Case History No. I

 

Miss K. was ten years old when her parents brought her to see me, on emergency call.Prior to her visit she had been hospitalized for one month in the Paediatric in-patient department of Rambam hospital, Haifa, but her condition did not improve.

 

Miss K. suffered acute gastrodynia with occasional nausea. Her epigastric region was very tender, her face very pale, and she appeared very emaciated and under severe pain.

Her pulse was fast, and her tongue had red points on tip and both sides.

 

I diagnosed her condition as a stagnation of Stomach-Qi due to irregular eating habits, and emotional problems.

 

This conclusion was reached after aninterrogation, during which her parents admitted the facts. She did not have the Food stagnation signs, neither Phlegm, nor Blood stagnation.

I applied the points-combination with the addition of Liangqin (ST-34). Liangqin is the Xi-Cleft point of the stomach. It is applied in cases of acute pain in the organ to which it is connected.

 

All the points were manipulated in the regular sedation technique.

 

During the first few treatments, Miss K. experienced pain relief which sometimes lasted for a few hours after the treatment. After nine treatments, which were carried out during eleven days, her problem resolved completely. one year after the termination of the treatment there has been no recurrence of symptoms.

 

Case history No. 2

 

Mrs. G., age 37, married plus four children, was in her seventh month of pregnancy, when she came to see me. Since the beginning of her contemporary pregnancy she had suffered severe nausea and vomiting. Since her fifth month she had been experiencing lassitude, anorexia, heartburn, vomiting and nausea.

 

Furthermore, Mrs. G. complained of dry mouth, especially at night, constant thirst and craving for fruit. In addition she felt abundant phlegm in her throat.

 

Her pulse was very Slippery and her tongue was scalloped.

 

In Mrs. G.'s case a stagnation ofStomach-0i was also present, but the pattern was more complex.

 

In the first place it was obvious that her Spleen and Stomach were not in harmony. There were symptoms such as lassitude, anorexia and phlegm, along with a scalloped tongue, suggestive of Spleen-Oi deficiency. On the other hand, her Stomach-Qi was rebellious, she had heartburn, vomiting and thirst, all of which indicated a Shi/Hot Stomach.

 

The deficient condition ofthe Spleen, gave rise to abundant phlegm, a Shi pattern, which aggravated the situation of the patient. Thus, we could see that she was constantlythirsty, and craved for fruit (a very Yin food), but, at the same time, she was anorectic and nauseous because of Phlegm stagnation at her stomach.

 

It is very common, of course, to see nausea and vomiting in pregnant women. The T.C.M. explanation for this phenomenon is the heavy burden that pregnancy exerts uponthe Spleen and Kidney. Both organs play a major role inproduction of Blood and Yin,essential substances for conception andmaturation of the foetus. This burden weakens both the Spleen and Kidney, giving rise to abundant Phlegm, and weakening of Stomach-Qi (70).

 

The prescription for Mrs. G. included, of course, the points-combination, with the addition of the following points: Tiantu (CV-22) and Fenglong (ST-40) to reduce Phlegm in the throat, and generally in the body. The mutual functioning of these two points was already explained in the previous case, number 11. In addition, two other points were also added: Neiting (ST-44), and Gongsun (SP-4).

 

Neiting - in order to decrease Stomach-Heat and stagnation, and Gongsun, as the Luo-connecting point of the Spleen, to shift excess energy from the Stomach to the Spleen.

symptomatically, Gongsun is capable of relieving nausea andit thus aids the overall action of the points-combination.

 

It is important to note here that Zusanli was manipulated in tonificaiton, gently, whereas the other points were all manipulated in sedation. As Mrs. G. was somewhat frightened and sensitive to the treatment, the manipulation of the needles,even in sedation, was carried out rather gently.

 

Mrs. G. felt much better immediately after the first session. After the third session, she had significantly less phlegm, her nausea and vomiting subsided, and she felt much stronger.

 

The whole treatment lasted three weeks after which Mrs. G. felt that she had regained full strength. she gave birth in due time, without any complications, and in good health.

 

 

13. CHANGQIANG (GV-1), CHENGSHAN (B-57), PAIHUI (GV-20)

 

Main effect and clinical purpose

 

This points-combination has indeed a long history. The first two points, Changqiang and Chengshan, were already mentioned as a combination 500 years ago, in 1529, by the Physician Gao Wu, in his Bai Zheng Fu (ode of a Hundred syndromes) (71).

 

Thisis the basic formula to treat hemorrhoids of any aetiology. This combination treats haemorrhoids symptomatically, including bleeding and prolapse, but it may need addition of points in order to effectively treat the underlying cause of the haemorrhoids.

