Traditional versus modern Acupuncture

 

Philip A.M. Rogers MRCVS

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1980, updated 1990, 1996
Postgraduate Course in Veterinary AP, Sydney, 1991

     

 

SUMMARY

 

Traditional Chinese Medicine (TCM) is based on ancient Chinese concepts of health and disease, including the theories of Yin-Yang, Qi, Change, Five Phases, the Six Evils, oriental diagnostic methods and the necessity for balance/control in all aspects of life. Some of these concepts are considered irrelevant to western-trained professionals. Others are highly relevant.

 

Acupuncture (AP) is part of TCM. It is based primarily on a knowledge of the location and function of AP points . In western concepts, AP is based on a knowledge of the input/output terminals of a two-way system of data transmission between superficial reflex (reactive) points and the organs or parts which are related to these points via the neuro-endocrine system.

 

AP diagnosis and therapy depend in part on TCM concepts. Mastery of traditional AP (TAP) demands years of study under expert teachers. Most western professionals will not invest the time and effort needed for that.

 

The basics of AP and Cookbook methods can be learned in 40-120 hours of concentrated course-work and 6-12 months part-time home-study. That training (combined with western medical knowledge) can produce excellent clinical results in properly selected cases.

 

Success with AP therapy demands a knowledge of medicine and basic AP. Those who have not studied or will not study the basics of both systems delude themselves and their clients/patients if they try to use AP in any but the simplest of cases. The more a clinician knows of TCM and western medicine, the greater the probability of being able to select an effective regime of therapy for the patient.

INTRODUCTION

 

The Guide to Professional Behaviour (page 22), issued by the Veterinary Council of Ireland in April 1988, states:

 

"19. Meeting an unqualified person in consultation. By this is meant the meeting for the purpose of consultation, with an unqualified person such as an acupuncturist, osteopath, bone setter, chiro-practitioner etc. Such a consultation is unethical and would be construed as conduct disgraceful in a professional respect...".

 

On being found guilty of that charge, the penalty may be removal of the veterinarian's name from the Veterinary Register of Ireland. He or she would be unable to practice veterinary medicine legally in Ireland or in any other country which recognises the Irish veterinary qualification.

 

Before and since the advent of western medicine, TCM and TAP have stood the test of time. They serve more of the world's population than our medicine and it will not go away because some westerners scoff at it. Among professionals and the public in the west, there is also growing awareness that holistic medicine must involve the study of many modalities, including western and eastern. Today, a small but slowly growing number of medical, dental, physiotherapy and veterinary graduates in almost every country in the developed world use acupuncture (AP) routinely. However, AP is practised at levels of proficiency ranging from grossly incompetent (by professionally qualified people who may have attended an expensive but worthless weekend AP crash-course) to highly skilled (by people fully trained in Classical AP but deemed to be professionally "unqualified").

 

Orthodox colleagues of "professionally qualified" acupuncturists have mixed reaction to their use of AP, ranging from encouragement, to disinterest (due to complacency with the status quo or intellectual laziness), to honest scepticism (based on genuine criticism of the poor standard of science/statistics behind many of the published claims for AP, or based on ignorance of the body of solid research and clinical results from well conducted AP trials), to antagonism (based on prejudice, if not malign intent in the face of knowledge that AP has a useful role in medicine).

 

Three main factors limit the more widespread use of AP and allied methods in "western medicine":

• a. Scepticism and/or vested interest;
• b. Refusal of orthodox practitioners to re-train and
• c. The difficulties of organising AP training.

 

a. Scepticism and/or vested interest among the more influential members of the professions inhibit active promotion of training, clinical trials and basic research in AP by the professional associations and academic authorities. If they were to admit openly that AP methods are effective, even in some human and animal diseases, the implications for the establishment would be enormous.

For example:The public image of professorial/scientific authority would be weakened. Competent AP teachers and clinicians would have to be found, selected and graded. Who would be competent to select/grade them? Who would pay their salaries and how much?Academic undergraduate curricula (already over-stretched) would have to be re-scheduled to incorporate considerable time for AP at the expense of other course-work.

 

Research teams would have to recruit expert AP specialists and fund AP research in the face of a multi-national, multi-million dollar drug industry which has a powerful influence on funding of orthodox research, sponsorship of drug-related professional seminars/conferences and junkets for cooperative practitioners.

 

The National Health, med/dental/vet hospitals, physiotherapy clinics and the general professions would have to establish AP services.

 

How would the establishment treat AP practitioners unqualified to practice in the orthodox professions and how would the latter react to attempts to control or ban "unqualified" practice?

 

 

b. Refusal of orthodox practitioners to re-train: If post-graduate basic- to master- class training were to be made available (even a voluntary basis, at the State's expense) many professionals would probably opt out.

 

 

c. The difficulties of organising AP training: Most western countries have no cohesive national approach to AP training, the minimum standard needed, whether classical or simplified AP should be taught. There are many differences of opinion on these questions within and between AP factions within the professions, and between the "professionally qualified" and "unqualified" acupuncturists. Even if these differences can be resolved, there is a chronic shortage of competent AP teachers.

 

This paper compares and contrasts aspects of the two main schools of AP: the Classical and the Cookbook. It concludes that both systems have strengths and weaknesses and that the minimum requirement is a working knowledge of the basic principles of AP theory and a good knowledge of the main AP points. Neither the Traditional nor the Cookbook system (alone or combined) is effective as a therapy for all types of disease. Therefore a complete approach to professional therapy requires more than proficiency in AP.

 

The ideal for western societies is an orthodox professional training, combined with a mixture of classical and modern AP, to say nothing of integration of other complementary therapies (homoeopathy, manipulative therapy, etc). Ideals are difficult to attain. A good compromise solution would:

a. allow graduates from bona fide AP Schools to continue to practice and
b. encourage Universities to provide highly practical, elective AP courses (including the Cookbook method and short, basic instruction in Classical AP) at undergraduate and postgraduate level.

 

Without such a compromise, acupuncturists (even those with recognised qualifications within the medical and paramedical professions) are likely to remain "out in the cold" for the foreseeable future in most western countries.

AP SYSTEMS

 

Historically AP developed from applications of Tibetan/Chinese thought. Today there are many variants of AP. The two main ones are the Traditional (Classical) school and the Modern (western-oriented school). The latter is based on a limited study of what westerners consider to be the relevant classical principles, combined with Cookbook (prescription) AP and western concepts of physiology and medicine. Both systems demand knowledge of the AP points and Channels.

 

There were/are major differences (cultural, philosophical, political, sociological, economic and environmental) between our world and that of the Chinese, ancient and modern. Difficulties in communication, not least of which are language and conceptual differences between eastern and western minds, can be traced to that fact. Even highly educated Chinese scholars have difficulty in interpreting the meanings hidden in the ancient Chinese texts. The ideograms and their context have subtleties of meaning which can be distorted or lost in "technical" translations.

 

Conceptual differences are also barriers to understanding. Concepts of Yin-Yang, Five Phases, the Emotional Causes of disease, the Six Evils, direction and flow of Qi (life energy), the Qi body clock, pulse diagnosis etc have no parallel in western thought. The closest we can come to them is by analogy and by some specific examples. But, in spite of years of exposure to these concepts, many western students of AP still regard them as "foreign, Chinese or traditional", e.g. "non-self", not part of "our" world-view. But, if we are to improve our clinical results, we must be prepared to learn from other effective medical systems, including TCM.

 

TRADITIONAL AP (TAP)

 

TAP is based on ancient Chinese concepts, which will be discussed:

• 1. AP Points and Channels
• 2. Qi and Yin-Yang
• 3. Change (Transformation, Rhythms, Cycles, Relativity, Balance)
• 4. Five Phase Theory
• 5. Concepts of ecology, Syndromes and causes of disease in TCM
• 6. Diagnosis in TCM
• 7. Therapy in TCM
• 8. AP methods
• 9. Methods of choosing effective AP Points

 

These concepts are discussed in more detail in other papers and in texts on TCM (Austin 1974; Connolly 1979; Kaptchuk 1983; Mann 1973; Porkert 1983; Wu Wei Ping 1973; van Nghi 1971).

 

The western student who wants to make rapid progress in the study of TAP must "forget" western ideas for a time. He or she must approach the study of AP as a child approaches a wise teacher- in a spirit of openness, total ignorance, tranquillity and trust.

 

The teacher is there to teach and the student is there to learn. There is little value in questioning each step of the lessons from a critical, analytical western viewpoint. From western viewpoints there are no satisfactory answers to many valid questions. At best, such questions impede the student's progress and, at worst, may discourage him or her from continuing the study. Because of unsatisfactory answers, many western "scientific" research workers reject the entire system, throwing the baby out with the bath water.

1. AP POINTS AND CHANNELS

 

AP POINTS

 

The diagnostic, therapeutic and preventative value of AP depends totally on a knowledge of the AP points, the Channels and their functional and anatomical relationships with each other.

 

Characteristics of AP points There are two main types of AP points: (a) Ahshi points and (b) codified AP points. Most AP points of type (b) are reactive electro-permeable points (REPP) relative to nearby skin areas. Hyper-reactive AP points, whether of type (a) or (b) are hypersensitive to pressure-palpation, electric current or heat. Hypo-reactive AP points, usually type (b) only, are hypo-sensitive to pressure-palpation, electric current or heat.

 

a. Ahshi points Ahshi points are abnormally tender to palpation pressure. The patient may be unaware of their presence until they are pressed. When Ahshi points are pressed, the human patient usually grunts, groans, swears or jerks (AH = Ah! SHI = Yes !; Ahshi = "Ouch!"). In animals, pressure on Ahshi points elicits definite defensive or aversive behaviour (movement, dipping, swishing of the tail, attempts to kick or escape in horses; movement, bellowing or attempts to kick in cattle; attempts to bite, howling, whining, attempts to escape in dogs).

 

Some Ahshi points are just painful locally, corresponding with "fibrositic nodules", "motor points" and other irritable foci in muscle and fasciae.

 

These are not as important in therapy as those which are painful locally and refer pain to the area in which the patient reports the clinical pain. The latter type of Ahshi points are the Trigger Points (TPs) of "Western Medicine", as they trigger pain to the referred area of pain. For instance, many headaches may be caused by TPs points in the trapezius, neck or temporal muscles; shoulder pain may be due to TPs in the infraspinatus or supraspinatus muscles. (See Travell and Simons 1984).

 

Ahshi points may occur anywhere in the body but are usually in muscle. Many (up to 70%) occur at codified AP points but others occur at positions not codified in AP texts. They are usually present in myofascial syndromes and are very useful in diagnosis and prognosis. In the absence of signs of other pathology, they confirm that muscular spasm is the main problem and that the prognosis is very good if they can be eliminated successfully.

 

Ahshi points may also occur in disorders of internal organs (especially at the Shu (paravertebral reflex) and Mu (front alarm) points). For instance, in heart/pericardial disease, pressure along T4,5,6 (BL14,15,16) or from under the xiphoid cartilage to a point between the nipples (CV14-17) may be painful. These points are the Shu and Mu points for HT and PC (see section (a) under MASTER POINTS below).

 

Apart from diagnostic value, Ahshi points have great therapeutic value. They are always treated as part of AP therapy.

 

So far, it would appear that treatment of tender points (Ahshi, Shu and Mu points) is all that is needed for successful AP therapy. Unfortunately, that is not sufficient. Point tenderness does not always occur in clinical disease. In the absence of point tenderness, the therapist can not begin to use the AP system unless he/she knows the position and uses of the codified AP points.

 

b. Codified AP points

 

There are over 1000 codified AP points. Apart from the 361 classical Channel Points, there are over 639 other points described in this century, mainly outside the Channels. These are the "New", "Strange", "Hand", "Ear", "Foot", "Scalp", "Face", "Nose", "Red Doctor Zone" points etc.

 

Each point has a Chinese name and an alpha-numeric code (e.g. ST36 is the 36th point on the ST Channel). The Chinese name describes its function, location or other detail of use to those who know the language, for example Tsu San Li (ST36) translates as Foot Three Li (3 Li = 1 mile), a point for tired legs and also 3 TSUN below the patella; Fei Shu (BL13) is the reflex point for Lung; Hsin Shu (BL15) is the reflex point for the Heart etc). As few westerners know Chinese, much valuable "automatic information" is hidden from them by not knowing what the point name means. They must learn the points the hard way- by alphanumeric code and functions, as most texts do not translate the point name for western readers.

