Philip A.M. Rogers MRCVS

AP and Immunity


Deadman_P1; Al-Khafaji M (1996) Some AP points Which Treat Disorders of Blood: Part 1. Adapted from WWW ( Acupuncturists who study TCM encounter a great array of herbs, prescriptions and protocols which treat disorders of Xue. By comparison, AP may seem inadequate, and some say that there are only 3-4 AP points which are important to treat Xue disorders. However, careful examination of the traditional and modern indications of AP points, traditional commentaries and classical combinations, reveals that many AP points can nourish Xue, dispel Xue Stasis, clear Heat from the Xue or stop bleeding. This article lists the main AP points to treat Xue diseases (LU03,05,09,10; ST29, SP01,06,08,10,21; HT06; BL15,17,40; KI05,08,14; PC04; LV01,08; GV14, CV07). Indications, discussion and classical combinations of the points given here refer only with their actions in Xue diseases; many other important aspects of the use of these points are omitted.

LU03 Tianfu: Relevant indications: Nosebleed, spitting blood, coughing blood, wheezing, dyspnoea, cough, asthma. In the Discourse Into the Origins and Development of Med "LU is the delicate Zang, neither Heat nor Cold is appropriate: too Hot and the Fire will melt the Metal and the Xue will stir". As early as the Spiritual Pivot (Chapter 21: On Hot and Cold Disease) LU03 was indicated for "Severe thirst, internal upsurge, LV and LU struggle against each other, blood pours from the mouth and nose". This is a clear reference to the Syndrome of LV-Fire attacking LU. LV-Fire rushes upwards and scorches LU, injuring the blood vessels and causing reckless pouring of blood from the mouth and nose. At the same time there will be coughing, which manifests as bouts of spasmodic coughing with a red face. Classical combinations: Bleeding from the nose: LU03 and LI04 (Ode to the 100 Syndromes).

LU05 Chize: Relevant indications: Spitting blood, coughing blood, nosebleed, vomiting blood, HT pain, HT agitation. LU05 is the Water, Sedation and He-sea point of LU. Its main action is to clear all forms of Heat (whether shi or xu) from LU. LU-Heat may injure the blood vessels and cause reckless bleeding, manifested as coughing or spitting of blood or nosebleed. LU Channel originates in the Middle Jiao. As well as being indicated for Heat-induced bleeding from LU, due to its secondary action of descending ST-Qi, LU05 may also be used for vomiting blood. The Song of Points for Miscellaneous Diseases uncompromisingly says: "For vomiting of blood, the action of LU05 is without comparison". LU and HT are intimately associated in the Upper Jiao. Yang Zhao Li says "LU and HT are mutually connected; LU-Heat most easily enters HT" and the Spiritual Pivot (Chapter 75) says "If Zongqi does not descend, Xue Stasis will occur in the Vessels". If LU-Heat enters HT, there will be agitation of HT; if LU- and Zongqi- Xu occurs, there will be Xue Stasis, causing HT pain (angina). Classical combinations: Spitting blood, at times Hot and at times Cold: tonify (Bu) LU05 (Water point) and disperse (Xie) LU10 (Fire point) (A Systematic Classic of AP and Moxibustion).

LU09 (Taiyuan, Great Yuan): This is the LU-Earth, Mother and Shu point and Yuan-Source point. LU09, the Hui-Meeting point of the Vessels, is an important point to harmonise the relationship between the Zongqi and Xue. When Zongqi is weak (Xu) and fails to circulate the Xue, it will pool and stagnate in the chest and HT (Xue Stasis), causing oppression and fullness, agitation, HT pain with a choppy pulse, and manic raving in severe cases. LU09 is further indicated for disorders of the blood vessels in general such as vomiting, spitting or coughing of blood and pulseless Syndrome. The Plain Questions says: "LU governs the 100 Vessels", and the Classic of Difficulties (45th Difficulty) says: "The Vessels gather at LU09". The Classic of Categories says: "The flow of the Jingmai (Channels and Vessels) must follow the Qi; the Qi is dominated by LU, therefore it is the Meeting of the 100 Vessels". These statements refer to the important relationship between Qi-Xue, expressed in the saying "Qi is the commander of Xue", and the statement in The Classic of Categories that "The Vessels are the conduits of Xue-Qi; the movement of the Vessels is dependent on Qi". In other words, Xue moves through the blood vessels by virtue of the movement of Qi, and in the chest and HT region especially, the circulation of the Xue depends on Zongqi which is formed from the gu Qi and air inhaled by LU. Classical combinations: Pain of LU and HT: LU09 and LU10 (A Systematic Classic of AP and Moxibustion). Raving speech: LU09, LI05, LI08 and BL60 (The Great Compendium). Relevant indications: Spitting blood, coughing blood, vomiting blood, agitated HT with HT pain and choppy pulse, oppression of the chest, manic raving, pulseless Syndrome.

