Classical Points Combinations and Clusters of Points, in Acupuncture Therapy

Shmuel Halevi Ph.D
P.O.Box 159 Kfar Veradim
Telfax: 972-4-9973480
25147 ISRAEL
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1. Diagnosis

Diagnosis is of prime importance in T.C.M. Actually, it is impossible to construct a treatment formula, unless one has reached a sound diagnosis.

Knowing that, in ancient times the Chinese developed a unique diagnostic skill, based on procedures that matched their medical doctrine.

Remaining faithful to their basic concept, that via the meridians' system the inside of the body can be perceived by the outside of the body, most diagnostic procedure was based on techniques of how to best decipher these outside signs.


Points-combinations - general rules

The various laws for combining points

Formula building in acupuncture therapy utilizing points combinations

Survey of classical and effective points-combinations


Thus, the famous four-methods of diagnosis emerged. These four methods are:

I. Looking
II. Listening and smelling (which is the same word in Chinese)
III. Asking
IV. Touching (32)

Without giving a fully detailed description of each of these steps of diagnosis, suffice it to say that they consist of:

I. Looking - especially at the tongue shape, colors and fur.

II. Listening - to the pitch of voice, or cough - whether loud or low, labored breathing such as wheezing, etc.

III. Asking - which is an interrogation of specifities of the patient's complaints, and especially some peculiar questions, unique to T.C.M.

IV.Touching - especially the art of taking the pulse, but also palpation of the abdomen, or of some special acupuncture points.

After these procedures have been performed, the practitioner has to configurate a diagnosis, based on the eight principles of T.C.M. These principles are:

Yin or Yang (1+2)

Hot or Cold (3+4)

Shi or Xu (5+6)

Internal or External (7+8)

In addition, the information gathered so far must include the site of disease (whether the spleen organ, or the colon, or any of the meridians), and, of no less importance, the cause of the disease.

All these details and knowledge have a strong impact on the treatment scheme, as well as on the prognosis.

When all of this information has been collected and processed into a logical and workable diagnosis, then we must determine our treatment approach. This approach is based entirely on diagnosis. Thus if we have diagnosed a simple case of a Wind-Heat condition, the approach would be: elimination of Wind-Heat and restoring normal balance. Or, in a more complicated case, where our diagnosis led us to a conclusion of:

disharmony of stomach and spleen, and a Kidney-Yin deficiency, our approach should be: tonify Spleen Qi and sedate Stomach Fire, while placing an emphasis on strengthening Kidney-Yin.

At this stage, the practitioner must assess whether Stomach-Fire is more severe than the deficiency condition of the kidneys, and this conclusion must lead him either to put an emphasis on sedating the stomach, or on tonifying Kidney-Yin and Spleen-Qi.

It is no less important to educate the patient as to how to behave in the future, enabling him to keep his reharmonized state of health intact. This education cannot be of value unless the real cause of disease has been grasped by the practitioner.

When a specific approach has been determined, as we have illustrated above, our next step is to choose a specific technique for the treatment.

A specific technique may actually be comprised of several techniques, with one goal: to induce a general effect on the patient, in order to achieve the aims of the approach.

A technique may be a tonifying technique, based on choosing points that usually tonify. It may use moxa, in order to enhance the tonifying effect, and it should apply certain needle manipulations that cause an effective tonification.

A technique may need to disperse stagnant blood that causes pain, swelling and immobility. Therefore dispersion techniques should be adopted such as: drawing blood with a cup, or, again, certain needle manipulations like: "needling one point In four different directions" (33), etc.

While discussing the technique stage, we must also bear in mind that, at this stage, we have to set the course of the whole treatment. We have to decide whether we treat the Ben first, or the Biao (i.e. the symptoms, or the cause), or we have to decide whether we treat an externally inflicted disease, before we treat an internal imbalance - or, sometimes, vice-versa. In the same manner, we shall have to decide whether to treat the Shi condition or the Xu condition first - and make many other difficult decisions.

As a rule, all these decisions, and others, will be the outcome of a careful assessment of our patient's condition, which will dictate the treatment technique, its impetus, its rhythm, and above all - the treatment formula.

Building the treatment formula is really the climax of the practitioner's intellectual ability. By composing the formula, the practitioner's diagnostic skills, as well as his thorough memorization of points, combinations and actions, will come to full realization.

There are many methods and approaches as to how to construct a formula. Some of these approaches even contradict each other. Some approaches state that any formula should have close points, medium points and distant points (34), in order to have a full effect.

Some approaches advocate the use of the Five-Elements school, as the basis for any treatment. Other approaches recommend prescriptions by the new China T.C.M. approach.

There are even practitioners who are trained to build a treatment formula that will match their patient's astrological map, and some that use the famous I-Ching trigrams hexagrams and to construct a formula.

The methods are numerous, and differ entirely. However, the China T.C.M. stream is the main, and this is the method that yields the best results, according to Chinese researchers (35).

