The bibliography of 138 titles (1974-1998) documents the effects and clinical efficacy of stimulation of acupoint Renzhong (Jenchung, GV26) in humans and animals. It, and the Acupuncture Data Assistant [ADA, see below], indicate that GV26 is the most-used emergency point in acupuncture. However, it has many other physiological effects and clinical applications.
The bibliography suggests that stimulation of GV26 resuscitated to consciousness humans and animals (some that were pronounced clinically dead) in acute emergencies, narcosis and shock. It had potent anti-shock effects and decreased mortality rates in haemorrhagic-, surgical-, postpartum-, endotoxic-, anaphylactic- and other forms of shock. It countered exhaustion, enhanced hepatic metabolism and adrenocortical function, promoted membrane transport action, and helped recovery in prostration. It regulated the central nervous system and had anticonvulsive and analgesic effects (APA) in humans and animals. It reversed the depressive effects of general-anaesthetics on the central nervous-, autonomic-, cardiovascular- and respiratory- systems. It was effective in mental diseases and had sedative effects in mania and stimulant effects in depression. It enhanced cardiovascular and cerebrovascular function: it enhanced heart function, had sympathomimetic (cardiostimulant) effects on the cardiovascular system, had pressor effects in haemorrhagic shock and ischaemic hypotension but had little effect on blood pressure in normal animals. It was effective in acute brain- and cerebral- emergencies and in treating their sequels. It enhanced brain perfusion and hastened clinical recovery after cerebrovascular accidents (CVA). It enhanced respiratory function, and reversed neonatal- and anaesthetic- apnoea, increased neuronal activity in the respiratory centre and increased the amplitude of phrenic nerve-discharges. It was effective in abdominal and lowback conditions (acute sciatica, lumbar or waist pain, sprain or trauma, intervertebral disk pain; digestive disorders (nausea, vomiting, abdominal pain and to induce APA for abdominal surgery)). However, ST36 had the strongest effects in abdominal applications. GV26 inhibited gastric antral movement. It was effective in obstetrics, gynaecology, andrology, urology and APA in fallopian tuboligation, male impotence and female premenstrual syndrome, postpartum pain, postpartum uroschesis and menopausal syndrome. Miscellaneous clinical uses included sneezing in allergic rhinitis, and to activate the reticuloendothelial system.
ADA [the Acupuncture Data Assistant], a database assembled over 11 years (1973-1984) from >55 textbooks and dozens of clinical articles on AP, indicates dozens of primary and secondary clinical indications for GV26 in humans. Primary clinical indications from ADA are: acute emergencies and first-aid (general point for all acute emergencies and acute sudden illness, anaphylaxis, apoplexy, apnoea, asphyxia, cardiac arrest, coma, shock, syncope); disorders of the psyche and mind; disorders of the brain and cerebrum (CVA, convulsions); disorders of the spinal cord and nerves and general point for the face. Secondary and tertiary clinical indications from ADA are: emergencies and first-aid (syncope, fainting, nausea); disorders of the head & its organs & functions (psyche & mind: to calm the Shen, mood swings, psychosis, addictions; brain and its functions & parts: brain circulatory problems, palsy and paralysis; head; face, cheek; maxilla, mandible, jaw, masseter m. & n., temporomandibular joint; eye muscles; eye, eyelid; nose; larynx; ear, hearing; lip, oral muscles, mouth; tooth, gum, especially upper; tongue, speech); disorders of the neck, neck vertebrae, cervical spine, neck ms.; disorders of the thoracic limb; disorders of the thorax & its parts (general point for thorax, chest, ribs, back, dorsal area, thoracic spine; heart & blood pressure; peripheral circulation; blood & bone marrow problems; lung, bronchi, trachea, respiratory diseases; disorders of the diaphragm; disorders of the abdomen (bileduct; pancreas; stomach, intestine, anus; menstruation; thoracolumbar area, spine & back, lumbar-renal-loin area; disorders of the pelvic limb; fever, hyperthermia, pyrexia, cholera; and to balance Yang Organs and Channels.
Some of the primary indications, and many of the other indications, have not been well researched, especially in humans. Well-controlled research of the lesser-known functions of GV26 in humans and animals is warranted. Until the results of good research are published in peer-reviewed journals of high standing, "evidence-based" western medicine will probably focus the clinical applications of this powerful point mainly around its known efficacy in acute emergencies.