LU10 Yuji: Relevant indications:Coughing blood, vomiting blood, blood in the urine, genital Damp itching, impotence with abdominal distention. LU10 is the Ying-Spring and Fire point of LU. In the Classic of Difficulties (68th Difficulty), ying-spring points are indicated for "Heat in the body", and LU10 is effective to clear Heat from both LU Channel and LU Zang. Xue-Heat (a form of Yang-Shi (Excess)), may cause excessive and reckless movement, and hence haemorrhage. LU10 is indicated for bleeding disorders affecting all Three Jiao (the entire TH area). LU-Heat may injure the Vessels (including blood vessels) of LU causing coughing of blood, transmit to the origin of LU Channel in the ST causing vomiting of blood, or transmit to HT and thence the SI and BL causing urinary bleeding (which may be accompanied by genital Damp itching or impotence). Classical combinations: Vomiting blood: LU10, PC03 and HT07 (The Great Compendium of AP and Moxibustion). Pain of the penis: LU10, KI03, CV03 and SP06 (The Great Compendium of AP and Moxibustion).

ST29 Guilai: Relevant indications: Amenorrhoea, irregular menstruation, uterine blood Stasis due to Cold. The name of this point, Guilai (Return) refers to its ability to restore the menstruation to normal, and its overriding action is to warm the Lower Jiao, most particularly the uterus in women. The uterus (along with the ST, SP, SI, LI) belongs to that group of the Zang-Fu or Extra-Fu that can suffer from direct attack by External Cold (e.g. without initially causing symptoms and signs of an External Syndrome such as chills and fever, body aches etc). Injury of the uterus by Cold may be due to inadequate clothing or sitting on cold ground, or over-consumption of Cold foods and drinks, especially during menstruation or after childbirth. Plain Questions (Chapter 82: "On Regulating the Channels") says: "Qi-Xue desire warmth and dislike Cold; when Cold is encountered they coagulate; when warmth is encountered they disperse and flow"; the Spiritual Pivot says:

Deadman_P2; Al-Khafaji M (1996) Some AP points Which Treat Disorders of Blood: Part 2. "The Qi-Xue of the human body circulate ceaselessly, in the same way that the stars in the heavens and the rivers in the earth. When Cold pathogens invade the Channels, Xue coagulates; when Xue coagulates the Channels do not move". Pathogenic Cold in the uterus causes Qi-Xue Stasis and disrupts the function of CV and Chong Mai, causing disorders such as amenorrhoea, irregular menstruation and abdominal masses. ST29 is normally treated with warm needling to Warm the uterus and Dispel pathogenic Cold.

SP01 Yinbai: Relevant indications: Uterine bleeding, menorrhagia, vomiting blood, nosebleed, Heat illness with nosebleed, blood in the urine, blood in the stools. In the Supplements to Commentaries "SP gathers the Xue; in SP-Xu, SP is unable to unite the Xue", whilst the Treatise on Disorders of Blood says "In SP-Yang Xu, the Xue is not gathered". SP01 (SP jing-well point) is one of the best AP points to strengthen SP function of holding Xue. This Syndrome, which is usually chronic in nature, may manifest as bleeding in any part of the body, but mainly in the Lower Jiao, whether as uterine bleeding or as bleeding into the urine or stools. In such cases moxibustion at SP01 is often employed, and it is very helpful to instruct the patient in use of moxibustion daily at home. The action of SP01 in stopping bleeding, however, is not confined to SP-Xu, but may also be applied where Shi or Xu Heat attacks Xue, causing reckless bleeding, especially in the upper part of the body (nosebleed, vomiting blood). In these cases, needling is usually employed. Classical combinations: Bloody stools: SP01 and ST36 (Gatherings from Outstanding Acupuncturists). Bloody dysentery: SP01, ST25, ST44, CV06, KI06 and PC06 (The Great Compendium of AP and Moxibustion). Vomiting and nosebleed: SP01, BL20, BL18 and CV13 (The Great Compendium of AP and Moxibustion). Severe and ceaseless nosebleed: SP01 and BL40 (Classic of Supplementing Life with AP and Moxibustion). Hot head and nosebleed: SP01, BL58, BL64, BL60 and BL57 (1000 Ducats).

