18. TIANSHU (ST-25), SHANGJUXU (ST-37), SHANGQIU (SP-5), YINLINGQUAN (SP-9)

 

Main effect and clinical purpose

 

This combination is a classical points-combination to clear Damp and Heatfrom the intestines.

It is therefore used to treat problems such as chronic diarrhea, dysentery, enteritis and colitis.

 

Points discussion

 

 

Tianshu was discussed in case number 16, dealing with constipation. As the Front-Mu point of the Large-Intestine, this point actually deals with all the afflictions of the intestines.

 

Its indications imply that it regulates and facilitates the functioning of the intestines, and eliminates stagnation. This indeed covers all the possible diseases of the intestines.

Theoretically, the Large-Intestine is the organ by which the Spleen applies its transportation function. The Large Intestine transports and evacuates the residues of the digested food and fluids (87).

 

When the Spleen Qi is weak, the transportation ability of the Large Intestine is impaired, giving rise to constipation or diarrhea. Another phenomenon which often exists when Spleen Qi is weak, is the formation of Damp and Phlegm. When this Damp "pours" into the intestines, there is a Damp stagnation, giving rise to chronic diarrhea, colitis, etc.

 

As a Fu organ which is in close contact with external inluence, the Large Intestine might occasionally be involved with intoxication brought about by contaminated food or drink.

This intoxication usually has the characteristics of Damp Heat, or Fire-Poison, and it causes diseases such as severe colitis, ulcerative colitis, dysentery and the like.

 

Tianshu, as the Front-Mu point of the Large-Intestine, is capable of eliminating stagnation in the organ, and that includes Damp-Heat, Damp-Cold, Blood stagnation, etc.

 

Shangjuxu is the lower He-Sea point of the same organ, the Large-Intestine. We have described already how the classics refer to He-Sea points, in case number 12, with reference to point Zusanli, which is the lower He-Sea point of the Stomach.

 

Also Shagjuxu is connected directly with its organ, and affects it very similarly to Tianshu.

It regulates the Oi of the Large Intestine and Stomach, and eliminates pain.

It eliminates accumulations and stagnation, but mainly involving Damp stagnation, characterized by various types of diarrhea.

It clears and cools Dampness and Heat, treating Damp-Heat conditions such as colitis, diarrhea with blood and pus and the like.

It is important to note in this context, that Shangjuxu is one of a group of three points, situated along the muscle tibialis anterior, that have an influence over the whole gastrointestinal tract. Zusanli (ST-36), the lower He-Sea point of the Stomach, Shangjuxu (ST-37), the lower He-Sea point of the Large-Intestine, and Xiajuxu (ST-39), the lower He-Sea point of the Small-Intestine.

 

These points, when used together, have a strong draining effect on the gastro-intestinal tract, and they are used in this form only when a strong purgation is needed, in order to clean and clear the digestive tract of a food intoxication.

Shangqiu has a sedative effect on excessive conditions of the Spleen, concerning the digestive system.

 

It is the Metal point of the Spleen, regarding the Five Elements, and as such it acts as the Son of Earth, which is the Spleen. Son points are used mainly for sedation purposes, which is in accord with the classics: "If a meridian is empty, tonify its mother. If it is full, sedate its child" (Zhenjiu Yixue).

 

The most common excessive condition of the Spleen is abundant Phlegm, or accumulation of Damp. Thus, Shangqiu is utilized to sedate the Spleen, and disperse the Damp.

 

In its classical indications, therefore, we can find that it is used to transform Damp stagnation, and thereby to strengthen the Stomach and Spleen.

 

In the list of diseases that this point is capable of treating, we may find the following: gastritis, enteritis, indigestion, edema, diarrhea, intestinal noises, and more.

 

Yinlingquan is very much associated with the urinary and digestive systems, in all afflictions brought about by Dampness. Its main indication is to transform Damp stagnation, very much like the former point, Shangqiu, only it is equally beneficial for the digestive and urinary systems.

 

Thus, in the digestive system it may treat diarrhea, whether acute or chronic, distension of the abdomen due to retention of fluids, ascites, enteritis, dysentery and more.

 

The theoretical background for this point's indications, is, also here, related to the Five Elements law.

 

Yinlingquan is the Water point of the Spleen meridian. Because Dampnessis an energetic phenomenon related to the element Water, and the Spleen is the organ mostly associated with Damp conditions, therefore the Water point of the Spleen is sedated, or dispersed. Dispersion of this point is considered to abate Damp, improve Water metabolism, and balance the Spleen.

 

This points-combination is actually two points-combinations combined together, in order to have a more comprehensive effect on a specific problem.

 

Tianshu and Shangjuxu have a direct effect on the Large Intestine, as both of them are related directly to this organ. In fact, in many sources both of the points appeaer as a combination by itself for the treatment of enteritis (88) or dysentery.

 

Shangqiu and Yinlingquan represent, in this formula, a function which is related to the Spleen, and this is to eliminate Damp conditions.

 

The connection of these two pairs together, have centered the effect of eliminating Damp, in the Large Intestine.