 

Points discussion

 

Changqiang is the first point of the Du Mai channel, and is also the connecting-Luo point of Du Mai and Jen Mai.

On its route, the Du Mai encircles the anus and then climbs up the spine, to the brain, and emerges at the vertex, at point Paihui. Due to its course, this channel is also associated with diseases of the anus, such as haemorrhoids.

 

Haemorrhoids, in most cases, is a Shi phenomenon, associated with inflammation and bleeding of the rectal area, causing veins there to bulge out and cause sharp pain. In most cases the disease involves Heat symptoms such as redness, acute pain, bleeding and a burning sensation. In some cases Damp also exists when there is pus involved, diarrhea, and a heavy sinking sensation.

 

In some other cases the most salient etiology is a Spleen Qi deficiency, an etiology that may also cause bleeding, prolapse and diarrhea, but then the symptoms will not be so acute, rather more chronic. In any case, even on the basis of a Spleen-Qi-Xu condition, a Shi condition may arise, of the previously described symptoms and signs, a condition which is both severe and acute at the same time.

 

In order to drain excess from the rectal area, and from the Du Mai, there are three main techniques:

1. Puncture in sedation the point Changqiang, which is the Luo point withthe Ren Mai, and thereby to transfer excess from Du Mai to Ren Mai, and disperse the stagnation in the rectal area.By doing so we also take advantage of the fact that Changqiang, too, is a local point, situated in the rectal area, and affecting this place symptomatically.

2. Any extra meridian, including the Du Mai, may be "opened" and drained, by simultaneously puncturing two points, one at each end. Thus, puncturing Changqiang and Palhui simultaneously, woulddrain the excess and harmonize the Governing Vessel.

3. It is also possible to drain excess energy from an extra meridian, by puncturing its master and coupled points.

 

In this points-combination, both techniques No.1 and No. 2 are utilized, making use of two possible methods to drain the excess from the Du Mai, and to resolve the haemorrhoids problem.

 

Taking into consideration the facts mentioned above, it is no wonder that one of the main indications of Changqiang, is to treat haemorrhoids and prolapsed anus. Its traditional functions quote:

"To regulate and remove obstruction from the Du Mai and Jen Mai, to promote the functions of the intestines, to treat haemorrhoids and rectal prolapse”.

 

Chengshan is a point located on the Bladder meridian, and is the first-choice symptomatic point to deal with haemorrholds. The Bladder meridian traverses the anal region and therefore affects it.

 

Chengshan has an effect over all the Yang organs. Its indications are:

1. It regulates the Qi of the Yang organs.

2. It benefits haemorrholds.

 

Since haemorrhoids are situated on the "outer-gate" of the Large Intestine, which is a Yang organ, and because the Bladder meridian itself connects with the same "outer-gate", it is not surprising that Chengshan exerts such an influence over the anus.

 

Paihui ("hundred meetings") is the highest point on the vertex. Pictorially it constitutes the other end of the body – in relation to Chengqiang. This point is a part of the formula for two reasons:

1. It is located at the other end of the Do Mai channel, and thus used in conjunction with Chengqiang to drain this channel from excess. This function has already been explained previously.

2. Paihui is the crossroad point on the vertex for all the Yang channels, and it has the function of strengthening Yang, and elevating Qi. It is also known to raise the sinking Qi of the Spleen, and by this arrest bleeding, and raise prolapsed organs (72).

 

It is important to remember here that the Spleen is responsible, in T.C.M. thinking, for the functions of "holding the blood in the blood vessels", and "keeping the organs in their places". Therefore, functional bleeding, or prolapse of organs such as: rectum, uterus, stomach, etc., are attributed to Spleen Qi-Xu, and/or Yang-Xu.

 

It should be obvious by now how these three points together have a common calming effect on the haemorrhoids. Nevertheless, as with almost any other points-combination, an assessment of the etiology and energetic manifestation of the haemorrhoids must be made. This done, a comprehensive formula may be built, utilizing also other points, in order to deal effectively and holistically with the disease.

 

To illustrate this more clearly, here are a few examples:

1. In chronic haemorrhoids due to Spleen and Kidney deficiency, Tatbai (SP-3), Taixi (K-3), Sanyinjiao (SP-6), may be utilized, in tonification. (Palhui, too - in tonification)

2. When Damp and Heat coexist, it is possible to add: Dachangshu (B-25), Chengfu (B-50), Quchi (LI-11) and Erbai (extra).

3. If massive bleeding is predominant, it would be appropriate to use: Yinbai (SP-1) - in directmoxibustion, Xuehai (SP 10), and Qihaishu (B-24).