SP06 Sanyinjiao: Relevant indications: Irregular menstruation, uterine bleeding, uterine bleeding with dizziness, menorrhagia, amenorrhoea, dysmenorrhoea, difficult labour, failure of the lochia to descend, postpartum dizziness, palpitations, blurred vision, insomnia, eczema, urticaria. Along with BL17, SP10 and SP08, SP06 is considered one of the main AP points to nourish, harmonise and cool Xue and to promote and invigorate its circulation. This explains its main application in gynaecological disorders, but extends to other disorders where Xue disharmony plays an important role such as skin diseases. In SP-Qi-Xu or SP-Yang Xu there may be: 1. inadequate formation of blood (palpitations, blurred vision, amenorrhoea, postpartum dizziness, dizziness associated with uterine bleeding etc.), or 2. failure of SP to hold the Xue (uterine bleeding, menorrhagia). SP06 is an essential point to treat these disorders, especially uterine bleeding and menorrhagia, because of its ability to tonify SP-Qi and Yang and the SP ability to hold the Xue. The further ability of SP06 to regulate SP, LV and KI Channels and to treat all disorders of the lower abdomen makes it an important point to treat gynaecological disorders due to Xue Stasis, KI-Xu, Phlegm-Damp or LV-Stasis. Classical combinations: Uterine bleeding: SP06, CV07 and TH04 (The Lyric of Standard Profundities). Ceaseless uterine bleeding: SP06, KI08, KI10 and LV03 (Classic of Supplementing Life with AP and Moxibustion). Menorrhagia: SP06, HT05 and LV02 (The Great Compendium of AP and Moxibustion). Disordered menstruation: SP06, GB41 and CV03 (The Great Compendium).

SP08 Diji: Relevant indications: Irregular menstruation, dysmenorrhoea, abdominal masses in women due to Qi-Xue-Stasis. SP08 is SP Xi-Cleft point. The Xi-Cleft points are where the Qi-Xue, which flow relatively superficially along the Channels from the jing-well points, gather and plunge more deeply. The Xi-Cleft points in general are indicated to treat acute conditions and pain, whilst the Xi-Cleft points of the Yin Channels have an additional action of treating disorders of Xue. SP controls Xue and its Channel enters the lower abdomen, joining with the CV at CV03 and CV04. SP08 has a specific and important action on resolving Xue Stasis in the uterus and lower abdomen, being indicated to treat irregular menstruation, abdominal masses in women and dysmenorrhoea due to this pathology. As the Xi-Cleft point, SP08 is especially suited to treating acute dysmenorrhoea, for which purpose it is often combined clinically with LI04. A specific indication for this point mentioned in the Illustrated Classic of AP points on the Bronze Man is a hot flowing sensation spreading down the inner thigh to the knee when pressure is applied to abdominal masses in women. Classical combinations: Irregular menstruation: SP08 and SP10 (Ode of the 100 Symptoms).

SP10 Xuehai: Xuehai, literally "Blood Sea", reflects its pre-eminent role in treating disorders of the Xue. It has 2 main actions: 1. to invigorate Xue and dispel Stasis, and; 2. to Clear Heat from the Xue. These 2 actions explain its ability to treat a wide range of gynaecological and dermatological disorders due either to Xue-Stasis or Xue-Heat. In gynaecology, normal menstruation depends factors which include the smooth circulation of Xue. Impaired Xue circulation and consequent Stasis may be due to Stasis or Xu of Qi, traumatic injury, haemorrhage, penetration of Cold, Xue Xu, Heat, chronic disease or emotional factors, and may cause many different disorders of menstruation. These include dysmenorrhoea and uterine bleeding manifested as severe fixed pain and the discharge of dark or clotted blood, and amenorrhoea accompanied by pain and distention, a purple coloured tongue and a choppy pulse. By contrast, in Xue-Heat, most often due to Internal Heat from LV or HT, or from overeating of excessively Heating foods, 2 main Syndromes may arise: 1. movement of Xue may become reckless and overflow, leading to uterine bleeding, or, 2. Heat may cause Xue-Dryness, leading to amenorrhoea. Both cases have signs of Heat such as a red dry tongue and a rapid pulse. Both the Xue-cooling and Xue-invigorating properties of SP10 join in its ability to treat uterine bleeding. Xue-Heat is the main Syndrome of uterine bleeding; as well as cooling Xue, treatment must stress resolving Stasis, since any pathological bleeding may lead to pooling and Stasis of extravasated blood. This is expressed in the TCM saying "where there is haemorrhage there is Stasis". Some authorities further attribute Xue nourishing properties to SP10 and incorporate it into prescriptions to treat Xue Xu. In the light of SP10's pre-eminence in invigorating Xue, this action reflects the saying in TCM "if Xue Stasis is not transformed, new Xue cannot be generated".