 

Each AP point is described anatomically, in relation to easily visible or palpable body landmarks; joints, tendons, body creases, intercostal spaces, vertebrae, umbilicus, xiphoid, nipples, mouth, ear, eye etc. Some of the better texts also describe the location of the point in relation to nearby blood vessels and nerves.

 

 

 

AP point location: The "body inch" or TSUN is the standard way of locating points in relation to each other (See Anon 1980: "Essentials of Chinese AP"). The average TSUN in humans is the width of the joint of phalanx 1-2 of the patient's index finger. 3 TSUN is approximately the width of the patient's hand (thumb excluded) at the level of phalanges 1-2. However, the length of the TSUN varies slightly with the part of the body being searched. The body is divided into a number of TSUN between fixed landmarks:

 

Points on the Head and Neck are located as follows:

• from anterior to posterior hairline (midline) is 12 TSUN

• from anterior hairline to spine of C 7 (midline) is 15 TSUN
• from anterior hairline to midpoint of eyebrows (midline) is 3 TSUN
• from midpoint of eyebrows to spine of C 7 (midline) is 18 TSUN
• from anterior hairline to cleft of chin (midline) is 10 TSUN
• between the left and right mastoid processes is 9 TSUN
• between the highest points of left and right cheekbone is 7 TSUN

Points on the Trunk are located as follows:

• from left to right nipple (male) is 8 TSUN

• from midline of spine to upper angle of scapula is 3 TSUN
• from upper angle of axillary crease to free end of 11th rib is 12 TSUN
• from xiphisternum to umbilicus is 8 TSUN
• from umbilicus to upper edge of pubis is 5 TSUN
• from xiphisternum to upper edge of pubis is 13 TSUN

Points on the Thoracic limb are located as follows:

• from upper angle of anterior axillary crease to elbow crease is 9 TSUN

• from elbow crease to distal wrist crease (medial or lateral) is 12 TSUN

 

 

Points on the Pelvic limb are located as follows:

from tip of great trochanter of femur to lateral edge of popliteal fossa is 19 TSUN

• from lateral edge of popliteal crease to external malleolus of tibia is 16 TSUN
• from upper edge of pubis to medial epicondyle of femur is 18 TSUN
• from medial condyle of femur to medial malleolus of tibia is 13 TSUN.

 

Thus, point KI27 (2 TSUN from the midline, below the clavicle), can be located easily in a child or in a huge man. The TSUN is a ratio system, as applicable in mice or elephants as it is in humans.

 

 

AP POINT FUNCTIONS

 

Apart from functions specified for each point in standard texts, AP points also influence:

 

For example, the GB Channel begins at the lateral canthus of the eye (GB01), travels upwards and backwards over the head, down the neck dorsomedial to the mastoid process (GB20), over the highest point of the trapezius (GB21), down the lateral thorax past the tip of the last rib (GB25), behind the femoral trochanter (GB30), down the lateral thigh to the fibular-tibial notch (GB34), down the lateral leg, to end on the 4th toe. GB34 (apart from functions specified in the textbooks) influences GB function and disorders (cholecystitis, cholelithiasis etc); pain and dysfunction along the course of the Channel from eye, to lateral headache, to neck/shoulder area pain, to lateral thoracic/abdominal pain, to hip, lateral thigh, knee, lateral leg, ankle, to 4th toe pain/sprain/paralysis etc.

 

Apart from specified and additional functions (above), certain points on the Channels are more powerful than others, even for local effects. For instance, GB34 is more often used than GB33 in knee problems, even though GB33 is near the knee. For other details, see the papers on the "Choice of Points for Particular Conditions" and "The Study of Points and Channels").

 

MASTER POINTS

 

(See paper on "The Study of Points and Channels"). Each of the 12 main Channels has a number of MASTER points, which are used in TAP:

 

a. Shu and Mu Points
Each Channel-Organ System (COS) has a Shu and Mu point. These are reflex points which may become spontaneously tender, or tender to palpation if the COS is disturbed. Thus they have diagnostic uses. The Shu and Mu points has a powerful therapeutic effect on affected organs and often are combined in those cases.

 

The Shu (Paravertebral reflex, Associated) points occur on the first line of the BL Channel between vertebral spines T 3 and S 4. There are 18 pairs of Shu points, 12 of which relate to the 12 main Channels. The Mu (Front Alarm) points occur on the anterior or lateral thorax and abdomen. There are 12 points corresponding to the 12 main Channels. Six are in the CV line between CV03 and CV17 (BL, SI, TH, ST, HT, PC) and six are bilateral (LU, LV, LI, GB, KI, SP).

 

Because of overlap in the spinal nerve supply to the organs, the Shu and Mu points are not as organ-specific as TCM/TAP states. For example BL14 (paravertebral below the spine of T4) and CV17 (midway between the nipples) are the Shu and Mu points for the pericardium (PC). However, because of nerve overlap, disease of HT and LU could also activate reflex sensitivity at those points. Therefore, Shu and Mu point sensitivity is a guide but not a definitive indication as to the organ affected. Final confirmation is based on other evidence from TCM or western tests.

 

Anyone who practices AP, even in its most simple forms, should know the Shu and Mu points.

 

 

b. Five Phase Points
These transfer Qi between the Channels in the Five Phase Cycle (see section 4 below).

 

 

c. Luo Points
These transfer Qi between the Husband and Wife Channel within each Yin-Yang pair within each Phase (see section 4 below).

 

 

d. Yuan (Source), Xi (Cleft), Tonification, Sedation, Hour Points etc. These are discussed in the papers on the Study of AP.

 

Point types b, c, d (above) are powerful Energetic Points of AP. Their use needs a study of the principles of TAP.

 

As a knowledge of point location and functions is essential to the use of AP, beginners may feel daunted by the large number of points. Please take courage from the fact that most western AP experts are familiar with as few as 50-150 points ! If beginners grasp the principles of basic AP, they can consult AP textbooks for details of the less commonly used points, as the need arises.

 

The Channel-Organ Systems (COSs) of AP

 
When the Chinese use the term Hsin (Heart, HT), Pi (Spleen-pancreas, SP), Fei (Lung, LU), Shen (Kidney, KI), Kan (Liver, LV) etc, they imply much more than the physical organs (heart, spleen-pancreas etc). They include the nature, structure and functions of the organs and many other attributes, as well as the superficial, collateral and deep paths of the Channels. Thus, it is better to think of the Twelve COSs (each with many specific attributes) rather than to anatomical pathways or localised physical organs. The extended COS (Channel-Organ System) concept is most important in diagnosis and therapy by TAP.

 

TAP is a system of Energetics and Correspondences. Classical practitioners are interested in symptomatology, only in so far as it indicates WHICH COS(s) has/have energy (Qi) imbalance. By correcting the Qi imbalances, all amenable symptoms and signs are expected to regress rapidly. For example, Hsin (HT) is of the Fire Phase. It controls the heart, tongue and psyche. Thus, neurasthenia, restlessness, insomnia, excitability, rapid speech, angina pectoris, red complexion, dislike of summer weather or heat etc indicate a disorder in Fire, manifest in a disturbance in Heart function. (In that case, ECG and heart muscle enzymes etc may be normal but treatment of the HT Channel can eliminate most or all of the symptoms).

 

There are twelve main Channel-Organ Systems, which either begin or end on a finger or toe. The superficial paths of the 12 main Channels have bilateral symmetry: Lung (LU); Large Intestine (LI, colon); Stomach (ST); Spleen-Pancreas (SP); Heart (HT); Small Intestine (SI); Bladder (BL); Kidney (KI); Pericardium (PC, Circulation-Sex, Heart Constrictor); Triple Heater (TH, Endocrine, (Respiration, Digestion, Reproduction)); GallBladder (GB); Liver (LV). The superficial paths of the Channels are longitudinal lines of low electrical resistance (high conductivity) which connect AP points of similar function. The deep paths are planes of low electrical resistance (high conductivity) which connect the superficial path to their related organs.

 

Each Channel passes through an arm or leg, has a polarity (negative (Yin) or positive (Yang)), belongs to one of the Five Phases and has a specific number of AP points:

 

Limb	ARM	LEG	ARM	LEG	ARM	LEG
Polarity	- +	+ -	+ -	- +	- +	+ -
Meridian	LU LI	ST SP	HT SI	BL KI	HC TH	GB LV
Phase	Metal	Earth	Fire	Water	Fire	Wood
Number of points	11 20	45 21	9 19	67 27	9 23	44 14

 

The arm Yin Channels (LU, HT, PC) begin in their organs, become superficial on the chest and end at the fingers;
The arm Yang Channels (LI, SI, TH) begin on the fingers and end on the face but send a deep branch to their organs;
The leg Yang Channels (ST, BL, GB) begin near the eye and end on a toe but send a deep branch to their organs;
The leg Yin Channels (SP, KI, LV) begin on a toe and end on the chest but send a deep branch to their organs.

 

Channel circuits: In TAP, vital energy (Qi) flows in a specific daily circuit through the Channel network and in a fixed time sequence. It circulates throughout the body, reaching all parts and all organs. The Qi peaks in each COS at a fixed time each day. The peak times for the Channels are:

 

-	+	+	-	-	+	+	-	-	+	+	-
LU »	LI »	ST »	SP »	HT »	SI »	BL »	KI »	PC »	TH »	GB »	LV »	LU
0400	0600	0800	1000	1200	1400	1600	1800	2000	2200	0000	0200

 

The daily Qi Cycle ends in LV at 0300h, the "dead hour of night". A new cycle begins in LU at 0300h, peaks there at 0400h and passes to the LI at 0500h etc. In the daily Qi Cycle, LU is the Son of LV (LU receives Qi from LV) and LU is the Mother of LI (LU feeds Qi to LI). LI is the Son of LU and the Mother of ST etc.

 

Within each Phase, the Yin partner is the Wife and the Yang partner the Husband, e.g. in Metal (LU, LI), LU is the Wife of LI; LI is the Husband of LU. This pairing is important in Energetic AP, as Qi can be shunted from Husband to Wife (or vice-versa) via the Luo (Passage) point of the Deficient partner. This shunt (via Luo of Deficient partner) is also used in balancing disturbed Qi in the Five Phase Cycle (see below). Also, the pairings indicate that LU points can be used in LI diseases and vice-versa.

 

In addition to the 12 main Channels, there are Eight Mai (Vessels or Extra Channels). These intersect with some of the main Channels and act as Qi reservoirs for them. The Eight Mai are: Du Mai (Governing Vessel, (GV), in the dorsal midline, 28 points); Ren Mai (Conception Vessel, (CV), in the ventral midline, 24 points) ; Chong Mai; Dai Mai; Yang Chiao Mai; Yin Chiao Mai; Yang Wei Mai; Yin Wei Mai. There are 361 AP points on the 14 Channels (the 12 main Channels + GV + CV).

 

2. QI AND YIN-YANG (DUALITY)

 
Qi is the general Chinese name for energy. Qi is immaterial and is neither created nor destroyed; it just changes form. Qi and substance interchange. Every thing in the universe, organic/inorganic, material/solid, immaterial/intangible, hot/cold depends on, or is a manifestation of Qi. Life and death, health and disease, growth and senility, composition and decomposition is caused by changes in the proportions and types of Yin and Yang Qi.

 

There are many types and expressions of Qi, creative and destructive. Qi can manifest in Yin and Yang forms, in the Five Phases, in a flower, the wind, a laugh and in empty space, nothingness.

 

Yin-Yang: Thousands of years before the Bible spoke of Good and Evil, the Chinese developed the concepts of duality and relativity. To them, nothing was absolute, but was a mixture of opposing forces, Yin (the passive or negative force) and Yang (the active or positive force).

 

"Yin and Yang are the source of creation and the cause of destruction of all things": Chinese concepts of Yin and Yang were essential, fundamental parts of this world view. The Yin-Yang principle refers to opposites. Everything in creation has its opposite number. Yin-Yang referred to female/male, below/above, Earth/heaven, passive/active, front/back, dark/bright, etc.

 

This concept of Yin-Yang was applied to everything in life: art, politics, philosophy, medicine, architecture, etc. Everything in nature can be characterised by its proportions of Yin and Yang Qi.

 

In medicine, Yin-Yang referred to hypo/hyper states, solid organs/hollow organs, female genitalia/male genitalia etc. Chronic dis-eases were Yin, acute dis-eases were Yang, etc. Table 1 shows some other examples of Yin-Yang.

