2. HEGU (LI-4), YINGXIANG (LI-20), ZUSANLI (ST-36), NEITING (ST-44), XIANGU (ST-43) [43]

Main effect and linical purpose

This is a points-combination based on the law "one point above two points below" (see previous chapter). Its purpose is to clear obstruction from the Yang-Ming system, mainly sinusitis. It has a clear sedating effect, and is therefore used for excess patterns, characterized by Heat and Damp.

Points discussion

Hegu is one of the most frequently used acupuncture points. It is the strongest point on the hand Yangming channel, and is used vastly for all complaints of the head.

It is used to eliminate Wind-Heat or Wind-cold; Hegu is an analgesic point and it relieves pain. It is antiphlogistic, antipyretic, and used for all inflammatory processes in the head region.

Yingxiang is the last point of the hand-Yangming channel. Its indications are for all diseases of the nose, and to dispel Wind-Heat from the nasal-cavities. It is also an intersection point between the Large Intestine and Stomach meridians.

Zusanli is also one of the most frequently used points. It is the most powerful point on the Stomach meridian, and is used for all digestive complaints. In this context it is used to eliminate Damp and Heat from the Yangming channel. Zusanli may be either tonified, or sedated, depending on the nature of the disharmony. Thus, among its manifold activities, It may be used to eliminate Wind and Damp, to regulate circulation of Qi and Blood, to tonify weakness and promote anti-pathogenic Qi.

Neiting is a point of choice to treat excess patterns in the Stomach, or stomach meridian. It is mainly used to reduce Heat in the channel, or organs under control of this channel. This includes nasal cavities, upper teeth and gums, stomach and intestines. Its indications also list: to regulate Qi, and relieve pain.

Xiangu is indicated mainly for facial edema, for pain and elimination ofWind. Sinusitis is characterized as a Wind Heat disease, and it causes accumulation of fluid (Damp) In the face, due to Heat stagnation.

As we have explained in the previous chapter, this type of combination places an emphasis on regulating the Qi in the channel, makingit flow more vigorously in the right direction, by utilizing more points on the desired direction.

Thus, points Zusanli, Neiting and Xiangu provide a heavier weight than Hegu and Yingxiang, in order to promote the flow of Qi to their direction. This invigoration ofQi is said to clear the obstruction (sinusitis) where the hand Yangming, andleg Yangming meet (the nasal area).

It is worthwhile mentioning that all of these points have a clear Damp and Heat clearing function, amongtheir other qualities.

Needling sequence, manipulation and stimulation

Needling sequence is of major importance in this combination. Since the whole idea is to propel the energy along the meridian in the desired direction, we have to stimulate the points in the appropriate order. By needling these points in succession, we propagate both the needle sensation, and the effect towards the oriented direction.

The fact that Nelting is needled before Xiangu is because Neiting is a stronger point than Xiangu, and therefore plays a more important role in the "see-saw" balance of the combination.

The points are naturally manipulated in a reducing, or sedating technique. This may be either anti-clockwise rotation of the needles, or pull-thrust maneuvering.

When an excessive Hot condition is observed, it is possible to perform the "Cooling the Sky" technique. By this technique the needle is inserted to the desired depth, and then forcefully raised up a fraction, and gently inserted again. This manipulation is repeated six times. The procedure is repeated at three different levels, from the deepest to the most superficial position, until the patient senses coolness. This is exactly the opposite procedure to "burning the mountain", which was described under the previous combination (44).

As a rule, for sedation purposes the needle manipulation requires stronger movements by the practitioner, with larger amplitude and angles than tonifying manipulations. In shallow surfaces It is often sufficient to point the needle tip along or against the energy stream, in order to tonify or sedate, respectively.

Case history

Mrs. S.A., age 40, has suffered from chronic sinusitis for 12 years. She had some 4-5 acute incidents each year, for which various antibiotics had been prescribed. Twice she had undergone nasal operation and sinus pumping - without long term satisfactory results.

She came to see me three years ago, suffering an acute attack which did not respond to antibiotic remedies. She had low fever, felt very weak and sick, and had unbearable pain around the supraorbital area, especially of her left eye. Mrs. S.A. had a purulent yellow, foul smelling nasal discharge, dry mouth and constipation.

Both her pulse and tongue indicated an excessive DampHeat condition. Her pulse was also weak, and indicated her general weakness.

Mrs. S. received six treatments. The prescription was built from the above combination, with the addition of Zanshu (B-2). Zanshu was manipulated by a dispersion technique, i.e. was punctured in three directions one after the other, and then was left intact.

Zanshu was chosen due to its local effect, in order to disperse thepurulent liquid around the eyes' orbit.

After two treatments Mrs. S. experienced significant relief, and after the fifth appointment, she proclaimed that she was free of all symptoms. Hence, she was given another treatment to consolidate the effect, and the treatment was terminated.

During the last three years, Mrs. S. suffered one more attack, which responded to treatment in the same fashion.