6. NEIGUAN (P-6), TALING (P-7), LIEHCHUEH (L-7)

 

Main effect and clinical purpose

 

This points-cluster helps facilitate the flow of Qi and blood to the palm and fingers. It is used in cases of Metacarpal Tunnel Syndrome, where Qi and Blood are blocked in the matacorpal joint vicinity, and the symptoms exhibit numbness and weakness of the fingers.

 

Points-discussion

 

Neiguan is the most important point on the pericardium channel. It is mainly used to treat chest or abdominal problems, and its functions spread from regulating the stomach activities, to improving blood circulation in the heart. One of its manifold characteristics is to regulate the Qi. The fact that it belongs to the Pericardium-Liver system, the Chueh-Yin, suggests that it is also closely linked with blood circulation problems. (In fact some authors call the Pericardium meridian "Circulation-Sex meridian" (49). As a tribute to its anatomical location near the metacarpal tunnel, it influences Qi and Blood circulation in this area. Due to its major role in improving blood circulation in general, Neiguan has a double effect on this area: one merely as a local effect, and the second as an influence on systemic circulation in the whole body. Another characteristic of Neiguan is that due to its anatomical location on the medial nerve of the arm, it is very easy to propagate the needle sensation as far as the finger tips. As Metacarpal Tunnel Syndrome usually exhibits numbness of the middle finger, or even the other fingers too, we can manipulate Neiguan to transmit a clear sensation to those fingers, thus facilitating the flow of Qi and Blood up to the desiredforemost target.

 

Taling has much the same characteristics as Neiguan, with one advantage over the latter. Its location is exactly above the metacarpal bones, and joint, a fact which makes Taling a barrier point for this area. Its needle senation is also most often felt through to the finger tips, and puncturing this point has a direct effect on the joint tunnel itself. Taling has a more cooling ability than Neiguan. It is a point often used to clear Heart-Fire, and resolve Heat in the meridian, or the organ. In many cases Metacarpal Tunnel Syndrome also exhibits Heat symptoms, due to the pressure of the stagnation there, and the use of Taling is very beneficial for such a condition.

 

Liehchuehis the Luo point, or connecting point of the Lung meridian. The connecting channel of the Lung, after leaving the main Lung channelat point Liehchueh, travels to the Large Intestine meridian and connects with it at point Pianli (LI-6). Another branch follows the Lung meridian into the palm, and spreads there through the thenar eminence.

Due to its course Liehchueh is also used for wrist joint problems, or abnormalities of the palm, such as: pain, hot palms, eczematous or numb palms. Liehchueh has to be punctured with the tip of the needle pointed toward the thumb, for maladies of the palm. The needle sensation must follow the route of the Lung meridian, or to spread into the palm.

 

In this points-combination we can see that besides its quality as a points-cluster, there is a combination of two points, Taling and Neiguan, whereby each enhances the action of the other. Thus, there is the principle of mutual-assistance, as well as the facilitation of the normal flow of Qi and Blood that any points-cluster would achieve.

 

Needling sequence, manipulation and stimulation

 

The order of needling these points is from Neiguan to Taling, so as to follow the ordinary flow of Qi in this meridian. These are also the more important points of the trio, and the pericardium meridian is more important that the Lung meridian, for this prescription’s purpose. Liehchueh is punctured last.

 

As was hinted above, after Deqi has been obtained, needles must be pointed towards the palm, and manipulated in dispersion so as to cause needle sensation to travel downwards - toward the fingers.

 

In Metacarpal Tunnel Syndrome, where definite Heat signs are absent, it is recommended to apply moxa stimulation on the points, after needling.

 

In severe cases, direct moxibustion is usually applied and scars are formed. In less severe conditions it is possible to lay the moxa cones, the size of beans, on a thin layer of fresh ginger (Sheng Jiang). The layer is punctured through, in order to allow the heat to penetrate easily, and the cones are placed one after the other, until the whole area becomes red.

 

Another technique advocates the use of white pepper mixed with flour to make a paste, and spread over the point. The thickness of the layer should be 0.1 inch, and a hole is made in the center.

 

A moxa cone is set upon i and ignited. This method is Indicated usually for numbness and stiffnss, and is most suitable for the Metacarpal Tunnel Syndrome (50).

 

Case history

 

Mrs. O.T., age 35, is the owner of a goat farm, and she is also the mother of case-history number 5 ( see above).

 

A year and a half prior to her first visit to my clinic, she began experiencing numbness along the anterior-medial aspect of her right arm, extending towards her fingers. It was more pronounced at night, while sleeping. Later, she began feeling pain when numbness reached its climax. In the last few weeks she began experiencing the same phenomena, though to a much milder extent, in her left hand too.

 

Routine checks at Nahariya Hospital revealed no signs on her cervical vertebrae, where they had projected their concern. The diagnosis given was of a Metacarpal Tunnel Syndrome, and she was advised to undergo an operation.

 

On questioning, Mrs. O.T. revealed that sometimes when sheawakens in the morning, she senses a sharp prick in her heart region, experiencing difficulty in breathing deeply, for a while. The sensation then disappears.

 

Questioning also revealed that she is in the habit of milking her goats for many hours, and that she rides a motorcycle in the fields.

 

Observation revealed a red tipped tongue with red points, and red rims. She also had peeled areas. Her right palm was dry and eczematous, she said that she had been told that it was a fungal infection, but it did not respond to medications. I diagnosed her condition as follows:

1. A pre-existing state of slight Heat-stagnation of the pericardium, which gave rise to the shape of the tongue, to the stabbing pain in the chest, and to disturbances of the Pericardium meridian.

2. Hard labour of milking had strained the brachial muscles, especially the flexor group. This strain had impeded the flow of Qi and Blood to the palm, and had laid an extra burden on the Pericardium channel.

3. Due to impeded flow of Qi and Blood to the palm, the palm became dry, undernourished and had developed the eczema.

 

The reason for aggravated numbness at night, was that rest hindered the flow of Qi and Blood even more, due to lack of movement, or activity, thus making the numb sensation more pronounced.

 

The treatment was constructed from the three cluster points, plus Tanzhong (CU-17).

 

Tanzhong was utilized to build the formula, due to its task as the Mu point for the Pericardium.It has a strong influence on blood circulation, and is said to propel Qi in the Upper-Burner, thus enhancing blood formation, and Qi and Blood circulation (51).

 

By choosing Tanzhang, I thus dealt with the local carpal stagnation, as well as assisting from afar by viewing the local problem in its holistic background.

 

After needling Neiguan I applied seven moxa cones on the point, using a layer of a paste made from flour and white pepper, underneath.

 

After seven treatments during two weeks, Mrs. O.T. improved by 90% - as she proclaimed.

 

About one year later she came to me again, saying she was afraid that her previous symptoms were returning. She was then given four more treatments, after which she felt better again.