7. JIANYU (LI-15), OUCHI (LI-11), HEGU (LI-4)

 

Main effect and clinical purpose

 

This very much used points-combination has been initiated in accord with the principle of choosing points on the same meridian, for mutual assistance.

 

It is used in many different problems of the arm, involving the shoulder, arm, hand and fingers.

Its main use, however, is to invigorate the flow of Qi and Blood in the upper limb, for problems such as Painful-Bi of different etiologies, or paralysis.

 

The fact that all these points are situated only on the Large-Intestine meridian, and not on one or more of the other five meridians of the arm, is because this meridian is known to have the richest supply of Qi and Blood (together with its counterpart, theStomach meridian).

 

The Nei Jing states: "When treating flaccidity of the limbs (Wei syndrome), use points only from Yangming" (52).

 

Points discussion

 

As stated above, all the three points are situated on the Large Intestine meridian, and are considered important points. The title of important points is usually given to those points which have a broad spectrum of activity, and that play a major role in many formulae.

All three have in their indications qualities such as: invigorating Qi and Blood circulation, removing obstruction from the Jing-Luo, relieving pain, scatter Bi, and the like.

 

By choosing these three points, we thus combine their efforts to assist each other, and to have a mutual impact on the disease, which is far better than any one of them alone.

The fact that all the three are members of the same meridian, enableseach point's sensation to travel to the next station, i.e. the next point, and thus propagate the needle sensation along the whole limb. When needle sensation is propagated, so is Qi, and thereafter - Blood.

 

There is a saying in T.C.M. that "Acupuncture is only effective when the Qi reaches the affected area". Many contemporary researchers have verified this idiom. They also found a significant correlation between the degree of induced propagated needle sensation, and therapeutic success (53).

 

As we have mentioned above, the Nei Jing has recommended the use of the Yangming system for diseases characterized by flaccidity, numbness, and hypertrophical features. The fact that the Yangming has been appointed for such tasks, is due to its abundance of Qi, and especially Blood.

 

Recent researchers in China have verified, for instance, that the use of these points in a C.V.A. sequelae, like hemiplegia, has no substitute. The reasons are those mentioned above.

 

Hemiplegia, as an example, is a paralysis of half of the body, caused by blood stagnation in the brain. This stagnation has induced Qi and Blood circulation impediment and in fact a real blockage, in half of the body, usually longitudally.

 

Thus, those three points (among other points), are manipulated to invigorate the blocked circulation and return the limb to its normal function.

 

By the same token, these points help eliminate pain either caused by a Xu condition, like paralysis, or a Shi condition such as paintful obstruction of the joints. The only difference is in the technique of stimulation, and in the combination of other points within the formula.

 

Needling sequence. manipulation and stimulation

 

The needling sequence in this combination is usually performed in accordance with the nature of the disease. In Xu conditions, when paralysis of the arm and fingers exists, or numbness, or weakness of muscles, the needling sequence is applied from Jianyu to Hegu. This is done in order to drive the Qi sensation toward the fingers, which, in most cases, are in a worse condition.

 

In painful Shi conditions Hegu is most often punctured first, due to its generalized analgesic effect, followed by the rest of the points. It is, nevertheless, possible to start with Jianyu, especially if there is a marked stagnation there.

 

In the conditions of paralysis, or atrophied muscles, the stimulation is, necessarily, by tonification. The method of tonification varies, but in most cases it is a strong tonification for two reasons:

A. The paralytic state of the limb does not allow a satisfactory Qi sensation, in many cases, if the manipulation is too weak.

B. This is a severe condition which generally will not respond satisfactorily to a mild stimulation. In this context we may compare the amount of stimulation, or degree of needle manipulation, to a measured dose in medication, or a herbal formula. In servere conditions the dose will generally be increased. The difference, however, between acupuncture and other remedies, is that only a well-experienced practitioner is able to develop the "touch" or sensitivity for the right amount of manual stimulation. In orally taken remedies the dosage is measurable, and recommended in the formula.

 

In many cases of Xu conditions, especially the most severe, or those in which Cold is a part of the condition, the preferred type of tonification is "Burning the Mountain" (54) technique, which was mntioned under case number 1, in this chapter.

 

Xu conditions of the upper limb are very often treated with moxa too. The warm needle techcnique is highly recommended, as it warms the channel, tonifies the Qi, and accelerates its flow.

 

Massage techniques,Tui Na, with warming and activating oils and ointments, are also very popular and widely used. The massage is carried along the limb meridians, with rubbing and pinching, and scraping movements, pressing on the acupressure points, and activating Qi and Blood.

 

For such conditions also the plum-blossom, seven-star hammer-needle is applied, by tapping it along the meridians, until the whole route is reddened.

 

In Shi conditions, such as painful Bi of the shouder, elbow, carpal and phallangeal joints, the needle technique is sedation and dispersion. The needle is inserted against the energy stream of the channel, or manipulated in sedating procedures, or in the HuiCi pattern, which was described earlier In this work.

 

Cupping is also applicable, as it drains excess, and disperses stagnation. Also electroacupuncture is possible, usually combining two points from the trio in a disperse-wave.

 

Case history

 

Mr. G., age 63, a barber by profession, left handed, had, a month before he came to see me, a marked decrease in the power of his left hand, fingers and leg.

 

He had a sudden decrease of mental acuity, of his usual sense of humor, as well as physical abilities of hand and leg. Mr. G. had to cease working in his barber-shop, since he was left handed.

 

A week before coming to me, he suddenly felt very unwell, and almost lost consciousness. He could not speak properly, and suffered a staggering headache. He was taken to Nahariya hospital where he underwent a C.T. scan of the head. The diagnosis was a cerebro-vascular infarct in his right brain lobe.

 

Upon examination it was obvious that he had significant difficulty in moving his left fingers freely, and his gait was a little clumsy. His tongue was big, red and peeled. The pulse was moderate, and big at Cun and Guan positions.

 

Mr. G. confessed to a long history of moderate hypertension.

 

My diagnosis was a basic Shi condition of Liver Yang, complicated by a Xu condition, after the brain damage had occurred.

 

The treatment principle was, therefore, to invigorate the flow of Qi and Blood in his left hand and leg, subdue Liver Yang, and invigorate the blood circulation in general.

The points chosen for these purposes, were: Jianyu (LI-15), Ouchi (LI-11, Hegu (LI-4), Baxie (extra), Biguan (ST-31), Zusanli (ST-36) - all in the left side only, and, Taichong (LIV-3), Sanyinjiao (SP-6), Xuehai (SP-10) bilaterally.

 

Jianyu, Ouchi and Hegu were manipulated in a strong tonification. Baxie, are eight points situated between the knuckles of the fingers. These were stimulated in order to facilitate the flow of Qi and Blood in the fingers.

 

Biguan and Zusanli are a combination of two points on the leg Yangming channel, and the principle of their choice and use is exactly the same asfor the three Yangming points of the arm.

 

Taichong and Xuehai act on the blood level, in general. Taichong reduces Liver-Yang and improves blood circulation by facilitating Liver-Gi, and Xuehails role in the blood has already been discussed in case Number 5 of this chapter.

 

Mr. G. felt mental improvement after the first treatment. Following this treatment he never again experienced any episode of losing consciousness, ordifficulty in speaking. After the third treatment, which took place during the same week, his leg returned to normal, and he had lost his clumsy gait.

 

After the seventh treatment, his hand and fingers regained their normal flexibility and strength.

 

Mr. G. was advised to come once a month for a check-up for his Liver Yang, and was consulted about his way-of-life for the same purpose.