16. ZHIGOU (T-6), ZHAOHAI (K-6), TIANSHSU (ST-25)

Main effect and clinical purpose

 

This combination of points has a special effect on regulating the function of the intestines, and eliminatingconstipation.

 

Points discussion

 

Zhigou was broadly described and analysed in the previous combination, number 15.

 

There, we also mentioned that Zhigou is very effective in the treatment of constipation due to its ability to remove obstructions from the intestines. The explanationfor this ability of Zhigou is In two of Zhigou's characteristics:

1. Situated on the beginning ofShao-Yang, this point has the ability to invigorate the movement of Yang-Qi throughout the, body, in a direction from above to the inferior parts of the body. Since all the Yang-Qi travels from above downward, while all the Yin-Qi starts from below and travels upward, Shao-Yang is utilized to facilitate the Yang movement, as much as Shao-Yin, by the same principle, the movement of Yin-Qi.

2. As a point belonging to the Triple-Burner, this point helps regulate the circulation of Qi in the three Jiaos. Along with Zhigou's ability to remove obstructions, it makes a powerful point in both regulating and cleaning the intestines.

 

Zhaohai is located in the leg Shao-Yin meridian. The ShaoYin starts the movements of the Yin-Qi towards the upper parts of the body (81), and this makes Zhaohai one of the most Important points to tonify the Yin.

 

One of the most frequent causes of constipation is accumulation of excess Heat in the Large Intestine, that dries the stools, making them hard, and difficult to evacuate.

 

Another frequent cause, is lack of sufficient fluid in the Large Intestine, which causes dryness of the bowel and insufficient lubrication to allow smooth passage of the stools. The lack of fluid, or Yin, may be either because there is excess Heat in theLarge Bowel, or because of a Xu condition of systemic Yin, or Blood deficiency.

 

Zhaohai, as a Yin tonic, supplies the Large Intestine with Yin Qi, and thus provides lubrication for the constipated dry intestines.

 

Another facet of these ingeniously combined two points, is the energetic outcome of the simultaneous use of both of them.

 

Zhigou starts an accelerated movement of Yang Qi downward. Yang Qi makes peristalsis faster and better, as Yang-Qi manifests itself inmovement and function. Zhaohai, for its role, starts an accelerated movement of Yin Qi upward. Yin Qi brings coolness and fluid, as those are the manifestations of Yin. As the result of this, the intestines are moved to expel their contents, and at the same time are irrigated to allow its free passage. Thus, the use of these points together creates an energetic motion, harmonious and complementary, that has a regulating effect on the function of the Large Intestine.

 

Tianshu is the Front-Mu point of the Large-Intestine. In this way it is connected directly with the organ itself, and is therefore associated with all the problems of this organ.

In its Indications we can find the following:

• Tianshu adjusts the function of the intestines.

• Tianshu regulates the Qi of the intestines.

• It relieves stagnation of Qi, Blood and Food in the intestines.

• It regulates menstruation.

Because of these qualities, Tianshu is used in both chronic and acute constipation.

As do most of the Front-Mu points, Tianshu also serves as a local point, close to the focus of disease. As such it has a direct and immediate effect upon the Large Intestine, an effect that may be taken advantage of, even by hand manipulation of the Tui-Na massage.Using Tianshu as a pressure point moves the intestines, relieves distension, and helps achieve an evacuation, especially in acute, painful constipation.

 

The combination of Zhigou with Zhaohai was mentioned, as an effective treatment for constipation, as far back as the year 1537.

 

It was mentioned then in the Yu Long Ge (Song of the Jade Dragon), found in the collection of Gatherings from outstanding Acupuncturists (Zhenjiu Juying) (82).

 

The methodology by which these two points were combined has already been explained previously. The addition of Tianshu to the couple, centers their effect in the Large Intestine, and adds the strong influence of Tianshu itself upon the intestine.

 

Needling sequence, manipulation and stimulation

 

Zhigou and Zhaohai are needled one after the other to perform their energetic influence, as was described previously.

 

Tianshu is then needled and manipulated.

 

Zhigou is usually manipulated in a dispersion fashion. Zhaohai has a better effect if its Qi is made to travel upward along the medial aspect of the shin, towards Sanyinjiao. Tianshu is also manipulated in dispersion, usually.

