Wednesday, October 16, 2013

Quiz 5

My apologies! I forgot to post this quiz! We will not hold a formal quiz tomorrow.

Thursday, October 10, 2013

Class Notes 6

POINT COMBINATIONS
CLASS NOTES: Extraordinary Vessels

There are a variety of interpretations of what the Eight Extraordinary Vessels are, and how they may be used. Here are two broad views of Extraordinary Vessels:

JOHN PIROG
Here is what John Pirog said with regards to the Extraordinary Vessels:

“By using the master points, the acupuncturist could extend the effects of his treatment to a deeper, more constitutional level of bodily function. And because the affected energies were deeper, the impact of the treatment was broader, extending beyond the extraordinary vessel to the many meridians that were connected to its route. The total system functioned like a great tree: the kidneys were the roots, the extraordinary vessels formed the trunk, the main meridians were its limbs and branches, and the essence was its sap.”

He then goes on to say that using master points is like clicking on icons to open up windows on a computer screen. The window for the extraordinary vessel might contain even more icons, representing the broad range of functions that an extraordinary vessel might representingpresent.

Pirog organizes the Eight Extraordinary Vessels into Yin (Ren, Chong, Yinqiao, Yinwei) and Yang (Du, Dai, Yangqiao, Yangwei), and Nuclear or Central (Ren, Chong, Du, Dai) and Peripheral (Yinqiao, Yangqiao, Yinwei, Yangwei).

He further characterizes each Extraordinary Vessel role as follows:

Ren Mai : Store Yin energy.
Du Mai: Store Yang energy.
Chong Mai and Dai Mai: Circulate energy between Yin and Yang regions of the body.
Yinqiao Mai/Yangqiao Mai: Distribute energy between Yin and Yang surfaces of the anatomy.
Yinwei Mai/ Yangwei Mai: Link Yin and Yang aspects of energy together.

In further detail:
REN MAI:
Functions:
sea of Yin meridians
binds together Yin meridians, especially on lower abdomen
controls anterior chest and abdomen
closely connected to functions of abdominal organs, esp. kidney, bladder, uterus, lungs
stores essential qi that spills over from yin meridians
absorbs yin meridian repletion, esp. stagnant qi and blood
upper branch supplies face and eyes

Choose Ren mai when:
symptoms focused on lower abdomen
a lot of stagnation, especially yin substances such as blood and fluids
a lot of yin pathogenic activity: damp, cold, blood stagnation, phlegm
yin substance deficiency, blood deficiency
deficiency of yin organs, especially kidney and liver
lung symptoms in general
gynecological conditions

DU MAI:
Functions:
sea of yang meridians
supports and connects yang meridians, especially on upper back and head
controls head, neck, and back; controls marrow
central nervous system
stores essential qi that spills over from yang meridians
absorbs yang meridian excess, especially heat and internal wind
abdominal branch connects with penis, vagina, and lower ren mai

Choose Du Mai when:
symptoms on head, neck, back
symptoms of stiffness, pain in muscular exterior, spasms, tremors, convulsions
yang pathogenic activity: heat, internal wind
deficiency of yang and qi
deficiency of kidney yang
impotence, urinary disorders, sterility

YINQIAO/YANGQIAO:
Functions:
nourish muscles and joints of lower limbs
allow mobility of legs, control standing and walking
nourish and moisten eyes
harmonize spirit
possibly lift spirit to head

Choose Yinqiao/Yangqiao when:
visual symptoms
difference in tension between medial and lateral aspects of legs
general differences between Yin (deep) and Yang (superficial) pulse depths
difficulty walking or standing; epilepsy

CHONG:
sea of blood
regulates menses
controls ability of blood to nourish skin and hair
circulates blood uninhibited through body
nourishes 5 viscero and 6 bowels
sea of 12 meridians; flushese qi and blood through main meridians
helps move digestate
involved in both and spiritual heart organs.

DAI MAI:
links upper and lower halves of body from waist
links yin meridians (front) with yang meridians (back)
controls shaoyang
controls muscles of abdomen that support abdomen and back

Choose Dai mai when:
weakness and sagging of lumbar and lower abdomen
parapysis and hemiplegia
cold, damp, deficiency of lower body (leukorrhea)
upward rising yang disturbances of upper body including dizziness, headache, visual disturbances
stress disorders that combine excess yang in upper body with deficiency cold in lower body

YINWEI MAI/YANG WEI MAI
links respective yin and yang meridians together.
binds and strengthens mind and body; provide structural and psychological support’’

Choose Yinwei Mai/Yangwei Mai when:
weakness/limpness of body together with insecurity and mental disturbance
contralateral/ipsialteral symptom distribution.