1Phil Rogers MRCVS <email@example.com>, Teagasc, Grange Research Centre, Dunsany, Co. Meath, Ireland
2Roman Skarda DVM, PhD <firstname.lastname@example.org)>, Ohio State University, Columbus, OH 43210, USA
To conserve space, many abbreviations (Table 6) were used in this article. As the article cites many uncommon Chinese terms and point names, these are given hyperlinks (in blue underlined print). "Clicking" on these links brings the user to other parts of the document for definitions. Also, all cited reference numbers are in blue underlined hyperlinked superscripts, for example references (1, 14, 28). This allows users to find the abstract with a single click on the reference number. Clicking the Back-Button on the browser returns users to the previous position.
The following acupoints are used in clinical emergencies in humans and animals: GV26, KI01, PC06, Shixuan. Their alpha-names and locations are from human texts, but they can be located in animals by creative transposition. In animals, as well as those 4 points, Weijian (Tail-Tip) is often needled strongly in emergencies.
1. GV26 [Shuigou, shuikou = Water Trough, also called Renzhong, jenchung = Man Middle] is in the midline of the nasal philtrum, 1/3 of the way from the nose to the edge of the upper lip. In animals, the point is in the centre of the horizontal line joining the lower edge of the nostrils. GV26 has many clinical uses, the best known being its use in emergencies (coma, shock, apnoea, anaesthetic emergencies, drowning etc).
2. KI01 [Yongquan, yungchuan = Gushing Spring] is on the sole of the foot, in the hollow between metatarsals 2-3, between the pad of toes 1, 2 and the pad of toes 3, 4, 5.
3. PC06 [Neiguan, neikuan = Inner Pass] is 2 Chinese body units above PC09 (palmar wrist crease), between the tendons of palmaris longus and flexor carpi radialis ms.
A search of PubMed Medline (November 7 1998) produced 16 hits for acupoint GV26, or its synonyms (see Endnote 1). In the bibliographic references (Appendix 1), each Medline abstract has a PMID number at the end. A further 122 abstracts were located from a link to an online Chinese database, China-a2z Acupuncture Progress and from abstracts in the American Journal of Acupuncture (Amer J Acup), and from references sent by colleagues. The other abstracts have no PMID number.
Table 1 lists the sources used in ADA. ADA indicates dozens of primary, secondary and tertiary clinical indications for GV26 in humans. Table 2 lists the primary indications; Table 3 lists the secondary and tertiary indications.
Synthesis of the data on GV26 from recent abstracts (1974-1998) and ADA (mainly textbook sources)
1. Bibliographic data on GV26 (138 abstracts, 1974-1998)
Resuscitation: GV26 was used to resuscitate animals and humans to consciousness in all kinds of acute emergencies and shock. It was effective for resuscitation in AMI, asystole, cardiac arrest, coma, unconsciousness in apoplexy, cerebral infarction, encephalitis and stroke, but usually was combined with points from KI01, PC06, Yintang, GV20, GV25, LI04, or SP06 (1, 16, 20, 38, 64, 77, 85, 93, 98, 105, 130).
Resuscitation in asystole and cardiac arrest: AP at GV26 (and points from PC04, PC06, PC07, HT03, KI03, SP06, CV17, GB20, GB30) improved human heart function and helped resuscitation in acute AMI with arrhythmia (77). It strengthened left ventricular function in cerebral infarct patients (105), was successful for cardioconversion in AF (78), or inhibited experimental cardiac pain in cats by descending inhibition. ES of intercostal nerve inhibited it to the same degree but by segmental inhibition (40). GV26 revived 43% of cases of anaesthetic apnoea with concurrent cardiac arrest and absence of vital signs in dogs and cats. Cases that recovered needed 4-10 min of AP (38). GV26 successfully revived 2 caesarean-born kittens that had failed to respond to conventional cardiopulmonary resuscitation (CPR), including Doxapram sublingually. AP began 15 and 35 minutes, respectively after termination of unsuccessful CPR. Each AP-resuscitation lasted approximately 20 minutes. A third kitten that was given similar CPR and no GV26 stimulation, could not be resuscitated (98). GV26 increased the activity of SDH and LDH in myocardial muscle in rabbits and protected against damage to myocardial cells (113).
