TH04,06,13,14,16; AhShi
16 LI11; GB34; AhShi
17 LU05; LI04,11,14,15; HT03; SI03,06,07,08; TH05,15; GV14; AhShi
18 LI11; TH10
19 LI02,03,04,10,11; TH05; AhShi
20 LI10,11; HT03; GB21
21 LI11; AhShi
22 LU05; LI11; TH05; AhShi
Ranking these points in order of frequency, we find that in 22 text books, LI11 was listed 21 times. Then followed: TH05; LU05; LI10; AhShi points (in local area, shoulder area and neck) 8-9 times; LI03,04,12; HT03; SI04,07,08,11; PC03; TH10 (4-6 times); LU06; LI02,08,14,15; TH01,03,15; GB21,34; GV14 (2-3 times), Mentioned only once were: LU07; LI01,03,05,06; SP04; HT04; SI03,06,09,10,11,12,13,14; BL10,20,23,37,40,42,43,44,45; PC01,04,06; TH04,06,13,14,16; GV04,12.
Looking through these data, we can select the following points as those most frequently recommended:
LI11,10; TH05; LU05; AhShi points. Let us call these the "Primary Points". Further down the list (frequency 4-6/22) we have LI03,04,12; HT03; SI04,07,08,11; PC03; TH10. Let us call these the "Secondary Points". Still further down the list (frequency 2-3/22), we have LU06; LI02,08,14,15; TH01,03,15; GB21,34; GV14. Let us call these the "Tertiary Points". Other points (listed above) are recommended by single authors but for the purpose of the exercise they are ignored.
I would regard the Primary Points as the most important from which to choose the main points. Local and distant points would be chosen from the primary, secondary and (occasionally) tertiary points (or from other sources of information).
In the final prescription for elbow pain, sprain, arthritis, rheumatism etc, we could select the points as follows:
MAIN POINTS (all cases): LI11; TH05 and AhShi points. LOCAL POINTS (depending on the site of pain) from: LU05; LI10,12; HT03; SI09; PC03; TH10. For example, for pain along the biceps tendon: PC03 or LU05 or HT03 would be added to the main points.
DISTANT POINTS (depending on the site of pain) from: LU06; LI02,03,04,08,14,15; SI04,07,11; TH01,03,15; GB21,34; GV14. For example, in pain of the olecranon, distant points (TH03 or SI07 or LI04) could be added to the main points for elbow (LI11; TH05; AhShi) and local points near the olecranon (TH10 or SI08 and LI12).
This approach to the prescription would fulfill at least 3 of the Laws of choosing points and would also choose the most frequently recommended points for the condition. It should be a successful prescription for routine use and would be expected to give better results than if the Cookbook approach alone was used.
The greatest weakness of Cookbook AP is that it is statistical rather than individual therapy. The "best AP" is to adapt the Cookbook to individual cases and to fulfill at least 2 of the LAWS on the choice of points. At the same time, one should also try to see the whole case (not just the elbow pain) and to treat the patient as an integrated individual.
ALTERNATION OF POINTS
In generalised or systemic conditions, points are often used bilaterally. Thus, if 20 points appeared in the primary and secondary lists, one would have to needle 40 points if all were used!
To limit needles to 6-12 per session, points may be alternated between sessions. For example, primary points in the prescription for diarrhoea are: ST25,36,37; CV04,06,12; SP04,06,09; BL20,25; LV13. One could alternate the points as follows: (bi = bilateral):
Diarrhoea: Session 1: ST25 bi (Local and LI Shu point); CV04 (local and SI Shu point) SP06 bi (symptom point and used in low abdominal disorders); BL20 bi (SP Shu, frequently recommended in diarrhoea). Total 7 needles.
Session 2: ST36 bi (symptom point ); CV06 (Local and in an appropriate neural segment); CV12 (ST Shu; ST is often upset in diarrhoea); SP04 bi (distant point on SP Channel, which traverses affected area and is also appropriate for the symptom); BL25 bi (LI Shu). Total 6 needles.
Session 3: ST37 bi (symptom point); CV04 (SI Mu and local point); SP09 bi (distant point on an appropriate Channel); LV13 bi (SP Mu and on the appropriate Channel). Total 7 needles.
These combinations reduce the number of needles to 7 or 8 per session and meet the major requirements for choosing points. They should be successful. In acute diarrhoea, a response is usually evident after one or two sessions over a 24 hour period. Further sessions are seldom required but may be given over the following days to ensure that the symptoms do not recur.
POINT SELECTION BY PULSE
In classic human AP, the Laws listed above are used in choosing points. However, the Five Phase Points are said to be very important also. Their choice in each case is based on (a) the symptom picture (which may indicate imbalances between the Phases and within one or more Phases) and (b) the CHINESE PULSE DIAGNOSIS. In Western AP the CHINESE PULSE method is largely ignored, mainly because of lack of expertise. Modern texts from China, Taiwan and Hongkong also ignore it, or give it very brief discussion. Furthermore, high therapeutic success rates are reported by physicians who ignore the Pulse system. However, in skilled hands, Pulse Diagnosis can be extraordinarily accurate but I believe it to be a psychic rather than a physical, objectively demonstrable phenomenon. Those who wish to study Pulse Diagnosis will find details in Wu Wei Ping, Mary Austin or Nguyen van Nghi (see references).
In vet AP, even if one wished to use the PULSE system, this would be impossible to transpose directly because of anatomical differences in the arteries and also because the Five Phase Points are located on those parts of the limbs which show the greatest anatomical differences from Homo sapiens, with his/her five digits. (Some traditional vet texts, including Klide and Kung, report that the CHINESE PULSES may be taken in animals on the carotid or other accessible arteries but few of the vet colleagues whom I know use this system. Other psychic methods of Pulse assessment include taking a "surrogate pulse", possibly one's own or the client's or to use dowsing/divining method (pendulum etc). These methods are rarely used.
CONCLUSIONS
The choice of points in vet AP depends on which system (traditional or transpositional) is being followed. It also depends on one's depth of AP knowledge. Novices usually use the Cookbook Method of point selection but they should try to fulfil some of the Laws and to choose points which help the "whole patient", not just the more obvious symptoms.
In the transposition method a therapeutic index can be consulted in one or more human textbooks, or the student may make a personal cumulative therapeutic index from many sources and may rank the points by citation frequency. This will enable him/her to draw up lists of primary, secondary and tertiary points. From these lists one may select 1 to 12 (occasionally more than 12) points but one should ensure at least 2 of the following Laws are fulfilled in each point combination used:
1. Sensitive points (AhShi, Trigger Points etc). Be careful to examine for sensitive areas on surgical or other scars. If these are related to symptoms, treat the scar. (See the paper on "Methods of stimulating the AP points").
2. TianYing points (focus of a swelling etc).
3. Choose local points along affected Channels or nearby Channels.
4. Choose points along the affected Channels choose points on related Channels
5. Distant points on affected Channels
6. Points on related Channels
7. Some of the MASTER POINTS, especially Mu, Shu, Yuan, Luo and Xi points. Mu and Shu are often combined, as are the Yuan for the affected Channels and the Luo for the Phase-Mate Channel.
8. Combination of local and distant points on relevant Channels
9. Points according to the symptoms
10. Points according to the innervation
11. Fore and Aft points
12. Earpoints
In vet AP, few vets are expert enough to use the classical method of balancing the Channels by using the Five Phase Theory and the 66 Command Points. French colleagues are probably the most expert in this area, as they study the classic concepts in very great depth. Although vets in USA and other countries learn this system, few of them study it deep enough to be really familiar with it. Do not let this deter you!
One old Law of AP states that points on one side of the body may be used to treat problems on the opposite side. This is one aspect of the "Law of Opposites". However, it is more usual to use points on the same side as a local problem unless the problem is in the midline (or near it), in which case points are needled bilaterally.
In certain cases, contralateral points may be used. For example, in motor paralysis, Motor Points (on the Scalp) are needled on the side opposite to the paralysis. In toothache, left LI04 may be used to treat pain in the right jaw (although, more commonly, ipsilateral LI04 is used).
It may be desirable to alternate the points between different sessions if the student is unhappy with his first selection or if the results are not satisfactory.
In other cases of paralysis, contralateral body points (on the "good" limb) are used as well as ipsilateral points. In the Appendix to this paper a list of AP prescriptions is given.
Vets using the traditional AP system may use the therapeutic index in a suitable textbook or may construct their own index from many sources. However, there is a major difficulty of integration of various sources because of differences in point location, nomenclature and alphanumeric coding between various texts and even within texts.
FURTHER READING
1 Veterinary AP (1977). by Klide, A.M. and Kung, S.H. University of Pennsylvania Press, 297 pp.
2 Outline of Chinese AP (1975). by Academy of Traditional Medicine. Foreign Languages Press, Beijing, 305 pp.
3 Newest illustrations of the AP points (1973). by Medicine & Health Publishing Co., Hong Kong, 100 pp.
4 Basic AP: a scientific interpretation and application (1977). by Chinese AP Research Foundation. C.A.R.F. Box 84-223 Taipei, Taiwan, 311 pp.
