9. HEGU (LI-4), TIANTU (CV-22), FUTU (LI-18)

 

Main effect and clinical purpose

 

The points-combination above is mainly used to treat conditions in which phlegm has accumulated in the throat region, giving rise to problems such as: hoarse voice, asthma with a sensation of blocked throat, lumps in the throat, goiter etc.

 

Points discussion

 

Hegu is a point which possesses many qualities, some of which have been discussed in various parts of this work, and especially under cases numbers 2 and 7.

 

Hegu was placed in this points-combination due to its key role in the Large Intestine meridian, which makes its route through the neck and throat.

 

We have already discussed the invigorating quality of Hegu, which, when stimulated, sets in motion and invigorates the flow of Qi in this channel, thus clearning any blockages along its route. In case number 2, for example, the point was utilized to unblock stagnation in the nasal sinuses area. Here, the point serves to resolve Phlegm, or Phlegm Fire, or Damp-Phlegm in the throat region, all conditions that may cause, if untreated, grave problems in that area.

 

Due to Hegu’s other qualities, it may be used just as well for externally contracted Dampness that has aggravated into Phlegm, or internally originated Phlegm.

 

We already know that Hegu is a first choice point for externally contracted situations. That may include, in fact, all the patterns. Wind, Heat, Cold, Damp, plus combinations of them. Internally, Hegu Is the Yuan point of the Large Intestine, thus in close relation with the organ itself. The Large bowel is responsible for eliminating toxins and waste through the lower orifice, and thereby Hegu plays an important role. Moreover, Hegu also belongs to the Yang-Ming system, and thereby exerts an influence over the stomach too. As we know that the Stomach/Spleen malfunctioning is responsible for phlegm creation, we can imagine how Hegu may have an influence on the internal origins of Phlegm.

 

Tiantu is probably the most important symptomatic point in the case of asthma. It is located in the base of the throat, and formsthe barrier between the trunk and the head region.

 

In this area, people often feel a sensation as if "something" is stuck in their throat, a sensation metaphorically related to as "plum seed" in Chinese. This sensation is typical of the formation of phlegm accumulations in the throat.

 

Since phlegm has a dense energy, or "dirty" energy, it is stuck in the narrow passages of the throat, and blocks Liver-Qi, or the "Clear Yang" of Stomach Qi from ascending to nourish the brain (58).

 

Stimulation of Tiantu disperses the phlegm in this area and facilitates both ascent of Qi to the head, and absorption of air Qi, in the lungs.

 

Tiantu is also indicated when Fire exists in the throat. Fire may present on its own, but in the throat region, it is usually combined with Phlegm, thus creating the phenomena of Phlegm-Fire. Phlegm-Fire exists in cases of throat-cancer, or abscess, acute goiter, etc.

Futu is also a point on the Large Intestine meridian, and is located on both sides of the neck. It is combined with Hegu, which is on the other end of the meridian, forming the bond of one point in the vicinity of the diseased organ, and one point distant.

 

Futu’s traditional indications are:

Coughing and wheezing, excessive mucous, difficulty in swallowing, hoarse voice, and "duck-like" sounds in the throat.

 

It is therefore in mutual assistance with Hegu on the same meridian, and with Tiantu - in the vicinity of the focus of the disease.

 

Needling sequence, manipulation and stimulation

 

As with other conditions which are basically Shi, needling is initiated with distant points, and continued with close points (59).

Hegu is stimulated in sedation in order to invigorate the flow of Qi In the meridian, and to disperse Phlegm in the throat. Then Futu is preferably punctured, to make a continuum with Hegu, and take advantage of the propagated Qi that Hegu has transmitted upward.

Tiantu is lastly utilized to produce its effect on the whole area.

 

In Taiwan I have watched practitioners using the "warm needle" technique on Hegu in this context, when Heat signs were absent. The idea behind this is that the Nei Jing states that in cases of abundant Dampness "warm needle" technique is superior (60).

 

The logic is that the heated needle conveys warmth through the point to the meridian. This warmth helps dissipate the phlegm by drying it.

 

I have therefore occasionally used this technique myself with very good results.

 

Futu, in cases of goiter, or neck lumps, is sometimes stimulated with indirect moxibustian over a layer of ginger. This is applied after the point has been needled, and the needle is withdrawn right afterwards.

