8. SHAOZE (SI-1), TANZHONG (CV-17), RUGEN (ST-18)

 

Main effect and clinical purpose

 

This points-combination was mentioned in the "Great Compendium of Acupuncture and Moxibustian" (Zhenjiu Dacheng) written in 1601 in China during the Ming Dynasty, by Yang Jizhow (55).

 

Since those ancient times the relevance of the combination has not changed a bit, and its validity serves us today equally well.

 

The combination is suitable for all breast diseases, especially those of a Shi nature. It is used with great efficacy in cases of breast-abscess, mastitis, benign tumors of the breast, and the like. This same formula is also utilized in mastosis, or agalactia (insufficient lactation) which are primarily Xu conditions.

 

Points discussion

 

Shaoze is the Well point of the Samll Intestine meridian, and its main indications show:

1. Disperses Wind and Heat.

2. Facilitates the flow of milk in the breast.

 

Its first indication, which is in accord with its role as a Well point, makes it useful in acute conditions of febrile diseases, coma etc.

 

Its second indication points to its soothing effect on the breast.

 

The breast is where milk is originated and produced in the female body. It is anatomically located in the Upper Burner, where blood is also produced. Milk, according to Chinese medical theory, is made of seven parts Blood and one part Qi (56). The mechanism of milk production in the female body, is closely related to the functioning of the Chong Mai (the extra meridian which is also called the Sea of Blood), and which traverses the breasts (57).

 

The Stomach meridian also traverses the breasts, and this meridian too, as we know, is very rich in blood, thus both meridians nourish the breasts.

 

The close location of the breasts to the Lungs, and Lung meridian, permit the access of Qi from the air, to the blood of the breasts. Thus the intermingling of Qi and Blood, in the proper amounts, make the formation of milk possible.

 

Still, in order not to accumulate and become stagnant, milk needs a harmonizer, which will activate and supervise its flow. For this purpose, Liver Qi is responsible for two reasons:

1. This is the main task of Liver Qi in the whole body, as the Liver is responsible for the free-flow of Qi anywhere in the body.

2. The Liver meridian itself also traverses the breasts.

Milk flow, therefore, is very dependent on the free-flowing of Liver Qi, in the same manner as blood flow (like menstrual flow), is also dependent on Liver Qi. (Nei Jing: Qiis the ruler of Blood").

 

When Liver Qi stagnates, due to emotional problems, then blood and/or milk tends to stagnate too. In milk-giving mothers, this stagnation causes Heat (due to the pressure), and then mastitis, breast abscesses, etc.

 

Shaoze, both due to its milk-flow facilitating quality, as well as its Heat dispersing quality, is a first choice point for such problems.

 

Tanzhong was partially discussed in this paper under case history Number 6. It is the master point of the Upper-Burner, and the Mu point of the Pericardium. Its stimulation sets in motion the Upper-Burner Qi, in order to eliminate stagnation in the Upper-Burner. It thus helps facilitate the function ofthe lungs, aids in dispersion of phlegm in the chest in cases of asthma, facilitates the flow of Heart-0i and resolves anginapectoris, circulates the Qi of the breasts, and eliminates stagnation there.

 

In accord with these qualities, Tanzhong was selected to this combination.

 

In cases of agalactia due to a Xu pattern, Tanzhong is stimulated with moxa, to tonify the activities of the Upper Burner for milk production.

 

Rugen is situated in the fifth intercostal space, directly below the nipple. Due to its location, in the vicinity of the breast, and to its belonging to the Stomach meridian, its function is to regulate the breast. Rugen, therefore, assists either by tonification in Xu conditions, or by sedation in Shi conditions of the breast.

 

The combination, as wecan see, was based on the principle of joining points which can assist each other by influencing the same organ.Shaoze and Rugen are specific points fox breast problems, while Tanzhong is the most powerful point in the vicinity of the breast. Tanzhong has in addition some systemic influences, as we have seen above, influences that help regulate breast functioning through general physiologic functioning.

Needling sequence. manipulation and stimulation

 

Usually Shaoze is first punctured so as to direct the influence of the treatment to the breast. Then Tanzhong is stimulated due to its prime importance, and then Rugen.

Shaoze is punctured 1-2 fen deep, slantingly, in direction of the wrist.

 

Tanzhong is punctured either pointed upward or downward, until Deqi is obtained. When this is done, the needle is lifted to the skin surface, and redirected towards the diseased breast. Manipulation of the needle is then performed by twirling and lift-thrust movements, allowing the sensation to project to the breast. In cases of abscesses, or mastitis, it is imperative that needle sensation should project inside the diseased breast.

 

If both breasts are diseased, the same procedure is applied to the other breast too.

In Xu conditions of the Upper Burner, leading to agalactia, the use of moxa is very beneficial. It is possible to apply direct moxibustion, taking proper care not to cause too strong a burn. It is possible to warm the point with a moxa stick, or by indirect moxibustion on a ginger layer.

 

It is forbidden to stimulate Tanzhong with electricity, or cupping, as it may have an adverse effect upon the heart. Actually there are some texts that forbid the stimulation of this point even by acupuncture, and recommend only the use of moxa (Points of Chinese Acupuncture by Dr. J. Lavier, or CHINESE ACUPUNCTURE by Dr. Wu Wei Ping). In any case, contemporary experience in China strongly advocates acupuncture in this point, plus moxibustion.