5 Barefoot Doctor's Manual (1977). American translation of official Chinese Manual by U.S. Dept. Health & Education. Running Press, Philadelphia, 948 pp.
6 Chinese Acupuncture (1973). by Wu Wei Ping. Health Science Press, Wellingborough, Northants, U.K., 181 pp.
7 Acupuncture therapy (1972). by Mary Austin. Turnstone Books, London, 290 pp.
8 Pathogenic et Pathologic Energetiques en Medicine chinoise. (1971). by Nguyen van Nghi. Imprimerie Ecole Technique Don Bosco, 78 Rue Stanislas Torrents, 13 Marseille, France, 699 pp.
9 Essentials of Chinese AP (1980). by Beijing, Shanghai and Nanking Colleges of Traditional Medicine, with the Acad. Trad. Chinese Med. Foreign Languages Press, Beijing, 432 pp. Reissued 1993: Essentials of Chinese AP. (Coll. TCM, Beijing, Shanghai, Nanking) Foreign Languages Press, Beijing 432pp.
In the last two sections, we saw that points can be selected from therapeutic indices (Cookbook Approach) or by reference to the Laws of AP. (There are other Laws not discussed in this seminar). Ideally one should keep the number of points used in any one session to a minimum. In practice, however, western acupuncturists may use up to 10 or often 20 points in certain cases. Usually, the number would be <10; Master acupuncturists usually use <5 points. The ultimate aim of the Master is to cure with only 1 needle: few western-trained practitioners attain that standard.
There is no hard and fast rule as to the choice of points. Various combinations are possible but all combinations use the Sensitive (AhShi, Trigger etc) Points, when these are present. Examples would be:
ORGAN DISEASES:
Sensitive Points (if present) + Mu + Shu points + points for symptoms
(or) Sensitive points + Yuan + Luo + Xi + points for symptoms
(or) Sensitive points + Earpoints
(or) Sensitive points + Local points + Distant points on the affected Channel
(or) many other combinations.
LOCAL DISORDERS (say elbow pain):
Sensitive points (if present) + Local points + Distant points on affected and related Channels
(or) Sensitive Points + Earpoints for Elbow + Earpoint ShenMen
(or) Sensitive Points + TianYing point + Fore and Aft points
(or) other combinations.
As mentioned earlier, the Cookbook approach, especially when it is based on a comprehensive (cumulative) therapeutic index, may suggest dozens of points in specific conditions. One way to make a final selection is to use only those points which are most frequently recommended and to ensure that two or more of the AP Laws mentioned above are included in making that selection. An example of this method is given below.
Example: In my files, based on a large number of textbooks and other sources, the following points are recommended for the treatment of elbow pain, strain, trauma, arthritis, rheumatism, etc. The various authors are coded (1) to (22). For the purpose of this exercise, only the Channel points are noted.
Author Points Recommended as Effective
1 LU05,06; LI08,11,12,13,14,15; HT03; SI07,08,11; PC03; TH05,15; GB21,34; AhShi
2 LI11; HT03
3 LI10,11; HT03; SI09; BL10,20,23,37; GV04,12,14; LI11; TH05
5 LU05; LI11; TH05;
6 LU05; LI08,11,12,13; SI04,07,11; PC04
7 LU05; LI01,04,11; PC03; TH05,10; AhShi
8 LI11
9 LU05,06; LI08,12,13; SI04,07,11; PC03; TH01
10 LI10,11; BL40
11 LI10,11; SP04; HT04; SI04; PC06; TH01,03,05
12 LU05,07; LI04,06,11; HT01; SI08; PC03; TH10
13 LI04,10,11,12; HT03; TH05,10;
14 LI11,12; HT04; SI04; TH03,05,10; GB34; AhShi
15 LI02,04,05,10,11,13; SI04,08,10,11,12,13,14; BL42,43,44,45; TH04,06,13,14,16; AhShi
16 LI11; GB34; AhShi
17 LU05; LI04,11,14,15; HT03; SI03,06,07,08; TH05,15; GV14; AhShi
18 LI11; TH10
19 LI02,03,04,10,11; TH05; AhShi
20 LI10,11; HT03; GB21
21 LI11; AhShi
22 LU05; LI11; TH05; AhShi
Ranking these points in order of frequency, we find that in 22 text books, LI11 was listed 21 times. Then followed: TH05; LU05; LI10; AhShi points (in local area, shoulder area and neck) 8-9 times; LI03,04,12; HT03; SI04,07,08,11; PC03; TH10 (4-6 times); LU06; LI02,08,14,15; TH01,03,15; GB21,34; GV14 (2-3 times), Mentioned only once were: LU07; LI01,03,05,06; SP04; HT04; SI03,06,09,10,11,12,13,14; BL10,20,23,37,40,42,43,44,45; PC01,04,06; TH04,06,13,14,16; GV04,12.
Looking through these data, we can select the following points as those most frequently recommended:
LI11,10; TH05; LU05; AhShi points. Let us call these the "Primary Points". Further down the list (frequency 4-6/22) we have LI03,04,12; HT03; SI04,07,08,11; PC03; TH10. Let us call these the "Secondary Points". Still further down the list (frequency 2-3/22), we have LU06; LI02,08,14,15; TH01,03,15; GB21,34; GV14. Let us call these the "Tertiary Points". Other points (listed above) are recommended by single authors but for the purpose of the exercise they are ignored.
I would regard the Primary Points as the most important from which to choose the main points. Local and distant points would be chosen from the primary, secondary and (occasionally) tertiary points (or from other sources of information).
In the final prescription for elbow pain, sprain, arthritis, rheumatism etc, we could select the points as follows:
MAIN POINTS (all cases): LI11; TH05 and AhShi points. LOCAL POINTS (depending on the site of pain) from: LU05; LI10,12; HT03; SI09; PC03; TH10. For example, for pain along the biceps tendon: PC03 or LU05 or HT03 would be added to the main points.
DISTANT POINTS (depending on the site of pain) from: LU06; LI02,03,04,08,14,15; SI04,07,11; TH01,03,15; GB21,34; GV14. For example, in pain of the olecranon, distant points (TH03 or SI07 or LI04) could be added to the main points for elbow (LI11; TH05; AhShi) and local points near the olecranon (TH10 or SI08 and LI12).
This approach to the prescription would fulfill at least 3 of the Laws of choosing points and would also choose the most frequently recommended points for the condition. It should be a successful prescription for routine use and would be expected to give better results than if the Cookbook approach alone was used.
The greatest weakness of Cookbook AP is that it is statistical rather than individual therapy. The "best AP" is to adapt the Cookbook to individual cases and to fulfill at least 2 of the LAWS on the choice of points. At the same time, one should also try to see the whole case (not just the elbow pain) and to treat the patient as an integrated individual.
ALTERNATION OF POINTS
In generalised or systemic conditions, points are often used bilaterally. Thus, if 20 points appeared in the primary and secondary lists, one would have to needle 40 points if all were used!
To limit needles to 6-12 per session, points may be alternated between sessions. For example, primary points in the prescription for diarrhoea are: ST25,36,37; CV04,06,12; SP04,06,09; BL20,25; LV13. One could alternate the points as follows: (bi = bilateral):
Diarrhoea: Session 1: ST25 bi (Local and LI Shu point); CV04 (local and SI Shu point) SP06 bi (symptom point and used in low abdominal disorders); BL20 bi (SP Shu, frequently recommended in diarrhoea). Total 7 needles.
Session 2: ST36 bi (symptom point ); CV06 (Local and in an appropriate neural segment); CV12 (ST Shu; ST is often upset in diarrhoea); SP04 bi (distant point on SP Channel, which traverses affected area and is also appropriate for the symptom); BL25 bi (LI Shu). Total 6 needles.
Session 3: ST37 bi (symptom point); CV04 (SI Mu and local point); SP09 bi (distant point on an appropriate Channel); LV13 bi (SP Mu and on the appropriate Channel). Total 7 needles.
These combinations reduce the number of needles to 7 or 8 per session and meet the major requirements for choosing points. They should be successful. In acute diarrhoea, a response is usually evident after one or two sessions over a 24 hour period. Further sessions are seldom required but may be given over the following days to ensure that the symptoms do not recur.
POINT SELECTION BY PULSE
In classic human AP, the Laws listed above are used in choosing points. However, the Five Phase Points are said to be very important also. Their choice in each case is based on (a) the symptom picture (which may indicate imbalances between the Phases and within one or more Phases) and (b) the CHINESE PULSE DIAGNOSIS. In Western AP the CHINESE PULSE method is largely ignored, mainly because of lack of expertise. Modern texts from China, Taiwan and Hongkong also ignore it, or give it very brief discussion. Furthermore, high therapeutic success rates are reported by physicians who ignore the Pulse system. However, in skilled hands, Pulse Diagnosis can be extraordinarily accurate but I believe it to be a psychic rather than a physical, objectively demonstrable phenomenon. Those who wish to study Pulse Diagnosis will find details in Wu Wei Ping, Mary Austin or Nguyen van Nghi (see references).
