15. ZHIGOU (T-6), QIMEN (LIV-14), YANGLINGQUAN (G-34), TAICHONG (LIV-3)

 

Main effect and clinical purpose

 

This points-combination is used to regulate the Liver and Gallbladder meridians, to remove obstruction from their passages, and to resolve stagnation of Liver-Qi.

 

Therefore it is often used in cases of flank pain, oppression and discomfort in the chest, and distension of the breasts.

 

Besides this it may also treat sciatica which occurs along the route of the Gallbladder meridian, or paralysis of one side of the body associated with this meridian.

 

Points discussion (79)

 

Zhigou is a point on the hand Shao-Yang meridian, which is in continuum with the leg Shao-Yang, Gallbladder meridian.

 

Its indications are mainly concerned with the domain of the Shao-Yang system. It spreads and invigorates the Qi in this meridian, and disperses obstructions which are located along its route.

 

The axilla, side of the chest and the ribs cage, are all irrigated by the Qi of the Shao-Yang and Chueh-Yin meridians. These meridians form the internal/external relationship, and points from each of them also affect the other.

 

Zhigou is located at the beginning of the Shao-Yang, which is literally the small-Yang. The points at the beginning of the Shao-Yang, have anaccelerating effect on the movement of the Yang from the upper parts of the body, to the lower parts. By accelerating this movement, we can disperse obstructions along the route, one of which is chest, or flank pain (80).

 

Symptomatically, Zhigou is very relevant in cases of flank pain, and it is often mentioned in ancient works from China, thus: "In pain of the ribs and flank, needle Zhigou” was written in the BIAO YOU FU (Ode of the Standard of Mystery). Also, in the YU LONG GE (Song of the Jade Dragon), we find: "When there is pain and obstruction of the flanks, using Zhigou, will give excellent results."

 

Zhigou is also very much used in the treatment of constipation, due to its ability to remove obstruction from the intestines as well.

 

Qimen is the Front-Mu point of the Liver channel. It is located in the costal region, and has a local effect on this area. Besides its location in the site of the pain, it has a similar action to Zhigou. It spreads and invigorates the Qi. Furthermore,it also has the ability to transform congealed blood, and remove blood stagnation. Thus, even in cases of traumatic injury, such as a broken rib, Qimen is indicated.

 

Qimen, as the Front-Mu point of the Liver, has a direct effect on this organ. Since the Liver is the organ mostly associated with Qi stagnation, Qimen, as its Mu point, has an effect on invigorating the Qi in general. Therefore, even costal pain that is due to emotional problems (i.e. depression), or internal diseases (i.e. hepatitis), may be treated by Qimen.

 

With regard to its effect on the flanks, we can find in the Zhen Jiu Dacheng (Great Compendium of Acupuncture and Moxibustion), written by Yang Jizhou in 1601, the following recommendation: "pain, fullness and obstruction of the flanks, when Qimen is used, great results will be achieved".

 

Yanglingchuan constitutes the counterpart of Zhigou on the same segment of Shao-Yang. It is the He-Sea point of the Gallbladder, and has a strong effect on this organ.

 

As we know, the Gallbladder is anatomically situated under the costal region, and malfunctioning of this organ, often gives rise to flank pain, distension and soreness of the whole area.

 

Stimulation of Yanglingquan has a calming effect on the Gallbladder, and it regulates its function. Thereby it is beneficial for flank pain.

 

Besides regulating the function of the Liver and Gallbladder, Yanglingquan is the meeting point of the tendons and ligaments. Its indications say in this respect that its use benefits tendons and bones. Thus, in cases of traumatic injury, this is a very important point to resolve stagnation in the costal region, brought about by accident.

 

In the "Song of Points for Miscellaneous Diseases (Zabing Xuewei Ge), written in 1537, we find: "When there is flank pain, Yanglingquan must be used".

 

Taichong constitutes a continuum in this points-combination with Qimen. They are both situated on the Liver meridian, and Taichong makes the Yuan-Source point of the Liver.

Yuan-Source points are closely connected with the organ to which they are linked. In this respect, Taichong has the same qualities that we have mentioned under Qimen, only it operates from afar.

 

Taichong is actually the strongest point in the treatment of stagnant Liver-Qi. It is most useful in internal diseases caused by stangnation of Qi, but may be used in any form or cause of stagnation.

 

Taichong has pain-relieving qualities, due to its role as a destagnation point. It is so remarkably effective in relieving pain, that it has been used for generations, in the renowned combination known as the "Four Gates". The combination is Hegu (LI-4), two points above, and Taichong, two points below. This combination has a strong sedative effect by activating and dispersing Qi and Blood in the whole body.

 

In the treatment of flank pain, Taichong plays its role by relieving pain, dispersing stagnant Qi, regulating the Liver and Liver channel, and regulating the Blood.

