Acupuncture Points

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I have not yet done any posts regarding specific cases in my office but this one stood out to me as a success story that should be shared. It is not uncommon for patients to come to me as a “last resort.” After seeing western doctor after western doctor and getting no results, or being offered a multiple drug regimen with multiple risks and side effects people become frustrated. They want to get better, they think they CAN get better, and they try acupuncture in a “last ditch” effort to get better. These cases are especially exciting to me for two reasons. One, often these are situations in which TCM excels. Whenever someone’s situation is “mysterious” or unresponsive to western medicine, it is often quite responsive to acupuncture and herbs. Two, when they get better, they are so thankful and it warms my heart to know that they have been helped after so much time feeling desperate and frustrated. It is particularly satisfying when they report back to their western physician that they have indeed gotten better with this medicine. It plants a seed in that physicians head that maybe there is something to this Asian medicine.

So, back this case I want to share.

A 27 year old man came to me 2 months ago with a five year history of urinary frequency, small bladder capacity and pain. His bladder could not hold the normal amount of urine and when it became “full” he would have severe, sharp lower abdominal pain that could only be resolved by urinating. He woke 3 to 4 times a night to pee, and had trouble falling asleep due to lower abdominal discomfort. He had been through every western bladder/kidney/prostate test available including a very invasive Cystoscopy. He had been to three different Urologists, none of whom could offer him a diagnosis or a treatment plan. The last of which prescribed him antidepressants. Now, side note, this happens ALL THE TIME. My patient was not the least bit depressed. He had some anxiety around the urination issue, but nothing outside of what would be considered normal considering the intensity of the pain and the lack of diagnosis. I have seen this so often I am no longer surprised when it happens. When western medicine cannot find the cause of a physical problem, patients are given antidepressants. Maybe this was all “in his head”, but this man decided he did not want to take drugs that he didn’t think he needed and sought out alternatives.

During his initial visit I discovered that the man had lower back pain as a result of an injury in which he was run over (!) by an ATV when he was 7 years old. He did not require surgery but several of his lower lumbar vertebrae were permanently damaged. This piece of information would mean nothing to a urologist but it meant a lot to this TCM doctor. In addition to back pain he suffered from knee pain that he chalked up to “getting older” at his mere 27 years. His urine was usually clear, although occasionally cloudy and was slow to come out. His hands and particularly his feet, were always cold. He was always thirsty, for room temperature water, but he was afraid to drink because of the bladder problem. He felt fatigued all the time which he didn’t feel was caused by the night waking.

Urinary frequency can be the result of several different TCM patterns. In this case all signs pointed to one thing: Kidney yang vacuity with blood stasis in the bladder. I was fortunate that his symptoms painted such a clear picture, as this isn’t always the case with such chronic conditions. I believed that the Kidney vacuity was primary, and had existed since that terrible childhood accident, if not before, and the blood stasis was a result of the bladder not functioning well for so long. (Chronic conditions often develop blood stasis over time.)

Treatment was simple. We were to start with acupuncture and moxibustion weekly and would add herbs if we didn’t see results in 6 visits. For you TCM geeks out there I used a combination of BL23, 28, Du4, Ki7, Sp8, Ht7, Ren2, 4, 6, and Ki11 over the course of 6 sessions. I applied moxa to the points on the low back and lower abdomen. The results have been great with progressive improvement after each treamtment. After the first couple of visits he noticed a reduction in the number of times he woke at night to pee. After the 5th he noticed a reduction in daytime frequency and a big reduction in anxiety. After the 6th visit he reported he was peeing around 5 times a day (as opposed to hourly) and he was only waking once a night to urinate with a big reduction in fatigue. Although we have reached our 6 visit goal we have determined that more treatment will be necessary as it would be best if he were not waking at all at night. We will continue weekly treatment until we accomplish that and if it hasn’t been accomplished in 3 more visits we will add a granular herbal formula. For the TCM geeks: Jin Gui Shen Qi Wan + Lian Zi, Fu Pen Zi, Tu Si Zi, Suan Zao Ren, Yuan Zhi

In addition to the physical improvement mentioned above, one of the things that stands out to me when I think about this patient is how much his affect has changed in the two months I’ve known him. The first few visits he was somewhat “tightly wound” so to speak. He was visibly uncomfortable, a little defeated in his tone, and all around frustrated. Now when he comes in he is downright cheerful and bright. I hope that he continues to improve and that he can get on with being a normal healthy 27 year old with a life that does not revolve around having a bathroom nearby.