In vet AP, even if one wished to use the PULSE system, this would be impossible to transpose directly because of anatomical differences in the arteries and also because the Five Phase Points are located on those parts of the limbs which show the greatest anatomical differences from Homo sapiens, with his/her five digits. (Some traditional vet texts, including Klide and Kung, report that the CHINESE PULSES may be taken in animals on the carotid or other accessible arteries but few of the vet colleagues whom I know use this system. Other psychic methods of Pulse assessment include taking a "surrogate pulse", possibly one's own or the client's or to use dowsing/divining method (pendulum etc). These methods are rarely used.
CONCLUSIONS
The choice of points in vet AP depends on which system (traditional or transpositional) is being followed. It also depends on one's depth of AP knowledge. Novices usually use the Cookbook Method of point selection but they should try to fulfil some of the Laws and to choose points which help the "whole patient", not just the more obvious symptoms.
In the transposition method a therapeutic index can be consulted in one or more human textbooks, or the student may make a personal cumulative therapeutic index from many sources and may rank the points by citation frequency. This will enable him/her to draw up lists of primary, secondary and tertiary points. From these lists one may select 1 to 12 (occasionally more than 12) points but one should ensure at least 2 of the following Laws are fulfilled in each point combination used:
1. Sensitive points (AhShi, Trigger Points etc). Be careful to examine for sensitive areas on surgical or other scars. If these are related to symptoms, treat the scar. (See the paper on "Methods of stimulating the AP points").
2. TianYing points (focus of a swelling etc).
3. Choose local points along affected Channels or nearby Channels.
4. Choose points along the affected Channels choose points on related Channels
5. Distant points on affected Channels
6. Points on related Channels
7. Some of the MASTER POINTS, especially Mu, Shu, Yuan, Luo and Xi points. Mu and Shu are often combined, as are the Yuan for the affected Channels and the Luo for the Phase-Mate Channel.
8. Combination of local and distant points on relevant Channels
9. Points according to the symptoms
10. Points according to the innervation
11. Fore and Aft points
12. Earpoints
In vet AP, few vets are expert enough to use the classical method of balancing the Channels by using the Five Phase Theory and the 66 Command Points. French colleagues are probably the most expert in this area, as they study the classic concepts in very great depth. Although vets in USA and other countries learn this system, few of them study it deep enough to be really familiar with it. Do not let this deter you!
One old Law of AP states that points on one side of the body may be used to treat problems on the opposite side. This is one aspect of the "Law of Opposites". However, it is more usual to use points on the same side as a local problem unless the problem is in the midline (or near it), in which case points are needled bilaterally.
In certain cases, contralateral points may be used. For example, in motor paralysis, Motor Points (on the Scalp) are needled on the side opposite to the paralysis. In toothache, left LI04 may be used to treat pain in the right jaw (although, more commonly, ipsilateral LI04 is used).
It may be desirable to alternate the points between different sessions if the student is unhappy with his first selection or if the results are not satisfactory.
In other cases of paralysis, contralateral body points (on the "good" limb) are used as well as ipsilateral points. In the Appendix to this paper a list of AP prescriptions is given.
Vets using the traditional AP system may use the therapeutic index in a suitable textbook or may construct their own index from many sources. However, there is a major difficulty of integration of various sources because of differences in point location, nomenclature and alphanumeric coding between various texts and even within texts.
FURTHER READING
1 Veterinary AP (1977). by Klide, A.M. and Kung, S.H. University of Pennsylvania Press, 297 pp.
2 Outline of Chinese AP (1975). by Academy of Traditional Medicine. Foreign Languages Press, Beijing, 305 pp.
3 Newest illustrations of the AP points (1973). by Medicine & Health Publishing Co., Hong Kong, 100 pp.
4 Basic AP: a scientific interpretation and application (1977). by Chinese AP Research Foundation. C.A.R.F. Box 84-223 Taipei, Taiwan, 311 pp.
5 Barefoot Doctor's Manual (1977). American translation of official Chinese Manual by U.S. Dept. Health & Education. Running Press, Philadelphia, 948 pp.
6 Chinese Acupuncture (1973). by Wu Wei Ping. Health Science Press, Wellingborough, Northants, U.K., 181 pp.
7 Acupuncture therapy (1972). by Mary Austin. Turnstone Books, London, 290 pp.
8 Pathogenic et Pathologic Energetiques en Medicine chinoise. (1971). by Nguyen van Nghi. Imprimerie Ecole Technique Don Bosco, 78 Rue Stanislas Torrents, 13 Marseille, France, 699 pp.
9 Essentials of Chinese AP (1980). by Beijing, Shanghai and Nanking Colleges of Traditional Medicine, with the Acad. Trad. Chinese Med. Foreign Languages Press, Beijing, 432 pp. Reissued 1993: Essentials of Chinese AP. (Coll. TCM, Beijing, Shanghai, Nanking) Foreign Languages Press, Beijing 432pp.
Table 1
Examples of point selection using Local, Adjacent and Distant points.
Examples of point selection using Local, Adjacent and Distant points.
APPENDIX
ACUPUNCTURE PRESCRIPTIONS
1980
(See Appendices 1-3 of the paper "Choice of AP points for particular conditions" for a later Cookbook)
INTRODUCTION
These prescriptions have been compiled by the frequency ranking method for points and prescriptions in more than 30 textbooks and many other articles on human AP. Prescriptions are available from such sources for more than 800 human disorders and symptoms, of which less than 10% are listed in this Appendix. This material is presented to students as a guide to the selection of points in the more common conditions.
The prescriptions concentrate mainly on the Channel points and some of the more commonly used "Strange", "New" and "Hand" points. They ignore the "Scalp points", "Earpoints", "Foot Zone points", "Nose points", "Face points" and other valuable reflex points. (Students interested in these methods should consult the relevant texts).
AP therapy is not a panacea, nor is it equally effective for all conditions listed below. Certain condition, such as muscular lameness, vomiting, diarrhoea, anaesthetic apnoea, hormonal infertility and convulsions are said to respond quickly and successfully. Others, such as lameness in severe spinal trauma, osteoarthritis, chronic bronchitis etc require longer courses of AP therapy man may have failure rates of 30-40%. Still other conditions, such as peripheral nerve paralysis, paraplegia, paralysis after cerebrovascular accident, urinary incontinence, severe arthritis (especially polyarthritis) are even more difficult to treat successfully.
Acute conditions often respond in 1-4 sessions at intervals of 12-14 hours. Chronic and more difficult conditions may require up to 14 or more sessions at intervals of 3-7 days. As a general rule, if some improvement is not seen by the 6th session, the probability of success becomes less and less with each subsequent non-responding session.
AP is frequently combined with other forms of therapy, such as hyperbaric oxygen and physiotherapy in nerve paralysis; antibiotic therapy in acute, progressive infections, artificial respiration, transfusion and vasodilator therapy in severe toxaemic shock (Chinese Medical Journal, Beijing, November 1978 p.497); herbal medicine in cough and many other conditions. However, concurrent use of large doses of sedatives, narcotics, opiate antagonists, corticosteroids and analgesics is unwise according to some authorities. These drugs may antagonise the effects of AP at the level of the specific or non-specific receptors in the brain, spinal cord or other target areas. If possible, patients should be weaned off these drugs before AP is used. However, other authorities dispute this claim. Therefore, at this time, the question remains unresolved. In emergencies and in very serious conditions, AP is given despite the concurrent use of "antagonistic drugs". Examples are GV26 + KI01 in narcotic- induced apnoea and the use of Earpoint "Lung" to prevent withdrawal symptoms in narcotic addicts being detoxified by intravenous naloxone injections.
Channel codes used in the Index are: LU= Lung; LI= Large Intestine, colon; ST= Stomach; SP= Spleen-Pancreas; HT= Heart; SI= Small Intestine; BL= Bladder; KI= Kidney; PC= Pericardium, Circulation-Sex, Heart Constrictor; TH= Triple Heater; GB= Gallbladder; LV=Liver; GV=Governing Vessel (Du, dorsal midline); CV=Conception Vessel (Ren, ventral midline).
Z 01-31; Y 01-19; X 01-35; A 01-44; L 01-42 are the "Strange Points" for Head & Neck; Thorax and Abdomen; Loin and Back; Upper Limb and Lower Limb respectively.
NZ01-35; NY01-06; NX01-16; NA01-15; NL01-36 are the "New Points" for Head & Neck; Abdomen; Loin and Back; Upper Limb and Lower Limb respectively, H are the Hand points".
In this system, ST08 (TouWei) is on the temple and BL40 (WeiZhong) is in the popliteal crease.
Thus, the point identification system used in these prescriptions is that adopted by IVAS. The name of each point is listed in the Appendix to the paper on the Study of the Points and Channels.
CHOOSING POINTS FROM THE INDEX
These prescriptions are usually in the format of a Primary + Secondary + Tertiary list. The Primary (P) list is the most important. They are regarded as the Main Points. Points in the Secondary (S) and Tertiary (T) lists are added only if the symptoms dictate. For example, in chronic debilitating diseases, Primary (P) points are: BL43; ST36; X 18. Secondary (S) points are: BL17,20,23; CV06; PC06. If abdominal pain or uterine pathology is present: add CV06; if kidney disease is present: add BL20 (or BL21) etc.