 

In casesof lumps in the vicinity of Futu, it is often seen that the lump itself is pierced rather deeply, to follow right afterwards with the indirect moxibustion procedure.

 

Regarding Tiantu there are two main possibilities. The first is to insert the needle parallel to the sternum posteriorly, until Deqi is obtained, and then to withdraw it. The second is to do likewise, but suspend the needle until the whole treatment is terminated.

 

Herbal equivalent

 

A herbal formula consisted of the following herbs:

1. Thallus Algae (Kun Bu)

2. Herba Saragassi (Hai Zao)

3. Radix Cynanchi Stautoni (Bai Qian),

is very similarin action to the above-mentioned points combination.

 

Kun Bu and Hai Zao assist each other in dissipating Phlegm nodules in the neck region, or they are used together to treat goiter. Their nature is cold and salty, and they clear Heat and reduce Phlegm.

 

Bai Qian is very similar in action to point Futu, and probably Tiantu as well. It is used to treat Phlegm conditions in the throat, and to redirect rebellious Lung Qi, which means asthmatic conditions.

 

Its traditional indications also mention that Bai Qian is effective in treating "gurgling sounds In the throat", which is a sign of accumulation of Damp Phlegm.

 

This indication in particular reminds us of the classical indication of the point Futu, which we have mentioned above, that it treats: "sounds in throat - like duck".

 

Case history

 

Miss S., age 26, also a stage actress, and a close friend of Miss K. from case history Number 9, was diagnosed five years before as having a benign tumor on her vocal cords.

 

She exhibited symptomsof hoarse voice, a fact that was not at all unwelcome In her profession, and a constant sense of mucous in her throat.

 

She had an odorless vaginal discharge, occasional stomachache, and not very frequently, nausea.

 

All four methods of Chinese diagnosis revealed a state of Lung and Spleen Qi Xu, as a basis for formation of Phlegm, and obstruction of the throat by Phlegm.

 

Her pulse was thin, soggy and weak, especially on right Cun and Guan positions.

Her tongue body was slightly flabby, and covered with a thick, white, transparent and slippery coating.

 

Changmen (LIV-13) on the left side was tender but very ticklish, and Zhongwan (CV-12) was very tender too.

 

Miss S. was a ten-year smoker, and used to smoke at least 20 cigarettes a day.

The treatment principle was to eliminate Phlegm in the throat, and to tonify Spleen and Lung Qi.

 

I therefore chose the following points for treatment:

Hegu (LI-4), Futu (LI-18), Tiantu (CV-22), Panglianquan (extra), Liehchueh (L-7), Fenglong (ST-40)

 

Since there were no Heat signs, despite the fact that Miss S. was quite a heavysmoker, Hegu was acted on by the warm needle technique.

 

Panglianquan are two points located 0.5 cun on both sides of Lianquan (CV-23). These are special points for diseases of the vocal cords. One should insert the needle there transversely, along the skin, in an upward proximal direction, until the patient feels as if he or she "had swallowed fish bones"…

Liehchueh and Fenglong make a very effective points-combination to treat Phlegm in the upper respiratory tract. Liehchueh is the Luo point of the Lung meridian, and is very useful in resolving Damp conditions of the Lungs, as well as redirecting rebelliousLung Qi. It is also the master point of the Jen Mai, the extra meridian which passes through and nourishes the throat, and which is very prone to Damp-Phlegmatic diseases. Liehchueh was also chosen because of the leukorrhea of the patient, a problem which is also subject to the functioning of the Jen Mai.

 

Fenlong is the point to treat any Phlegm condition in the body, as it adjusts the functioning of the Spleen and Stomach meridians.

 

The last points-combination in this formula is Hegu and Liehchueh which follow the "Host-Guest" principle, and have a renowned ability to harmonize the Lungs, dissipate Phlegm, and redirect Lung Qi.

 

The patient was instructed to cut-off her cigarette consumption, as well as coffee and milk products.

 

She made efforts to eat more regularly and to avoid junkfood and too much salt.

 

Miss S. received seventeen treatments, after which all her symptoms had practically disappeared. She would not agree to undergo another examination of her vocal cords, in order to check upon the tumor there. She was completely satisfied with the way she felt, and said she could not care less whether or not the tumor was still there.