 

 

 

I have a fertility-turned-obstetric patient who just emailed me to cancel her appointment for this morning. She was in labor and wouldn’t be needing an induction treatment as we had planned. This is someone who had faithfully come in for treatment throughout her pregnancy, and to whom we applied pre-birth acupuncture from week 36 on. She went into labor 5 days after her due date.

This is typical of primigravidas (first time moms). Having pre-birth acupuncture most typically results in babies that come during the 40th-41st weeks. Rarely do I see those who come in weekly for this treatment get to week 42. The protocol is simple, and the hour spent in session gives the mom some much needed self-care time. Not only is the pre-birth acupuncture helpful for getting labor going in due time, but it has also been shown to reduce the overall time in early labor by an average of 2 hours. 2 hours might not sound like a lot, but believe me, to a woman in labor it is significant. In addition, there is strong anecdotal evidence that women who receive pre-birth acupuncture require less medical intervention during labor than women who do not. I encourage all of my obstetric patients to come in once a week from week 36 to week 41. Once we pass week 41, we can apply a stronger induction-style treatment 3 times in a week as these moms may be facing a decision to medically induce with Pitocin should they reach week 42. I do not actively induce moms before their due dates, and I find that those who receive pre-birth treatment rarely require it.

For acupuncturists interested in incorporating the pre-birth protocol into their obstetric practice, I use the following points as a base of treatment, and add any points that I feel will benefit the particular patient depending on other symptoms present and using a differential diagnosis.

Weesk 36-38: (using no stimulation) GB34, ST36, Sp6 (if there is a history of rapid uncontrolled labor, substitue with Ki8), Bl62, yin tang. If the baby’s position is not optimal, add Bl67 and Bl60

Weeks 38-40: (using no stimulation) GB34, St36, Sp6, Bl62 (again, add Bl67 and Bl60 if needed), yin tang, GB21

Week 41: (using strong stimulation) GB34, St36, Sp6, Bl62 Bl60,, Bl67, yin tang, GB21, LI4 Bl31, Bl32

These points can all be needled bilaterally in a seated position, or unilaterally in a side-lying position. I favor side-lying as many moms become quite relaxed and meditative.

 

 

 

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When I was in my last semester of acupuncture school, I was pregnant with my first daughter. Once that fact became obvious to my teachers and classmates, my two Chinese instructors insisted that I needed to needle Kidney 9 regularly. It is thought that this point will produce a beautiful baby when needled throughout the pregnancy. I thought it was humorous at the time, but I have since come to rely on this point with all of my pregnant patients, as it is one of the most useful for securing a pregnancy and preventing miscarriage. I joke with my patients that we are needling the “beautiful baby” point, but in truth, I am using it to be sure that the uterine environment is as healthy as possible for the growing embryo and fetus.

From the book Acupuncture in Midwifery (which I highly recommend to acupuncturists focusing on Obstetrics) by Yelland:

“Kidney 9 is said to produce a child with particularly luminous complexion who would sleep at night, laugh in the daytime, be virtually immune to diseases or if he/she did catch a disease would heal quickly, be sane in mind, morals and body.”

 

Interesting note: Peter Deadman’s A Manual of Acupuncture, which is the main text used in American acupuncture schools, does not include miscarriage prevention or “beautiful baby” as indications for this point. The name of the point, however, translates to Guest House. To me, this sounds as though it is for the uterus while it is “housing” a guest, aka, a baby.

 

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This past weekend I saw 4 women in the early stages of pregnancy who were struggling with nausea and vomiting. Morning sickness is considered a normal symptom of pregnancy, and even lauded as a “good sign.” While it does indicate higher levels of progesterone necessary for maintaining pregnancy, for some women it can be debilitating. For many, it is so severe that they are unable to work and often resort to western drugs which can be effective, but are not without risks.

In the hands of an experienced acupuncturist, a woman can find significant relief for morning sickness. In my experience, the most helpful protocol is to receive treatment three or four times within a short period of 1-2 weeks, then continue once-weekly treatment through the first trimester. I will also prescribe herbs if they seem necessary, and encourage women to keep their blood sugar as stable as possible by taking bites of crackers, or other carbs throughout the day. Rest is very important in these situations, and I ask my patients to get to bed early and nap when they can. I have a very strong ginger candy that many women swear by as well.