In short prescriptions, the Secondary (S) list could be added as a routine. For example in skin diseases involving malignant pustules, the Primary (P) point is GV12 and the Secondary (S) points (LI04; BL40) could be added routinely.
The Laws governing the choice of Points (see the preceding paper) should be kept in mind and at least two of them should be fulfilled by the points used. Also consider alternating the choice of points between sessions.
AP PRESCRIPTIONS IN ANIMALS
(Transposition Method)
The convention x to y means a needle penetrating from point x to point y (for example GB39 to SP06); the convention x-y means any or all points between point x and point y (for example SI10-14).
GENERAL CONDITIONS
To stimulate immune reaction (antibody production (immunostimulant effect), leucocytosis, phagocytosis in infections or leucopenia) P: LI04,11; GV14; ST36; GB39 to SP06; S: In localised infections add points for the region or organ affected.
Chronic disease (slow convalescence; to improve constitution after debilitating diseases) P: BL43; ST36; X 18; S: BL17,20,23; CV06; PC06.
Weak constitution (fatigue, poor general health, general weakness (as a tonic) P: CV03,04; ST36; SP06; LI11; BL20,43; S: PC06; SP21; CV12; LI04; HT09; BL10,11; LV03; GV14; GB34,38; X 18.
Fever, hyperthermia P: LI04,11; GV14; S: ST36,44; LU10; Bleed Earpoint "Apex"; Dehydration, thirst: add KI07.
Allergies, hypersensitivities (immunosuppressant effect) P: LI04,11; ST36; GV14; LV03; GB39 to SP06; S: Local allergies: add local and distant points for the region or affected organ; Urticaria: add SP10.
Anaemia P: GV14; ST36; BL17; CV04,06; LI11; S: GV04; CV12; BL18,20,22,23; T: PC06; SP06,10; LI04; KI01; GV20
Anaesthetic emergencies (apnoea, respiratory and cardiac arrest), neonatal asphyxia P: GV26; S: KI01; T: strong stimulation of ear canal.
Recumbency, downer-cow syndrome: Injection of 2% procaine solution into BL22,23,24,28 (bilateral), GV03; 5 ml per point, at a depth of 35-40 mm. Alternative is 250 ml 1% methylene blue solution (i/v) into jugular vein. (Take great care not to allow perivascular leakage !)
Muscle cramp, poor finish in racing animals P: AhShi points in muscles; Forelimb: search forelimb, neck, thoracic muscles. Hindlimb: search hindlimb, lumbosacral and abdominal muscles). Add main points for cramping region; (Hindlimb, esp. BL23,40,57; GB30,34; Lowback especially BL23,25,27,31; GV02,03,04; X 35 (L1-S4); S: BL40,60; GB30,34; Forelimb especially GB21; LI11,15; TH05,14; BL11,12,41; X 35 (C1-T6 area)).
Paralysis of peripheral motor nerves, spinal paralysis P: Stimulate nerves (bilaterally), with strong stimulation on affected side. Use local points for the region or affected limb, especially a chain of points over affected nerves. Use AhShi points, if present (but they are seldom present). Use the Scalp points (on the opposite side) for the Motor Areas; S: Massage and physiotherapy, if possible. If cerebral anaemia is suspected, add GV26. Consult textbooks for further details.
DISORDERS OF THE SKIN
Neurodermatitis, dermatitis, eczema, urticaria, pruritus P: LI04,11; SP06,10; KI09; ST36; S: LI04,15; GV14; BL13,17,23,25,40; PC07; GB20; ST25; SI03.
Malignant-pustules, carbuncles, furuncles, boils, folliculitis (anywhere on the body) P: GV12; S: LI04; BL40.
Abscess, felon, whitlow (nailbed) P: GV10; S: BL40.
NERVOUS DISORDERS
Epilepsy, during attack P: GV26; KI01; LU11; SI03; BL62; Between attacks P: GV14,20; PC06; HT07; ST36,40; BL15; CV12; Y 29; S: GV06,08,13,24; PC05; HT05; GB20: CV15; SI03; BL62; T: GV01,12,15,16,17; KI06,09; SP01; PC07,08; GV06,17; LI04,11; BL03,05,61,63,64,65; GB09,13,15; ST41,42,45; SI08; TH17; LV02,03; A 01; Z 01.
Convulsions, during attack P: KI01; GV26; Between attacks P: LI04; LV03; SI03; BL20; ST36; S: LU11; LI11; SP01; BL60,63; GB20; LV02; CV04,06,12; GV12,14,21,22.
Hysteria, during attack P: KI01; GV26; Between attacks P: PC06; HT04,07; SP06; GV08; KI01,05: LI04; BL15,22; CV12; GV13,26; ST36,40; SI03; GV14,20.
Unconsciousness, coma P: GV26; KI01; LU11; A 01; S: GV20; PC06,08,09; LV03; HT09; T: LI01,04; ST36; CV06; GV24,25.
DISORDERS OF THE NECK AND THORACIC LIMB
Neck pain, sprain, rheumatism, spasm, arthritis, slipped disc, wry neck and paralysis P: GB20,21,39; BL10,11; GV14,16; SI03,07; X 35 (C2-T4); A 23; AhShi; S: BL12,41; SI06,14,15; LI04,11; LU07; TH05,15; BL40,43,60,64,65; SI10,11,16; GB34,36; GV13,18; CV24; TH10,12,16; HT07; LI15; KI01; A 22.
Upper limb pain, sprain, rheumatism, spasm, arthritis P: LI04,11,15; TH05; AhShi (neck, back, shoulder area and arm) and local points; S: SI03,06,08; BL11; LI10; T: TH07,14; BL18,40,62; GB34; ST44; NZ23; A 30,32.
Upper limb paralysis P: LI15; LI11 to HT03; TH09 to TH10; TH05 to PC06; LI04 to PC08 (or LI04 to SI03); S: LI09,10; SI09; A 30; NX04; SI06; GB21; TH03,04.
Shoulder, pain, cramp, rheumatism, stiffness, arthritis, bursitis P: TH14,15; LI11,15,16; BL11; SI09,11; AhShi; S: TH10; SI03,10,13; GB21; T: TH03,06,11,13; GV12,14; SI12,14,15; LI04,10; BL13,41,44; A 42.
Shoulder, Shoulder muscles and thoracic back pain, spasm etc P: LI11,15; SI09,10,11,12,13,14; GB21; TH14; AhShi; S: BL11; SI03,08,15; LU02,09; LI02; T: TH03,11,13,15; SI06; LI04; BL12,13,41,42,44; GB20; HT02.
Shoulder and arm muscles: pain, cramp, rheumatism P: LI04,11,15; TH05,14; AhShi; S: LI10; TH06,15; GB34; ST36; T: LI07,16; TH10,11,13; SI11.
Elbow pain, sprain, arthritis, rheumatism P: AhShi; LI11 to HT03; LI12; LU05; TH05; S: LI04,10; GB34; SI04; T: LI08,12,13,14; SI07,08,11; PC03; TH01,10; LU06; GB21; HT01,04.
Wrist, carpal pain, sprain, rheumatism, arthritis P: (Choose according to the affected Channel and side): AhShi (local and shoulder girdle); LI04,05,06; SI04,05; TH04,05; HT05,07; PC07; LU07; S: SI06,11; TH06; LU08; A 09,22; T: SI03,05,08,10-14; LU06,09; LI03; HT06; PC04; TH02,03,13,14; BL12-17; BL41-46.
Metacarpal pain, sprain, rheumatism P: LI03,04; LU01,07; PC01,07,08; HT01,07; A 22; SI04; TH04; AhShi; S: LI05,06,11,20; LU05,08; SI03,07; TH02,03,05,23.
Finger (digital, upper limb) pain, sprain, rheumatism, arthritis P: AhShi; A 22; PC07; LU07; LI03,04; SI03,04,07; S: LI05; HT07; TH03,04,05; local periosteal AP (Thumb: esp. LU07 and periosteal local AP; Index: especially LI03,04,05; PC07; Middle: especially PC07,08; Fourth finger: esp. TH03; HT07; Little finger: especially SI07; TH03; HT07; T: LI06; HT03; TH06,13,14; A 09,17; PC04,06,08; GV14; SI06,08,10-14; BL12-17,41-46.
DISORDERS OF THE THORACIC AREA, HEART, LUNGS, TRACHEA
Pain, trauma, rheumatism, stiffness, spasm, arthritis, slipped disc in thoracic spine and thoracic back muscle area P: Spinal AhShi; X 35; GV points esp. 09,12,13,14; GB30; S: GV05,06,08,11; BL23,46,49,50; GB21,26; SI11,14; T: GV01,02,03,07,10,15,16; KI01,02,03,04,08; CV04,06,12,22; ST13,37,39,41; BL40,56,60,64; LI05; GB20,25; LU02; LV13.