HOW PIROG USES EIGHT EXTRAORDINARY VESSELS:
Determine if the patient’s problem is one of STORAGE, DISTRIBUTION, CIRCULATION, or LINKING. Then, choose the specific vessel involved.
Needle Master point of chosen channel.
Needle other points in treatment; HERE is where Pirog diverges from other stylists. He uses points on the trajectory of the Extras to bring essence to more specific channels.
Needle Coupled points of chosen channel.

WANG JU YI
Here is what Wang Ju Yi says about extraordinary vessels:

Wang Ju Yi wrestled with the concept of the extraordinary vessels, because they had a flow outside that of the regular channels. How could he conceive of such a flow? “One way to understand this is to think of the eight extraordinary vessels as representing the classical understanding of the slow movement of interstitial fluids, and possibly of cerebrospinal fluid. These fluids are ‘outside’ the flow of the blood, lymphatic vessels, and organs.”

He relies on a metaphor of waterways:

“While the twelve regular channels may be thought of as streams passing between mountain ranges, the extraordinary vessels may be likened to a wetland reservoir lying in the lowlands. In the spring when the streams are full, the wetlands absorb the overflow of water. In times of drought, on the other hand, the wetlands act as a source for filling the streambeds with needed water.”

To Wang Ju Yi, the eight extraordinary vessels are an “inter-regulator” that helps to regulate the 12 channel system when the regular 12 channel system cannot function. In other words, the eight extraordinary vessels are only used when more specific interventions on the 12 channels “don’t work.”

Wang Ju Yi’s notions of REN and DU are similar to the somewhat universal picture of REN and DU.

In addition to SI 3-UB 62 combos, he discusses points directly on the Extraordinary Vessels:

DU 1 is helpful for rectal prolapse/hemorrhoids;
DU 9 brings Yang to chest and stomach, and is used for chronic asthma or ulcers due to cold accumulation;
Du 12 is often used in pediatric developmental cases;
DU 19 is used to stimulate Yang to restore circulation through entire Du vessel, for back pain;
DU 21 can bring clear Yang to head in cases of dizziness, mental fogginess, etc;
DU 24 can help to calm the mind, and can be combined with REN 12 to treat speech problems (failure to connect thoughts to words).

In addition to Lung 7-Kidney 6, here are direct applications for Ren points:

REN 3 is for excess type bladder problems (prostatitis);
REN 4 with SPLEEN 6 can “reset” blood circulation, and with 4 Gates, “reset” qi circulation;
REN 6 is similar to REN 4, but has more of an effect on Qi;
REN 11 is used in combo with LI 10 and St 36 to stimulate digestion and post-natal qi;
REN 12 can both tonify and sedate the middle burner;
REN 17 reverses counterflow qi along Ren.

YINQIAO and YANGQIAO traverse the legs (and are thus used to treat all manner of leg problems) AND meet at the eyes (and are thus used to treat eye problems, including insomnia [too much eye opening] and somnambulance [too much eye closing]). We think of YINQIAO and YANGQIAO as a kind of see saw that modulates the amount of Yin and Yang in the body. Consider YINQIAO when there are COMBINED problems of the KIDNEY, SPLEEN, BLADDER, and MEDIAL EYE, and YANGQIAO when there are COMBINED problems of GALLBLADDER, BLADDER, STOMACH, LARGE INTESTINE, and LATERAL EYE.

UB 62 is often used for problems with balance and coordination of multiple muscle groups for walking and balance. “Elderly patients who have problems with coordination, or even younger patients who are clumsy, are often treated with this point.” This point is also used to treat insomnia or hypersomnia, as well as some forms of facial paralysis.

GB 20 and GB 15 are representative points on Yangqiao that may be used.

Kidney 6 may be thought of as the analog to UB 62, that is, as treating the medial muscles of the leg. However, Kidney 6 may also be thought as affecting the musculature surrounding internal organs (GI tract, swallowing, digestion). It is also considered to help with microcirculation to the brain. Kidney 6 is used to treat hypersomnia and epilepsy.

Kidney 8 is the Xi cleft of the Yinqiao, and can be used to treat certain types of DEPRESSION. It is most effective when depression involves symptom patterns that include pain/dysfunction of internal organs. Kidney 8 (Yinqiao) should be used when there is actual pain/discomfort, whereas Pericardium 6 (Yinwei) should be used when there is a vague sense of discomfort.

YINWEI and YANGWEI help to circulate energy throughout ALL Yin or Yang channels. YANGWEI is used to circulate energy (mainly source Qi, because SJ is the master point) throughout all Yang channels. YINWEI is used to nourish and irrigate all Yin channels (mainly blood, because Pc is the master point).

