Wednesday, October 26, 2011

Shi Dou (Sp 17) Food Hole: A Forgotten Acupoint

Most Chinese-trained acupuncturists rarely use the point Shi Dou. It is not considered an important or particularly useful point according to current Chinese acupuncture education. In fact, it is probable that most Western acupuncturists promptly forget everything about this point after taking their licensure exams and would be more likely to use its neighbor, Da Bao (Sp 21) if a local point in this region were required.

However, according to the Bian Que Xin Shu (Bian Que’s Heart Writings), a Song dynasty text by Dou Cai as interpreted by Sung Baek in his book Classical Moxibustion Skills in Contemporary Clinical Practice,1 direct moxibustion of this point with tiny threads of high grade mugwort moxa is singularly useful in many if not most cases of spleen qi vacuity, liver-spleen disharmony, spleen dampness, and especially where the qi mechanism (upbearing and downbearing) is impaired due to a combination of liver depression, qi vacuity, dampness, and heat existing all at the same time. In fact, when reading author Sung Baek’s description of this point’s uses, what he appears to be describing is Li Dong-yuan’s yin fire theory. There are several sites in his book that support this idea.

In one case, Baek states that moxa on this point is of vital importance in cases of edema with urinary retention and the inability to breath when lying down. This symptom picture suggests that treatment must downbear turbid counterflow qi and also supplement the lung qi (by supplementing the spleen qi) so that is can properly depurate and downbear both qi and body fluids.

In another case, he suggests using Shi Dou for the treatment of spleen stomach damage with dry heat above due to excessive consumption of cold food causing loss of communication between the three warmers. This again suggests that moxa on this point promotes qi rectification, clearing of heat, and spleen qi supplementation.

In a third case, the same author suggests applying 300-500 threads of moxa on Sp 17 in case of chronic malaria in order “to balance hot and cold within the body” by fortifying the spleen.

Finally, he suggests the use of moxibustion on this point for all types of edema due to inadequate engenderment of latter-heaven qi by the spleen, in cases of high fever but where the lower limbs are cold, in cases of diarrhea due to spleen qi vacuity, nue-type diseases with alternating fever and chills, vomiting and loss of appetite, yellow jaundice with red-colored urine and yellow eyes due to cold damage, and chest and rib-side pain due to poor digestion. Also, he insists that these complex disorders must be treated first by fortifying spleen qi. He further states that treating Shi Dou on the left is for specifically for supplementing the spleen, while, on the right, it is for soothing the liver.

In searching for other views on the use of this point, I found that Felix Mann’s The Treatment of Disease by Acupuncture, which is a translation of the treatment formulary section of the Zhen Jiu Da Cheng (Great Compendium of Acupuncture & Moxibustion), states that Shi Dou can be used to treat chest and limb heaviness, diaphragmatic pain, intermittent fever of the spleen, paralysis and numbness, ascites, and pulmonary congestion. Again, if we look at these symptoms, we see the disease mechanisms of spleen qi vacuity, blood vacuity, dampness, and liver depression qi stagnation with possible damp heat.

According to Li Dong-yuan, the disease mechanisms of yin fire include spleen qi vacuity, liver depression, damp heat, yin and/or blood vacuity with vacuity heat, and stirring of ministerial fire. If one analyzes his treat protocols, it becomes clear that, to treat this kind of complex disease mechanisms, one must, at the very least, supplement the spleen, rectify the qi, and clear heat, as well as doing whatever else is necessary in each patient’s case. Based on Baek’s and Mann’s description of this point’s effects, we see that it is exactly these disease mechanisms which are being treated. We also see that they are discussing difficult-to-treat, complicated conditions similarly to Li Dong-yuan.

As a final note, it is my own clinical experience that this point will be tender, often exquisitely so, when it is most needed. I also agree that it is necessary to burn many, but very tiny, moxa threads on the point, usually at least 50 and often as many as 200. Needling the point is not suggested as a replacement for moxibustion since the two types of therapy do not perform the same functions as well as the fact that it is just over the lateral lung in a very slender person. If time does not permit you to treat both sides with moxa, I suggest using the right side, since it is away from the heart and prevents the possiblity adding unwanted heat to that organ (although I have not had that happen in actual clinic practice). I have used this point with excellent results on many patients and hope you will consider it the next time you encounter a patient with a similar complex condition. Knowing the type of patients that most of us see every day, you may find yourself treating this point on a regular basis.

For more information about moxibustion, see Lorraine Wilcox’s Moxibustion: Modern Clinical Handbook and Moxibustion: The Power of Mugwort Fire. For more on yin fire theory, see Bob Flaws translation of The Treatise on the Spleen and Stomach and his one-hour online course, Li Dong-yuan’s Theories on Internal Damage Disorders.

1 Baek, Sung, Classical Moxibustion Skills in Contemporary Clinical Practice, Blue Poppy Press, 1990. Out of Print

Thursday, October 6, 2011

Have Patients with Anxiety Attacks?

Q. Hi Honora, A few years ago I came to a seminar you taught. During that weekend, I remember you suggested an interesting treatment for anxiety disorder. A patient came in last week with anxiety attacks as a major complaint and I wondered if you could refresh my memory on that treatment. –Sarah in Chicago

A: Hi Sarah, There are several good treatments for anxiety disorder. In fact, acupuncture in general has an anti-stress, down-regulating effect on many patients. That said, however, there are several approaches that I suggest you consider as rotating treatments, using them in succession and then repeating from the beginning. Here you go:

  1. Start with Four Bars (often called Four Gates) as an opening treatment. While these needles are in, do some simple massage on the head and neck, dragging across Yin Tang and doing small circles on Tai Yang, GB 20, along the cervical spine and occipital ridge.* (The only time this is inappropriate is if the person really is not comfortable being touched and we do, on the odd occasion, get patients like that.) If they don’t like to be touched, but a needle into Yin Tang.
  2. The next time that patient comes in, hopefully within a few days, do the treatment that you saw me do, which is a cross treatment as follows.

a. Insert LI 4 and Sp 4 on the right

b. Insert Per 6 and Liv 3 on the left

c. If using Ion pumping cords, use black clips on the right and red clips on the left. Connect LI 4 to Liv 3 and connect Per 6 to Sp 4.

d. If using polarized needles, use Gold plated needles in place of the red clip and Stainless steel in place of the black clip.

e. Insert needles very shallowly, because electrical flow in the body is strongest on the surface.

f. No jewelry; don’t leave the room during tx; 15-20 mins or until they wake up.

3. As a third alternating treatment, you could do Miriam Lee’s Great 10 Needles adding points such as Liv 2 and LI 11 for excessive heat, Ht 7 and CV 17 for palpitations and severe fearfulness, or An Mian (extra point), Sp 6, and Ear Shen Men for insomnia.

4. In terms of self care, suggest that the patient use exercise, stretching or progressive muscle relaxation routines, calming music, aromatherapy oils, and an anti-inflammatory diet high in Omega-3a and plant-based protein and low in sugar and caffeine! While acupuncture can calm people down in the moment very quickly and effectively, in the long run the patient has to find ways to help him-or-herself as well.

5. I received a comment from a reader suggesting that, since most anxiety attacks are at least partially due to the qi and blood not nourishing and constructing the heart qi, herbal formulas that do this are vital for long term change in such patients. She is right about this, so if you have access to herbals, choose or create a formula appropriate for your patient to help rectify this pattern.

Hope that helps. If you want details of the theory that goes along with either Four Bars treatment, Miriam Lee Great 10 Needles Treatment, or ti Ion Pumping Cord treatment, check out my online CEU courses attached to these links. Thanks for your question and best wishes.