Recovery from anaesthetic, and anaesthetic apnoea: GV26 was effective in anaesthetic apnoea, or in respiratory failure in chronic pulmonary heart disease (1, 44, 85). It was often combined with points from KI01, PC06, GV20, GV25, ST36, CV01. Apnoea was produced by halothane-overdose in sheep. GV26 stimulation, tibial nerve stimulation and no stimulation produced spontaneous breathing in 16, 37 and 47 sec respectively. Tibial nerve stimulation had no effect on the initiation of breathing. GV26 may activate a direct neural reflex in the inspiratory centre (22).AP at GV26 revived 77-100% of cases of anaesthetic apnoea in dogs, cats, rats within 10-30 sec (38, 90, 100, 101). Noradrenaline i/v was 75% effective in dogs, but AP at a non-acupoint (just lateral and superior to the nostril) was only 40% effective (100). AP at GV26 was used in 243 cases of anaesthetic (especially thiopentone) apnoea in 17 species of domestic and zoo animals and birds. Points KI01, HT09, PC09 were used occasionally. The success rate in zoo animals was 93% (101). Doxapram i/m has powerful effects in resuscitation in cases of respiratory arrest under general anaesthesia. Effects of AP at GV26 on the respiratory centre in rats involved increased levels of ACh in the medulla. Doxapram did not have this effect; thus other mechanisms may be involved in Doxapram effects (104). AP at GV26 and Shangen was used to treat apnoea in sows; most recovered (69). GV26 was stimulated by EAP in 10 patients, and by placebo treatment in 10 controls, immediately after ending inhalation anaesthesia for 15 min. The time from cessation of inhalation to the first eye opening and to extubation did not differ between groups. Plasma catecholamine levels increased by 30% from 0 to 15 min in the control group but decreased by 6% in the EAP group. The levels at 30 min were approximately the same as at time 0. The change in catecholamine levels from 0 to 15 min was significantly lower in the EAP groups than the control group (103). EAP at GV26 significantly shortened the duration of thiopentone anaesthesia in dogs from 20.2+1.25 to 8.1+2.42 min and time to complete recovery from 65.5 to 15.5+3.22 min (46).
Shock and exhaustion: GV26 had marked antishock effects in humans and animals. It was often used with KI01, LI04, PC06, ST36, GV20, LU06, LU07, CV12 or HT07 (26, 66, 122) . EAP at GV26 or ST36 improved hepatic metabolism and promoted membrane transport action of rats with endotoxic shock (37) . The Finnish Lapps use reindeer as draught-animals to pull sleighs etc; they stimulate the GV26 area, and/or cut the tip of the tail (traditional acupoint Weijian) to revive reindeer exhausted by overexertion (47) . AP at GV26 and Shangen was used to treat shock in sows. Most cases recovered within minutes (69). EAP at GV26 improved adrenocortical function and helped recovery of endotoxic shocked rats to some extent (36, 107). GV26 improved the functional activity of the cortical cells, as assessed by histochemical changes in lipid and cholesterol in the zona fasciculata of the adrenal cortex in rabbits (73). EAP at GV26 + CV24 was effective in shock induced by injection of bovine serum in mice. Phentolamine or propranolol injection before EAP partially blocked the effect but practolol, naloxone or depletion of pituitary EPs had no effect on the anti-allergic effect of EAP. The anti-anaphylactic effect of EAP may have different mechanisms from the analgesic and cardiac effects (83).
Haemorrhagic shock: Haemorrhagic shock is associated with severe hypotension and often unconsciousness. AP at GV26 had a pressor effect and helped to restore consciousness in haemorrhagic-, surgical- and postpartum- shock in humans and animals. It was often combined with points from GV20, PC06, ST36, CV03, CV06 or Shixuan, Sishencong, or BP Point (2" from C6-C7 space) (6, 13, 26, 29, 34, 35, 38, 63, 65, 68, 71, 72, 114, 119, 131) . Shock altered sugar metabolism. AP at GV26 raised blood sugar, 5-HT levels and CPK activity and increased glucogenesis and gluconeogenesis (26, 35>). It slightly rectified the acidosis in haemorrhagic shock in rats, possibly via modulating the respiratory function and reducing the acidic metabolites in blood. AP did not significantly correct shock-induced hyperkalaemia (36) . GV26 had an antishock effect, decreased mortality and increased the catecholamine levels in adrenal medulla, preventing their depletion in haemorrhagic shock in rabbits (72) . It had little effect on BP in normal animals but increased it strongly in animals with haemorrhagic shock (71). It improved EEG in rabbits in haemorrhagic shock (34). It increased the activity of hepatic dehydrogenases, SDH and LDH (119), activated myocardial metabolism (increased glycogen content and phosphorylase activity) and raised the energetic supply to the myocardium (114). AP at GV26 and CV24 regulated the level of blood catecholamine and raised arterial blood oxygen volume in shocked animals. Shock decreased, and AP increased, the rate of oxygen intake to the lungs. AP decreased the rate of oxygen use in adrenal tissue and increased the oxygen content used in heart and liver tissue (29). AP at GV26 failed to revive sheep in haemorrhagic shock after liver biopsy (38).