YANGWEI DISORDER: sensation of chills and fever (exterior deficiency); lack of Wei Qi. SJ 5

YINWEI DISORDER: “suffering from heart pain”, emotional angst tied to organ discomfort. Pc 6.

Kidney 9, the xi cleft of Yinwei, can be thought of as “a cleft point for all of the yin channels. Because the yinwei is associated with irrigation of yin in areas outside the reach of the twelve regular vessels, its cleft point (a moving point) stimulates movement in yin areas throughout the body. In the clinic, this point has been used in the treatment of TUMORS.”

CHONG integrates flow of blood to the internal organs, while DAI binds to influence the up and down movement of qi. CHONG is used when there are COUNTERFLOW symptoms (abdominal pain and/or cramping), especially when accompanied by odd internal movement felt by patient.

Spleen 4 is a helpful pain for COUNTERFLOW in general (nausea, stomach pain) but also hypertension leading to pulsing/fullness in head (remember that it modulates blood flow up).


WANG JU YI’s Different Combinations of Extraordinary Vessel Masters
Lu 7 + Sp 4: Harmonize blood circulation in reproductive organs; used to regulate menses when length of time between periods is irregular. Not appropriate for menorrhagia, amenorrhea, or painful menses.

Pc 6 + Kid 6: Diffusely irrigates Yin, combined with regulating effects of parasympathetic nervous system. Harmonizes nourishment and movement in internal organs. Symptoms: palpitations (or other heart irregularities) that are undiagnosed or stubborn to resolve; stomach pain/vomiting with no discernable disorder; plum pit qi; IBS.

SJ 5 + UB 62: Stimulate Yang circulation. Helpful in cases of sudden paralysis due to emotional/psychological causes.

SI 3 + Lu 7: For “improper Qi gong practice,” particularly of microcosmic circulation, in which Qi is stuck or blocked along the course of the microcosmic orbit due to improper practice.

Saturday, October 5, 2013

Quiz 4


Class Notes 5

POINT COMBINATIONS CLASS

CLASS NOTES 5

FIVE ELEMENTS TREATMENT

Five elements is a theoretical model, and not a completely consistent treatment strategy. There are many times when Five Elements treatments might look good in theory, but in actual execution (when taking other factors into consideration) doesn’t really make sense.

For example, the FOUR NEEDLE TECHNIQUE that is taught as the basic Five-Element-for-Dummies model can be useful sometimes, but not always.

FOUR NEEDLE TECHNIQUE is based on a simple strategy. First, determine if the problem is PRIMARILY one of EXCESS or DEFICIENCY (this can be difficult if you have a mix of excess and deficiency). If EXCESS:

SEDATE SON on the affected channel. So, for Liver Excess, sedate the son (or Fire), i.e. Liver 2.
SEDATE SON on HORARY channel. Son element is Fire, so sedate horary point: Heart 8.
TONIFY GRANDMOTHER (controlling element) on affected channel. So, for Liver Excess, tonify metal (i.e. Liver 4).
TONIFY GRANDMOTHER (controlling element) on HORARY channel. Metal. So, Lung 8.

For DEFICIENCY:

TONIFY MOTHER on affected channel. So, for Spleen Deficiency, tonify Spleen 2 (mother of earth is fire).
TONIFY MOTHER on HORARY channel. Heart 8.
SEDATE GRANDMOTHER (controlling element) on affected channel. Metal. So Spleen 5.
SEDATE GRANDMOTHER (controlling element) on HORARY channel. So Lung 8.

Notice a contradiction? A common pattern is Liver Excess with Spleen Deficiency. And yet, in both of these prescriptions, we are needling Heart 8 and Lung 8, BUT WITH OPPOSITE techniques. Problematic.

Remember that much of Five Element “style” acupuncture is determined not only be the manner of point selection, but also on how a diagnosis is reached. Some styles of Five Element acupuncture, for example, are more psycho-spiritual in nature, and rely upon a CSOE (Color-Sound-Odor-Emotion) that only arises during a relatively freeform (i.e. psychoanalytical) interview. Other styles rely upon pulse to determine the most deficient channel.

WHEN WOULD WE CONSIDER FIVE ELEMENTS?

We could consider Five Elements if we determine an imbalance occupies or influences channels that are not otherwise related. For example, the Lung and Kidneys do not have any other relationship with each other (channel-speaking) other than through their Five Element connections. If there is a problem involving both of these channels, then it is probably worth your while to consider using a Five-Element style treatment.