Deadman_P3; Al-Khafaji M (1996) Some AP points Which Treat Disorders of Blood: Part 3. This refers to situations either where Xue Xu and consequent poor circulation lead to Stasis, or where Xue Stasis prevents the creation of new Xue. Both of these Syndromes are commonly encountered in postpartum Xue-Xu. Xue disharmony also plays a central role in dermatology. The main dermatological Syndromes treated by SP10 are Xue-Heat, manifested as red lesions, and Xue-Stasis manifested as purple lesions. SP10 may also be used for concomitant Xue-Xu and Xue-Stasis seen for example in eczema with thickening of the skin (lichenification) or post-herpetic neuralgia. SP10 may also be used to treat the manifestations of Wind in skin diseases, especially severe itching. This illustrates the TCM saying "to treat Wind first treat the Xue; once Xue moves Wind will be dispelled". Although the action of SP10 on invigorating and cooling Xue is classically confined to the 2 main areas of gynaecology and dermatology, its application may be extended to any disorder in the body with these pathologies. Classical combinations: Irregular menstruation: SP10 and GB26 (Classic of Supplementing Life with AP and Moxibustion). Relevant indications: Irregular menstruation, dysmenorrhoea, amenorrhoea, uterine bleeding, clotted uterine bleeding, sudden uterine bleeding, postpartum Qi-Xue-Xu, urticaria, eczema, erysipelas, herpes zoster, painful Hot sores, ulceration and itching of the scrotum, blood line.

SP21 Dabao: Relevant indications: Pain of the whole body, weakness of the 4 limbs, flaccidity of the limbs. Dabao (Da=great, Bao=to wrap, to envelop). The Spiritual Pivot says: "Dabao is SP Great Luo point". Luo means Collateral, Connection, Reticulum, Net or Web. The Spiritual Pivot says: "Dabao spreads in the chest and flanks; it is like a net embracing the Xue of all the Luo-Collaterals. When it is Shi there is pain of the whole body. When it is Xu the 100 joints are flaccid. Dabao". It also says that one of the functions of all Luo is to assist (via their network) the Channels and Vessels to distribute Qi, and more especially Xue, to all tissues of the body. Since SP controls Xue, Dabao (SP Great Luo) dominates Xue distribution in the body. In Xue-Stasis "there is pain of the whole body"; in Xue-Xu, Xue can not nourish the tissues and "the 100 joints are flaccid".

HT06 Yinxi: Relevant indications: HT pain, fierce stabbing pain of HT, fullness of the chest, palpitations, fright palpitations, sudden turmoil disorder with HT pain (angina), nosebleed, vomiting blood. HT06, HT Xi-Cleft point (see SP08 above) is indicated for HT pain due to Xue Stasis, and bleeding disorders due to Xue-Heat. However, in terms of both these actions, Ximen PC04, PC Xi-Cleft point, is clinically more important. Acute severe pain in Xue-Stasis, which threatens the survival of HT Zang, is thus mainly treated by using points of the PC Channel, the "Protector" of HT. This is reflected in the statement in the Spiritual Pivot (Chapter 71): "HT is the great master of the Five Zang and Six Fu; it houses the Jing-Shen (the Essence of the Spirit). If HT is injured, Shen-Spirit departs; if Shen-Spirit departs, death follows; therefore the Perverse Qi that attacks HT is diverted to reside in PC".

BL15 Xinshu: Relevant indications: HT pain, oppression of the chest with restlessness, chest pain extending to the back, palpitations, irregular pulse, poor memory, anxiety, weeping with grief, insomnia, excessive dreaming, absent-mindedness as if in a trance, delayed speech development, coughing blood, vomiting blood, nosebleed, night sweats. BL15 (HT Back-Shu point) is where HT-Qi emanates from the interior to the body surface. All Shu-Back points, especially those of the Zang (Yin, Solid Organs), strongly regulate and tonify their corresponding Zang at the deepest level. BL15 is used equally to tonify Xu of HT Xue and to resolve Xue Stasis. In the Spiritual Pivot (Chapter 18) "Xue is the Qi of the Shen-Spirit", whilst the Plain Questions (Chapter 8) says "HT is the monarch from which the Shen-Spirit emanates". Since storage is a Yin function, it is mainly HT Xue and Yin that have the function of nourishing HT and providing the material basis for HT to house the Shen-Spirit. Xue and Yin Xu of HT may originate from physical causes such as loss of blood, chronic illness and overwork, or from emotional causes. Fei Bo Xiong (1800-1879) says: "The 7 emotions injure the 5 Yin organs selectively but they all affect HT"; the Plain Questions (Chapter 62) says: "HT stores the Shen-Spirit; in Shen-Shi (Spirit Excess) there is ceaseless laughter; in Shen-Xu (Spirit Weak) there is sadness". When HT-Xue or HT-Yin are Depleted (Xu), the unrooted and unanchored Shen-Spirit loses its harmony and becomes restless and unquiet, resulting in such symptoms as anxiety, poor memory, insomnia and excessive dreaming and weeping with grief. HT controls the pulse; in HT-Qi-Xu, HT is unable to regulate the Xue; there may be palpitations or irregular pulse, especially if HT-Xue is also weak (Xu). In that case, palpitations are more likely to be accompanied by anxiety, in contrast to the palpitations caused purely by Qi-Xu which are usually unrelated to emotional changes. In Essential Readings from TCM, "That which is stored by HT internally is Xue, externally it is emitted as sweat; sweat is the Jin-Fluid of HT". For this reason, BL15 is also indicated for night sweats. References to the relationship between HT, the Xue and its Vessels abound in the classics. The Plain Questions says: "All Xue pertains to HT" (Chapter 10), "HT dominates the blood vessels of the entire body" (Chapter 44), and "HT stores the Qi of the blood vessels" (Chapter 18). The Classic of Categories says: "The Vessels are the conduits of Xue-Qi, the movement of the Vessels is dependent on Qi"; the Spiritual Pivot says: "When the Qi of hand Shaoyin Channel is exhausted, the Vessels will not move, thus the Xue will not flow; when the Xue does not flow the circulation will eventually stop and the Xue will die". The Methods and Rules of Med says: "In chest Bi-Syndrome, pain in HT region is caused by Yang-Xu and invasion of Cold". Treatment Planning According to Syndrome Categories says: "In chest Bi-Syndrome, the Yanqi of the chest does not move; after a long time, Yin takes the place of Yang". All those statements emphasise the close relationship between the circulation of Xue in the chest and the Qi and Yang of HT. In HT Yang Xu and HT cannot circulate the Xue in the chest and HT, there may be consequential HT Xue Stasis causing pain and oppression of the chest. BL15 is important for all kinds of HT and chest pain, whether due to Xu, Stasis of Xue, or Stasis of Qi or Phlegm. The action of BL15 in treating Xue Stasis as well as Xue Xu, reflects its ability to treat both xu and shi Syndromes of HT with equal effect.

