17. YINBAI (SP-1), QIHAI (CV-6), XUEHAI (SP-10), SANYINJIAO (SP-6)

 

Main effect and clinical purpose

 

This combination has a strong effect on the blood. Most of the points here have a regulating effect on the blood, and as a whole, it is used for astringent purposes. It arrests bleeding from any of the body nine orifices, but particularly uterine bleeding, or bleeding of the digestive tract.

 

Points discussion

 

Yinbai is frequently used to tonify the Spleen. one of the Spleen's main functions is to contain the Blood, or keep the Blood in the blood vessels. This function of the Spleen comes in continuum with its role in creation of Blood. By commanding the digestive function of the Stomach, the Spleen extracts the pure essence of digested food and drink, and transforms it into Qi and Blood (83).

 

Thereafter, as the master of transportation too (i.e. the Yin-Hua activity of the Spleen, translated as transformation and transportation), the Spleen is responsible for keeping the Blood flowing through its proper routes - the blood vessels.

 

Because of these functions, the Spleen meridian, or points that tonify the Spleen, are used in all diseases associated with Blood.

 

Yinbai is the most important point on the Spleen channel regarding its function of containing the Blood. This function of Yinbal is probably due to its role as the "Well" point of the Spleen meridian.Well points are used primarily in acute, or dangerous conditions, as they connect the Yin and the Yang, exterior interior channels. Thus they are commonly used in acute fever, delirium and excessive Heat conditions, or resuscitation from fainting and coma. Loss of blood is also considered a dangerous condition. Loss of Blood is a loss of Qi, too. Thus, the Well point of the channel most associated with "keeping the blood in the vessels" function, is the most appropriate to deal with such problems.

 

As stated before, the other function of Yinbai, is to strengthen the Spleen. By strengthening the Spleen in general, all the Spleen's activities are strengthened, including digestion, Blood and Qi production, containing the Blood, holding the organs and tissues in their proper position, nourishing the muscles, transporting waste outside the body, and more.

 

Qihai was already discussed under case number 1 in this chapter. As the ruler of the "sea of energy" in the lower Dantien, this point has a strong impact upon the amplitude of Qi in general, in the body.

 

Since abnormal bleeding implies, first of all, a weak Qi, such that is incapable of "ruling the Blood" properly, this point is called upon to draw out extra Qi from the reserves which are located in the "Sea of Qi”.

 

The special relationship between Qi and Blood is one of the cornerstonesof Chinese medical thinking. Qi is considered the commander of Blood, and Blood is regarded as the mother of Qi (84).

 

This means that Qi regulates the Blood, moves it and keepsit in place, while the Blood nourishes the organs that produce Qi.

 

The Spleen, of all organs, is mostly involved in this relationship. It creates Blood, as we have already seen, and if Blood is abundant enough to feed the Spleen itself, the Spleen is capable of producing Qi.

 

If Qi fails, however, it may be strengthened and supplied, by tonifying the Spleen itself, and by drawing Qi from its reserves, namely Qihai.

 

Xuehai was also discussed previously in this chapter, under case number 5.

 

We would like to remind, however, that this too is a point on the Spleen channel, mostly associated with Blood. Xuehai drains Heat from the Blood, and cools it. Since many of the abnormal bleeding incidents occur due to this phenomena of Heat in the Blood, causing reckless movement of Blood and bleeding (85), Xuehai is perfectly appropriate for treating this kind of problem.

 

In addition, Xuehai regulates the movement of Ying Qi (nutritive energy) and Blood, and is thus a counterpart for Yinbai in the function of keeping the Blood in place.

 

Also Sanyinjiao was thoroughly discussed in this chapter, under cases number 1 and 15. In short, Sanyinjiao tonifies Yin and Blood, and the three organs that produce and control Blood, except for the Heart.

 

By tonifying the Blood and its production, and by tonifying the Spleen, this point is a substantial addition to this combination, whose aim is to stop abnormal bleeding.

 

This combination is, as we have shown, constructed of three points that have a strong tonifying effect on the Spleen itself, and have been chosen, from all the other points on the Spleen channel, because of each one's personal characteristics as a Blood regulator.

 

Thus, their mutual effect on the Spleen organ strengthens this organ's functions of "building Blood", and "holding Blood", while the points themselves exert their symptomatic influence for the same purpose.

 

The fourth point, Qihai, acts on the Qi directly, as a phenomenon by itself, reinforcing it, and enabling it to perform its duty as the "commander of the Blood", meaning: to prevent reckless movementand stop bleeding.

 

It is important to note here that the combination is effective primarily for digestive or uterine hemorrhage. It is less effective for epistaxis, coughing up blood, blood in the urine, or bleeding haemorrhoids.

The reasonis that the involvement of the Spleen channel is primarily in diseases associated with uterine function and digestive disturbances.

It does not mean, however, that this combination cannot be used in other haemorrhagic problems, because as was explained, the Spleen does have an effect on all abnormal bleeding occurrences. Still, the combination should then be modified to deal with these problems specifically.

 

Needling sequence, manipulation and stimulation

 

In this combination we start from below, and proceed in an upward direction. The reason for this is twofold:

1. In order to tonify the Blood, it is necessary to act on the Yin, since Blood is mostly Yin. Yin starts flowing from below (from earth), and travels upward, while Yang does the opposite. Thus, we start with Yinbai, go on to Sanyinjiao, and advance to Xuehai.