 

TABLE 1. Examples of Yin-Yang (states of relative opposition)

 

Yin	Water	Ice	Cold	Female	Passive	Dark	Material	Solid
Yang	Fire	Steam	Hot	Male	Active	Bright	Immaterial	Gas
Yin	Slow	Centripetal	Precipitation	Winter	Night	Downwards	Inner
Yang	Fast	Centrifugal	Evaporation	Summer	Day	Upwards	Outer
Yin	Solid organs LU SP HT KI PC LV CV	Below waist	Dorsal	Medial	Lower
Yang	Hollow organs LI ST SI BL TH GB GV	Above waist	Ventral	Lateral	Upper
Yin	Inhibition	Relaxation	Hypo- (Xu, Deficient)	Chronic	Cold	Moon
Yang	Excitation	Contraction	Hyper- (Shi, Excess )	Acute	Hot	Sun
Yin	Parasympathetic	Diastole	Flaccid	Conservative	Black hole
Yang	Sympathetic	Systole	Erect	Radical	Big bang

 

3. CHANGE (transformation, rhythms, cycles, relativity, balance)

 
Change: Everything in existence must change in a ceaseless cycle of anabolism (building up) and catabolism (breaking down). Change reverses to the original state, in time. Nothing is permanent. Everything changes.

 

All great civilizations were aware of the rhythms and cycles in nature:

 

We have the activity/rest, the day/night cycles, sunspot cycles, political cycles. Internal (diurnal) cycles include the cardiac cycle (systole/diastole), the respiratory cycle (inspiration/expiration), the hormone secretion cycle (tropins/inhibitors) etc. All of life and nature follows cyclic patterns.

The Wheel symbolises change/transformation in a cycle of endless and beginningless revolution. The Monad, symbolises the Yin-Yang, and within the Yin is some Yang and vice-versa. Diagram of the Wheel and Monad: 

 

               

 

 Yin and Yang are opposite, essential but complementary parts of the same whole. Yin (dark area) changes to Yang (bright area) and Yang changes to Yin in a changing, yet changeless cycle. Thus, mountains become flat land and flat land becomes mountains. Rock becomes sand and sand becomes rock. Thus, tears and laughter are opposite yet essential parts of the same whole. Birth/death, day/night, potency/impotence, fertility/sterility, joy/sorrow are the lot of nature.

 

Yin-Yang concepts imply continuous Change, movement and transformation. Nothing is static. Day must become night. Change occurs because of the interplay of Yang Qi and Yin Qi. Winter becomes Summer as Yin Qi weakens and Yang Qi strengthens. Summer becomes Winter because of a reverse change. Thus Winter must become Summer when Yin reaches its LIMIT (mid-winter solstice) and transforms into Yang. Summer must become Winter when Yang reaches its LIMIT (Mid-summer solstice) and transforms into Yin.

 

Different Syndromes are categorised into Yin and Yang types. For example, chronic diarrhoea, with cold extremities and abdomen is Yin Syndrome and an acute febrile disease with raging thirst is a Yang Syndrome. But Yin disease can become Yang and vice-versa.

 

The change from Yin to Yang to Yin has many other analogies: In childhood, the male (Yang) may have predominantly Yin characteristics (soprano voice, no body hair, tendency to cry if hurt etc). Between puberty and old age, the Yang characteristics develop and the Yin characteristics decay. In old age, the male may revert to predominantly Yin characteristics again (quav-ering voice, breast enlargement etc). The opposite may occur in female (Yin) from childhood (tomboy = Yang characteristics) to fertile womanhood (Yin) to post-menopausal old age (many Yang characteristics).

 

Substance (Yin) transforms into function (Yang) and function transforms into substance. In the most profound sense, in the midst of frenetic change, nothing changes. Energy is merely transferred elsewhere in the total system.

 

RELATIVITY: Nothing is created or destroyed, it only changes form. Structure/mass (Yin) and blueprint/energy (Yang) transmute. That is all. The concept predated Einstein's equation (e = mc2) by thousands of years.

 

There was no "Instant of Creation" in which "Something" was created from "Nothing". Nor can there be an "Instant of Annihilation", in which "Something" can become "Nothing".

 

Nothing is absolute and all things must exist in relation to each other. Yin and Yang are RELATIVE states. The head is Yang relative to the chest (Yin), but the chest is Yang relative to the feet (Yin) and is Yin relative to the back (Yang). The front and inside are Yin, the back and outside are Yang etc. But the outside can become the inside (the neural tube becoming the brain and spinal cord) and the inside (emotions, organs) can become externalised (see correspondences in the paper on the Five Phases).

 

A man is predominantly Yang (aggressive, strong, phallus etc) but may have some Yin characteristics also (gentleness, laziness, compassion, sensitiv-ity). A woman is predominantly Yin (pacifying, gentle, compassionate, sensitive) but may have some Yang characteristics also (creativity, perseverance, courage, extroversion etc). In the family there must also be Yin and Yang. If both Husband and Wife are Yang (active, bossy) there are family arguments, and if both are Yin (passive, inactive the marriage will be dull, apathetic and uncreative. Either way, the lack of balance (antagonism between Yin and Yang) leads to poor family life. If the Yin-Yang balance is maintained, the marriage (unity) can be very stable.

 

BALANCE: The totally balanced system has equal amounts or Yin and Yang. Yin and Yang are necessary for the other (interdependence) yet each opposes the other (inter-opposition). Balance or equilibrium is maintained by the mutual antagonism, yet mutual dependence of opposing forces. For example, for life to exist (as we know it on our planet) we need a balance of sunlight and darkness. If there was perpetual sunlight or perpetual darkness, life on the planet would cease.

 

Yin or Yang can not exist in isolation. If there is no day, there is no night. If there is no excitation, there is no inhibition. The balance of Yin-Yang is a dynamic, changing state. There is seldom exact balance, with equal amounts of Yin and Yang. For instance in Summer, daylight exceeds darkness (Yang is predominant) but in Winter, darkness exceeds daylight (Yin is predominant). Equal amounts of Yin and Yang (night/day occurs only at the equinoxes (March 2lst and September 23rd). The limits of Yin and Yang are seen, for example at the Winter solstice (December 2lst) when Yin is maximal (relative to Yang) and Summer solstice (June 2lst) when Yang is maximal. This transformation of Yin to Yang and Yang to Yin is a natural, universal phenomenon. It is natural for Yin to predominate at certain times and Yang to predominate at other times, in dynamic cycles. Allowing for the transformation of energy within the system, the overall state is one of balance.

 

The concept of balance is very important in Oriental philosophy, including TCM/TAP concepts of health and disease. The balanced body has a time for work and a time for rest (physical and mental). Deficient (depleted) energy must be conserved or renewed; Excessive energy must be drained or released.

 

Overactivity or underactivity in any facet of life causes Qi imbalance. Too much work (overexertion) or underactivity (laziness); too much sexual activity (loss of KI Qi) or inability to release sexual energy in some constructive way (frustration); overindulgence in food or drink, or undernutrition etc can have adverse effects. For example, too much sex (Water) can weaken the Water organs (KI, BL), resulting in lumbago, sciatica (controlled by BL, KI Channels), as well as throwing strain on HT, PC (heart, circulation) via the Ko Cycle (Deficient Water allows Excess Fire (HT, PC)). Inability to release sexual energy can cause Excess Qi in KI, causing Deficient HT Qi (Excess Water Qi causes Deficient Fire). Apart from cardiac problems and hypertension, this may cause, frustration, lack of drive, spirit and mental energy).

 

Balance also extends to food: too much (or too little) bitter food (Fire), sweet food (Earth), acrid/pungent food (Metal), salty food (Water) or sour food (Wood) can damage the corresponding COS in the Five Phase Cycle (see next section). Balance of the taste and food types helps to maintain good health. Over-cooking of food can destroy some of the good Qi in food. Under-cooking of food can cause indigestion or food-poisoning.

 

Similarly, the emotions are associated with the Five Phases (see section 5c). Control of the emotions to maintain a good balance is important.

4. FIVE PHASE THEORY

 
As well as a binary classification (Yin-Yang), the Chinese classified natural phenomena into five archetypes, translated as the Five Phases, once called the Five Elements. The word "Phase" is more appropriate, as it signifies that the five classifications are relative and it infers the idea of change between the phases. The Five Phases are Fire type, Earth type, Metal type, Water type and Wood type. The Five Phases stand together as a mutually nourishing (anabolic) and controlling (catabolic) whole, as in the diagram (below):

 

The outer clockwise circle ( ---> ) is the Sheng, creative or nourishing cycle. Things of a Fire nature nourish ( --> ) things of an Earth nature in the Sheng Cycle: Fire --> Earth --> Metal --> Water --> Wood --> Fire. In the Sheng Cycle, Fire is the Mother on Earth; Metal is the Son of Earth.

 

 

THE SHENG AND KO CYCLE OF THE FIVE PHASES

 

               

The inner clockwise star ( > ) is the Ko, controlling cycle. Things of a Fire nature control or weaken ( X ) things of a Metal nature in the Ko Cycle: Fire X Metal X Wood X Earth X Water X Fire.

 

Each Phase also contains Yin and Yang attributes or correspondences (see paper on the Five Phases). Each Phase also relates to a specific Yin-Yang pair of COSs and Fire relates to 4 COSs (HT, SI, PC, TH). For instance Wood Yin relates to Liver and Wood Yang relates to Gallbladder function, as in the diagram (below).

 

The Yin-Yang pairs in each Phase are called Husband-Wife pairs. For instance ST (Yang) is the Husband of SP (Yin). Each Channel has a special AP point (the Luo (Passage) point). The Luo points are used to shunt Qi between Husband and Wife.

 

Each Phase also has relationships to a specific season, food, emotion, sound, body tissue, secretion etc. (See details in the paper on the Five Phases). Any imbalance of Qi in the Five Phase system can affect the balance in the whole system. For instance, Deficient KI (Water) Qi can cause Deficient LV Qi (the Mother can not feed the Son in the Sheng Cycle), or it can cause Excess HT (Fire) Qi (via the Ko Cycle, Deficient Water allows Excess Fire). Excess KI Qi would have the opposite effect.

 

Five Phase Theory has very practical use in TAP therapy. For instance, if there is a Qi Deficiency in one Channel and an Excess in another, the Qi can be balanced very easily by needling special points (selected from the Five Phase Points and/or the Luo (Passage) points). Each Channel has a special point which relates to each Phase (5 x 12 points = Sixty Phase Points). These points are used to shunt Qi between the Phases.

 

One stimulates the appropriate TAP point on the Deficient Channel (always the Deficient Channel!) to draw the Excess Qi directly into it (or indirectly via other Channels), thereby balancing the whole system.

 

In the Five Phase relationships (below), the Yang organs (SI, TH, ST, LI, BL, GB) are those on the outside of the diagram and the Yin organs (HT, PC, SP, LU, KI, LV) on the inside.

 

CHANNEL RELATIONSHIPS VIA THE SHENG AND KO CYCLES

 

               

Five Phase Theory teaches that disorder in any one COS can directly or indirectly cause disorder in any other COS via Sheng, Ko or other energetic transfer routes. It is essential to the understanding of disease interactions in TCM and in the selection of the primary sites of disease.

 

It also teaches that if the primary disorder is corrected, the secondary disorders may self-correct rapidly.

 

A detailed study of Five Phase relationships and the uses of the Phase and Luo Points is essential to the therapeutic use of energetic TAP. The system can give dramatic clinical results in complex Syndromes but few western acupuncturists have the patience to study the system properly.

 

5. CONCEPTS of ECOLOGY, SYNDROMES and CAUSES of DISEASE in TCM

 

TCM teaches that Nature (all of creation, macrocosm and microcosm) is a unity which reflects the interplay of Qi, Yin-Yang, the Five Phases, the material and the immaterial. As we are wed to Nature, we feel Her claws or Her caress. And if we ravish Nature, or sow black seed at the time of white seed-sowing, or work against Her changeless Laws, we plant a bastard harvest, which we will reap. And we will weep alone, groan long in the hell of a Man-made night.

 

Health is a relative state. Optimal adaptation to prevailing circumstances (and the ability to adapt to new ones, if needed) are important factors in health. Healthy people adapted to living high up in the Andes mountains may have Packed Cell Volumes which would indicate serious dehydration or disease in people living in, say, Belgium. Adaptation to internal changes are also important. What may be healthy sport for a strong young man may kill a weak old man.