Deadman_P4; Al-Khafaji M (1996) Some AP points Which Treat Disorders of Blood: Part 4. In classic texts BL15 is an important point to clear Heat (both Shi and Xu) from HT, whilst the Illustrated Appendices to the Classic of Categories says: "BL15 is indicated for clearing Heat of the Five Zang in combination with the Five Zang Shu-Back points". This reflects the application of Five Phase Theory in which HT pertains to "Sovereign Fire" and plays a role in governing the Fire of the whole body. When HT-Fire injures the blood vessels of LU or ST, therefore, there may be coughing or vomiting of blood. Classical combinations: Weeping with grief: BL15, HT07, ST41 and PC07 (Classic of Supplementing Life with AP and Moxibustion).
Melancholy and trance-like absent-mindedness: BL15, TH10 and GV11 (Classic of Supplementing Life with AP and Moxibustion).
Trance-like mental confusion: BL15, TH10 and CV14 (The Great Compendium of AP and Moxibustion). Mental stupidity and dull-wittedness: BL15, HT07, LU11 and KI01 (The Great Compendium of AP and Moxibustion). Agitated HT: BL15 and CV14 (Classic of Supplementing Life with AP and Moxibustion). Coughing and spitting blood: BL15, BL18, ST12, CV14 and CV15 (Classic of Supplementing Life with AP and Moxibustion).