The T.C.M. method of formula building relies most of all on empiricism. It relies also on strong foundations of sound traditional medical theories. Its main theoretical source is syndrome-differentiation according to the Tzang-Fu system, but, nevertheless, it adopts any treatment procedure that has proven itself valuable throughout the ages.

It is no wonder that a method that relies most of all on clinical experience, will use as many points-combinations as does this method.

We have already shown that points-combinations have both theoretical and empirical background as their backbone.

Thus, we can rarely find a treatment formula that does not include, at least, one practical points-combination. In order to illustrate this assumption, the following is a casually chosen list of treatment formulae, for various complaints - in which I have marked the points-combinations:

I. Ganshu (B-18), Qimen (LIV-14), Danshu (G-24), Changman (LIV-13). This Is a formula for infectious hepatitis, combined by two pairs of points-combinations according to the Shu-Mu principle.

II. For acute enteritis: Tianshsu (ST-25) with Shangjuxu (ST-37). This combination is one point above,one point below, on the same meridian.

III. For bronchitis: Chitze (L-5), Hegu (LI-4) and Liehchueh (L-7). In this formula, Hegu and Liehchueh form the "Host Guest" relationship combinations.

IV. Ermen (T-21), Tinggong (SI-19), Tinghui (GB-2), Yifeng (T17), Waiguan (T-5) and Chungzhu (T-3), is a recommended formula to treat deafness.

Ermen, Tinggong, Tinghui and Yifeng, make a cluster of points for ear problems.

V. For rectal prolapse we may choose Paihui (GV-20), Changqiang (GV-1), Zusauli (ST-36), Sanyinjiao (SP-6), Qihai (CV-6) and Shenchueh (CV-8) - the last two points, and probably Paihul too, with moxa.

Paihui, Qihai and Shenchueh together make a very strong points-combination, that powerfully raises Yang-Qi, thus elevating prolapsed organs, like the rectum. This combination is based on the mutual-assistance principle (see previous chapter, paragraph No. 9).

Changqiang and Paihui is another combination in this formula, built on the principle of "one point above, one point below," on the same meridian. While puncturing both ends of the meridian, we balance its activities, and if it is on an extra meridian, like the Du Mo meridian, by doing so we drain its excess energy (36, 37).

VI. For the treatment of palpitations caused by ventricular septal defect, with symptoms such as: general weakness and shortness of breath, the following formula was utilized (38):

Neiguan (P-6), Shenmen (H-7), Tanzhong (CV-17), Zusanli (ST-36), Qihai (CV-6), Sanyinjiao (SP-6), Shaohal (K-6), Jueyinshu (B-14), Xinshu (B-15), Keshu (B-17).

In this formula, several classical points-combinations were used, in order to bring about the desired effect. This is obviously a case that needs a direct effect on the main symptom - palpitations, while not neglecting the rest of the problem, which Is Qi and Blood deficiency.

The points Neiguan, Shenmen and Tanzhong thus serve as a well-known combination to relax the heart, calm the Shen and "open the chest". ("Open the chest" is a Chinese metaphor used to describe functions such as: to improve blood circulation between heart and lungs, or to relax symptoms, such as sensations of fullness or congestion and tightness In the chest.)

Jueyinshu and again, Tanzhong, is another combination which uses the principle Shu-Mu. In this case, of the pericardium organ and function, adding mutual assistance to the previous combination to enhance heart circulation.

Zusanli, SanyinJiao and Qihai constitute an even more frequently used combination, whose goal is to tonify the Qi, and eliminate lassitude. In this case it also has another task, which is to help in blood creation, since "QI is the mother of blood" (39), so, tonifying the Qi will help produce new blood.

But, this excellent formula creator has made another important link, and added Shaohai and Sanyinjiao to the formula. This pair have a mutual-assistance effect on the general Yin. Since blood is Yin, it is important to tonify both Qi and Yin, in order to supplement blood.

The last combination in this formula is Sanyinjiao, Xinshu and Keshu. This is also a blood strengthening combination (based on Keshu which is the blood associated point), only it puts an impetus on the heart's blood. We have to bear In mind that according to Chinese physiology, blood is also formed in Tanzhong area, with the aid of the heart.

From the few examples above, we can see that treatment formulae may vary considerably from one another. A formula may contain, or even be composed of one points-combination, and it may have as many as four, or even more points-combinations.

In any case, the purpose of including these combinations so deliberately in the formulae, is to ensure that certain influences shall be exerted as decisively and promptly as possible. Since many of the points-combinations have proved themselves most valuable in clinical work, it is obvious that one should use these combinations while composing a treatment program.

Thus, besides taking advantage of the use of already clinically proven combinations, and by doing so, giving our formula a solid basis, there is also benefit in utilizing premade segments for our formula, liberating us from the necessity of building them by ourselves.