12. NEIGUAN (P-6), ZUSANLI (ST-36), ZHONGWAN (CV-12)

 

Main effect and clinical purpose

 

This points-combination is the basic, and most fundamental prescription for all stomach complaints. Its action is to regulate and harmonize Stomach-Qi, resolve gastric stagnation of any kind and redirect the rebellious Qi of the Stomach.

 

It is therefore mainly used for gastric pain of different etiologies, nausea and vomiting, such as in the morning sickness syndrome.

 

Points discussion

 

Neiguan is one of the most popular points in clinical practice. It is very often encountered in treatments, and it has a broadspectrum of indications. It is the third points-combination in this work, in which Neiguan takes part.

 

Under points-combination number 10, we have already mentioned that Neiguan is one of six points considered "Main Points" in the classics. There, its indications say: "Take Neiguan for the heart and thorax."

 

Actually the two main organs Neiguan is very effective for, are the heart and the stomach. The influence that Neiguan exerts upon the stomach, is reflected in its indications list:

"To promote the function of the stomach, and regulate the Middle Jiao."

 

Neiguan is also used as an important point to regulate the heart, and calm the mind. It is therefore used extensively in cases of anxiety and palpitations, etc.

 

The fact that Neiguan is so helpful in these conditions, is probably due to its role as the Master point of the extra vessel Yin Wei Mai.

 

This extra vessel is used primarily to treat emotional problems related to deficiency of Yin Qi, and Blood. It is a vessel that binds all the Yin meridians, and controls the heart functioning, related to Blood (67).

 

Neiguan, as its Master point, is situated on the Chuehyin segment, which is the hinge of the Yin, and thus controls the Yin.

 

In order to have an effect on Blood production, so as to tonify the heart functioning, Neiguan must regulate Somach-Qi, in order to permit the Stomach and Spleen to produce Blood. Its coupled point in the Yin Wei Mai meridian, Gongsun (SP-4), actually complements Neiguan's influence upon the stomach due to its role as the connecting Luo point between the Stomach and the Spleen. Thus, Gongsun has a tonifying effect on the Spleen, it pacifies the Stomach and it regulates the Chong Mai, of which it is its Master point.

 

In summary, Neiguan has a regulating and tonifying effect over the Stomach, due to its manifold connections with other vessels in the body.

 

Zusanli is the lower He-Sea point of the stomach. It is also called the Fissural-point and its action is described in the Ling Shu as follows: "They (Fissural points) refer to the deep regions where the energy of the meridians gathers together, and they are more effective in relieving acute pain in the travelling regions of the related meridian, and also in the internal organ to which the meridian in question belongs."

 

Zusanli is also one of the "Six Main Points" of the classics described before, and is indicated there for all diseases located in the abdomen and belly.

 

As the lower He-Sea point of the stomach, Zusanli adjusts the function of the Stomach and Spleen, and is used as the major point to tonify the Spleen. It is often used in conjunction with point Taiyuan (L-9) to tonify the Qi of the whole body, as the source of post-natal Qi are the Lungs and Spleen.

 

Zusanli also regulates circulation of Qi and Blood, and tonifies anti-pathogenic Qi In the body.

 

In all Stomach diseases it plays the most important role, and is used to strengthen deficiency conditions, as much as to sedate excess.

 

Zhongwan is the Alarm-Mu point of the Stomach. It is also used in all Stomach syndromes, both Xu and Shi. It regulates Stomach-Qi and is therefore used in painful syndromes, or nausea and vomiting. It relieves Food stagnation and treats indigestion, abdominal distension and the like. It is also used to tonify stomach and Spleen, and therefore treats anorexia, anemia, chronic diarrhea, and the like. Zhongwan relieves abdominal pain, and is used to treat gastric ulcers and gastrodynia of various etiologies.

Zhongwan is also a confluent point of all the Fu organs, and so exerts its influence on all their activities. It is known, for instance, that the intestinal rhythm, or peristalsis, affects the stomach function, and vice versa. Zhonwan, as the meeting point of all the Fu organs, is thus used to harmonize and regulate peristalsis of stomach and intestines.