Emergency resuscitation in shock, syncope, fainting and first aid: GV26 was effective in such emergencies (25, 79, 85, 108, 129, 131) but usually was combined with points from Shixuan, CV04, CV06, GV01, GV14, GV15, GV16, GV20, KI01, PC06, PC09, ST36, Jing-Well points, or Yintang.
Effects on the CNS and acupuncture analgesia (APA): Electroacupuncture analgesia (EAPA) at GV26, especially when combined with small doses of Dolantin etc, gave excellent analgesia in 90% of women operated for extrauterine pregnancy and other gynaecological operations (65, 66). For abdominal tuboligation in women, APA at GV26, CV24 and BL32 was better than APA at SP06 + BL32, or GV26 + CV24, or Earpoints Lung + Shenmen + Uterus + Endocrine + Paraincision (106). GV26 was used with points from LI04, PC06, LI18, Shenmen => Sympathetic, Spleen => Lung to induce EAPA in human thyroid surgery (123). GV26 induced APA in rats and cats (60, 61, 62). EAPA at GV26 and CV24 increased pain threshold in rats. ES of the HPVN significantly increased the pain threshold and enhanced the effect of EAPA. Electrolytic lesion of HPVN decreased the effect of EAPA, which was restored by icv injection of 300 ng of AVP. Pretreatment icv with VP-antiserum attenuated the effect of EAPA. The HPVN of rats plays an important role in pain modulation and in the effect of APA. This role may be mediated by VP-containing neurones in the HPVN (12). Neurones containing beta-EP in the hypothalamic arcuate nucleus (HAN) may be involved in APA at GV26 and CV24 in rats (10). AP at ST36 and GB34 induced dorsal root potentials (DRPs) of neighbouring rootlets. PC06 and GV26 also depolarised primary afferent terminals at remote segments, by augmenting DRPs. GABA mediated the effect (138) and also mediated the anticonvulsive effect of GV26 (111) . The HPVN is important in pain modulation and in the effect of APA at GV26 in rats. The effect may be mediated by the VP-containing neurones in HPVN (11). Both DMSO and AP by electrocautery at GV26 evoked an analgesic effect in dogs (19) . Compared with a control group, AP at GV26 and KI01 depressed the activity on the thalamic nuclei and midbrain of rats. AP at ST36, ST25, HT07 and PC06 enhanced neocortical-, limbic cortical- and thalamic nuclear- activity. Pentobarbital anaesthesia concealed most activity all over the brain, which hardly responded to any AP stimulus. Brain neuronal activity reflected the signals from AP stimuli and activity changed depending upon each acupoint (27).
Convulsion, epilepsy, grand-mal, chorea minor: GV26 was effective in convulsions, but usually was combined with points from Shixuan, GV14, GV20, GV25, KI01, LI04, LI11, LV03, PC06, PC08, arm Jing-Well points, SI03, or Yintang (31, 84, 87, 111, 117, 120, 130). Giving Vitamin B6 facilitated the anticonvulsive effect of GV26 in experimental mice (111) .
Mental diseases (epilepsy or convulsions in mental disorders, hysteria, hysterical aphasia or stupor, depression, mania, manic depression, psychosis, schizophrenia): AP was seldom used alone to treat mental disease in China. It usually was combined with other forms of therapy, especially herbal medicine. GV26 was used in mental diseases, usually combined with points from CV15, CV17, GV14, GV16, GV18, GV20, GV24, HT07, Hubian, KI01, KI03, LI04, LI11, LV03, PC05, PC06, PC07, PC08, SI03, SP06, ST36, or TH06 (5, 24, 33, 42, 81, 97, 116, 124, 128). The 13 Guixue include GV26. They are used mainly in mental disease and mania but, amongst them, the Jing-Well points (LU11, SP01 (thumb and big toe, Taiyin level) are better (42). ECT via GV26 and GV20 needed much less current than conventional ECT and was better and safer than it (116).
Depression of the central nervous system (CNS): General anaesthetics, especially at high doses, depress the ANS, CNS, CVS and respiratory systems. Stimulation of GV26 has potent effects in reversing those effects (see details in other sections, above and below).
