4. FENGCHI (G-20), TAIYANG (EXTRA), XINJIAN (LIV-2), YANGLINGCHUAN (G-34)

 

Main effect and clinical purpose

 

This points-combination works primarily on the Liver and Gallbladder channels, and has a strong Yang, or Fire-reducing action, as well as Wind clearing, especially Liver Wind from the head.

 

As a result of these properties, the combination is widely used to treat hypertension of Liver Yang, or Liver Fire origin. It may also treat headaches, migraine, or pressure behind the eye (glaucoma) of the same etiology.

 

Points discussion

 

Fengchi is an important point, situated on the Gall-Bladder meridian, below the occipital bone. It is involved in almost every formula that treats headaches, especially of a Shi nature. The point is indicated to eliminate Wind (external, or an internal Liver Wind), to pacify the Liver and reduce Yang, to clear the mind, brighten the eyes, to benefit the ears, and to reduce Heat. Fengchi is usually punctured toward the eyeball of the opposite site, with care not to point the tip upward, the direction of the medulla oblongata. Since its use is most often indicated to calm hyperactive Yang, or sedate Wind, it is manipulated to sedate by a leftward twirling, or withdrawing forcefully and thrusting back gently. Fengchi is often combined with Hegu (LI-4) for various headaches and this is a basic combination for headaches. Hegu has a strong effect on the face, forehead and the anterior half of the head, whereas Fengchl has the same effect on the posterior half. Both points, therefore, circulate the Qi and Blood of the whole head, and disperse Wind and stagnation.

 

Taiyang is an extra point situated on both temples. Its indications are also to disperse Wind and Heat from the head and eyes. It is often used for migraine headaches, red and painful eyes, fever or high blood presssure. Taiyang has a close relationship to the Gall Bladder meridian, firstly because of its location, as well as its functioning. It is punctured up to a depth of one cun perpendicularly, and it is often pricked with a triangular needle to release a few dropsof blood. This is usually done in acute conditions, involving pain, Heat, severe inflammation, etc.

 

Xinjian has also similar properties. It Is widely used to reduce Liver Fire, but it is located on the other end of the body, i.e. the foot. Besides draining the excessive Liver Fire, Xinjian is also said to spread the stagnant Qi of the Liver. This is usually a Heat stagnation, which is one of seven stagnations that exist in classical Chinese medicine: Stagnation of Qi, Blood, Damp, Cold, Heat, Phlegm and Food (47). This stagnation of Heat often involves the Blood too, as it causes the Blood to coagulate.Since Blood and Heat both have a close physiologic link with the concept of Liver in T.C.M., it is not surprising that hypertension in its most common etiology, is treated via the Liver or Gall meridians. Xinjian, therefore, is an important point for this disorder, as it treats both Heat and stagnation.

 

Yanglinchuan also has the ability to cool Liver Heat, as well as to clear Damp.It regulates and benefits the Liver and Gall bladder, and strengthens the tendons, sinews and bones.

After analyzing each point in the combination, it is clear that this points-combination is built on the concept of mutual assistance. Actually all the above-mentioned points have the quality of lowering Yang, and susbduing Liver Fire.

 

The most frequently encountered etiology for high blood pressure in T.C.M. is hyperactive Liver Yang. This pattern usually involves symptoms like: headache, glaucoma, red eyes, red face, dizziness, tinnitus, etc., all of which are very common in the modern concept of hypertension.

 

According to Chinese medical philosophy, when the Liver lacks Yin (due to Kidney deficiency, most often), or Blood (due to spleen deficiency), or its Qi stagnates due to other causes, it creates Heat. Heat tends to climb up, or float to the head region, via the Gallbladder meridian, which is the Liver coupled meridian, or via the internal branch of the Liver meridian itself. The Heat causes expansion of blood, and blood vessels, thus creating the hypertension, as well as the accompanying symptoms.

 

Needling sequence. manipulation and stimulation

 

Needling sequence in this combination is, in general, from above downward, in order to lower, or bring down Liver Yang.

 

It is therefore necessary to use the head points first, in orderto sedate Liver Fire or Wind in the head region, then Xinjian which is more important for this purpose, and finally Yanglingchuan.

 

Manipulation of the needles is effected to sedate Liver Yang, and therefore the amplitude and strength should be as high as the patient can tolerate. Nevertheless, care must be taken in cases of fragile constitution, or a pattern which includes a Xu condition, at the same time. In this case the practitioner must assess which is predominant, the Shi or the Xu condition, and stimulate accordingly. It is also advised, in any case, not to be too vigorous with the manipulation at the first session.

 

As we have stated before, in cases which Involve an acute head or eye pain, with inflammation or Fire signs, it is possible to bleed Taiyang, and release a few drops of blood, with the prysmatic needle.

 

Herbal equivalent

 

The effect of this points-combination may be compared to the use of Spica Prunella Vulgaris (Xia Ku Cao), together with Flos. Chrysanthemi Morifoli (Ju Hua).

 

The first herb is Cold in nature and acrid, and is used to clear the Liver and brighten the eyes. Very much like Taiyang and Xinjian. The latter herb is slightly Cold and Bitter, and is used to disperse Wind and clear Heat. It therefore clears Wind Heat in the Liver channel, and pacifies the Liver and relieves headache, dizziness, red and painful eyes, etc. Its action resembles that of Fengchi.

 

The two herbs together are therefore classically used for headache, dizziness, vertigo, painful and red eyes and high blood pressure.

 

Case history

 

Mr. G., age 46, businessman, has suffered for the past eight years from hypertension and occipital headaches. During this period he has regularly taken hypotensive drugs (50 mg Convertin), which have affected his sexual abilities adversely. With the drugs, his blood pressure was 140/110 Hg.

 

Mr. G. had a shiny red face, red eyes and darkish lips. He spoke loudly, and was very talkative.

 

Examination of the tongue revealed red rims, and a slippery yellow coating.

 

His pulse was moderate, and first and second positions of his right hand were Shi.

It was apparent that Mr. G. had an excess Heat condition. The problem was whether it was of Liver Yang origin, or Stomach Fire. As neither of these possibilities required the consideration of other symptoms, it was decided to clear Heat from the Yangming system through a combination renowned for this purpose. The combination is: Quchi (LI-11), Zusauli (ST-36) Neiting (ST-44).

 

Actually the Yangming channel was chosen to operate upon because of the pulse, which showed predominance on the right Guan position.

 

A few treatments were carried out by this method, but the patient showed no improvement.

 

The diagnosiswas then reconsidered, and changed to hyperactive Liver Yang. The pulse abnormality was thence interpreted as an overactivity of the right Liver channel, rather than both channels, a fact which has shown itself on the right hand pulse.

 

The formula for treatment was thus changed to the following: Fengchi (G-20), Taiyang, Xinjian (LIV-2), Yanglingchuan (G-34), Qimen (LIV-14) on the right side only, and Fuliu (K-7).

 

All points, except Qimen and Fuliu, were sedated in a broad angle twirling and raise-thrust manipulation. Qimen was manipulated in aneven manner, in order to regulate Liver-Qi, and Fuliu was tonified so as to tonify Kidney-Yin.

 

After the first treatment, Mr. G’s blood pressure decreased to 140/100 Hg., and after five more treatments to 140/90 Hg. He was advised not to take any more hypotensive drugs, advice which he accepted readily, and his blood pressure remains stable.

 

Since Mr. G. was not prone to anger, he was only advised to regulate his diet, to exclude Yang nourishing foods (coffee, sea food, fried food, pepper, alcohol, etc.), and to tend his business in a more relaxedmanner.