 

After analyzing thethree points' functions, it is obvious now how these three points have a regulating effect over the Stomach. It is important to bear in mind, however, that this is, a very fundamental combination, despite its great efficacy. It is necessary, as a rule, to add other points to this trio, according to the various manifestations of gastric stagnation.

 

In order to further elaborate on this, let us take a few examples:

1. If we have diagnosed a gastric stagnation due to Food and Heat accumulation, it would be appropriate to add: Neiting (ST-44) and Weishsu (B-21).

2. If the stagnation isdue to Liver Qi invading the Spleen, we may add: Taichong (LIV-3) and Changmen (LIV-13).

3. Or, in the case of Phlegm accumulation: Fenglong (ST-40) and Yinlingchuan (SP-9). And so on.

 

Needling sequence, manipulation andstimulation

 

Neiguan, as the Master point of Yin Wei Mai, and a distant upper point, opens the treatment by its regulating effect over the chest and abdomen. It is mostly proper to do so when nausea and/or vomiting exist, due to Neiguan's calming effect, and ability to diminish nausea.

 

In Shi syndromes it is manipulated with lift-thrust and twirling movements. In case number 6 we havestressed the verydistinct Qi sensation of this point, and it is of importance to direct this sensation in proximal direction. (In contrast with case number 6 which was a distal direction).

 

This may be done by pointing the needle tip in a proximal direction, and gently massaging the route of the Pericardium channel, from the needle upward (68). Zhongwan is then needled to produce a sore, or tight sensation, usually in waves encircling the point. It is manipulated in the same way as Neiguan, with one difference. This is a point which "loves" Heat stimulation, and reacts extremely well to it. Thus, in cases where Cold is the cause of disease, or one of its manifestations, this point may be stimulated by all forms of moxa applications (which were discussed earlier In this work), or, even better, a moxa-box. This is a perforated metal box with a handle, in which moxa is lit until it gets hot. Then it is placed over the point, after a piece of gauze has been placed between the body surface and the instrument (69).

 

In cases of nausea or heartburn, the needle tip at Zongwan may be pointed downward, so as to redirect Somach-Qi. In cases of prolapsed stomach, due to Yang deficiency, the needle tip should be pointed upward, and Zhongwan stimulated by heat.

 

Zusanly is also manipulated in the same fashion as Neiguan, only it is more difficult to cause its sensation to travel proximally. It is also unnecessary as it may sometimes aggravate the patient's condition. Quite often, Zusanli is also stimulated with moxa, reacting extremely well to it, too.

 

Herbal equivalent

 

A proper herbal equivalent for this points-combination is probably the following prescription:

• Pericarpium Citri Reticulata - Chen Pi

• Cortex Magnolia Officinalis - Hou Po

• Rhizome Atractylodis - Cang Zhu

• Fructus Citri seu Ponciri - Zhi Shi

This, too, is a basic prescription to regulate Stomach, and Spleen-Qi. It is used for epigastric and abdominal fullness, distension and pain from stagnant Qi, and it treats nausea and vomiting due to rebellious Stomach-Qi.

 

Chen Pi moves stagnant Stomach-Qi, and tonifies Spleen-Qi. It also redirects rebellious Stomach-Qi and is used for any type of nausea and vomiting. In addition, it is an important herb to treat coughing due to excessive Damp and Phlegm originated by the Spleen.

 

Hou Po also moves the Stomach stagnant Qi, redirects rebellious Qi with symptoms of nausea and vomiting, and much as Chen Pi, it dries Dampness, and transforms Phlegm. It, thus, complements Chen Pi, and accentuates its action.

 

Cang Zhu too has more or less the same qualities, with the addition of tonifying the Spleen. It is therefore used also for anorexia and diarrhea caused by weak Spleen.

Zhi Shi breaks up stagnant Qi and reduces accumulations, and it deals therefore more adequately with the painful symptoms of stagnant Stomach Qi.