Cardiovascular system (CVS): Key indices of cardiovascular function include cardiac output (CO), stroke volume (SV), heart rate (HR), mean arterial pressure (MAP), pulse pressure (PP), central venous pressure (CVP), total peripheral resistance (TPR), pH, PaCO2, PaO2 and base deficit. EAP at GV26 in rabbits activated noradrenergic neurotransmission in the brain, which in turn reduced the depressive activity of anaesthetics on the CNS. This stimulant action of EAP was not mediated by endogenous opioids and/or 5-HT, as naloxone and pCPA had no effect on it (7). Stimulation of GV26 by AP, EAP, low frequency TENS, or electrocautery had sympathomimetic (cardiostimulant) effects on the CVS in animals (rats, rabbits and cats) under halothane anaesthesia. The effects included a significant increase in CO, SV, HR, MAP, and PP and a significant decrease in TPR (6, 19, 48, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 71). Electrocautery had a more marked effect than that produced by simple AP, AP with twirling, or EAP (55, 56, 58, 59). Low frequency TENS (0.5 Hz) produced similar effects to electrocautery - higher CO, SV and PP and lower mean BP and TPR (55). Propranolol (beta-blocker), and to a lesser extent phentolamine (alpha-blocker), inhibited the sympathicomimetic effect of AP at GV26 (6, 52, 56, 59) . Naloxone, which inhibits the analgesic effects of AP, does not inhibit the symphathomimetic effect of GV26 stimulation in dogs under light MAC-1 halothane anaesthesia (50, 51) . AP by electrocautery at GV26 reversed the depressant parasympathomimetic (cardiodepressive) effect of morphine or EP on CO, HR, BP and MAP in dogs under halothane anaesthesia. Stimulation of GV26 could be helpful in resuscitating patients whose CVS is depressed by morphine and/or halothane anaesthesia (46, 49, 54) . EAP at GV26 significantly (p<.05) increased RR and HR, decreased arterial PaCO2 and pH, and improved respiratory acidosis in thiopentone-anaesthetised dogs (46). Dill et al (23) studied the effects of stimulation of the upper lip on the CVS in 7 healthy ponies during 2 episodes of halothane anaesthesia. They used EAP at GV28 and GV26 in one episode, and moxibustion by electro-probe-cautery at GV28 and a "non-point" in the other. During each period of anaesthesia, two "non-points" were used for control stimulation. Control and AP stimulations were of equal intensity and duration (5 minutes). The authors concluded that GV26-stimulation can not be relied upon to provide stimulation of the CVS in ponies under halothane anaesthesia. One might query the conclusion, because the "non-points" were in the muzzle/nasal area, and may have had a significant effect on the CVS, thereby being invalid for comparison of the "active" versus the "control" points.
Blood pressure (BP): EAP at GV26 had little effect on BP in normal animals but increased it strongly in animals with ischaemic hypotension (7). EAP at GV26 in rats increased BP in hypovolaemic hypotension. The effect was increased by cholinergic stimulation (by ACh) or by inhibiting cholinesterase activity (physostigmine) and blocked by blocking ACh synthesis (by Hc3). The pressor effect of EAP is probably mediated by the cholinergic (parasympathetic) system. Naloxone also had a pressor effect in hypotension, abolished by Hc3, suggesting that there is a link between the cholinergic and opiate systems in BP regulation (112). This is in contrast to the sympathicomimetic effect of GV26-stimulation in anaesthetised animals (see Endnote 3). EAP at GV26 increased BP in rabbits (13, 15) . Specific nuclei in the brain, the RVL and NPBM (15) play a role in the pressor response of AP at GV26.
CVA, acute brain and cerebral emergencies: GV26 was the most cited acupoint for use in acute brain and cerebral emergencies, such as acute apoplexy, stroke, cerebral thrombosis, infarction, ischaemia, haemorrhage or capillary embolism. In acute CVA, GV26 was often combined with Shixuan, KI01, SP06, PC08 + points for main symptoms from BL40, CV24, GB20, GB30, GB34, GV20, HT01, LI04, LI11, LI15, LU05, PC06, the 12 Jing-Well points, ST06, ST31, ST36, ST40, or TH05 etc (18, 32, 41, 63, 88, 89, 94, 95, 96, 105, 121) . The cure rate of cerebral infarction was higher than that of cerebral haemorrhage (96) . Addition of herbal liquid injection helped in cerebral thrombosis (41).
Sequels to brain and cerebral emergencies: GV26 was used to treat the sequels of brain and cerebral emergencies (paralysis, hemiplegia, paraplegia, facial paralysis, aphasia, mutism etc) (21, 67, 82, 118) . For such cases, GV26 usually was combined with points from GV20, KI01, PC06, Sishencong, SP06, ST36 + points for main symptoms.