 

Of course, as is in the case of other successful points-combinations, Shangqiu and Yinlingquan are symptomatically helpful in Large Intestine afflictions, as is evidenced by their listed functions, as much as both Tianshu and Shangjuxu are effective in the treatment of excessive Damp conditions. This is also evidenced by their list of functions.

 

Needling sequence, manipulation and stimulation

 

Because this combination deals with problems of the Large Intestine, Tianshu and Shangjuxu are first to be needled. Shangqiu and Yinlingquan are secondary in Importance, and they are therefore needled secondly.

 

In most of the cases all the four points are needledin reducing technique, in order to disperse the excessive Damp, and most of the Heat. Nost often, however, the Shi condition of the enteritis or diarrhea, is complicated with a basic Xu condition, usually of the Spleen, and in such cases care must be taken not to over sedate the patient, as it might aggravate the condition.

 

Sometimes the basic condition is a Shi condition, such as with Food intoxication (Sha), and if prolonged enough the true Qi of the patient becomes damaged, resulting in a Xu condition. In such cases, the manipulation of the points must be effected with utmost care and consideration, using other tonifying points, as main points, and this combination becomes secondary.

 

When there is a Cold dysentery, or diarrhea of the Xu type, and there are no Heat signs, moxibustion is recommended over Tianshu and Yinlingquan. This may be done as a warming needle technique, or, in severe cases, direct moxibustion. In such cases moxibustion therapy is imperative, and results are astonishingly decisive.

 

In the case of bleeding along with the diarrhea, as in ulcerative colitis, dysentery, etc., other points must be introduced in the formula. Yinbai (SP-1) (please refer to the previous case, number 17), or Paihui (GV-20) (89) and Keshu (B-17), are the points of choice.

 

Herbal equivalent

 

A very familiar prescription for Damp-Heat dysentery-like disorders, is the following:

1. RadixScutellaria Baicalensis (Huang Qin)

2. Rhyzoma Coptidis (Huang Lian)

3. Radix Peonia Lactiflora (Bai Shao)

 

Huang Qin drains Damp-Heat and is considered a major herb for Damp-Heat in the Stomach or intestines. This Damp-Heat, as we know, may manifest as diarrhea with a burning sensation in the anus, or dysentery-like disorders, with pus and blood.

 

Huang Lian has very similar qualities, especially in regard to the digestive system, and it is used for the same problems. Its advantage, however, over Huang Qin, is that it is capable of arresting bleeding due to Heat.

 

Bai Shao is usually used to nourish the Blood, but it is also capable of adjusting the functions of the Liver and Spleen, and to alleviate abdominal pain associated with dysentery-like disorders.

 

These three herbs imitate the functions of points Tianshu and Shanjuxu, which, as we have seen, regulate the Qi of the Large-Intestine, stop pain, drain Damp-Heat, Cool and stop bleeding.

 

Nevertheless, in order to provide a comprehensive herbal equivalent to the points-combination, two other herbs are added:

Radix Saussaria seu Vladimiria (Mu Xiang)

Sclerotium Poria Cocus (Fu Ling)

 

Mu Xiang is a herb that regulates the Qi, and is used in Qi stagnations involving pain. It is often a partner in a formula that treats intestinal problems such as we have discussed here, as most of them involve pain. Its indications say that it adjusts and regulates stagnant Qi in the intestines, and is used for diarrhea and dysentery-like disorders, or for abdominal pain and tenesmus. This herb is said to enter the Spleen meridian,

and to strengthen the Spleen. The other herb, Fu Ling, also tonifies the Spleen, and is the most important substance for draining Damp conditions. Much like point Yinlingquan it is useful both for excessive urinary and digestive conditions.

 

Case history

 

Please refer to the case history described in my article: The Astringent Quality of Point Paihui in myhomepage: http://www.acumedico.com/articles.htm

The article was originally published in Sept. 1989 in the Journal of Chinese Medicine in England.

 

Even though point Shangqiu is missing from the points-combination in this article, I decided to link to the case history as it is, for the following reasons:

1. The case history is very relevant to the examples of the disharmony for which this points-combination is used.

2. Point Shangqiu has been substituted in the initiative formula of the case history by Sanyinjiao (SP-6), because of Blood and Yin deficiency exhibited by the patient. Nevertheless, Sanyinjiao is also capable of performing Shangqiu’s functions, such as transforming Damp stagnation in the intestines, and strengthening the Spleen. Its advantage, however, lies in its powerful Influence over the Spleen, an influence which makes it a better associate for Yinlingquan in most cases.

3. This case history includes some other common points-combinations as well, also relevant to the treatment of Damp-Heat-dysentery-like stagnations. They are metnioned and discussed briefly throughout the article.

4. This case history has been written by me as an article for the magazine, and is more comprehensive and detailed than any of the case histories introduced so far in this work. It encompasses many facets of both diagnosis and treatment according to T.C.M., as well as an interesting treatment process. It was therefore considered fitting as the last accord in this work.