 

Many factors regarded by TCM to be involved in health are discussed below but TCM was also aware of acute causes of illhealth: trauma/wounds; undernutrition, genetic influences. (Modern Chinese medicine also recognises many other causes, as in western concepts: stress, toxicities, infection, parasitism, nutrient imbalances and deficiencies, metabolic and hormonal imbalances, senility etc).

 

Health depends on self-control: Chinese/Japanese parents dote on children, but their children are programmed very early in life to develop a high degree of self-discipline. This helps them to develop self-control of body and mind, which is perfected further in adulthood, to a degree which puts many westerners to shame. Mastery of the self was also part of the training and lifestyle of the oriental monks, who were said to be very healthy and resilient. The secret of good health is to strive for physical and mental control and to live in balance with Nature and with the Laws of Nature.

 

As part of Nature, the human or animal organism is influenced by Natural Laws, forces and energies. We dance or writhe to Nature's rhythmic tune. Conversely, the activities of the organism influences Nature for good or ill. Today's specific problems of environmental pollution (production and preservation of food to be eaten out of season by the use of chemical preservatives; dumping of toxic metals and chemicals, nuclear waste; the ozone hole/greenhouse effect etc) may not have been foreseen by the ancients but the global philosophy of Yin-Yang would have predicted them- we are creators and destroyers, a mixture of good and evil. A more recent law of physics can be adapted and extended to apply to biological systems: "To every action, in due time, there is an equal and opposite reaction". We decorate, or foul, our den, which, in time, empowers, or overpowers, us.

 

Avoidance of attack is the first law of self-defence. This implies that self-training to heighten one's awareness, perception and intuition have a prime defensive role. Strength (Qi) and skill (physical and mental) to deflect or minimise an unavoidable attack is the second law of self-defence. Rapid adaptation to prevailing circumstances is the key to survival.

 

Adaptation implies the ability to respond optimally to challenge. Clean air, exercise of mind, good food and a fit mind-body helps to develop Qi and to direct it when and where it is needed.

a. Qi IN RELATION TO DISEASE

 

Qi (the vital force and defence energy of the body and mind) comes from different sources: Ancestral Qi (genetic energy), Qi from Heaven (the energy of life) and from earth (vital energy from air, food). Healthy lung and gastrointestinal function are vital to balanced Qi. Deep breathing exercises (imagining the air being drawn down as far as the pelvis) and visualisation of Qi streaming through the Channel system (in the correct direction of Qi flow, and in time with deep, slow breathing) are part of TAI Qi and Qi KUNG exercise systems which are used to counter stress and attain physical/mental wellbeing.

 

Health and disease are determined by the amount and balance of Qi in the organism. The healthy body/mind has a perfect balance of Qi which can circulate freely in the body through the Channel network, the collateral Channels, the deep Channels and the organs. Adepts can direct Qi (by conscious or subconscious control) to circulate to those parts which may need extra Wei (Defensive) Qi. In the body, upset Qi (Excess of Yin or Yang, Deficiency of Yin or Yang etc) is the cause and result of disease.

 

If the Wei (Defensive) Qi is weak, disease can invade from outside (see 4b below). Body Qi can also take many forms: Qi of Kidneys, Qi of life (semen) etc. Blockage of Qi flow, whether caused by trauma, scar tissue or other causes) is followed by functional or organic disease of the affected COS.

 

b. INTERACTION BETWEEN ENVIRONMENT AND THE ORGANISM

 

"Man (the organism) stands between Heaven and Earth". This ancient teaching infers the external environment (extra-terrestrial and terrestrial energy) can influence us and that we can influence the heavens and earth. Natural environmental forces (Qi) include magnetism, gravity, electromagnetic fields, solar, lunar and planetary influences etc. Others include geophysical/geopathological fields, as known to the practitioners of Feng Shui (Chinese diviners, who would shun the valley where no bird sings). We must cope with seasonal changes, which can predispose to their own Syndromes, or types of disease. To dress and work outdoors in the depths of winter as if it were the middle of summer (or vice-versa) can seriously imbalance Qi and cause disease. The wise one wears thick skins in snow, fine silk in sun.

 

In Yin-time live a Yin-type life; in Yang-time, Yang.

 

THE SIX EVILS

 

TCM recognises six climatic causes of disease: Heat, Summer-Heat; Damp, Dryness, Cold and Wind.

 

Each one of the Six Evils (type of perverse energy which attacks the body from the Exterior) has a preference for a specific COS in the Five Phase Cycle:

 

Perverse Energy Heat, Summer-Heat Damp Dryness Cold Wind

 

Phase attacked Fire Earth Metal Water Wood

 

Yin SYSTEM attacked HT, PC SP LU KI LV

 

Yang SYSTEM attacked SI, TH ST LI BL GB

 

These "devils" gain access to the body via the skin-holes (the AP points). Pathogenic Qi can reach the Interior of the body via the superficial and deep course of the Channels in two ways:

a. if, relative to the force of the attack, the Wei Qi is weak (unable to deflect the acute attack), or

b. if the condition is not treated successfully (by increasing Wei Qi using TCM/TAP at that stage).

 

Once the inner organs are invaded, the condition is serious and may become chronic, life-threatening and difficult to treat.

 

Apart from the preferred organ, other organs and functions can be attacked, using routes in the Five Phase Cycle (Sheng and Ko and reverse-Ko routes). For example, Summer-Heat can attack HT-PC (heatstroke, circulatory collapse, heart attack), the mind (febrile hallucination, heatstroke) and also the SI (summer gastroenteritis). Wind can attack LV, the eyes, GB, the muscles and the mind (anger, jealousy) etc and can also counter-attack LU (via a reverse Ko route: Wood (LV) is controlled by Metal (LU)).

 

Treatment at that stage aims to increase the adaptive reactions of the primary organ attacked and the general resistance of the body in an attempt to expel the invader. (Treatment can include induction of vomition, purgation, diuresis, sweating etc if the invader can be expelled by these routes).

 

c. THE ROLE OF THE EMOTIONS IN DISEASE

 

Each of the Five Phases is associated with specific emotions. Balance of the emotions is important, as imbalance in any one of them can imbalance the Qi, to weaken the corresponding COS:

 

Phase	Emotion	Sound expressed
HT Fire	Pleasure/Joy/Excitement	Laughter
SP Earth	Anxiety/Obsession/Meditation	Singing/Whistling
LU Metal	Grief/Sorrow/Melancholia	Weeping
KI Water	Fear/Fright	Sighing/Moaning
LV Wood	Wrath/anger	Shouting/Screaming

 

For example, too much excitement/pleasure/joy can weaken the HT COS (angina, heart attack etc) and one of the signs of HT disorder is too much laughter/excitability. Too much anxiety (obsession) can weaken the SP COS and one of the signs of SP disorder is a tendency to obsession and sing (to oneself) a lot. Similarly for the other organs (LU, KI, LV).

 

Psychosomatic disease: The Chinese were among the first people to note an association between the emotions/psyche and disease. They were aware of the importance of psychosomatic disease before the time of Christ. Similarly, in imbalance of a Channel, the appropriate emotions can be fostered and used in the Ko Cycle to redress the imbalance. For instance, in grief (Deficient Metal), stimulation of laughter/joy, pleasure can reduce grief and strengthen LU via the Ko Cycle (Fire controls Metal). Fear (Deficient KI) can be helped by stimulating meditation, singing, or whistling (Earth controls Water).

DISEASE CLASSIFICATION BY THE EIGHT PRINCIPLES (the EIGHT TYPES)

 

The Eight Principles classify disease by 4 categories:

a.Yin orYang

b.Hot orCold

c.Shi (Excess) orXu (Deficiency)

d.External orInternal.

 

a. Yin and Yang Syndromes

Balance of Yin and Yang Qi is the normal state. Disease is classified according to its disturbance of Yin and Yang Qi. However, Yin organs may have Yin or Yang diseases (and Yang organs likewise). If Yin or Yang (or both) deviate from the normal level, a state of relative Excess (Shi) or Deficiency (Xu) exists.

 

	Yintype	Yangtype*
Activity	Hypo-withdrawn ,inhibited, quiet	Hyper-, excited, fidgety
Body and limbs	Cold, seeks warmth	Hot, avoids warmth
Pulse	Deep and slow	Shallow and fast, bounding
Tongue	Pale, moist	Red, dry, coated
Respiration	Feeble	Rapid and strong
Thirst	No	Yes
Urine	Clear, copious	Scanty, coloured
Complexion, skin	Pale	Red
Attack site**	Interior, deep (internal organs)	Exterior, superficial (Channels and their collateral branches)
Onset	Cause chronic	Cause acute
Progression	Inwards and downwards	Outwards and upwards

 

* Moxa (heat cautery) is usually contraindicated in Yang and Hot Syndromes.

 

** Internal or External attack sites can not always be classified as Yin or Yang respectively. Yin organs can be attacked by Yang diseases and vice versa.

 

Collapse of Yang and the Collapse of Yin are other Yin-Yang Syndromes:

 

Collapse of Yang: Profuse cold sweat; respiration feeble; pallor; prefers hot drinks; skin cool; limbs cold; dislikes cold; listless; pulse of Xu type (thready and fading); tongue pale and moist.

 

Collapse of Yin: Sticky sweat; respiration rapid and short; face red; thirst and prefers cold drinks; skin hot; limbs warm; dislikes heat; restless; pulse of Xu type (thready and rapid); tongue red with little saliva.

 

To complicate matters, the law of Yin-Yang implies that change can occur; one Syndrome can change to another: "Cold with fullness moves downwards and transforms into Heat; Heat, with fullness, moves upwards and transforms into Cold" (Turner and Low, 1981). Also, some of the features of Cold and Hot Syndromes can give misleading impressions of Yin-Yang balance- they may be False Yin or False Yang conditions. Collapse of Yang resembles a false Yin Syndrome and Collapse of Yin resembles a false Yang Syndrome.

 

 

 

b. Hot and Cold Syndromes

 

Hot Syndromes are caused by pathogenic Heat, Summer Heat and Dryness (3 of the Six Evils). Cold Syndromes are caused by pathogenic Cold. Also, Excess (Shi) of Yin or Yang can cause Cold and Hot Syndromes of the Shi type respectively.

 

Cold Syndrome of the Shi (Excess Yin) type: Chills; limbs cold; no thirst; pallor; excess sputum; asthmatic breathing; indigestion; vomiting; abdominal pain, worse on pressure; stools loose; urine clear and copious; pulse deep and slow; tongue pale with white sticky coating; craves warmth.

 

 

Hot Syndrome of the Shi (Excess Yang) type: Continuous high fever; thirst; face flushed, eyes red; abdomen full and distended, worse on pressure; consciousness; delirium; constipation; urine concentrated; pulse rapid; tongue red to deep red, with dry yellow coating; craves cold.

 

 

c. Shi (Excessive)and Xu (Deficient)Syndromes

 

In TAP, the needling technique depends on whether the Syndrome is Shi or Xu type. In Shi type (Excess) the needling method is Xie (reducing type), to dispel the Excess Qi. In Xu type (Deficiency) the needling method is Bu (reinforcing type), to stimulate the Deficient Qi. The TCM rule of needling is Shi needs Xie but Xu needs Bu:

 

Shi Syndrome needs Xie needling;

 

Xu Syndrome needs Bu needling.

 

Palpation pressure on the affected areas helps to distinguish the Shi and Xu Syndromes. In Shi (Excess), with Yang fullness, pressure aggravates discomfort. In Xu (Deficiency), with Yang emptiness, pressure alleviates discomfort.

 

In Shi Syndromes, body resistance is normal but the body is attacked by an exogenous pathogenic factor. The prognosis is not serious if the attacking factor can be expelled, thereby preventing the disease from reaching the internal organs.

 

Shi (Excess) Syndromes: Disease recent; elation; robust constitution; restless; spastic; voice sonorous; breathing coarse; chest and abdomen full and distended; abdominal pain, worse on pressure or palpation; constipation; tenesmus; urination painful or difficult; urine scanty and concentrated; pulse of Shi type (coarse, rapid, full); tongue red and coated; skin warm.

 

Syndromes of Shi (Excess) type are usually (but not always) of the Hot type:

 

 

Xu (Deficiency) Syndromes: Disease chronic; listless, depressed; weak; asthenic appearance; apathy; pallor; lies curled-up; voice weak; breathing feeble; palpitation; shortage of breath; tinnitus; vision blurred; insomnia; memory poor; sweating; night sweats; abdominal pain, relieved by pressure or palpation; loose stool; nocturnal spermatorrhoea; enuresis; copious clear urine; pulse of Xu type (fine, weak, irregular); tongue pale, with thin coating; skin cold.