 

only when the cause of the constipation is a deficiency of Yin and/or Blood in the Large Intestine, usually due to old age, may Zhaohai and Tianshu be tonified. Otherwise, the condition of a constipation is Shi (obstruction, Heat, congestion, stagnation) in general, and the points should be sedated.

 

Herbal equivalent

 

Semen Trichosanthis (Gua Lou Ren), Semen Cannabis (Huo Ma Ren), Semen Persica (Tao Ren), Semen Biota orientalls (Bai Zi Ren) and Semen Sesami Indici (Hei Zhi Ma), all treat constipation.

 

Gua Lou Ren treats constipation due to Heat in the Lungs that penetrates into the Large Intestine, usually after fever.

 

Huo Ma Ren treats constipation due to deficient Qi, especially in the elderly. Deficient Qi causes stagnation and dryness in the intestines.

 

Tao Ren is an herb used to invigorate the blood, and treat constipation due to congealed blood and Heat stagnation.

 

Bai Zi Ren tonifies Blood and Yin in the intestines, as it is a nourishing herb, and is therefore used in treatment of the elderly and debilitated.

 

Hei Zhi Ma, maybe used like point Zhaohai. It tonifies the Yin of the Kidney and Liver, and lubricates the intestines.

 

This formula encompasses, actually, all the possible causes for constipation, and each herb contributes its personal quality, plus a generalized effect, common to all of them, namely, to lubricate the intestines, and smooth their action.

 

This prescription must be modified in any particular case, according to the diagnosis. Thus, if Blood-Xu dominates the picture, then herbs such as Radix Angelica Sinensis (Dang Gui) must be added, and so on.

 

Case history

 

Mrs. K, age 45, suffered for many years from constipation. Sometimes she did not have a bowel movement for a whole week. In addition she complained of halitosis, and much gas in the abdowen.

 

A month before our first appointment, she started experiencing weakness, and sometimes evenpalpitations.

 

She was slightly obese, and had puffy bags below her eyes.

 

Observation also revealed a bright red tongue, pourplish in the center, with many red prickles around the tip and sides. It was peeled andslightly scalloped in the sides.

 

The pulse was regular and soft, with the Kidney position deep and weak.

 

These symptoms were evidently a Yang within Yin condition, or a Xu condition giving rise to Shi symptoms.

 

The basic pattern, as evidenced by the soft pulse, puffy eye bags, scalloped tongue and obesity, pointed out a Spleen Qi Xu. Spleen Qi Xu affects the transformation-transportation function of the Spleen, giving rise to obesity and lazy bowel movements - hence constipation.

 

Long termconstipation causes stagnant Qi in the Large Intestine, which in turn develops Heat. Heat causes dryness of the intestines, hard stools, and may also cause Blood stagnation. Mrs. K. showed a shiny red tongue with purplish center, and red prickles. All of these signs pointed to Heat stagnation, probably with Blood congealed inside too.

 

The treatment given to Mrs. K. included our points-combination, to treat the basic stagnation and to lubricate the intestines.

 

In addition, other points were combined, in order to form a comprehensive formula.

Dachangshu (B-25) - The Back-Shu point of the Large Intestine, in order to activate the bowel, and disperse the Heat therefrom. Dachangshu and Tianshu together, make another points-combination, based on the Shu-Mu principle, that has a strong draining effect on the bowel.

 

Taichong (LIV-3) and Sanyinjiao (SP-6) - were also added as another points-combination. These points regulate the Qi, disperse stagnant Qi and Blood, and tonify both Liver and Spleen.

 

Zusanli (ST-36) - is perhaps the most important point to tonify Spleen Qi, and strengthen its transportation function. In addition, it has a strong influence on constipation, it tonifies the Blood and strengthens its circulation in all the gastro-intestinal tract.

 

Mrs. K. has been treated several times during the past three years. She usually receives a few treatments based on the above prescription, her constipation improves for a year or so, until the next time.

 

It is very important to educate the patient regarding the proper life habits, for dealing with constipation. Fiber rich foods are essential, along with Yin supplementing foods, such as: whole wheat, vegetables, fruit, oils, dried fruit, almonds, and so on. Physical exerciseis inavaluable for people with weak abdominal muscles, and, no less, regular eating habits.