Brain perfusion (see resuscitation, above): GV26 and other acupoints for motor, sensory, visual and speech centres increase brain perfusion and hasten clinical recovery after CVA. Stimulation of these points decreases peripheral arterial resistance, relaxes spasm and increases blood flow in the cerebral artery (5). AP at GV26 + GV20 cured 29/33 cases of mental disorder followed by stroke (45). AP at GV26 was much more effective in increasing blood flow in the common carotid artery of conscious rabbits than was AP at ST36, LI04, or "Ear Apex" (137). AP of GV26 increased the mean diastolic velocity of blood flow in the common carotid artery and decreased the pulsatile index and vascular resistance in anaesthetised humans. These effects favour cerebral blood perfusion, hence the resuscitation effects evoked by AP at GV26 (86). AP at GV26 increased PO2 in the frontal cortex of the rat brain immediately and reproducibly. AP may increase brain tissue perfusion, which may be, at least in part, responsible for arousal of unconscious patients. Dilatation of cerebral vascular vessels and improvement of autoregulation in the brain by AP stimulation may also explain the effectiveness of AP in the treatment of migraine headache (8, 9) . AP at GV26 dilated and congested the arteries of the cerebral pia mater and raised the temperature of the ear (71). GV26 was used with other points, and sometimes other therapies, to restore consciousness, promote brain perfusion, limit brain damage, and promote repair of damaged brain tissue (5, 8, 9, 18, 32, 41, 45, 63, 71, 86, 88, 89, 94, 95, 96, 105, 121, 137).
Respiratory system (see apnoea also): Neonatal apnoea: In Finland and Austria, many generations of farmers have stimulated the nasal septum, naso-incisival duct, or acupoint GV26 of neonatal calves, pigs and reindeer to induce respiration in neonatal hypoxia or apnoea (28, 47). AP at GV26 increased neuronal activity in the respiratory centre in rats, rabbits and cats under halothane anaesthesia. The effect was inhibited by beta-adrenergic blockers (propranolol) and to a lesser extent by alpha-blockers (phentolamine) (6). AP at GV26 reversed experimental apnoea and recovered respiratory rhythm in rabbits (14, 75, 132). AP at other facial points did not induce the effect (75). The infraorbital branch of the trigeminal nerve is the afferent pathway of the respiratory effect induced by AP of GV26 (75, 132). The AP signals transmit to the nucleus of the trigeminal spinal tract, and go to influence the respiratory nucleus. The afferent signals include those of pain and other somatic senses (127). The dorsomedial region of the facial nucleus plays an important role in respiratory rhythm (75). The NPBM plays a role in the respiratory effects induced by stimulation of GV26, but is not essential to it (14). The effects of EAP at GV26 on Phr in rabbits result from a nervous reflex. The higher centres are not essential for it. Bulbar respiratory related neurons may play an important part in it (132). The effects of AP at GV26 in stimulating the respiratory centre are not totally, or necessarily, due to the pain produced by EAP; other sensory signals may be involved (125, 127).
Abdominal and lowback conditions: Lumbar area and waist: GV26 was used in acute pain, sprain or trauma, intervertebral disk pain in the lumbar area or waist, and in acute sciatica. In such cases, it was often combined with points from Ahshi, BL01, BL02, BL20, BL23, BL24, BL40, GV03, GV14, GV20, GV28, LI19, Handpoint Shangdou, SI03, SI06, ST36, TH03, or Yaotong (17, 39, 70, 80, 99, 102, 109, 126).
Digestive system: The classical points for digestive disorders are ST36, PC06, BL21 and CV12, usually in combination (91). ST36, BL20 and PC06 increased gastric bicarbonate secretion (133). However, GV26 was used to relieve nausea, vomiting, abdominal pain and induce APA for abdominal surgery. It was often combined with points from CV24, GV20, PC06, or ST36 (43, 74, 85) but ST36 had the strongest effects in those applications (43, 74). AP at GV26 markedly inhibited gastric antral movement, increased the storage of gastrin and decreased its release in dogs. The effect is mediated by the NRL of the VLM and 5-HT. Stimulation of raphe nuclei in the medulla increased motility but stimulation of the VLM inhibited both frequency and amplitude of motility. Lesion of the VLM abolished the AP effect (115, 133, 134, 135, 136).
Obstetrics, gynaecology, andrology and urology: GV26 was used to treat impotence in men, premenstrual syndrome, postpartum pain, postpartum uroschesis and menopausal syndrome in women, and for APA in surgery for fallopian tuboligation (18, 68, 76, 106). Usually it was combined with points from BL17, BL18, BL19, BL20, BL21, BL22, BL23, BL32, CV01, CV02, CV04, CV06, GB20, GB34, GV04, GV16, GV20, KI03, LI04, LI11, LV03, PC06, Sishencong, SP06, SP10 and ST36.
Miscellaneous: GV26, Yintang, GV25, LI04, KI01 were used in emergencies with high fever (130). GV26 and CV22 were used for sneezing in allergic rhinitis (30). GV26, GB14 were used to treat idiotic unconscious smiling after apoplexy (110).