Palpitations, atrial fibrillation, functional cardiac disorders P: HT05,07,09; PC06,07; BL15; S: HT06,08; PC03,05; BL10,14; CV14; T: HT03; PC04; BL11,12; LU04; LI04; ST36; LV01,03; GB20; CV06,12,17; GV24.
Bronchitis P: LU05; BL11,12,13,43; CV17,22; S: LU01; LI03; ST13,14,15,40; SI15; BL42,44; KI22,23; PC06; CV18,19,23; GV10,12,14; NX04; T: LU09; ST36; BL08,14,17; CV14; X 01; Acute P: LU05; BL13; CV22; LI04; GV14; S: PC06; TH05; BL12; ST40; GB20; T: LU07,08,09; LI06; SI17; BL10; SP06; GB21; CV17; GV16; Chronic P: LU05; BL13; CV22; ST40; CV12,17; BL12; S: PC06; BL08,20; LU06,07; CV06; GV12; LI04; T: LU01; ST36; BL11,17; CV18; NX04.
Asthma, bronchospasm, functional emphysema P: CV17,22; NX04; X 01; BL13; PC06; ST40; S: LU01,02,05,07,09,10; ST36; LI04; CV06,12; BL11; GV14; T: LU03,06,08; ST09,10,12,13,16; KI04,27; CV04,16,18,23; GV10,12; SI15; GB19,23,35,44; SP06.
Chronic rhinitis, sniffles P: LI04,20; Z 03,14; GB20; GV23,25; S: LI11,19; GV14,20,24; Z 15,16; BL07,08; LU05; GB04.
Soft moist cough, excess phlegm P: ST40; CV12; S: LU07; BL20; LI18.
Cough P: BL13; LU05,07; CV17,22; ST40; S: LU02,06,08,09,10,11; LI04; ST36; KI03,27; CV21; T: LU01,04; LI18; ST16; SP18; BL11,12,43; KI24,25,26; PC02; CV12,16,20; GV11,14.
Tracheitis (see laryngitis) P: CV22; BL11,13; S: LI04; GV14; ST40; LU05,07.
DISORDERS OF ABDOMINAL AREA, DIGESTIVE, REPRODUCTIVE, URINARY SYSTEMS AND LOW BACK; DISORDERS OF THE DIGESTIVE TRACT
Malabsorption, ill-thrift, weight loss P: ST36; BL20,21; CV06; bleed A 09; S: CV12; KI03; LV13; BL17.
Anorexia, total inappetance P: ST36, KI17; CV12; S: CV10; GV07; ST21,22; SP04; HT07; BL20.
Poor appetite, inappetance P: BL20; ST36; S: KI17; CV12; GV07; ST22; SP06; HT07; BL18,21; LI04.
Digestive upsets, indigestion P: ST36; CV12; S: BL21; SP06; ST25; CV10; T: ST45; BL20,22,47,49; LV13,14; GV05,11; SP04,05,16; PC06; T: GV06,13,14; BL66; LI04; ST21,23; SP15,21.
Vomiting P: ST36; PC06; CV12; S: ST25; SP03,04; BL20,21; KI20; GV18; CV11,13,14,18,22; T: BL45,46,49,50; KI20,21,25,26; TH19; GB23; CV06,08,15,16; SI04; LV03,13; LI04; Neurogenic, nervous vomiting P: ST36; PC06; CV12; BL17.
Nausea P: PC06; CV12; ST36; S: HT03; BL21; CV02,03,13,14; Continuous: add KI01; Neurotic: add BL17; ST21.
Gastritis P: PC06; ST21,36; CV12,13; BL21; S: BL18,20; ST20,25; CV06; T: BL17,19,22; SP04,05,06; ST19,23,37.
Colic, gastric: see vomiting.
Enteritis P: BL22,25,29,53; GV05; S: ST25,36,37,39; BL21,27; CV06,08,10; GV03; SP05; Chronic: add Moxa CV08.
Gastroenteritis P: PC06; ST25,36; S: BL21; SP04; CV12; moxa CV08; needle points 0.5" near CV08; A 09 (4 points 1" near umbilicus)).
Ulcerative colitis, colic, spasm P: ST25,36; SP15; CV06; BL25,27; S: CV12; BL20,21; LI04; HT07. T: LI10; ST17,28,37,40,44; HT03; BL22,24,31; PC06; GB28,34; LV03; CV03,04,08,13.
Diarrhoea P: ST25,36,37; CV04,06,12; SP04,06,09; BL20,25; LV13; S: ST34; moxa CV08; SP03,14,15; BL21; KI07; GV05,06; T: LI03,04: KI08,13,14,20,21; GV01,03; LV14; Chronic: add moxa CV08.
Constipation P: TH06; KI06; SP15 (or) ST25,26; CV06; BL25; SP03; KI16; S: CV12; BL27,28,33,36,38,50,51,57; SP03,16; GV01; GB34; T: ST40,44; CV03; LV01,02; LI02,11; GB28.
Colic (intestinal) P: ST25,36; CV06; moxa CV08; S: LI04; BL25; CV12; LV03; T: ST37; LV02,05; SP14.
Paralytic ileus P: ST25,36; SP15; BL25,27.
Anal/perineal pruritus, pain P: GV01,20; BL57; SP10; S: BL25,32; TH06.
Tenesmus, anal ptosis, protrusion P: GV01,20; BL57; CV08 (moxa); S: GV02,06; CV06; ST25,36.
DISORDERS OF REPRODUCTIVE SYSTEM
Pseudopregnancy (to terminate); to induce birth near term, misalliance (to abort) P: SP06; ST36; BL32; CV05,06; LI04; KI08; "labour points" (in human, 2" lateral and 2" below umbilicus, bilateral; S: ST25; CV02; SP09.
To facilitate calving, relaxation of pelvic ligaments in dystocia P: GV02,03,04; BL32,53; S: BL23,24,26,31,33,34,54.
To facilitate reposition of prolapsed uterus P: GV02,03,04; BL23,26,31,53; S: BL24,32,33,34,54.
Placental retention P: CV03; BL60,67.
Uterine inertia, failure to regress postpartum P: CV02,04; GV20; SP06; Y 16 to Y 18; S: ST29,36; CV03,06.
Lochiorrhoea P: CV07; Y 15.
Vaginal discharge, leucorrhea P: CV03,04,06; SP06; ST25; LV03; GB26; S: CV02,05; BL27,31-35; KI10,12; ST29; LV11; T: CV07; BL23,30; GV04; SP10; ST36; LV04.
Metritis P: BL30; SP12; GB26,27; S: BL27,28,31,32; GV04; CV07; GB28,29; T: BL25,33,35; SP06,10; ST29,36; LI04; CV02,03,04; Y 18.
Anoestrus, cystic ovaries, repeat breeders in cows, infertility P: Main point is 4" from mid-line in L5-L6 space (bilateral); use also AhShi points in lumbosacral area (i.e. in area BL23 to BL34); S: points from GV02,03,04; BL23,24,26,31-34,44,53.
DISORDERS OF URINARY SYSTEM
Urinary tract disorders P: CV03,06; ST25; BL31-34; AhShi; S: CV04,05; SP06; LV08; BL23; GV04; X 35 (Sacral 1-4).
Bladder disorders P: CV03,06; SP06; BL23,28; S: BL32; CV04; SP09.
Cystitis P: BL28,38,58; CV03,04; KI02,03; ST28; S: BL23,25,26,31-33,54; GB26,29; SP06,09; CV02; T: ST27.
Bladder pain, spasm (in obstruction, calculi, colic) P: BL23,28; SP06; S: SP09; BL24,25,27,31,33; CV03,04,06; ST30,36
Dysuria, pain or difficulty on urination P: SP06,09; CV03,04; BL32; S: HT08; BL23,27,28,31,33,34,52; SP11; CV02,05,06,09; LV05,08; KI01,04,05,11; ST28,36; GV20.
Haematuria P: BL23,27; CV04,06; S: SP06; LV03; BL28; KI07.
Spastic bladder P: SP06; CV04; S: BL23; KI10; CV06; LV03.
Polyuria, diabetes insipidus P: BL23; CV04; S: GV04; BL21,22,24; LV13; CV03,06; SP06; KI07.
Urinary incontinence P: CV03,04; GV04; SP06; BL22,23; X 35 (L2-S5); S: CV02,06; GV20; BL25,27,28,67; LV01,02,03; KI02
Bladder paralysis P: CV02,03,04; S: GV03; LV02; KI11; BL23,28,40.
Urine retention, postoperative urethral stricture, sphincter spasm; to evacuate bladder in cerebrovascular accident, stroke etc P: SP06; CV04; S: SP09; CV03; BL28; T: BL23,32,43; CV02; ST28
Anuria, retention with coma, unconscious P: KI01; S: GV26
DISORDERS OF LUMBOSACRAL AREA
Lumbar, loin, renal area, sacral area pain, rheumatism, stiffness, lowback syndrome, arthritis, spondylitis P: AhShi; X 35; BL23,25,27,31,40,52,60; GB30,38; GV02,03,04; S: BL22,24,26,32,37,57; SI03; LV09; GV01; GB26,29,34; T: BL33,34,36,39,54,63,64,65; KI03,07; SP08; ST31; GB27.