 

With Rugen, the procedure of needling is the same as with Tanzhong, only after obtaining the Qi, the needle is directed proximally toward the breast, and then manipulated.

 

Herbal equivalent

 

This points-combination, especially when performed in order to soothe Shi patterns, resembles a herbal prescription generally used to treat the same disorders.

1. Pericarpium Citri Reticulata (Qing Pi)

2. Semen Vaccaria (Wang Bu Liu Xing)

3. Radix Salvia Miltihorriza (Dan Shen)

 

This herbalprescription is used to treat pain and swelling of the breasts, palpable masses or lumps in the breasts, due to congealed Blood, or constrained Qi.

 

It is also used to promote lactation. Just as the points-combination, it is a basic prescription, on which other herbs are usually added according to the various necessities of any specific case.

Qing Pi is a major herb to regulate the free-flow of Liver Qi. It reduces Qi accumulations due to constrained Liver-Qi in the breasts, and therefore alleviates pain and distension.

 

Dan Shen invigorates blood flow, and breaks up congealed blood. It may be used also for palpable masses in the chest, cysts and lumps. Dan Shen also clears Heat and may be used therefore to treat breast abscess due to Heat stagnation.

 

Wang Bu Liu Xing with its qualities regarding the breasts, may be adequately compared to point Shaoze. It also promotes lactation and treats breast abscesses and swellings. The meridians it enters are those of the Stomach and Liver, exactly the same meridians that play such a large role in breast physiology.

 

This formula, when tonifying herbs such as radix Astragali (Huang Qi) are added, may be used to treat agalactia due to Qi Xu conditions which have led to constrained Qi.

 

On the other hand, when herbs like Taraxacum (Pu Gong Ying) are added, it may treat breast abscesses, due to Fire and Poison origin, and constrained Liver-Oi.

 

Case history

 

Miss K., age27, a stage actress by profession, complained of a large abscess on her left breast. A month prior to that, she had another abscess on her right thigh, on the path of the Liver meridian, near Yinlian (LIV-11).

 

She was treated at that time with antibiotics, which caused the former abscess to disappear, and the new one to appear on her left breast.The antibiotics, she proclaimed, had made her very weak, lethargic, and depressed.

 

On arrival at my clinic she had fever, and suffered great pain in her left breast, a pain that radiated along the Pericardium channel of her left arm.

 

The abscess was large, situated under her left nipple, inflamed, and resembled a second red, big nipple.

 

Miss K.'s pulse was moderate and choppy, deep and weak. The Cun position, on both sides, was very choppy.

Her tongue was red-purple, with even redder rims. The inside of her eyelids showed a red shaded line on the upper part of the lids - a Blood-Stagnation indication.

 

In reply to my question as to whether she had had any problems with her liver, she said that she had suffered a severe jaundice five years earlier.

 

Thus, in accordance with all the symptoms and signs, I diagnosed Miss K. as suffering of Liver-Heat stagnation, affecting the meridian. The abscess on her left breast was of the Fire-Poison category, and also involved Blood-Stagnation. This Blood involvement had caused the fever, and involvement of the Pericardium channel. The pericardium channel is in continuum with the Liver channel, as a partner in the Chueh-Yin system.

 

The formula for treatment was as follows:

Left side: Shaoze (SI-1), Tanzhong (CV-17), Rugen (ST-18), Zulinqi (G-41), Waiguan (T-5)

Both sides:Quchi (LI-11), Zusanli (ST-36).

 

This formula was actually constructed from three well knownpoints-combinations.

on the first combination there is no need to elaborate, it is sufficient to say that in this case all the criteria existed in order to utilize this combination.

Zulinqi and Waiguan are the Master and Coupled points of Dai Mai - the Girdle Vessel.This extra meridian harmonizes Liver and Gall-Bladder activities, and its area of influence is the waist, ribs and chest, and the head. Dai Mai, as an extrameridian, absorbs excess energy from the Liver and Gall channels, and adjusts their functioning.

 

Moreover, Zulinqi is indicated for Liver-Qi stagnation affecting the breast, and that includes mastitis and abscess.

 

Waiguan, in addition to its role as the coupled point of the Dai Mai, is the Luo point of the hand Triple-Burner (San Jiao) meridian. Its coupled meridian is the Pericardium meridian. Puncturing Waiguan may be thus used to divert excess from the Pericardium, and to adjust its functioning. All this is due to the Luo points' role as a "tap", that maybe used to balance two coupled (Yin-Yang) meridians.

 

Quchi and Zusanli, both on the Yangming segment of channels, drain excess Heat, relieve fever and invigorate and regulate the Blood. They are therefore widely used in hypertension due to excess Heat - a fact which has already been discussed in this paper.

 

The first sesion lasted 30 minutes, in which Tanzhong and Zulinqi were manipulated every 10 minutes. The patient experienced a "sucking" sensation, travelling from Tanzhang to the abscess. Following the treatment, she experienced the same "sucking" sensation plus pain along her left arm, for about six hours.

 

After six hours the abscess burst open, and a great deal of pus and blood was discharged. Afterwards, she experienced a sudden relief. The pain subsided almost completely, as did the fever and the depression.

 

Miss K. came thereafter for six consecutive treatments, following which herbreast healed completely.

 

Miss K. came to me a year later for a different problem, and while examining her I noticed that her breast did not bear even the slightest mark of the episode she had undergone.