2. GV26 data from ADA (mainly textbook sources, 1973-1984)
Primary clinical indications from ADA can be summarised as:
Emergencies and First-Aid: general point for all acute emergencies and acute sudden illness, as in CVA, head injury, drug overdose, unconscious, haemorrhage, drowning, electrocution; anaphylaxis, serum sickness, transfusion reaction; apoplexy, CVA, stroke; asphyxia, hypoxia, apnoea, respiratory emergencies, collapse, failure; cardiac arrest, AF, heart attack, heart failure; coma, collapse, prostration; heatstroke, prostration, sunstroke; poisoning / overdose by anaesthetic, gas, carbon monoxide, alcohol, drugs; shock (allergic-, anaphylactic-, circulatory-, electric-, haemorrhagic, heatstroke-, obstetric-, postpartum-, septic-, toxaemic-, toxic-); syncope, vagal, fainting, vertigo during treatment.
Psyche, mind, mental disorders (delirium, dementia, hysteria, insanity, mania, manic depression, schizophrenia, stupor, total apathy).
Disorders of the brain and cerebrum (cerebrovascular accident (CVA), apoplexy, congestion, embolism, haemorrhage, stroke, subarachnoid haemorrhage, thrombosis; convulsions (eclampsia, epileptiform fits; epilepsy (during attack, seizures), generalised tremors; muscle spasms; postpartum convulsions, tetany, twitching, febrile convulsions); encephalitis_virus B, tremor).
Disorders of the spinal cord and nerves (multiple sclerosis, tetanus, tremor)
Face: general point for the face
Secondary and tertiary clinical indications from ADA can be summarised as:
Emergency and First-Aid: in syncope (anaemia; anuria, kidney failure, fluid loss; BP (hypertension, hypotension); fainting (blurred vision, cold sweat, cold extremities, dazed, dizzy, pallor, vertigo); nausea (travel-sickness, motion sickness - air, car, sea, train).
Head & its organs & functions: Psyche & mind: to calm the Shen and release pent-up emotions; mood swings (anger, boredom, depression, excitement, irritability, confusion, disorientation, idiocy, mental retardation); psychosis (hallucinations; illusions); Addictions (detoxification; withdrawal symptoms: alcoholism, hangover, delirium tremens); Brain and its functions & parts [cerebrum, cerebellum, hypothalamus, meninges, pituitary]; brain circulatory problems (anaemia, arteriosclerosis, collagen vascular disease, ischaemia, poor memory); palsy and paralysis (cerebral palsy, spastic paralysis; hemiplegia, quadriplegia, infantile paralysis, poliomyelitis); Head (oedema, headache, neuralgia, sinus problems); Face, cheek, maxilla (allergy; anaphylaxis; inflammation, oedema, congestion; Bell's palsy, facial paralysis, numb, hemiplegia, spasm, tic douleureux, pain, trigeminal neuralgia, rheumatism; sinusitis); Mandible, jaw, masseter m. & n., temporomandibular joint (difficulty opening mouth; lockjaw, spasm, tetanus, trismus); Eye muscles (eye deviation, fatigue, nystagmus, paralysis, spasm, strain, squint; strabismus, tremor; twitch); Eye, eyelid (distortion, palsy, paralysis, ptosis); Nose (allergy, anaphylaxis, hayfever, catarrh; rhinitis, rhinorrhoea; epistaxis, haemorrhage; influenza, colds; polyps); Larynx (laryngitis, pain); Ear, hearing (ataxia, dizziness, Meniere's disease, vertigo; deafness, hearing impaired, tinnitus); Lip, oral muscles, mouth (general problems - atony; deviation; distortion; numb; paralysis; aphthae, herpes simplex, sores; neuralgia, pain, stomatitis, cellulitis, moniliasis, thrush, ulcers); Tooth, gum, especially upper: (APA for dentistry, oral surgery; pain, neuralgia, pain referred or postoperative; toothache, gingivitis, swelling, haemorrhage, ulcer); Tongue, speech (general problems; cellulitis, glossitis, pain, spasm, atony, numbness, paralysis, hypoglossal/sublingual n paralysis; swelling, ulcers; dehydration, polydipsia, thirst; alogia, aphasia, dumb, dysphasia, mutism, slurred speech).
Neck, neck vertebrae, cervical spine, neck ms. (arthralgia, arthritis, difficult movement, disc, fibrositis, neuralgia, pain, pain referred to arm, radiculitis, rheumatism, rigidity, spasm, spinal pain, spondylitis, sprain, stiffness, torticollis).