Lower limb paralysis, posterior paralysis, paraplegia P: X 35; GB30,31,39; ST36; local points for region; GB34 to SP09; S: ST31,32,38,39,41,42; BL11,37,40,54,57,60; KI03; GB33; T: ST33,37,40; SP03,04,06; BL23,25,32,38,39,55,61,62; GB37,40,43; LV03,11; KI07,08; GV02,03; L 24.
Hip, thigh pain/rheumatism, arthritis etc P: AhShi; GB30,31,34; BL23,24; LV08,11; S: GB28,29,32,39; BL30,60; KI03.
Hip dysplasia (dogs) Prevention: Avoid breeding from carriers. Treatment P: GB30,34; Peck periosteum of femoral trochanter; S: GB29,31; BL40,60. (Lumbar pain add BL21,23; GV03). Alternative: under anaesthesia, implant 5-8 gold beads around acetabulum (anterior, dorsal and posterior ridge). This method is safe and highly effective
Knee (stifle) pain, rheumatism, arthritis etc P: AhShi; GB34 to SP09; GB33 to LV08; L 16 to L 16; GB30,38,39; ST33,35; BL40; S: ST34,36; LV07; BL57,60.
Ankle (hock) pain, strain, spavin, arthritis, rheumatism etc P: AhShi; BL60 to KI03; GB39,40; ST41; S: BL59,62,63; SP05,06; GB37
Metatarsal pain, rheumatism, sprain, inflammation P: AhShi; BL60; ST42,43; L 05; S: BL57; ST41,44; KI03; LV03; T: GB34,39,41; SP04,05; KI06; LV02.
Toe (hind digit) pain, arthritis, rheumatism etc P: AhShi; L 08; SP04; LV03; S: ST41,43; GB34,40; BL60; KI03.
AP ANALGESIA
Abdominal surgery in large animals: LU01 with TH08 to PC04.5 (i.e. between PC04 and PC05). See the paper on AP Analgesia.
Abdominal surgery in small animals: BL23 (bilat) with ST36 (bilat) (or) SP06 to BL59 (bilateral).
Thoracic, head and upper limb surgery in small animals: Needle penetrating through the limb at level of PC06 and TH08 (both bilateral).
Inguinal and lower limb surgery in small animals: SP06 to BL59 (bilateral) +\- BL23 (bilateral).
ACUPUNCTURE PRESCRIPTIONS
1980
(See Appendices 1-3 of the paper "Choice of AP points for particular conditions" for a later Cookbook)
INTRODUCTION
These prescriptions have been compiled by the frequency ranking method for points and prescriptions in more than 30 textbooks and many other articles on human AP. Prescriptions are available from such sources for more than 800 human disorders and symptoms, of which less than 10% are listed in this Appendix. This material is presented to students as a guide to the selection of points in the more common conditions.
The prescriptions concentrate mainly on the Channel points and some of the more commonly used "Strange", "New" and "Hand" points. They ignore the "Scalp points", "Earpoints", "Foot Zone points", "Nose points", "Face points" and other valuable reflex points. (Students interested in these methods should consult the relevant texts).
AP therapy is not a panacea, nor is it equally effective for all conditions listed below. Certain condition, such as muscular lameness, vomiting, diarrhoea, anaesthetic apnoea, hormonal infertility and convulsions are said to respond quickly and successfully. Others, such as lameness in severe spinal trauma, osteoarthritis, chronic bronchitis etc require longer courses of AP therapy man may have failure rates of 30-40%. Still other conditions, such as peripheral nerve paralysis, paraplegia, paralysis after cerebrovascular accident, urinary incontinence, severe arthritis (especially polyarthritis) are even more difficult to treat successfully.
Acute conditions often respond in 1-4 sessions at intervals of 12-14 hours. Chronic and more difficult conditions may require up to 14 or more sessions at intervals of 3-7 days. As a general rule, if some improvement is not seen by the 6th session, the probability of success becomes less and less with each subsequent non-responding session.
AP is frequently combined with other forms of therapy, such as hyperbaric oxygen and physiotherapy in nerve paralysis; antibiotic therapy in acute, progressive infections, artificial respiration, transfusion and vasodilator therapy in severe toxaemic shock (Chinese Medical Journal, Beijing, November 1978 p.497); herbal medicine in cough and many other conditions. However, concurrent use of large doses of sedatives, narcotics, opiate antagonists, corticosteroids and analgesics is unwise according to some authorities. These drugs may antagonise the effects of AP at the level of the specific or non-specific receptors in the brain, spinal cord or other target areas. If possible, patients should be weaned off these drugs before AP is used. However, other authorities dispute this claim. Therefore, at this time, the question remains unresolved. In emergencies and in very serious conditions, AP is given despite the concurrent use of "antagonistic drugs". Examples are GV26 + KI01 in narcotic- induced apnoea and the use of Earpoint "Lung" to prevent withdrawal symptoms in narcotic addicts being detoxified by intravenous naloxone injections.
Channel codes used in the Index are: LU= Lung; LI= Large Intestine, colon; ST= Stomach; SP= Spleen-Pancreas; HT= Heart; SI= Small Intestine; BL= Bladder; KI= Kidney; PC= Pericardium, Circulation-Sex, Heart Constrictor; TH= Triple Heater; GB= Gallbladder; LV=Liver; GV=Governing Vessel (Du, dorsal midline); CV=Conception Vessel (Ren, ventral midline).
Z 01-31; Y 01-19; X 01-35; A 01-44; L 01-42 are the "Strange Points" for Head & Neck; Thorax and Abdomen; Loin and Back; Upper Limb and Lower Limb respectively.
NZ01-35; NY01-06; NX01-16; NA01-15; NL01-36 are the "New Points" for Head & Neck; Abdomen; Loin and Back; Upper Limb and Lower Limb respectively, H are the Hand points".
In this system, ST08 (TouWei) is on the temple and BL40 (WeiZhong) is in the popliteal crease.
Thus, the point identification system used in these prescriptions is that adopted by IVAS. The name of each point is listed in the Appendix to the paper on the Study of the Points and Channels.
CHOOSING POINTS FROM THE INDEX
These prescriptions are usually in the format of a Primary + Secondary + Tertiary list. The Primary (P) list is the most important. They are regarded as the Main Points. Points in the Secondary (S) and Tertiary (T) lists are added only if the symptoms dictate. For example, in chronic debilitating diseases, Primary (P) points are: BL43; ST36; X 18. Secondary (S) points are: BL17,20,23; CV06; PC06. If abdominal pain or uterine pathology is present: add CV06; if kidney disease is present: add BL20 (or BL21) etc.
In short prescriptions, the Secondary (S) list could be added as a routine. For example in skin diseases involving malignant pustules, the Primary (P) point is GV12 and the Secondary (S) points (LI04; BL40) could be added routinely.
The Laws governing the choice of Points (see the preceding paper) should be kept in mind and at least two of them should be fulfilled by the points used. Also consider alternating the choice of points between sessions.
AP PRESCRIPTIONS IN ANIMALS
(Transposition Method)
The convention x to y means a needle penetrating from point x to point y (for example GB39 to SP06); the convention x-y means any or all points between point x and point y (for example SI10-14).
GENERAL CONDITIONS
To stimulate immune reaction (antibody production (immunostimulant effect), leucocytosis, phagocytosis in infections or leucopenia) P: LI04,11; GV14; ST36; GB39 to SP06; S: In localised infections add points for the region or organ affected.
Chronic disease (slow convalescence; to improve constitution after debilitating diseases) P: BL43; ST36; X 18; S: BL17,20,23; CV06; PC06.
Weak constitution (fatigue, poor general health, general weakness (as a tonic) P: CV03,04; ST36; SP06; LI11; BL20,43; S: PC06; SP21; CV12; LI04; HT09; BL10,11; LV03; GV14; GB34,38; X 18.
Fever, hyperthermia P: LI04,11; GV14; S: ST36,44; LU10; Bleed Earpoint "Apex"; Dehydration, thirst: add KI07.
Allergies, hypersensitivities (immunosuppressant effect) P: LI04,11; ST36; GV14; LV03; GB39 to SP06; S: Local allergies: add local and distant points for the region or affected organ; Urticaria: add SP10.
Anaemia P: GV14; ST36; BL17; CV04,06; LI11; S: GV04; CV12; BL18,20,22,23; T: PC06; SP06,10; LI04; KI01; GV20
Anaesthetic emergencies (apnoea, respiratory and cardiac arrest), neonatal asphyxia P: GV26; S: KI01; T: strong stimulation of ear canal.
Recumbency, downer-cow syndrome: Injection of 2% procaine solution into BL22,23,24,28 (bilateral), GV03; 5 ml per point, at a depth of 35-40 mm. Alternative is 250 ml 1% methylene blue solution (i/v) into jugular vein. (Take great care not to allow perivascular leakage !)