 

In Xu Syndromes, body resistance is lowered and the disease can reach the internal organs more easily. The prognosis is more serious. Deficiency (Xu) of Yin or Yang can cause Hot or Cold Syndromes of the Xu type respectively. In both cases, resistance is low.

 

Xu (Deficiency) Syndromes are usually (but not always) of the Cold type:

 

 

An example of the Yin Xu Syndrome (Cold Syndrome of the Xu type): Chills; limbs cold; pallor; no thirst; listless; apathy; weak; sweating; stool loose; urine copious and clear; pulse slow and deep; tongue pale with white coating.

 

But, as in most aspects of Chinese thought, the paradox exists also, the Yang Xu Syndrome (Hot Syndrome of the Xu type): Afternoon fever; malar flush; mouth and throat dry; insomnia; restlessness; feverish feeling in palms and soles; night sweats; constipation; urine concentrated; pulse rapid and thready; tongue red with little coating.

d. External and Internal Syndromes

 

External Syndromes result from invasion of the superficial areas of the body by exogenous factors. Onset is sudden and duration is short. Exterior Syndromes are usually mild. They are the early signs of exogenous disease but may develop to Internal Syndromes.

 

Internal Syndromes result from penetration of exogenous factors to the Interior of the body, as in an External type which was unsuccessfully controlled, or by direct attack of the organs by exogenous factors. Internal Syndromes are usually severe and involve functional or organic damage of the organs. Dysfunction of the organs is also an Internal Syndrome.

 

Both External and Internal Syndromes can be complicated by Cold, Heat, Xu (Deficient) and Shi (Excess) Syndromes.

 

External Syndromes:

 

Cold: Fever; no sweating; chills; pulse superficial and strong; tongue coating thin and white

Hot: Fever; intolerance of wind; may sweat; mild thirst; pulse superficial and rapid; tongue coating thin and yellow.

Xu: Sweating; intolerance of wind; pulse superficial and slow

Shi: No sweating; general aches; pulse superficial and strong; tongue coating white

Internal Syndromes:

Cold: Chills; cold limbs; pallor; no thirst; stool loose; urine clear and profuse; pulse deep and slow; tongue pale

Hot: High fever; thirst; irritable and restless; face flushed; eyes red; constipation; yellow scanty urine; pulse rapid; tongue red with yellow coating.

Xu: Breathing feeble; apathy; lassitude; palpitation; dizziness; pulse deep; tongue flabby and pale, with white coating

Shi: Breathing coarse; voice strong; irritability; fullness of chest; distended abdomen; constipation; pulse deep; tongue rough, with thick coating

 

Thus, TCM has a set of 8 criteria (the Eight Principles) to define disease Syndromes (the type (nature) of disease), based on the clinical signs. By combining one type from each of the 4 categories (Yin or Yang; Hot or Cold; Shi or Xu; External or Internal), 8 possibilities arise (1 X 2 X 2 X 2 = 8). Syndrome classification by the Eight Principles is discussed further in Lee and Cheung (1978); The Essentials of Chinese AP (1980); Turner and Low (1981); Porkert (1983).

 

As well as classification by the Eight Principles, Syndromes are classified according to the main organs involved and the energy imbalance in them. Each of the following strangely-named Syndromes has defined clinical and functional upsets:

 

LU Syndromes:LU Yin Deficiency; Wind attack on LU; LU Damp-Phlegm Retention; LU Heat-Phlegm Retention

LI Syndromes:Damp-Heat invasion of LI; LI Obstruction; Blood and Heat Obstruction of LI

ST Syndromes: Retention of food; Retention of fluid; ST Fire Excess

SP Syndromes:SP Qi Deficiency; Cold-Damp invasion of SP

HT Syndromes:HT Qi Deficiency; HT Yin Deficiency; Obstruction of HT Blood; Excess HT Fire; disturbed Shen (mental derangement)

SI Syndromes:SI Heat

BL Syndromes:Damp-Heat invasion of BL; BL dysfunction

KI Syndromes:KI Qi Deficiency; KI Yin Deficiency; KI Yang Deficiency

PC Syndromes:Heat invasion of PC

GB Syndromes:Damp-Heat invasion of GB

LV Syndromes:LV Qi Deficiency; LV Fire Excess; Cold Obstruction of LV; LV Blood Deficiency; LV Wind stirred by Heat

 

There are many other types of Channel Syndromes (see Porkert 1983).

 

Disease is classified also according to the main Channel involved (LU, LI, ST, SP, HT, SI, BL, KI, PC, TH, GB, LV). It may be classified also by disturbance in the Eight Mai (Vessels or Extra Channels):GV; CV; Chong; Dai; Yang Chiao; Yin Chiao; Yang Wei; Yin Wei). Each of these Channels and Vessels has its own symptomatology.

6. DIAGNOSIS IN TCM

 

TCM Diagnosis was based on four principles: looking, listening, feeling and smelling, i.e. on input signals from 4 of the 5 senses (sight, hearing, touch and smell).

 

LOOKING: The patient is inspected carefully for any abnormalities of gait, posture, swellings (oedema, inflammation etc), atrophy, muscle spasm, paralysis etc. Great attention is paid to the skin and face (colour, texture, sweat), ears (abnormal blotches, scales, flakes, papules), tongue (colour, saliva, coating) and iris. Colour and consistency of stools, urine and other secretions/excretions are noted.

 

LISTENING: The case history is taken. The emotions, symptoms and sounds (strength of voice, respiration, abnormal gut and joint sounds etc) are noted.

 

FEELING: The patient is palpated carefully to check skin temperature (hot or cold); variation in skin temperature, for instance one limb colder than the other; location of abnormal swellings, muscle tension, flaccidity; location of Ahshi (tender) points. Great attention is paid to palpation of the Mu and Shu points, the Xi, Yuan and Luo points. Tenderness at these points can indicate the COS involved.

 

Channel diagnosis by point sensitivity: In severe disorders of a Channel, many points along the Channel may show abnormal tenderness to pressure palpation, electric current or heat. This is especially true for the Ting (most distal) points at the nail of a toe or finger). Ting (Well, near the nail) point sensitivity is the basis of the diagnostic methods of Akabane (Japanese diagnosis by measuring heat sensitivity) and Voll (German electrodiagnosis). The Shu and Mu points may also be tender. Other important points (which may be tender in Channel disorders) lie below the knee or elbow: the Five Phase Points, the Luo, Yuan and Xi points.

 

Pulse Diagnosis is the ultimate in TCM diagnostic palpation. According to TCM, the pulse in the distal, middle and proximal positions on the left radial artery reflects the energy status of the SI, GB and BL Channels on superficial palpation and the HT, LV, KI Channels on deep palpation respectively. The pulse in the distal, middle and proximal positions on the right radial artery reflects the energy status of the LI, ST, TH Channels on superficial palpation and the LU, SP, PC Channels on deep palpation respectively. Porkert (1983) describes 31 different pulse types.

 

Some TCM practitioners claim to be able to make an accurate energetic diagnosis in human patients (which Channels are involved and whether they are hyper- or hypo-active) on the basis of Pulse Diagnosis alone ! However, many translations of Chinese medical AP texts ignore or pay little attention to the classical pulse types.

 

Classical Pulse Diagnosis is a controversial issue, even in China and Japan. Recent studies (doppler ultrasonography or use of pressure transducers to measure pulse characteristics) cast great doubt on the objective validity of Classical Pulse Diagnosis. Most veterinary AP texts ignore it. In my opinion, pulse diagnosis is not objective but some people can make accurate diagnosis by the Pulses by subjective (psychic, extra-sensory perceptive) means, as in medical radiaesthesia/medical divination and Extra-Somato Projection.

 

SMELLING: In TCM, the practitioner smells the breath, the skin and excreta of the patient. TCM attributes typical smells to various disorders. For instance, in Earth disorders (SP, ST, diabetes), there may be a sweet (ketone) smell; in Water disorders (KI, BL), there may be a putrid smell (uraemia, ammonia) etc.

 

The aim of TCM/TAP diagnosis is to establish (a) the nature of the disease in terms of the Eight Principles and the Six Evils and (b) the COSs involved.

 

Having assessed the patient by the four principles (looking, listening, feeling and smelling), the nature and location of the disorder is defined in traditional terms. Steps are then taken to remove or alleviate the cause, or to enhance the body's Wei (Defensive) Qi, or to re-balance any energetic imbalances which have been diagnosed.

 

TCM diagnosis was developed at a time when knowledge of internal anatomy and physiopathology were primitive. Millennia had to pass before the development of current western concepts of biochemistry, microscopy, immunology, bacteriology, genetics, Selye's concepts of the Stress Reaction, concepts of nutrition (mineral, vitamin and essential amino-acid imbalances etc) and biotechnology.

 

In spite of ignorance of modern medicine, the ancient Chinese had one very important concept: They knew that vital energy (Qi, Vix Naturae) was the key to health and recovery from disease; they taught that the body healed itself by its own natural defense systems; the aim in healing is to stimulate and enhance those mechanisms, thereby attaining balance (homeostasis).

7. THERAPY IN TCM

 

All methods aim to correct imbalances of Qi. Where the cause is bad lifestyle (XS eating; XS work; insufficient food or sleep; XS alcohol etc) steps are taken to advise on moderating this. As far as possible, the patient is advised on environmental, behaviourial or dietary changes etc which may be necessary to alleviate or remove the cause. To restore the normal balance of Qi (resistance), many methods are used alone or in combination.

 

TCM relies heavily on herbal medicine (HM). The Chinese herbal pharmacopoeia is very extensive, running into thousands of plants, herbs, venoms, inorganic compounds, animal by-products etc. These remedies are prepared as decoctions, concoctions, powders, ointments etc and a typical prescription would contain 4-10+ separate components. Many of the crude extracts have been purified in recent years and the active alkaloids or other compounds have been isolated. Several HMs, or extracts of them, have potent antitoxic effects in patients on cytotoxic radiotherapy or chemotherapy (cisplatin etc) for cancer. Herbal products and HM extracts have many high-ranking pharmacological properties, including immunomodulators, hypoglycaemic, anticancer, antiinflammatory, antiviral, antibacterial, antiprotozoal, antiasthmatic, antioxidant, antihypertensive and anti-liver disease activities.

 

Other methods include physiotherapy (exercises; massage; moxibustion (cautery of the AP points); Taichi (ritual slow movements to utilise every muscle of the body in conjunction with breathing exercises) and psychotherapy (Qi Kung (visualisation-meditation of the energy flow through the Channel circuits, together with specific slow deep breathing exercises, inhalation for centripetal Channels and exhalation for centrifugal Channels); mental/emotional exercises to balance the emotions).

 

AP is only a small part (maybe 20%) of the total TCM system.

 

8. AP METHODS

 

For proper use, AP, moxibustion and Chinese massage (acupressure) depend on a detailed knowledge of the point and Channel system. Having selected the points most suitable for the patient, these points are stimulated by many different methods, depending on the training and preferences of the practitioner and the equipment available. The most common type of AP uses fine stainless steel, solid, needles 1-6 cm long and 25-32 gauge. The most common needle is about 3.5 cm long, 30 gauge, but others (including some barbaric-looking instruments) are occasionally used in remote, rural areas. In veterinary AP, the needles vary with the species. For experimental work in small animals and laboratory animals, the finest human-type needles may be used. For clinical work in the dog-cats, one usually uses 1-6 cm, 28-30 gauge needles. In larger animals (pigs, ruminants, horses, mules etc), larger and thicker needles are used (2.5-15 cm needles 18-28 gauge, depending on the preferences of the practitioner and the depth of the points).

 

The skin around the point is prepared as aseptically as possible. Sterile needles are inserted to the correct depth and are stimulated (by twirling and pecking) to obtain DeQi. This phenomenon ("the arrival of Qi") is regarded as crucial to AP success. It is similar to the "funny bone sensation": paraesthesia, tingling, numbness, heaviness, "sour feeling" etc in the vicinity of the point.

 

In humans, the objective and subjective sensations are unmistakable - the verbal feedback from the patient ensures this. It is not uncommon for human patients to invoke the name of the founder of the Christian religion when Qi arrives! In animals, however (because they cannot relate their subjective feelings), the main signs of DeQi are: sudden change in the animal's behaviour: a temporarily fractious animal suddenly standing quite motionless or a quiet animal suddenly beginning to tremble or vocalise. Respiration may be temporarily inhibited or accelerated. Local muscle spasms or twitches may be seen.