2. As we have shown, this combination has also the aim of tonifying the Spleen. One of the rules of tonification is to needle the points in the direction of the energy stream. Since the Spleen meridian is Yin, and it flows from Yinbal upward, the needling order follows suit.

 

Qihai is an additional point in this combination, as we have demonstrated earlier. Therefore it is needled last, and it crowns the combination. The Spleen points act on the Blood, while Qihai balances the formula by acting on the Qi, the commander of the Blood.

Clinical experience has shown that stimulation of Yinbai with tiny moxa cones, bears the best results. It is a tiny point at the angle of the thumb nail, so, tiny moxa cones, the size of rice grains, are placed directly on it, and ignited. Usually three cones suffice for every treatment.

 

The rest of the points are punctured in tonification, in the case of a Xu condition, and in even manipulation in the case of Heat in the Blood that causes the bleeding.

 

In performing an even manipulation, it is Important to distinguish the relative importance of Xu and Shi within a complicated syndrome.In our case, Xu means deficient Spleen Qi and deficient Blood, while Shi is usually the presence of Heat in the Blood and Ying Qi.

 

When Xu symptoms are predominant one should reinforce with doubled effort, and reduce with a single effort. One should also reinforce first, and then reduce.

 

Traditionally, the procedure is applied as follows: The needle is thrust nine times, emphasizing on thrusting forcefully, while lifting the needle gently. After nine times,the same point is reduced by lifting the needle forcefully six times, and thrusting it gently.

 

When Shi symptoms are more pronounced, the procedure is reversed (86).

 

Qihai is stimulated only in tonification. When Yang-Qi is in deficiency it is recommended to apply moxibustion, either by warm-needling, or indirect moxibustion upon a layer of ginger, or aconite (Fu Zi).

 

Moxibustion is, of course, permissable also on Sanyinjiao and Xuehai, if the patient's condition is a Cold/deficiency pattern. In such cases the warming-needle technique is superior, as it warms the channel, disperses Cold, and supports the Qi.

 

Herbal equivalent

 

Terra Flava Usta (Fu Long Gan), which is actually the center of the ashes from the bottom of a cooking stove, where Radix Lithospermi (Zi Cao) has been burnt, is used to tonify the Spleen Yang and stop bleeding.

 

When added to Crinis Carbonisatus (Xue Yu Tan), which is actually charred human hair, this combination is effective in treating abnormal uterine bleeding.

 

Both substances treat bleeding due to deficiency.

 

Herba Agrimonia Pilosa (Xian He Cao) treats abnormal bleeding, no matter of which aetiology. It may be added to other herbs according to a specific aetiology.

 

RadixSanguisorba (Di Yu) cools the Blood, and stops bleeding, both digestive and uterine. It may be, to some extent, compared to point Xuehai, especially because, like Xuehai, it also treats skin disorders.

 

The last herb, which also has an astringent influence on bleeding, is chosen, like point Qihai, to tonify the Qi, raise the Yang Qi of the Spleen, and treat the problem from its core. This herb is Radix Astragali (Huang Qi). Actually, its qualities may be compared to the actions of several points together. These qualities are:

1. It tonifies the Spleen in general, and treats symptoms of anorexia, weakness, chronic diarrhea, etc. This quality may be paralleled to the influence that point Sanyinjiao has upon the Spleen.

2. It raises the Yang Qi of the Spleen, and this may be compared to the mutual action of points Yinbai and Qihai.

3. It tonifies both Qi and Blood, and in this it is similar to points Xuehai and Qihai.

 

Case history

 

Mrs. H., age 30, has tried since she was 27 years old to become pregnant. At the age of 19 she had gone through an artificial abortion, and according to her doctors this was the reason why she could not retain her pregnancies.

 

Since the age of 27, she has had four miscarriages. 48 hours before her visit to my clinic she had had another miscarriage, followed by heavy bleeding, pain and nausea.

 

I observed a tall, slim woman, very pale, and very much in pain. Her lips were pale and dull, and her finger-nails were white.

 

The pulse was moderate, wiry and weak, while the tongue was bright red.

 

Mrs. H. also told me that she had a very weak digestion, and that she felt weak most of the time. She suffered from heartburn, swollen and painful gums, and dry mouth.

 

Her periods were always accompanied by excessive bleeding, and contained blood clots.

 

It was obvious that Mrs. H. suffered a basic Spleen-Stomach disharmony, caused by Spleen Qi-Xu. The Spleen deficiency caused deficient Blood, and an impairment of the Spleen function of retaining the Blood, or the foetus.

 

The first goal of the treatment was to stop the massive bleeding and the pain which followed the miscarriage. The second phase was planned to strengthen the Spleen, tonify Yin and blood, and reharmonize Stomach and Spleen.

 

Thus, in the first treatment I used the points-combinationwith an addition of Hegu (LI-4) and Taichong (LIV-3). The latter combination was supposed to "open the four gates", which means to regulate Qi, and Blood in the whole body, and to stop pain.

 

In the second day Mrs. H. had much less pain, and less bleeding. The second treatment was constructed of the same points-combination, excluding Hegu and Taichong. Instead Zhiyin (B-67) and ZhongJi (CV-3) were added. These points were added in order to cause the uterus to expel the remaining tissue of the dead foetus.

 

The next day there was almost no bleeding at all, but she felt contractions in her lower abdomen. Thus, the same formula was applied to her once again, and the next day she expelled some very big blood-clots.

 

Two days later, when she came to me again, there was no pain at all, and no bleeding. Her pulse had changed dramatically, and the wiry quality remained only at the Stomach position.