Thoracic limb (cold in chills, shock, cholera, nausea, vomiting).
Thorax & its parts: General point for thorax, chest, ribs (costal pain, neuralgia, trauma); Back, dorsal area, thoracic spine: (arched, arthralgia, arthritis, chills, curvature, disc, hyperextension, inflammation, kyphosis, neuralgia, opisthotonus, pain, radiculitis, rheumatism, scoliosis, spasm, spondylitis, sprain, stiffness, trauma); Heart & BP (general problems, bradycardia, fluid retention, hypertension, hypotension, left ventricular hypertrophy); Peripheral circulation (general problems; oedema, limb oedema, blood circulation impeded, Buerger's disease, frostbite, gangrene, ischaemia, snakebite, thromboangiitis obliterans); Blood & bone marrow problems (chloropenia, aplastic anaemia, chlorosis); Lung, bronchi, trachea, respiration: general point for respiratory diseases (asthma, breathing rapid or difficult, bronchial asthma, bronchiectasis, bronchitis, bronchospasm, dyspnoea, emphysema, panting, shortage of breath, wheezing).
Diaphragm (contracture, hiccup, musculophrenic spasm, spasm)
Abdomen (pain, bellyache, neuralgia); Bileduct (ascariasis, obstruction, pain); Pancreas (diabetes mellitus, hypo- & hyper- glycaemia); Stomach, intestine (parasitism; nausea, vomiting, gastralgia, diarrhoea); Anus (haemorrhoids, pain, pruritus, bleeding); Menstruation: (cramp, dysmenorrhoea, pain, spasm); Thoracolumbar area, spine & back, lumbar-renal-loin area (arthralgia, arthritis, backache, chills, fatigue, lowback syndrome, lumbago, myalgia, neuralgia, pain, rheumatism, spasm, spondylitis, sprain, stiffness, trauma).
Pelvic limb: (chills, Buerger's disease, circulation poor, gangrene, ischaemia, cold limbs); Leg & calf (atony, atrophy, claudication, cramp, fatigue, lameness, neuralgia, numbness, pain, paralysis, spasm, weakness).
Fever, hyperthermia, pyrexia, cholera
To balance yang organs and Channels
Acupoint Renzhong (Jenchung, GV26), the "Anti-Shock" point, the "Life-Saving" point (7, 8, 9, 38, 46, 92), is the best-known revival point in AP. GV26 is usually used with other points in clinical AP practice. It is seldom alone, except in emergencies. In many of the animal studies cited here, GV26 was used alone, often in controlled trials. However, in most of the clinical articles, GV26 was used together with other points, so it is not possible to say for sure that all the indications, and the physiological and clinical effects, reported were specific for that point.
Strong needling of GV26 + (KI01 + PC06) can resuscitate 90-100% of simple apnoeic cases in 10-30 seconds. Strong needling at PC06 + GV26 + KI01 is advisable in cases pronounced clinically dead. In contrast to simple apnoea, in recent cases of apnoea with cardiac arrest, AP must be continued for 5-30 minutes (with other emergency measures also). In that case success rates may drop to 40-50%. KI01, over the plantar digital nerve, distal to and between the proximal heads of metatarsal bones 2-3, has similar effects to GV26 in shock and resuscitation. PC06, over the median nerve, 1/6 of the distance between the palmar wrist crease and the elbow, has potent action on circulatory and cardiac function. It is added if needed.
Many other points, such as HT09, PC09, ST09, ST36, can stimulate revival from shock. However, the most often used are GV26, KI01 and PC06. PC06, combined with GV26 (or KI01), is useful in coma or unconsciousness with cardiac failure (92). In animals, acupoint Weijian (Tail-Tip) is often needled strongly in emergencies and in cases of exhaustion.
The bibliography (Appendix 1) suggests that stimulation of GV26 had potent clinical effects in humans and animals.
However, frequency citation scores in the ADA database, compiled mainly from AP textbooks, suggest dozens of primary indications and several dozens of secondary and tertiary indications for GV26. Some of the primary indications, and very many of the other indications, have not been well researched, especially in humans. In the light of centuries of Chinese clinical experience with this powerful point, this omission is amazing.
Acknowledgements: We thank the Webmasters of "Acupuncture Progress" and "Medline" for access to their data, Godfrey Bartlett (United Kingdom) for supplying 16 references, and Jukka Kuussaari (Vet Care, Finland) and Kurt Ganzberger (Vienna Veterinary School) for their references (28, 47) See also "Critical Comment on the Rogers and Skarda Review of Renzhong-GV26" by Jan Still
See also "Critical Comment on the Rogers and Skarda Review of Renzhong-GV26" by Jan Still