BL17 Geshu: Relevant indications: All Xue diseases, epigastric pain, fullness of the abdomen and flank, pain of the whole body, pain of the skin, flesh and bone, stabbing pain of HT, HT pain on eating, tidal fever, night sweats, spontaneous sweats, steaming bone Syndrome, fever without sweats, aversion to Cold, mania-depression disorder, coughing blood, vomiting blood, spitting blood, blood in the stool, urticaria, whole-body Bi-Syndrome. BL17 is one of the 8 Hui-Meeting points with a specific action on the Xue. Many classics simply state that this point can be used for "all Xue diseases". Disorders of Xue may be of 3 main kinds: Xue-Stasis, Xue Heat and Xue Xu. Impaired Xue circulation and consequent Xue-Stasis may be due to various causes (see SP10 above). Xue Stasis can cause many symptoms, but the main one is pain. Shi pain may be due either to Stasis of Qi or Stasis of Xue, as reflected in the TCM saying "when there is no movement there is pain". Pain due to Xue Stasis is manifested as its fixed and stabbing nature. Wang Qingren, Qing dynasty author of Correcting the Errors of Med, says: "when there is pain in the abdomen that does not move, it is Xue Stasis". In the Treatise on Disorders of Blood, Tang Rong Chuan says: "When Xue Stasis is between the Jingluo and the Zang-Fu the whole body is in pain; when it is in the Upper Jiao there is stabbing obstinate pain of the arm, chest and diaphragm; when it is in the Middle Jiao there is pain of the abdomen and flanks". BL17 is applicable in all these cases. Note, however, that due to its location, its special action is on the diaphragm/respiration, which intersects the Upper and Middle Jiao. Thus, its main sphere of action is on the Upper and Middle Jiao, and it is less used for Xue Stasis in the Lower Jiao. BL17 is also an important point to treat various kinds of fever due to Xue Stasis. The Treatise on Disorders of Blood says: "in Xue Stasis of the pores, Yingqi and Weiqi are not harmonised and there is fever plus chills; in Xue Stasis half-Internal half-External, there are alternating chills and fever; in Xue Stasis of the muscles and flesh, there is a burning fever; in Xue Stasis in the Jingluo and Zang-Fu there has to be steaming bone consumption fever". BL17 is also indicated for mania-depression disorder. In Correcting the Errors of Med, Wang Qingren says: "In insanity Syndrome of continual crying and laughing, swearing and singing, the Qi-Xue-Stasis is in the brain". An alternative explanation for this manifestation is that Xue Stasis may both transform to Heat and obstruct the blood vessels, preventing nourishment from reaching HT. This combination of Heat and malnourishment may disturb the Shen-Spirit. BL17 is important for many bleeding disorders, mainly due to Xue-Heat or Xue-Stasis. Xue-Heat may be due to many causes, including constitutional Heat, External Heat, overeating of excessively Heating food or drink, or Heat (Shi or Xu) generated by disharmony of the Zang-Fu. When Xue-Heat causes Xue to move recklessly and burst out of the blood vessels, causing haemorrhage that is usually acute and profuse. BL17 can cool the Xue and stop bleeding, mainly from the upper and Middle Jiao (LU and ST). Another important cause of haemorrhage is Xue Stasis. In Xue Stasis (Xue obstruction, failure to move) blood may be forced out of the blood vessels, causing haemorrhage manifested as its intermittent nature, dark purplish colour and presence of clots. At the same time, haemorrhage of any aetiology is itself in an important cause of further Xue Stasis, as blood that is forced out of the blood vessels easily pools and stagnates. This is reflected in the saying "where there is haemorrhage there is Stasis". The close inter-relationship between Xue Heat, Xue Stasis and haemorrhage is further illustrated, in that Xue Heat may condense to Xue-Dryness and Stasis, as stated in the Treatise on Acute Epidemic Febrile Disease by Wu You Ke (1642): "Because Latent Fire-Stasis evaporates the Fluid of Xue, Xue simmers and forms Stasis". The ability of BL17 to nourish Xue and Yin is clearly overshadowed in the classical indications by its ability to resolve Xue Stasis and Heat. Three areas show its nourishing and tonifying properties. 1. BL17 can treat disorders such as night sweats and steaming bone Syndrome due to severe Xu of Xue and Yin. 2. BL17 is used with BL19 in the classical combination of the "4 Flowers", first mentioned by Wang Tao (752 AD) in "Secrets of a Frontier Official". He did not specify the points but described rather a complex location method. [The method of locating these points described in the Secrets of a Frontier Official (752 AD) is as follows: Tie a piece of string around the neck, with a knot level with CV15. When the string is allowed to fall down the back, the knot will then lie on the vertebral column at the crossing point of two diagonal lines the end of each of which leads to one of the four points]. The Classic of Supplementing Life with AP and Moxibustion in the 13th century first defined the "4 Flowers" as BL17 and BL19 and said that they dominated Xue, being indicated (for treatment by moxibustion) for LU tuberculosis (consumption disorder) manifesting as exhaustion with steaming bone Syndrome, night sweats cough, asthma, feebleness and emaciation. 3. BL17 has a special ability to treat Xue Xu allied to Xue Stasis. It has long been understood that after haemorrhage, the consequent Xue Stasis prevents the formation of new Xue. This is reflected in the saying: "if Xue Stasis is not transformed, new Xue cannot be generated", and the statement by Tang Rong Chuan:

Deadman_P5; Al-Khafaji M (1996) Some AP points Which Treat Disorders of Blood: Part 5."In vomiting blood, nosebleeds and blood in the stool, the Xue leaves the Channels; any Xue outside the Channels is isolated, no longer connected with the Xue that nourishes the entire body; isolated Xue is unable to augment with good Xue, thus the transformation of new Xue is hindered". At the same time, by pooling outside the Channels, Xue Stasis may lead directly to Xue Xu as sufficient Xue is no longer available to nourish the body. Thus Xue Stasis may not only be the cause of, but may be the end result of Xue Xu. The action of BL17 on Bi-Syndrome, commonly referred to as Wind-Damp in TCM, which affects the whole body reflects its action of regulating Xue. Prolonged bi Syndrome may give rise either to Xue Stasis or Xue Xu. The importance of treating the Xue in such cases is reflected in the saying: "to treat Wind, first treat Xue; once Xue moves, Wind will be dispelled".