 

DeQi is more often obvious when the point is directly over a peripheral nerve (such as with the Great Points of AP, for instance: LI04; PC06; TH05; LI11; ST36; GB34; BL40 etc or directly over motor points (places where the motor nerve plunges into the muscle).

 

Once DeQi is obtained, the needle is left for 30 seconds to 20 minutes. In general, acute conditions require only short periods of needling and chronic conditions require 20 minutes or more. Before removal of the needle, it is twirled/pecked again.

 

Classical AP demands specific types of needle manipulation depending on whether the condition is diagnosed as a Shi (Excess) or Xu (Deficiency) type. These specific Syndromes of manipulation are described in standard texts but the issue is controversial in that many successful practitioners ignore them still obtain excellent results - the use the simple method described above.

 

The most comprehensive textbook on techniques of AP is "Current AP Therapy" by Lee and Cheung (1978). This is an excellent text and is recommended as ESSENTIAL reading for serious students.

 

Apart from simple needling, cautery and massage, other methods are common. They include electro-AP (with or without needles); injection of the points; ultrasound-, microwave-, laser-, cryo-, faradic-, static field-, magnetic field- and other therapies applied to the specific points. They also include implants, incisions direct massage of the exposed nerves etc.

 

In general, the simple needling technique is adequate for most purposes and expensive pieces of equipment (electro stimulators, lasers etc) are luxuries to impress the public rather than to enhance the results. There are some exceptions to this which will be discussed in other seminars.

 

The number of sessions and the intervals between sessions vary with the condition. Chronic conditions are normally treated 1-2 times per week for 4-20 sessions. In general, if there is not an obvious response by session 4-6, the chances of ultimate success are poor. Acute (but simple) conditions are treated every 6-48 hours, depending on the condition. For instance, acute traumatic pain could be treated for 20 minutes daily (GB34 on the affected side and 1 or 2 local points). Expect 70% success after 1 session and >90% after 3 sessions. Acute conditions usually require 1 to 5 sessions.

 

9. METHODS OF CHOOSING EFFECTIVE AP POINTS

 

Which methods are chosen will depend on the training, skill and experience of the practitioner. Classical AP has more than 14 laws for consideration, apart from the use of the Five Phase balancing method:

 

a. local points

b. distant points

c. points on affected Channel

d. points on related Channels (Husband-Wife pair of Channels or Channels passing near the affected one)

e. one point on each of the 4 limbs

f. encircling the affected area

g.Ahshi points

h.Mu and Shu points

i. the source point of affected Channel and the Passage (Luo) point of its linked Channel

j. "Fore and Aft" points ((in front of and behind the affected area)

k. a chain of points along the affected Channel

l. points long recognised as highly effective for specific symptoms or body areas (eg) PC06, ST36 for nausea and vomiting; LI04 for mouth, nose and throat

m.Xi (cleft) points.

On top of these, modern AP adds

 

n. needling points in the affected dermatome or along the innervation of the affected area

 

o. needling Scalp, Ear, Face, Nose, Hand or Foot Zone points associated with the affected area (e.g.) Scalp zone "Lower Motor Area" for leg paralysis; Hand point "Loin and leg" for lumbago/sciatica etc.

 

By far the most common prescription is a combination of Ahshipoints and local points and distant points on the affected Channel. This may seem to be a simple matter to resolve but a look at any standard chart will show the difficulties. One must limit the number of needles to 6-12 in most sessions. Therefore one must discriminate which local and distant points are most relevant). The textbooks (as individual texts) do not help much either. A careful study of the texts shows that there is major variation between them in their choice of points for specific conditions. One solution to the problem is to construct a database from many textbooks and to use the computer to do a frequency ranking on the points for specific conditions. In this way, the most commonly recommended points for any specific condition can be output in seconds.

 

COOKBOOK AND MODERN AP

 

Although Classical AP is also practised in Europe, USA, Soviet countries, Taiwan and Japan most countries, MODERN AP in those countries is a much simplified version. It needs less study of the more difficult classical concepts but it demands competence in western medicine as the foundation for sound diagnosis good clinical success. The following aspects will be discussed:

 

1. WESTERN CONCEPTS OF REFLEX DIAGNOSIS AND THERAPY

2. COMPUTER DATABASES

3. COOKBOOKS

4. TAIWANESE/JAPANESE APPROACH TO AP

5. COMBINATION OF MODERN AP AND WESTERN MEDICINE

6. THE FUTURE ?

1. WESTERN CONCEPTS OF REFLEX DIAGNOSIS AND THERAPY

 

The body is a unit. Each organ and part belongs to the whole and can influence the whole. The peripheral, central and autonomic nervous system, together with the endocrine system controls the harmony of the whole.

 

American, German, Scandinavian, Eastern European and Soviet (as well as Oriental) research in recent years has confirmed the enormous potential measuring deviations in of the autonomic-endocrine system as a diagnostic aid and of stimulating the system to obtain therapeutic results.

 

Research with infra-red thermography, Voll-Akabane-Ryodoraku measurements of altered sensitivity at peripheral points etc has confirmed the diagnostic claim of TCM: that organs project information of their dis-ease to the periphery via the autonomic nervous system. Clinical detection of the altered sensitivity aids in diagnosis. Any method (including AP) which speeds up the return to normal sensitivity is a good therapeutic method and monitoring the speed of return to normal sensitivity has prognostic value.

 

2. COMPUTER DATABASES

 

In every sphere of technology the computer is used to store vast amounts of data. The stored data can then be sorted, searched, analyzed and output (to screen, printer or graphics plotter or screen) as required. Many serious students of AP have observed the variation between texts mentioned in the last section. To overcome the difficulty and to assist in their final selection of points, they have cross-referenced every indication given for every point in as many authoritative sources as possible. This was usually done on a card-index or loose-leaf notebook system. When presented with an unfamiliar problem (say post-CVA aphasia), the practitioner could consult the card or loose-leaf for "Aphasia" and visually assess the most important points by frequency-ranking methods. This procedure can take lO-20 minutes for each condition in a good database. This system worked very well for static databases (i.e.) ones which were not altered by additions or deletions. Every time a new reference goes in or out, the ranking would possibly change. Furthermore, the manual system was rather inflexible, for instance, if a researcher wished to examine the most frequently used points for "head" (using all the conditions coded under "head") it could take hours to get the result.

 

This is a simple problem for modern computers. Having collected data from >50 textbooks and many clinical articles on AP over the past 10 years, I have stored it on computer. The database has >1170 clinical conditions and can generate prescriptions for any or all conditions. Every point listed anywhere in the source material is output and the score is also output. One can see at a glance how well or how badly the point is represented in the database. One can also see how often the condition is cited; conditions with very few citations are less likely to respond to AP therapy than those with many citations.

 

3. COOKBOOKS

 

Cookbooks usually provide instant details of the ingredients needed to prepare the required dish. They are used mainly by cooks who (a) have bad memories or (b) have not tried to prepare the dish before. Either way, they are very useful and many an enjoyable meal was prepared in this way. Really expert cooks however, through experience and good memory, seldom need to refer to the cookbook.

 

Cookbook AP is basically "prescription AP". It is suitable for statistical medicine (standardised approach to all "similar" cases). It is quite unsuitable for difficult, complicated or atypical cases, especially in man. To treat such cases successfully by AP would require a deep study of the classical concepts. Having said that, Cookbook AP is ideal for routine and simple cases. It is the quickest, least painful way of introducing busy professionals to the AP techniques. Whether right or wrong, many busy professionals are not prepared to devote the effort and time to a deep study of AP. Without the cookbook approach, most of these would never be able to attempt AP therapy, except for the simplest type (TP therapy or Ahshi therapy).

 

The main problem with Cookbook AP is which book to use. None of the AP texts available (even the most comprehensive ones, such as the "Essentials of Chinese AP", "Barefoot Doctor's Manual", "Acupuncture, a Comprehensive Text" or "Current AP Therapy") lists all the conditions which can be helped by AP, and there are considerable differences within and between texts. Thus, the serious student is forced either to construct a personal database (as already discussed) or to purchase a commercial card-index database (such as that by Shenberger). The latter is good but is very incomplete - being based on only a few textbooks.

 

At this time, micro-computer AP databases are available commercially.

 

One way to use the cookbook method is to select the 6 or 7 points with the highest scores. I have discussed this method with several highly trained and skilled AP practitioners. There is general consensus that while this will give useful clinical success ratios, it will not achieve the success ratio which would be possible if the points were selected from the cookbook not only by their scores but also keeping the Classical concepts and the laws of choosing points in mind. This pre-supposes that the user knows these concepts. Thus, in summary:

 

Cookbook + little AP knowledge = good clinical success

 

Cookbook + good basic AP " = better clinical success

4. TAIWANESE/JAPANESE APPROACH TO AP

 

Having discussed some of the fundamental concepts of TCM and TAP we should now consider how much of the Traditional approach is actually used in modern AP today. This is a very difficult question to answer and it largely depends on the training and experience of the respondent.

 

First, let us examine some of the characteristics of modern AP.

 

Medical diagnosis in China Today: Side by side with traditional systems, highly scientific, western oriented medical systems co-exist. This also applies in India, Japan, Taiwan, and most of the Far East. In the same city, you may find the back-street charlatan, the high-street Oriental Doctor (Traditional) and the western-style trained medical specialist.

 

Many Chinese and Japanese doctors, trained in western medicine but also trained (and expert) in AP ignore or dismiss much of the Five Phase Theory, the Chinese pulse diagnosis method etc as irrelevant to modern medicine. Lined up against them, as (many or more) of their colleagues hold fast to these concepts. Thus, a westerner asking "How important are the traditional concepts today"? cannot arrive at firm conclusions based on talking to these persons.

 

We can also try to assess the problem by examining the amount of text space devoted to Traditional Concepts in the English versions of the AP textbooks from the far East. In general, few of these texts issued in the past 10 years give more than a cursory nod towards the traditional concepts. Most of them approach the treatment of clinical disorders from a pragmatic viewpoint (i.e.) Cookbook AP. Many modern AP textbooks place little importance on the Six Evils, the Five Phase Theory and its uses etc. Many successful AP practitioners do not use those concepts in diagnosis or therapy.

 

However, one should ask the question: why was the traditional aspect understated? Was it because the authors believed it to be irrelevant or was it because they thought that full discussion would "turn off" western readers? I believe the latter is nearer the truth. Because of conceptual differences, there are no words in our languages for many of the Chinese concepts! Full discussion would be tedious: like trying to discuss nuclear physics with a theology student. In support of this argument, we must note that some of the authoritative texts place considerable emphasis on the traditional (Essentials of Chinese AP; AP a Comprehensive text; Current AP Therapy; Pathogene et Pathologie Energetiques en Medicine Chinoise - Van Nghi 1971). The fact that the Barefoot Doctor's Manual gives little attention to it is probably because it is for the barefoot doctor, whose training is too short to assimilate the complex traditional concepts.

 

Thus, the terminology and concepts used in medical diagnosis depend largely on where the patient becomes ill and which doctor is consulted, as is the case in Ireland!

5. COMBINATION OF MODERN AP AND WESTERN MEDICINE

 

In the Veteran's General Hospital, a huge, excellently equipped Army-Navy-Airforce Hospital in Taipei, one finds specialists in Oriental Medicine, specialists in western medicine and (more significantly) specialists in both systems. It follows that the diagnostic and therapeutic methods depend largely on which doctors are consulted. All the standard lab tests, clinical and neurological tests etc, are available, if required.

 

In China, the Barefoot Doctor is a technician with limited training, capable of diagnosing and treating the common and simple day to day conditions with reasonable accuracy. Where treatment is unsuccessful or the case appears to be more complex, the patient is referred one step higher to persons who have a longer, more formal training in Oriental and/or western medicine. If they need help, the patient is referred further up the pyramid, which is topped by first rate physicians, surgeons and oriental medical specialists.

 

Effective therapy is more important than putting traditional or modern names on the origin and nature of the clinical condition. AP therapy, as is the case with diagnosis, is an art-science as varied as there are practitioners. However, most medical AP practitioners (including those at the Veterans General Hospital, Taipei) use pragmatic or Cookbook AP in the majority of their cases: knee problems GB34, SP09, ST35, Hsi Yen (Knee Eyes), BL40; sciatica BL23,37,40,60, GB30,34 etc. They use their favourite prescriptions for each type of case, always including any Ahshi points found. This is also the case with practitioners of western medicine or veterinary medicine.