The main points that I use are KI-27, KI-21, KI-6, P6, Ren 14, Ren 12. I will add additional points based on the woman’s current Chinese Medicine pattern. Common additions are St-36, Sp-4, Liv-3, St-44, St-19, St-40.

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Located in the thenar eminence between the thumb and first finger, He gu means Joining Valley or Union Valley. This point is a very powerful and often used point. It is the command point of the face and mouth and can be added to any prescription when that area is affected such as TMJ, tooth pain, headache, etc. Another common use for this point is to ward off colds, or wind, as we say in Chinese Medicine. This point both clears wind on it’s own, and also as the Large Intestine channel is paired with the Lung channel, it can effect the Lung and Wei qi, or immune function. I always include this point when a patient has a cold, or feels one is coming on, regardless of the pattern.

When combined with the point Liver 3, we have what is called the “four gates.” This point combination is especially powerful at moving qi and is used quite frequently for this purpose.

When combined with the points Large Intestine 11 and Large Intestine 15, we have what is called a “chain and lock.” This combination is useful when treating any issues with the arm from tendonitis to numbness to muscle pain.

Large Intestine 4, He gu, is one of several points used to induce labor, and is therefore contraindicated in pregnancy unless labor is desired.

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I’ve heard this question a lot over the years. Coming from a culture in which the primary medicine is one-size-fits all, it is not surprising that we have a hard time grasping the way acupuncture works. In Western medicine if you have a particular symptom or disease, there is a specific treatment for that, a drug or a therapy or what-have-you. There is sometimes a bit of tailoring in which, of the 5 drug options, you are given one based on factors that are unique to you. In general though,  each disease has a set treatment, no matter the patient’s constitution or other symptoms.

In Chinese Medicine, the opposite is true. Each person is looked at individually, all symptoms are considered relevant, and the underlying imbalance is treated. We often say, we treat the person not the disease. For instance, if there are 5 people with Irritable Bowel Syndrome, the Chinese Medicine doctor will look at each of the five individually. Each will get a Chinese Medicine diagnosis, possibly all 5 will be different. One might have qi stagnation causing the IBS, one might have Spleen qi deficiency, one might damp phlegm collecting, one might have too much heat, etc. The doctor will then prescribe points and herbs specific to those five individual imbalances. There are points that move the qi, and do so very well in the digestive system. There are points that build spleen qi, and so on. There would likely be some crossover, but it is very unlikely that each person would receive the same exact prescription of points.  

Acupuncture points do not treat specific diseases, rather, they have the effect of adjusting the imbalances in the body in different ways. Stomach 36 is a powerful digestive point, but western disease diagnoses do not correlate to specific points. Sometimes St 36 would be called for in someone with IBS, sometimes it would not depending on the imbalance in that particular patient. Points are combined in such a way as to bring the individual back into balance thereby eliminating symptoms of dis-ease.

This is why seeing a licenced acupuncturist for acupuncture rather than an MD or Chiropractor with a few hours of “acupuncture training” is so important. While the MD may be able to reduce a little pain using acupuncture needles, to get to the root of the imblance using Chinese Medicine, a differential diagnosis needs to be made so that elegant point combinations can be chosen. Acupuncture was never meant to be practiced in a “this point is good for this disease” way and it is far more effective when used within the broader framework of Chinese Medicine as a whole system of medicine.

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Sanyinjiao translates to Three Yin Intersection. This point is unique in that the three yin channels of the leg intersect here. The Spleen, Liver and Kidney channels can all be accessed through this point making it very powerful, and very useful.

Locate sanyinjiao 3 cun (approximately 3 inches) up from the medial malleolus (the inner ankle bone) just behind the crest of the tibia, or leg bone. The point is often tender and might feel like a slight depression in the muscle tissue.

I use this point often, especially on women, as it is a lovely point for tonifying the qi of the Spleen and Stomach, thereby aiding in building blood. This has broad use, from menstrual irregularities to digestive discomfort. It resolves damp conditions and invigorates the blood, making it useful for regulating menstruation and also for inducing labor. It is therefore, contraindicated in pregnancy unless labor is desired. It is usefully for calming the spirit and rules the lower of the 3 jiao, meaning the intestines, bladder, uterus/tubes/ovaries, and the sexual organs.

Sanyinjiao is useful for any gynecological, urinary, sexual, digestive and emotional issues. Few points have so many, and such broad application, making Spleen 6 one of the most widely used acupuncture points.

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