BL40 Weizhong: Relevant indications: Pain and stiffness of the lumbar spine, heaviness of the lumbar region and buttock, nosebleed, clove sore (ding chuang), erysipelas. An alternative classical name for BL40 is Xuexi (Blood Xi-Cleft). In the Neijing, the Taiyang Channel (BL-SI) is abundant in Xue. This explains the powerful effect of bleeding BL40 to move Xue-Stasis in acute lumbar sprain; it also explains its ability to cool the Xue in nosebleeds and many skin disorders, in which case the point may also be bled. In the Neijing, the Jueyin Channel is the only other Channel abundant in Xue; this may help to explain certain similarities between BL40 (BL (Foot Taiyang) He-Sea point and Earth point) and PC03 (PC (Hand Jueyin) He-Sea point and Water point). Both points are bled to Clear Xue-Heat and are used to treat injury by summer-Heat, sudden turmoil disorder with Heat of the 4 limbs, ceaseless thirst, vomiting and diarrhoea. Classical combinations: Severe and incessant nosebleed: BL40 and SP01 (1000 Ducats). Carbuncles on the back: needle BL40 and GB21, and place a slice of garlic on the carbuncle and burn moxa. If there is no pain, then moxa until there is pain; if there is pain, moxa until there is no pain, the more moxa the better (The Great Compendium of AP and Moxibustion).

KI05 Shuiquan: Relevant indications: Amenorrhoea, irregular menstruation, dysmenorrhoea, delayed menstruation with epigastric pain on onset of menstruation, prolapse of the uterus. KI05 is the Xi-Cleft point of KI Channel (see SP08 above). The Plain Questions (Chapter 1) says: "At the age of 14, KI-Qi of the female is strong, the reproductive function matures, the CV flows and the Chong Mai fills, the menses come according to their times, and she can bear offspring". Normal development of the uterus and the CV and Chong Mai, therefore, depend on healthy functioning of KI. At the same time, harmonious menstruation depends on adequate formation of Xue in the body, especially LV-Xue which flows to the CV and Chong Mai to form menstrual blood. The close relationship between Xue of KI-LV was emphasised in Master Zhang's Med Encyclopedia which says: "When the Jing-Essence is not discharged it will return to LV and transform into clear Xue", whilst KI plays an important role in the formation of Xue, stated unequivocally in the Bing Ji Sha Zhuan "The source of Xue is KI". In KI-Xu, the function of the CV and Chong Mai will be disturbed and the formation of Xue inadequate. KI05 (Xi-Cleft point of KI) and thus able to treat disorders of Xue, regulates the Qi-Xue in KI, CV and Chong Mai. It is indicated for many menstrual disorders such as amenorrhoea, irregular menstruation, dysmenorrhoea and delayed menstruation, whether manifested as Xu (of Xue or Qi) or Shi (Stasis of Xue). Classical combinations: Amenorrhoea with much oppression and pain in the lower HT (upper epigastrium): KI05 and KI06 (1000 Ducats). Irregular menstruation: KI05 and ST25 (Ode to the 100 Syndromes).

KI08 Jiaoxin: Relevant indications: Uterine bleeding, irregular menstruation, dysmenorrhoea, amenorrhoea, uterine prolapse. KI08 is the Xi-Cleft point of the Yinqiao Mai on KI Channel. The Xi-Cleft points of the Yin Channels have a special action of treating disorders of Xue, especially resolving Xue Stasis, clearing Heat from the Xue and stopping bleeding. Although the Yinqiao Mai does not enter the uterus, like all the Extraordinary Channels, it has a close relationship with KI and originates at KI06. KI08 is indicated in many menstrual disorders, and most especially uterine bleeding. The Classic of the Central Viscera by the Han Dynasty doctor Huato says: "KI wraps the Xue". In women, KI injury due to excessive early sexual activity, sexual overindulgence, multiple pregnancies etc, either weakens (Xu) KI-Yin or KI-Yang, causing weakness of the CV and Chong Mai and hence uterine bleeding. KI08 is indicated mainly in Xu Syndromes of uterine bleeding, particularly in KI-Xu. However, as a Xi-Cleft point, and due to its secondary action of draining Damp-Heat, it is effective to treat uterine bleeding due to Xue Stasis, reckless movement of Hot Xue and Damp-Heat. Classical combinations: Ceaseless uterine bleeding: KI08, KI10, LV03 and SP06 (Classic of Supplementing Life with AP and Moxibustion). Diminished Qi uterine bleeding: KI08 and BL55 (Ode to the 100 Syndromes).