 

Thus, we see marked similarities between the actual field problems of diagnosis and therapy in the East and West. The bottom line for all therapists is "what will I use to treat this case of osteoarthritis?" etc, or "My patient's sciatica did not respond to BL23....GB34; what should I try now?".

 

6. THE FUTURE ?

 

Computers have invaded social, academic, professional and business aspects of our lives. Information technology is likely to become a commodity as valuable as oil or gold.

 

Clerics are using databases of the Gospels/Bible to construct sermons on "war", "love", justice" etc. Summaries of research papers on medicine, vet medicine, biology etc are already on databases and available to database subscribers for searches using any key-words of interest.

 

In the near future, we will have access at reasonable price to computers of enormous speed and storage space. Voice input and output will replace/supplement the keyboard/screen. With advances in computer graphics, the receptionist will be capable of taking a preliminary case history, to indicate the location of lesions (by interaction with the database and graphic display unit) and to generate a list of possible diagnoses (from by comparison of signs/lesions with the database lists). He/she will be able to output graphic charts of relevant points for the patient's complaints on the plotter.

 

At that stage, the patient and charts will be presented to the doctor, whose job will be to check (or alter) the facts on the computerised case-history. The doctor will scan the patient, using computer-controlled Kirlian-Voll-Akabane methods to determine which Channels are imbalanced.

 

When the most appropriate diagnosis is selected, the appropriate therapy (including the AP point prescription) will be selected and the patient will be directed to the therapy room for treatment. There, computer-controlled robots, assisted by optical scanners, will insert the needles at the appropriate points and will monitor the clinical response using electro-magnetic measurements of the vital energy at the AP points. George Orwell, eat your heart out!

 

Joking aside, to get the best mental satisfaction from Cookbook AP, the practitioner must know the basic rules of choosing points, so that the Cookbook recipe can be best modified to the patient's needs. Computers can store vast amounts of data (more than a human brain can recall accurately) but the "dead" information must be assessed and adapted by a trained human mind to be made really "alive".

 

Finally, the computer can not give the most vital of all therapies: the gift of unselfish love and compassion in response to the plea for help from a suffering patient.

CONCLUSION

 

Rambo attitudes ("Let's kill the Bastards !" or "Attack is the best means of defence" etc) are justified by many governments and generals as sound Defence Policy against perceived attack.

 

Ramboism may succeed for a time but, unless the attacked group and its genetic code is exterminated, that policy usually fails in the long-term, as is shown by the history of invaded lands. The wheel turns and the natives survive to rise again. (Ireland was occupied but won back its independence after more than 800 years).

 

Rambo policy is used in medicine and vet medicine (antibiotics against bacterial diseases, test and slaughter policy against bovine tuberculosis etc). Although it is very successful in some cases, it has failed to eradicate many of the infectious diseases (especially chronic diseases). TCM and holistic medical philosophies of ecology (avoidance of perceived attack and enhancement of apt adaptive responses) are more likely to succeed.

 

In western concepts, Avoidance of the Evitable and Adaptation to the Inevitable imply a fine-tuned balance of the immune, autonomic and neuro-endocrine systems, which can be brought under a degree of voluntary control (even in animals) by conditioning/self training/biofeedback/visceral learning. Active pursuit of passive defence is also in line with Judaeo-Christian guidelines for physical and mental health/wellbeing: a balanced life, in tune with nature; good diet/fasting, physical/mental work, relaxation/meditation, love of self/love of others etc. Yin-Yang concepts were not confined to the East.

 

Non-specific parasites and their reluctant human and animal hosts must learn, or be helped to learn, to co-exist in some form of harmony/balance. Otherwise, it seems the parasites will thrive long after the hosts shall have become extinct. But, as Murphy's Law prevails ("If something can go wrong, it will, at the worst possible time"), Rambo is unlikely to quit.

 

Meanwhile:

 

1. The basis for AP lies in a knowledge of the position and functions of the AP points and in relationships between the Channels, the direction and time sequence of Qi flow in the Channel circuits and the MASTER (energy transfer) points.

 

2. Few (if any) Master Acupuncturists know all the points. (There are over 1000 points if all AP systems are included). However, to claim to be an acupuncturist and not know the main points is tantamount to charlatanism, if not fraud.

 

3. Beginners can get good clinical results by Trigger Point (TP) Therapy, Scar Therapy, Neural Therapy, Dermatomal/Segmental Nerve Stimulation. These are all part of AP therapy but they are the simplest part and need no knowledge of Oriental medical concepts or AP principles. Thus, a TP therapist is not always an acupuncturist but an acupuncturist always uses TP therapy, where appropriate.

 

4. As a prospective acupuncturist, you can be as good or as mediocre as you wish to be. There are four main options in the study of AP therapy:

 

a. TP and allied therapy (very simple, little study needed).

 

b. Classical AP therapy (very complex; needs years of study; may not be essential; adequate training difficult to get in some countries).

 

c. Cookbook AP (Incorporates TP therapy. Relatively simple, if you have good charts, system - and a minimum of home study of AP methods).

 

d. Intermediate AP (Cookbook system plus a minimum of formal lectures on basic AP principles, plus a 6-12 months of part-time home study). The minimum requirement for proper use of AP is study of the location, function, uses and contraindications of the main AP points.

I suggest that option 4 is the best for most busy professionals. Your National AP association can help you to select a suitable course.

 

ESSENTIAL READING (the most authoritative texts; * = highly recommended)  

 

• Anon (1973) Newest Illustrations of the AP Points (Charts & Booklet). Med. & Health Publ. Co., Hong Kong 100pp.

   

• Anon (1977) Basic AP: Scientific Interpretation & Application. Chin. AP Research Foundation. 84-223 Taipei, R.0.C. 313pp.

   

• Anon (1980)* Essentials of Chinese AP. Foreign languages Press, Peking 432pp.

   

• Anon (1980)* Barefoot Doctor's Manual -Official paramedical Manual. Running Press, Philadelphia. 948pp.

   

• Chung, Chien (1983) The Ahshih Point: Illustrated Guide to Clinical AP. Chen Kwan Books, 5-2-1F Chung Ching South Road, Taipei, Taiwan 212pp.

   

• Connolly, Dianne (1979) Traditional AP: The Law of the Five Elements. Centre for Traditional AP. American City Bldg. Columbia, Maryland 21044, 197pp.

   

• Lee, Jane F. & Cheung, C.S. (1978) Current AP Therapy, Med. Interflow Publ. House, Hong Kong 408pp.

   

• O'Connor, J. and Bensky, D.(1983) AP: A Comprehensive Text. Shanghai College of Trad. Med. (Eastland Press, Chicago) 750pp.

    OTHER ORIENTAL TEXTS IN ENGLISH (* = highly recommended)    

 

• Anon (1974)* China's New Needling Treatment. Med. & Health Publ. Co., Hong Kong 80pp.

   

• Anon (1974) Principles & Practical use of AP Anaesthesia. Med. & Health Publ. Co. Hong Kong 325pp.

   

• Anon (1979)* Treatment of 100 Diseases by New AP. Med. & Health Publ. Co., Hong Kong, 89pp.

   

• Anon (1980) AP Manual, AP Research Centre, China Medical College, Taichung, Taiwan, R.O.C. 229pp.

   

• Anon (1983) Anatomical Atlas of Chinese AP Points, Shandong Scientific & Technical Press, Jinan, China, 256pp.

   

• Cheng, W.C. & Yang, C.P. (1976)* Synopsis of Chinese AP. Light Publishing Co. Hong Kong 128pp.

   

• Hyodo, Mayayoshi (1980) Recent Advances in AP Treatment. Dept. Anaesthesia, Osaka Med. College, Japan, 245pp.

   

• Hyodo M. & Kitade, T. (1980)* Guide to Silver Spike Point Electrotherapy, Dept. Anaesthes. Osaka Med. College, Japan 212pp.

   

• Kao, F.F. & Kao,J.J. (1973) AP Therapeutics, Eastern Press, New Haven, Connecticut, 98pp.

   

• Shen, Chou AI, Stenbaeck, L., Hammond, G.L. & Clausen, T. (1973)* Practical AP, FADL Publishing House, Copenhagen, 160pp.

   

• Shui, Wae (1976) A research in AP and its clinical Practice. Commercial Press Ltd., Hong Kong 231pp.

   

• Silverstein, M.E, Chang, I.L. & Macon, N. (1975) Handbook for Barefoot Doctors of China. Schocken Books, New York 372pp.

   

• Wong and Law (1982) Chinese AP Handbook. Light Publishing Co., Hong Kong, 150pp.

      OTHER WESTERN TEXTS (* = highly recommended)    

• Austin, Mary (1974) AP Therapy. Turnstone Books, London. 290pp.

   

• Callehr, H. (1976) AP in Psychosomatic Medicine: Diagnostic & Therapeutic Standards Amer. J. Acup. Vol. 4, 101-.

   

• Chaitow, Leon (1976) AP Treatment of pain. Thorsons Publ. Wellingborough, Northants, U.K. 160pp.

   

• Chan, Pedro (1975) Finger Acupressure. Price, Stern, Sloan Publishers, Los Angeles, California 92pp.

   

• Chan, Pedro (1977) Ear Acupressure, Price, Stern, Sloan Publ. Los Angeles, CA. 109pp.

   

• Chang, S.T. (1976) Complete Book of AP Celestial Arts, Milbrae, CA. 244pp.

   

• Connolly Dianne (1979)* Traditional AP: The Law of the Five Elements. Centre for Traditional AP, American City Building, Columbia, Maryland 21944, USA. 197pp.

   

• Dorrigo, Bruno et al (1979)* Fibrositic Myofascial Pain in Intermittent Claudication, Effect of TP block on Exercise Tolerance, Pain, Vol 6, 183-.

   

• Fox, W.W. (1975)* Arthritis & Allied Conditions. A New & Successful Approach, Ranelagh Press, Hampstead, London, 9lpp.

   

• Houston, F.M. (1974) Healing Benefits of Acupressure. Keats Publ. Inc., New Haven, Connecticut, 76pp.

   

• < >Huneke, F. (1961) Das Sekunden Phanomen. Karl F. Haug Verlag, Ulm, Germany (In German)Hwang F.T.K., Wong, J.S.L. & Chan, P.C.P. (1975) AP made Easy. AP Research Institute, Chan's Books, Alhambra, CA, USA. 97pp.

   

• Kajdos, V. (1974) Neural Therapy - Its possibilities in everyday practice. Amer. J. Acup. Vol 2, 113-.

   

• Kaptchuk, Ted (1983)* The Web that has no Weaver. Congdon & Weed, New York, USA.

   

• Kellgren, J.R. (1939-42) On the Distribution of Pain arising from Deep Somatic Structures & Charts of Segmental Pain Areas. Clin. Sci., Vol 4, 35-.

   

• Khoe, Willem (1979)* Scar Injection in AP. Amer. J. Acup. Vol 7, 15-.

   

• Lau, P.D. (No Date) Explanatory Manual of AP Hampton Gen. Hospital, Hampton, Virginia, U.S.A

   

• Lavier, J. (1974) Points of Chinese AP. Health Science Press, Wellingborough, Northants, U.K. 115pp.

   

• Lawson Wood, D. & J. (1973) AP Handbook. Health Science Press, Wellingborough, Northants, U.K. 141pp.

   

• Lee, I.J. & Lee, T.D.H. (1975) AP Atlas. Lycee Trading Corp. Melville, New York, 203pp.

   

• Lewitt, Karel (1979) The Needle Effect in Relief of Myofascial Pain. Pain, Vol 6, 83-.

   

• Lu, Henry C. (1974) Complete Textbook of Auricular AP. Acad. Oriental Heritage, Vancouver, Canada, 250pp.

   

• Manaka, Y & Urquart, I.A. (1973) Quick and easy Chinese Massage. Japan Publishing Trading Co., 1255 Howard St. San Francisco 31pp.

   

• Mann, Felix (1973)* APcure of many Diseases. Heinemann Medical Books, London, UK.

   

• Mann, Felix (1974) Meridians of AP. William Heinemann Med. Books; London 174pp.

   

• Mann, Felix (1974) Treatment of Disease by AP. William Heinemann Med. Books Ltd. London 202pp.

   

• Matsumoto, Teruo (1973) AP for Physicians, Charles C. Thomas, Springfield, Illinois 202pp.

   

• Melzack, Ronald et al (1977)* Trigger Points and AP Points for pain; Correlations and Implications. Pain, Vol 3, 3-.