Muscle cramp, poor finish in racing animals P: AhShi points in muscles; Forelimb: search forelimb, neck, thoracic muscles. Hindlimb: search hindlimb, lumbosacral and abdominal muscles). Add main points for cramping region; (Hindlimb, esp. BL23,40,57; GB30,34; Lowback especially BL23,25,27,31; GV02,03,04; X 35 (L1-S4); S: BL40,60; GB30,34; Forelimb especially GB21; LI11,15; TH05,14; BL11,12,41; X 35 (C1-T6 area)).
Paralysis of peripheral motor nerves, spinal paralysis P: Stimulate nerves (bilaterally), with strong stimulation on affected side. Use local points for the region or affected limb, especially a chain of points over affected nerves. Use AhShi points, if present (but they are seldom present). Use the Scalp points (on the opposite side) for the Motor Areas; S: Massage and physiotherapy, if possible. If cerebral anaemia is suspected, add GV26. Consult textbooks for further details.
DISORDERS OF THE SKIN
Neurodermatitis, dermatitis, eczema, urticaria, pruritus P: LI04,11; SP06,10; KI09; ST36; S: LI04,15; GV14; BL13,17,23,25,40; PC07; GB20; ST25; SI03.
Malignant-pustules, carbuncles, furuncles, boils, folliculitis (anywhere on the body) P: GV12; S: LI04; BL40.
Abscess, felon, whitlow (nailbed) P: GV10; S: BL40.
NERVOUS DISORDERS
Epilepsy, during attack P: GV26; KI01; LU11; SI03; BL62; Between attacks P: GV14,20; PC06; HT07; ST36,40; BL15; CV12; Y 29; S: GV06,08,13,24; PC05; HT05; GB20: CV15; SI03; BL62; T: GV01,12,15,16,17; KI06,09; SP01; PC07,08; GV06,17; LI04,11; BL03,05,61,63,64,65; GB09,13,15; ST41,42,45; SI08; TH17; LV02,03; A 01; Z 01.
Convulsions, during attack P: KI01; GV26; Between attacks P: LI04; LV03; SI03; BL20; ST36; S: LU11; LI11; SP01; BL60,63; GB20; LV02; CV04,06,12; GV12,14,21,22.
Hysteria, during attack P: KI01; GV26; Between attacks P: PC06; HT04,07; SP06; GV08; KI01,05: LI04; BL15,22; CV12; GV13,26; ST36,40; SI03; GV14,20.
Unconsciousness, coma P: GV26; KI01; LU11; A 01; S: GV20; PC06,08,09; LV03; HT09; T: LI01,04; ST36; CV06; GV24,25.
DISORDERS OF THE NECK AND THORACIC LIMB
Neck pain, sprain, rheumatism, spasm, arthritis, slipped disc, wry neck and paralysis P: GB20,21,39; BL10,11; GV14,16; SI03,07; X 35 (C2-T4); A 23; AhShi; S: BL12,41; SI06,14,15; LI04,11; LU07; TH05,15; BL40,43,60,64,65; SI10,11,16; GB34,36; GV13,18; CV24; TH10,12,16; HT07; LI15; KI01; A 22.
Upper limb pain, sprain, rheumatism, spasm, arthritis P: LI04,11,15; TH05; AhShi (neck, back, shoulder area and arm) and local points; S: SI03,06,08; BL11; LI10; T: TH07,14; BL18,40,62; GB34; ST44; NZ23; A 30,32.
Upper limb paralysis P: LI15; LI11 to HT03; TH09 to TH10; TH05 to PC06; LI04 to PC08 (or LI04 to SI03); S: LI09,10; SI09; A 30; NX04; SI06; GB21; TH03,04.
Shoulder, pain, cramp, rheumatism, stiffness, arthritis, bursitis P: TH14,15; LI11,15,16; BL11; SI09,11; AhShi; S: TH10; SI03,10,13; GB21; T: TH03,06,11,13; GV12,14; SI12,14,15; LI04,10; BL13,41,44; A 42.
Shoulder, Shoulder muscles and thoracic back pain, spasm etc P: LI11,15; SI09,10,11,12,13,14; GB21; TH14; AhShi; S: BL11; SI03,08,15; LU02,09; LI02; T: TH03,11,13,15; SI06; LI04; BL12,13,41,42,44; GB20; HT02.
Shoulder and arm muscles: pain, cramp, rheumatism P: LI04,11,15; TH05,14; AhShi; S: LI10; TH06,15; GB34; ST36; T: LI07,16; TH10,11,13; SI11.
Elbow pain, sprain, arthritis, rheumatism P: AhShi; LI11 to HT03; LI12; LU05; TH05; S: LI04,10; GB34; SI04; T: LI08,12,13,14; SI07,08,11; PC03; TH01,10; LU06; GB21; HT01,04.
Wrist, carpal pain, sprain, rheumatism, arthritis P: (Choose according to the affected Channel and side): AhShi (local and shoulder girdle); LI04,05,06; SI04,05; TH04,05; HT05,07; PC07; LU07; S: SI06,11; TH06; LU08; A 09,22; T: SI03,05,08,10-14; LU06,09; LI03; HT06; PC04; TH02,03,13,14; BL12-17; BL41-46.
Metacarpal pain, sprain, rheumatism P: LI03,04; LU01,07; PC01,07,08; HT01,07; A 22; SI04; TH04; AhShi; S: LI05,06,11,20; LU05,08; SI03,07; TH02,03,05,23.
Finger (digital, upper limb) pain, sprain, rheumatism, arthritis P: AhShi; A 22; PC07; LU07; LI03,04; SI03,04,07; S: LI05; HT07; TH03,04,05; local periosteal AP (Thumb: esp. LU07 and periosteal local AP; Index: especially LI03,04,05; PC07; Middle: especially PC07,08; Fourth finger: esp. TH03; HT07; Little finger: especially SI07; TH03; HT07; T: LI06; HT03; TH06,13,14; A 09,17; PC04,06,08; GV14; SI06,08,10-14; BL12-17,41-46.
DISORDERS OF THE THORACIC AREA, HEART, LUNGS, TRACHEA
Pain, trauma, rheumatism, stiffness, spasm, arthritis, slipped disc in thoracic spine and thoracic back muscle area P: Spinal AhShi; X 35; GV points esp. 09,12,13,14; GB30; S: GV05,06,08,11; BL23,46,49,50; GB21,26; SI11,14; T: GV01,02,03,07,10,15,16; KI01,02,03,04,08; CV04,06,12,22; ST13,37,39,41; BL40,56,60,64; LI05; GB20,25; LU02; LV13.
Palpitations, atrial fibrillation, functional cardiac disorders P: HT05,07,09; PC06,07; BL15; S: HT06,08; PC03,05; BL10,14; CV14; T: HT03; PC04; BL11,12; LU04; LI04; ST36; LV01,03; GB20; CV06,12,17; GV24.
Bronchitis P: LU05; BL11,12,13,43; CV17,22; S: LU01; LI03; ST13,14,15,40; SI15; BL42,44; KI22,23; PC06; CV18,19,23; GV10,12,14; NX04; T: LU09; ST36; BL08,14,17; CV14; X 01; Acute P: LU05; BL13; CV22; LI04; GV14; S: PC06; TH05; BL12; ST40; GB20; T: LU07,08,09; LI06; SI17; BL10; SP06; GB21; CV17; GV16; Chronic P: LU05; BL13; CV22; ST40; CV12,17; BL12; S: PC06; BL08,20; LU06,07; CV06; GV12; LI04; T: LU01; ST36; BL11,17; CV18; NX04.
Asthma, bronchospasm, functional emphysema P: CV17,22; NX04; X 01; BL13; PC06; ST40; S: LU01,02,05,07,09,10; ST36; LI04; CV06,12; BL11; GV14; T: LU03,06,08; ST09,10,12,13,16; KI04,27; CV04,16,18,23; GV10,12; SI15; GB19,23,35,44; SP06.
Chronic rhinitis, sniffles P: LI04,20; Z 03,14; GB20; GV23,25; S: LI11,19; GV14,20,24; Z 15,16; BL07,08; LU05; GB04.
Soft moist cough, excess phlegm P: ST40; CV12; S: LU07; BL20; LI18.
Cough P: BL13; LU05,07; CV17,22; ST40; S: LU02,06,08,09,10,11; LI04; ST36; KI03,27; CV21; T: LU01,04; LI18; ST16; SP18; BL11,12,43; KI24,25,26; PC02; CV12,16,20; GV11,14.
Tracheitis (see laryngitis) P: CV22; BL11,13; S: LI04; GV14; ST40; LU05,07.
DISORDERS OF ABDOMINAL AREA, DIGESTIVE, REPRODUCTIVE, URINARY SYSTEMS AND LOW BACK; DISORDERS OF THE DIGESTIVE TRACT
Malabsorption, ill-thrift, weight loss P: ST36; BL20,21; CV06; bleed A 09; S: CV12; KI03; LV13; BL17.
Anorexia, total inappetance P: ST36, KI17; CV12; S: CV10; GV07; ST21,22; SP04; HT07; BL20.