 

In this points-combination two principles have combined in order to form the theoretical basis for its existence. One is the principle of mutual assistance, and the second Is "one point above - two points below."

 

We have demonstrated, under each point description, the influence that it has upon the costal region. We have seen that each one of the points may affect by itself the flanks, chest and the ribs. Together, they exert a much greater potency in resolving any kind of pain in this region, than any of them alone.

 

The Shao-Yang and Chueh-Yin meridians, form the external/internal-Yin/Yang relationship. They thus influence one another, and may be treated also, one by the other.

 

In this combination we have two points belonging to the Shao-Yang segment, Zhigou - above, and Yanglingquan - below, and two points belonging to the Chueh-Yin segment, Qimen - above, and Taichong - below.

 

By the principle of "one above - two below", Zhigou, as was described above, accelerates the flow of Qi in order to unblock the stagnation in the costal region. Qimen serves as the local upper point, that invigorates Qi and Blood in the disease focus, and Taichong with Yanglingquan constitute the weight on the other end of the see-saw, so as to attract the energy and facilitate its flow.

 

It is very similar to the previously described sinusitis points-combination, under case number 2, of this chapter. The only difference being that the latter is based on one meridian segment, whereas the former, on two meridian segments. The effect, nevertheless, is the same.

 

Needling sequence, manipulation and stimulation

 

The order of needling in this combination, is as in other combinations based on the "one above-two below" principle. Zhigou is the starter, for the reasons mentioned above. Qimen, Yanglingquan and Taichong follow. The sequence, thus, goes in descending order, and follows the desired direction of energy.

 

The method of stimulation is dispersion, with an emphasis on conducting the Qi in the direction of the disease focus.

 

It is possible to administer electricity in the case of acute pain, in the same way as we have discussed in other cases.

 

In the case of traumatic injury of the rib cage, it is possible to apply moxa. This is usually done with a moxa stick above local points, such as Qimen or Ahshi points. It is not recommended to apply moxa immediately after the injury has occurred, but a few days later. It is also not recommended if Heat signs are evident.

 

Herbal equivalent

 

The opening herb, much like Zhigou, was chosen in this prescription, mainly because it enters both the Triple-Burner and the Liver meridians. This herb is rhizoma Cyperi Rotundl (Xiang Fu).

 

It regulates the flow of Qi in these two meridians, and it resolves stagnation of Liver-Oi.

Together with Radix Bupleuri (Chai Hu), it is classically used for pain and distension in the chest and flanks.

 

Chai Hu, together with its ability to release exterior conditions associated with the Shao-Yang pattern, is also used to relax constrained Liver-Qi, and as such its indications include: chest and flank pain, a feeling of constriction in the chest, and other symptoms not relevant in this context.

 

Another herb that may assist the function of the former couple, is Pericarpium Citri reticulata (Qing Pi). This herb enters the Liver and Gallbladder meridians, is used to regulate their Qi, and to alleviate pain. It is used for chest, breast, flank and hypochondriac pain due to Qi stagnation, and also Blood stagnation, to some extent.

 

The last herb in this formula is used to invigorate the Blood in the domain of the Shao Yang and Chueh Yin channels. It is a major herb, and is used in many pain syndromes, including headaches. The herb is Radix Ligustici Wallici (Chuan Xiong).

 

Due to its ability to invigorate the Blood and break-up congealed Blood, it makes the whole formula valid even in the case of traumatic injury in the chest or flank regions.

 

Case history

 

Mr. E. age 48, was a psychologist who had decided, a month prior to his visit at my clinic, to learn how to fly. Thus, he enrolled in a sky gliding course, and in his first attempt to take off, he broke three ribs on his left side.

 

After a month of suffering severe pain and sleepless nights, his X-ray examination did not show any improvement.

 

So, when he came to me for treatment, he was already weak and exhausted, not to mention his sincere repentance for his heroic aspirations.

 

Mr. E. was given a course of six treatments, during two weeks, after which his pain and distension had left him completely. A week later he underwent another X-ray examination which showed, this time, completely healed ribs.

 

His treatmentsincluded our points-combination, with the addition of Dazhu (B-11), and Shenshu (B-23).

 

The points-combination was chosen because the broken ribs were in the domain of the Shao-Yang and Chueh-Yin channels. The combination, as already explained, has the ability to resolve stagnation, and invigorate the Qi and Blood In the flanks and costal region.

 

Dazhu was added due to its task as the confluent point of the bones, and the effect it has on repairing skeletal damage, and strenghtening the bone structure.

 

Shenshu, as the Back-Shu point of the Kidneys, joined the formula in order to strengthen the patient in general, and to reinforce the Kidneys which, according to T.C.M., rule the bones. Thus by reinforcing the Kidneys, the bones are also tonified.