   

• Macdonald, Alex (1983)* Trigger Mechanisms and Myofascial Fain. 3rd Nordic Congress on AP (May 1983) and Annals Roy. Coll. Surg. Eng., Vol 65,44-.

   

• Moss, Louis (1972)* AP and You. Paul Elek Books, London, 196pp.

   

• Namikoshi, Tokujiro (1974) Shiatsu. Japan Publ. Trading Co., San Francisco, CA, USA. 81pp.

   

• Niboyet J.E.H. et al (1973) L'anaesthesie par l'acupuncture, Maisoneuve, Saint Ruffine, France 433pp.

   

• Patterson, Margaret (1975)* Addictions can be Cured. Lion Publ. Co., Berkhamsted, Herts, U.K. 95pp.

   

• Porkert, M. (1983) The Essentials of Chinese Diagnostics. Acta Medicinae Sinensis, Chinese Medical Publications Ltd., Zurich, Switzerland. 292pp.

   

• Rogers, Carole (1982)* AP Therapy for Post-Operative Scars. Amer. J. Acup., Vol 10, 201-.

   

• Pontinen, Pekka (1982) AP Seminar for Swedish Physicians, AP Research Dept., Tampere Univ. Finland.

   

• Shenberger, R.M. (1980) AP Therapy Prescription Index. Shenco, 205 Pinecroft Drive, Roselle, ILL 60172 U.S.A.

   

• Travell, J. and Simons M. (1984) Myofascial pain and dysfunction - the Trigger Point Manual, Part 1. (Williams & Wilkins, Baltimore & London), 713pp.

   

• Turner, Roger, N. & Low, Royston, H. (1981)* Principles & Practice of Moxa. Thorson's Publ. Wellingborough, Northants, UK 95pp.

   

• Ulett, G. (1982) Principles and Practice of Physiological AP. Warren Greene Inc., 8356 Olive Blvd., Missouri 63132, U.S.A. 220pp.

   

• Van Nghi, Nguyen (1971) Pathogenie et Pathologie Energetiques en Med. Chinoise. Imprimerie Ecole Don Bosco, Marseille. 679pp.

   

• Warren, F.Z. & Fischman, W.L. (1980) Sexual AP and Acupressure. Unwin Paperbacks, London, Boston, Sydney 238pp.

 

• Wu Wei Ping (1973) Chinese AP. Health Science Press, Holsworthy. Devon, UK. 181pp.

 

 

      SYMPOSIUM PROCEEDINGS, OVERVIEWS, REVIEWS (* = highly recommended)        

 

• Anon (1975) Summaries of Rep. of China (Taiwan) Delegation to 5th World Congress of AP 136pp.

   

• Anon (1975) Proc. 3rd World Symposium on AP and Chinese Medicine, New York (Amer. J Chin. Med., 3, Supp 1, 54pp.

   

• Anon (1979)* Abstracts from Symposium on AP, Moxa and AP analgesia. Peking and Jean Bossy's Synthesis (Doin Editors, Paris) 286pp.

   

• Anon (1981)* Symposium on Myofascial Trigger Points (Melzack, Renolds, Rubin, Simons, Travell) Archives of Rehabilitation Medicine, March 1981, 97-117.

   

• Lin, J.H. & Rogers, P.A.M. (1980) AP effects on the body's defence systems: a review. Vet. Bulletin, 50, 633-.

   

• Rogers, P.A.M. & Ottaway, C.W. (1974) Success claimed for AP in domestic animals: a veterinary news item. Irish Vet. J., 28, 182-.

   

• Rogers, P.A.M., White, S.S. & Ottaway, C.W. (1977) Stimulation of the AP points re analgesia and therapy of clinical disorders in animals. Vet. Annual (Wright Scitechnica, Bristol, UK), 17, 258-.

   

• Rogers, P.A.M. & Bossy, J. (1981) Activation of the defence systems in animals and man by AP and moxibustion. Acup. Res. Quart., (Taiwan), 5, 47-.

   

• Rogers, P.A.M. (1983) The Taiwan Report. Acup. Res. Quart., (Taiwan), 7, 44-.

1. One of the following statements is not correct. Indicate the incorrectstatement:

 

(a) The diagnostic, therapeutic and preventative value of AP depends totally on a knowledge of the AP points, the Channels and their functional and anatomical relationships with each other

 

(b)AP points are of two main types: (a) Ahshi points and (b) codified AP points

 

(c) Most codified AP points are reactive electro-permeable points (REPP) relative to nearby skin areas

 

(d) Hyper-reactive AP points, whether Ahshi or codified, are hyper-sensitive to pressure-palpation, electric current or heat

 

(e)Ahshi points are abnormally tender to palpation pressure. Human patients are usually aware of their presence even if they are not pressed

 

2. One of the following statements is not correct. Indicate the incorrectstatement:

 

(a) When Ahshi points are pressed, the human patient usually grunts, groans, swears or jerks

 

(b)Ahshi = Ah! Yes !, or "Ouch!"

 

(c) In animals, pressure on Ahshi points elicits definite defensive or aversive behaviour

 

(d) Some Ahshi points are just painful locally, corresponding with "fibrositic nodules", "motor points" and other irritable foci in muscle and fasciae.

 

(e)Ahshi points are never Trigger Points (TPs)

 

3. One of the following statements is not correct. Indicate the incorrect statement:

 

(a) Up to 70% of Ahshi points occur at codified AP points

 

(b)Ahshi points are not related to the Shu (paravertebral reflex) and Mu (front alarm) points

(c)Ahshi points are usually present in myofascial syndromes

 

(d)Ahshi points are useful in diagnosis and prognosis: in the absence of signs of other pathology, they confirm that muscular spasm is the main problem and that the prognosis is very good if they can be eliminated successfully

 

(e) In heart/pericardial disease, pressure along T4,5,6 (BL14,15,16) or from under the xiphoid cartilage to a point between the nipples (CV14-17) may be painful

 

4. One of the following statements is not correct. Indicate the incorrectstatement:

 

(a)Ahshi points are always treated as part of AP therapy

 

(b) Point tenderness always occurs in clinical disease

 

(c) There are over 1000 codified AP points in humans

 

(d) The "New", "Strange", "Hand", "Ear", "Foot", "Scalp", "Face", "Nose", "Red Doctor Zone" points etc are mainly non-Channelpoints

 

(e) The average TSUN ("Body Inch") in humans is the width of the joint of phalanx 1-2 of the patient's index finger. However, the length of the TSUN varies slightly with the part of the body being searched

 

5. One of the following statements is not correct. Indicate the incorrectstatement:

 

(a)AP points influence: the organ and associated functions of the Channel; the Channeland areas anatomically close to it; local tissue and functions

 

(b) Thoracic and abdominal AP points, including paravertebral points, influence organs anatomically close to them

 

(c) Point GB34 influences GB function and disorders (cholecystitis, cholelithiasis etc); pain and dysfunction along the course of the Channel from eye, to lateral headache, to neck/shoulder area pain, to lateral thoracic/abdominal pain, to hip, lateral thigh, knee, lateral leg, ankle, to 4th toe pain/sprain/paralysis

 

(d) All AP points on a Channel are equally powerful as regards local and distant effects. For example GB30 is as good as GB34 in stifle/femoro-tibial pain and cholecystitis

 

(e) MASTER POINTS include Shu and Mu points; Five Phase Points; Luo (Passage)Points; Yuan (Source), Xi (Cleft), Tonification, Sedation, Hour Points etc

 

6. One of the following statements is not correct. Indicate the incorrectstatement:

 

(a) Because of overlap in the spinal nerve supply to the organs, the Shu and Mu points are not as organ-specific as classical theory states

 

(b)Shu and Mu point sensitivity is a guide but not a definitive indication as to the organ affected

 

(c) The Five Phase Points transfer Qi between the Channels in the Five Phase Cycle

 

(d)Luo (Passage) Points transfer Qi between the Husband and Wife Channel within each Yin-Yang pair within each Phase

 

(e) The Chinese term HSIN (HT) relates to the Fire Phase. It controls the heart, tongue and psyche. Neurasthenia, restlessness, insomnia, excitability, rapid speech, angina pectoris, red complexion, dislike of summer weather or heat etc indicate a disorder in Fire, manifest in a disturbance in Heart function.

 

In that case, the diagnosis usually can be confirmed by western methods: abnormal ECG and elevated heart muscle enzymes in serum

 

7. One of the following statements is not correct. Indicate the incorrectstatement:

 

(a)TCM has Eight Principles for defining disease Syndromes, based on the clinical signs: it combines one type from each of 4 categories (Yin or Yang; Hot or Cold; Shi or Xu; External or Internal)

 

(b) Many translations of Chinese medical AP texts ignore or pay little attention to the classical Pulse types. Recent studies (doppler ultrasonography or use of pressure transducers to measure pulse characteristics) cast doubt on the objective validity of Classical Pulse Diagnosis.

 

(c) According to TCM, the pulse in the right radial artery reflects the energy status of the SI, GBand BL Channels on superficial palpation and the HT, LV, KI Channels on deep palpation.

 

(d) A disease of Yang, Hot , Shi, External type has a good prognosis

 

(e) A disease of Yin , Cold, Xu , Internal type has a poor prognosis

 

 

8. One of the following statements is not correct. Indicate the incorrectstatement:

 

(a) In TCM therapy, AP is more important than herbal medicine

 

(b) All methods of TCM aim to correct imbalances of Qi. Where the cause is bad lifestyle (XS eating; XS work; insufficient food or sleep; XS alcohol etc) steps are taken to advise on moderating this

 

(c) The patient is advised on environmental, behaviourial or dietary changes etc which may be necessary to alleviate or remove the cause

 

(d) To restore the normal balance of Qi (resistance), many methods are used alone or in combination: herbal medicine; physiotherapy; AP and moxibustion; Taichi; psychotherapy (Qi Kung); mental/emotional exercises to balance the emotions

 

(e) The most common needle used in human AP is about 35 mm long and 30 gauge

 

9. One of the following statements is not correct. Indicate the incorrect statement:

 

(a)DeQi ("the arrival of Qi") is regarded as crucial to AP success: paraesthesia, tingling, numbness, heaviness, "sour feeling" etc in the vicinity of the point

 

(b) In humans, DeQi is indicated by verbal feedback from the patient. In animals, the main signs of DeQi are: sudden change in behaviour; respiration may be temporarily inhibited or accelerated. Local muscle spasms or twitches may be seen

 

(c)DeQi is more often obvious when the point is directly over a peripheral nerve or directly over motor points

 

(d) It is very difficult to obtain DeQi at LI04; PC06; TH05; LI11; ST36; GB34; BL40

 

(e) Acute conditions require only short periods of needling and chronic conditions require 20 minutes or more

 

10. One of the following statements is not correct. Indicate the incorrectstatement:

 

(a) By far the most AP common prescription is a combination of Ahshipoints and local points and distant points on the affected Channel

 

(b) COOKBOOKS, based on frequency-ranking of point use in specific conditions aid in the selection of AP points for therapy

 

(c) Infra-red thermography, Voll-Akabane-Ryodoraku measurements of altered sensitivity at peripheral points etc has confirmed that organs project information of their dis-ease to the periphery via the autonomic nervous system

 

(d) Clinical detection of the altered sensitivity aids in diagnosis

 

(e) Any method (including AP) which speeds up the return to normal point sensitivity is a good therapeutic method and monitoring the speed of return to normal sensitivity has prognostic value

 

(f) One must use at least 12 needles in most AP sessions

 

 

11. One of the following statements is not correct. Indicate the incorrectstatement:

 

(a) Few (if any) Master Acupuncturists know all the AP points

 

(b) Beginners can get good clinical results by Trigger Point (TP) Therapy, Scar Therapy, Neural Therapy, Dermatomal/Segmental Nerve Stimulation. These need no knowledge of Oriental medical concepts or AP principles

 

(c) A TP therapist is not always acupuncturist but an acupuncturist always uses TP therapy, where appropriate.

 

(d) There are four main options in the study of AP therapy: TP and allied therapy; Classical AP therapy; Cookbook AP, with TP therapy; Intermediate AP (Cookbook plus the basics of classical AP)

 

(e)The minimum requirement for proper use of AP is study of the location, function, uses and contraindications of the main AP points. One intensive week's course (such as the Sydney Veterinary Postgraduate Course) is all that is needed.

 

 

 

Answers

 

1 = e

2 = e

3 = b

4 = b

5 = d

6 = e

7 = c

8 = a

9 = d

10 = f

11 = e