Poor appetite, inappetance P: BL20; ST36; S: KI17; CV12; GV07; ST22; SP06; HT07; BL18,21; LI04.
Digestive upsets, indigestion P: ST36; CV12; S: BL21; SP06; ST25; CV10; T: ST45; BL20,22,47,49; LV13,14; GV05,11; SP04,05,16; PC06; T: GV06,13,14; BL66; LI04; ST21,23; SP15,21.
Vomiting P: ST36; PC06; CV12; S: ST25; SP03,04; BL20,21; KI20; GV18; CV11,13,14,18,22; T: BL45,46,49,50; KI20,21,25,26; TH19; GB23; CV06,08,15,16; SI04; LV03,13; LI04; Neurogenic, nervous vomiting P: ST36; PC06; CV12; BL17.
Nausea P: PC06; CV12; ST36; S: HT03; BL21; CV02,03,13,14; Continuous: add KI01; Neurotic: add BL17; ST21.
Gastritis P: PC06; ST21,36; CV12,13; BL21; S: BL18,20; ST20,25; CV06; T: BL17,19,22; SP04,05,06; ST19,23,37.
Colic, gastric: see vomiting.
Enteritis P: BL22,25,29,53; GV05; S: ST25,36,37,39; BL21,27; CV06,08,10; GV03; SP05; Chronic: add Moxa CV08.
Gastroenteritis P: PC06; ST25,36; S: BL21; SP04; CV12; moxa CV08; needle points 0.5" near CV08; A 09 (4 points 1" near umbilicus)).
Ulcerative colitis, colic, spasm P: ST25,36; SP15; CV06; BL25,27; S: CV12; BL20,21; LI04; HT07. T: LI10; ST17,28,37,40,44; HT03; BL22,24,31; PC06; GB28,34; LV03; CV03,04,08,13.
Diarrhoea P: ST25,36,37; CV04,06,12; SP04,06,09; BL20,25; LV13; S: ST34; moxa CV08; SP03,14,15; BL21; KI07; GV05,06; T: LI03,04: KI08,13,14,20,21; GV01,03; LV14; Chronic: add moxa CV08.
Constipation P: TH06; KI06; SP15 (or) ST25,26; CV06; BL25; SP03; KI16; S: CV12; BL27,28,33,36,38,50,51,57; SP03,16; GV01; GB34; T: ST40,44; CV03; LV01,02; LI02,11; GB28.
Colic (intestinal) P: ST25,36; CV06; moxa CV08; S: LI04; BL25; CV12; LV03; T: ST37; LV02,05; SP14.
Paralytic ileus P: ST25,36; SP15; BL25,27.
Anal/perineal pruritus, pain P: GV01,20; BL57; SP10; S: BL25,32; TH06.
Tenesmus, anal ptosis, protrusion P: GV01,20; BL57; CV08 (moxa); S: GV02,06; CV06; ST25,36.
DISORDERS OF REPRODUCTIVE SYSTEM
Pseudopregnancy (to terminate); to induce birth near term, misalliance (to abort) P: SP06; ST36; BL32; CV05,06; LI04; KI08; "labour points" (in human, 2" lateral and 2" below umbilicus, bilateral; S: ST25; CV02; SP09.
To facilitate calving, relaxation of pelvic ligaments in dystocia P: GV02,03,04; BL32,53; S: BL23,24,26,31,33,34,54.
To facilitate reposition of prolapsed uterus P: GV02,03,04; BL23,26,31,53; S: BL24,32,33,34,54.
Placental retention P: CV03; BL60,67.
Uterine inertia, failure to regress postpartum P: CV02,04; GV20; SP06; Y 16 to Y 18; S: ST29,36; CV03,06.
Lochiorrhoea P: CV07; Y 15.
Vaginal discharge, leucorrhea P: CV03,04,06; SP06; ST25; LV03; GB26; S: CV02,05; BL27,31-35; KI10,12; ST29; LV11; T: CV07; BL23,30; GV04; SP10; ST36; LV04.
Metritis P: BL30; SP12; GB26,27; S: BL27,28,31,32; GV04; CV07; GB28,29; T: BL25,33,35; SP06,10; ST29,36; LI04; CV02,03,04; Y 18.
Anoestrus, cystic ovaries, repeat breeders in cows, infertility P: Main point is 4" from mid-line in L5-L6 space (bilateral); use also AhShi points in lumbosacral area (i.e. in area BL23 to BL34); S: points from GV02,03,04; BL23,24,26,31-34,44,53.
DISORDERS OF URINARY SYSTEM
Urinary tract disorders P: CV03,06; ST25; BL31-34; AhShi; S: CV04,05; SP06; LV08; BL23; GV04; X 35 (Sacral 1-4).
Bladder disorders P: CV03,06; SP06; BL23,28; S: BL32; CV04; SP09.
Cystitis P: BL28,38,58; CV03,04; KI02,03; ST28; S: BL23,25,26,31-33,54; GB26,29; SP06,09; CV02; T: ST27.
Bladder pain, spasm (in obstruction, calculi, colic) P: BL23,28; SP06; S: SP09; BL24,25,27,31,33; CV03,04,06; ST30,36
Dysuria, pain or difficulty on urination P: SP06,09; CV03,04; BL32; S: HT08; BL23,27,28,31,33,34,52; SP11; CV02,05,06,09; LV05,08; KI01,04,05,11; ST28,36; GV20.
Haematuria P: BL23,27; CV04,06; S: SP06; LV03; BL28; KI07.
Spastic bladder P: SP06; CV04; S: BL23; KI10; CV06; LV03.
Polyuria, diabetes insipidus P: BL23; CV04; S: GV04; BL21,22,24; LV13; CV03,06; SP06; KI07.
Urinary incontinence P: CV03,04; GV04; SP06; BL22,23; X 35 (L2-S5); S: CV02,06; GV20; BL25,27,28,67; LV01,02,03; KI02
Bladder paralysis P: CV02,03,04; S: GV03; LV02; KI11; BL23,28,40.
Urine retention, postoperative urethral stricture, sphincter spasm; to evacuate bladder in cerebrovascular accident, stroke etc P: SP06; CV04; S: SP09; CV03; BL28; T: BL23,32,43; CV02; ST28
Anuria, retention with coma, unconscious P: KI01; S: GV26
DISORDERS OF LUMBOSACRAL AREA
Lumbar, loin, renal area, sacral area pain, rheumatism, stiffness, lowback syndrome, arthritis, spondylitis P: AhShi; X 35; BL23,25,27,31,40,52,60; GB30,38; GV02,03,04; S: BL22,24,26,32,37,57; SI03; LV09; GV01; GB26,29,34; T: BL33,34,36,39,54,63,64,65; KI03,07; SP08; ST31; GB27.
Lower limb paralysis, posterior paralysis, paraplegia P: X 35; GB30,31,39; ST36; local points for region; GB34 to SP09; S: ST31,32,38,39,41,42; BL11,37,40,54,57,60; KI03; GB33; T: ST33,37,40; SP03,04,06; BL23,25,32,38,39,55,61,62; GB37,40,43; LV03,11; KI07,08; GV02,03; L 24.
Hip, thigh pain/rheumatism, arthritis etc P: AhShi; GB30,31,34; BL23,24; LV08,11; S: GB28,29,32,39; BL30,60; KI03.
Hip dysplasia (dogs) Prevention: Avoid breeding from carriers. Treatment P: GB30,34; Peck periosteum of femoral trochanter; S: GB29,31; BL40,60. (Lumbar pain add BL21,23; GV03). Alternative: under anaesthesia, implant 5-8 gold beads around acetabulum (anterior, dorsal and posterior ridge). This method is safe and highly effective
Knee (stifle) pain, rheumatism, arthritis etc P: AhShi; GB34 to SP09; GB33 to LV08; L 16 to L 16; GB30,38,39; ST33,35; BL40; S: ST34,36; LV07; BL57,60.
Ankle (hock) pain, strain, spavin, arthritis, rheumatism etc P: AhShi; BL60 to KI03; GB39,40; ST41; S: BL59,62,63; SP05,06; GB37
Metatarsal pain, rheumatism, sprain, inflammation P: AhShi; BL60; ST42,43; L 05; S: BL57; ST41,44; KI03; LV03; T: GB34,39,41; SP04,05; KI06; LV02.
Toe (hind digit) pain, arthritis, rheumatism etc P: AhShi; L 08; SP04; LV03; S: ST41,43; GB34,40; BL60; KI03.
AP ANALGESIA
Abdominal surgery in large animals: LU01 with TH08 to PC04.5 (i.e. between PC04 and PC05). See the paper on AP Analgesia.
Abdominal surgery in small animals: BL23 (bilat) with ST36 (bilat) (or) SP06 to BL59 (bilateral).
Thoracic, head and upper limb surgery in small animals: Needle penetrating through the limb at level of PC06 and TH08 (both bilateral).
Inguinal and lower limb surgery in small animals: SP06 to BL59 (bilateral) +\- BL23 (bilateral).
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