METAL - WATER PAIRINGS

Think of METAL-WATER pairings when there is a problem of a lack of WATER (Yin) nourishing the tissues of the Lungs (especially the throat).

Lung 7 - Kidney 6: extraordinary vessel pairing: often used clinically for problems affecting the throat (sore throat) because both Ren mai and Yinqiao mai go to the throat. This pair is also effective for problems with urination, and some types of lung-kidney type edema.

Lung 5 (water on metal) - Kidney 7 (metal on water): This pair is used to foster yin and regulate the lung. Used for chronic issues due to lung dysfunction with associated lack of kidney nourishment. For patients with chronic allergies and asthma. Effective for treating seasonal allergies.

Lung 5 (water on metal) - Kidney 6: used for acute conditions where lung is not receiving enough fluids, often due to accumulation of heat. Examples: loss of voice following external wind-heat, wind-dry, or fatigue.

WATER - WOOD PAIRINGS

Think of WATER - WOOD pairings when a lack of WATER (Kidney Yin) leads to “dry flammable WOOD” (i.e. variations of Liver Excess and Liver Fire).

Kidney 7 (metal on water) - Liver 2 (fire on wood): For Kidney Yin Deficiency with concurrent Liver Yang Rising leading to symptoms such as dizziness, tinnitus, red face, dry mouth, and red tongue.

Kidney 3 (earth on water) - Liver 3 (earth on wood): Similar to above, but tends to be used when symptom pattern is more of Kidney Deficiency than Liver Excess (Kidney Deficiency is PRIMARY). Used to “secure the source”, calm the Liver, extinguish wind. Symptoms: high blood pressure, dizziness, insomnia, tinnitus, seminal emission, vomiting, and other excess above deficiency below symptoms.

FIRE - EARTH PAIRINGS

Think of FIRE - EARTH pairings when there is a failure of nourishment and circulation of BLOOD leading to insomnia, low energy, shen disturbances, etc.

Heart 7 (earth on fire) - Spleen 6 (3 leg yin meeting): These two points have a beneficial effect on production and movement of blood. Used to tonify heart and spleen, foster blood, and calm spirit. Dual deficiency of heart and spleen leading to lack of blood nourishment to heart. Symptoms: palpitations caused by emotional stress, insomnia... GUI PI TANG, anyone?

WOOD - EARTH PAIRINGS

We of course think of WOOD - EARTH when there is an excess-deficiency problem centered on the digestive system; i.e. STRESS (Liver) related to digestive issues like IBS, diarrhea, nausea (Spleen).

Liver 2 (fire on wood) - Spleen 2 (fire on earth)

Liver 3 (earth on wood) - Spleen 3 (earth on earth)

EARTH - METAL PAIRINGS

(this happens to coincide with TAIYIN pairings, so will not be discussed separately)

WOOD - METAL

We think of WOOD - METAL whenever there is an insult along the controlling relationship, that is the Wood is rebelling against its overcontrolling grandmother Metal.  Think of Lung symptoms tied to stress.

Liver 4 - Lung 5 - This is a combination from Kiiko Matsumoto style, which may best be understood through Five Elements.  Liver 4 is metal on wood (controlling element).  Lung 5 is water on metal (this is a mother-son relationship).  The combination is used for (o)ketsu, or Blood Stagnation, and may best be understood as a form of Liver Qi and Blood Stagnation.  By needling Liver 4, we are controlling wood.  By needling Lung 5, we are draining metal and indirectly nourishing wood (through water).  This seems paradoxical, but it can be seen as a way to "flush out" the liver.

Aside from the Kiiko Matsumoto understanding, we might use this pairing to treat coughing due to Liver insulting Metal (stress-related coughing).

Liver 4 - Lung 9 - This combo can be used when there is Liver Qi stagnation combined with Lung Qi deficiency (phlegm cough, low energy, etc.).

WOOD - FIRE

WOOD and FIRE are mother and son.  Think of pathologies caused by Liver Qi stagnation/heat transferring over to the Heart.  NOTE: You can address several of these issues via Liver - Pericardium (i.e. JUEYIN pairings) outlined in last class.

Liver 2 - Heart 8 - Liver Fire (due to Yin Deficiency) causing or related to associated Heart Fire (due to Yin Deficiency) symptoms: insomnia, palpitations, anxiety.

METAL - FIRE

METAL and FIRE share a controlling relationship.  We rarely see this played out in practice, however.  Points on Lung and Heart may be used together when there is a general Upper Jiao issue (i.e. simultaneous Lung and Heart heat/fire, or simultaneous Lung and Heart Qi Deficiency).

FIRE - WATER (This is identical to Shaoyin).