KI14 (Siman, Four Fullnesses): One interpretation of the meaning of Siman is that it refers to 4 kinds of Stasis: Qi, Water, Food and Xue. Clear indications reflect each of these Syndromes, for example abdominal distention for Qi, abdominal oedema for water, diarrhoea or constipation for food, but overwhelmingly the indications reflect the presence of Xue Stasis, for example painful abdominal masses, cutting pain below the umbilicus, Xue Stasis in the uterus etc. Relevant indications: Abdominal distention, oedema of the abdomen, diarrhoea, constipation, masses below the umbilicus, painful masses, cutting pain below the umbilicus, irregular menstruation, uterine bleeding, Xue Stasis in the uterus, acute pain due to Xue Stasis.

PC04 Ximen: Relevant indications: Chest pain, HT pain, HT pain with vomiting, vomiting blood, coughing blood, nosebleed, furuncle and carbuncle, agitated HT, Shen-Qi-Xu, depression, low spirits, insomnia, melancholy and fear, fear of strangers and . PC04 (Cleft Door) is the Xi-Cleft point of the PC Channel (see SP08 above). Through its dual actions of invigorating Xue and moderating acute Syndromes, PC04 is strongly indicated for Stasis of Xue in the chest and HT, causing pain. Its important role to treat HT pain was both emphasised in the classics and is borne out by modern clinical practice and research. By virtue of its ability to clear Heat from the Xue and stop bleeding, PC04 is also indicated for Hot reckless bleeding in the Upper Jiao causing nosebleed, and vomiting or coughing of blood.

Deadman_P6; Al-Khafaji M (1996) Some AP points Which Treat Disorders of Blood: Part 6. The second main group of indications for PC04 includes many mental and emotional disorders such as agitation of HT, insomnia, melancholy and fear, fear of strangers and epilepsy. The relationship between PC04 and emotional disorders is expressed through its effect on the Xue and HT Qi. HT rules the Xue and houses the Shen-Spirit; there is therefore a reciprocal relationship between Xue and Shen-Spirit disturbance. On the one hand in Xue Stasis, when blood does not flow freely, essential nourishment will not reach HT and Shen-Spirit may be disrupted. On the other hand, emotional disturbance may lead to Xue Stasis. The Spiritual Pivot (chapter "On Original Causes of the 100 Diseases) says: "A person may be injured Internally by worry and anger; when this occurs Qi will rush upwards; when the Qi rushes thus the 6 Shu (points) will not move, the warm Qi will not circulate and the Xue-Stasis (coagulation) occurs internally". By resolving Xue-Stasis PC04 therefore can restore emotional harmony. Xue-Stasis in HT mainly occurs due to Xu of HT Qi and Yang. These Syndromes often cause feelings of fear, melancholy and gloominess, typically seen in patients after a myocardial infarct (MI) (the shock of which may further injure HT Qi). PC04 can regulate HT Qi, as well as the Xue, and is classically indicated for Shen-Qi-Xu (low spirits). Finally in Ying-Heat or Xue-Heat during febrile disease, when Heat rises to disturb the Shen-Spirit, symptoms may include of mental and emotional agitation, as well as haemorrhage. Thus the Treatise on Warm Febrile Diseases stated: "When Ying is invaded by Heat, Xue is consumed, Shen-Spirit is disturbed and there is insomnia". PC04 can calm Shen-Spirit in such cases by clearing Heat from the Ying and Xue. Classical combinations: HT pain: PC04, PC03 and PC07 (1000 Ducats). HT pain with dry heaves and agitation and fullness: PC04 and HT01 (Classic of Supplementing Life with AP and Moxibustion). Coughing blood: PC04 and PC07 (A Systematic Classic of AP and Moxibustion). Fear of people, Shen-Qi-Xu: PC04 and KI04 (1000 Ducats).

LV01 Dadun: Relevant indications: Irregular menstruation, ceaseless uterine bleeding, menorrhagia, metrorrhagia, bloody urine, nosebleed. LV01 is the LV Jing-Well point, Wood point and Hour point. The LV Channel encircles the genitals and enters the lower abdomen. Through its action of regulating Qi in the Lower Jiao, LV01 is indicated for many disorders of both urination and menstruation. LV stores the Xue; in menstrual disorders, if LV-Qi-Stasis transforms to Heat and enters the Xue, Xue-Heat will cause agitation and turbulence, manifesting in such disorders as irregular menstruation, ceaseless uterine bleeding, menorrhagia or metrorrhagia. The Great Compendium of AP and Moxibustion says "urine red like blood, moxa LV01 and CV04". The action of LV01 on stopping excessive uterine bleeding therefore includes urinary bleeding, and, according to Sun Si Miao, even nosebleed, which often is due to rebellious LV-Heat.

LV08 Ququan: Relevant indications: Abdominal masses in women due to Xue Stasis, infertility due to Xue Stasis, amenorrhoea, lower abdominal swelling, pain of the abdomen and flank, umbilical pain. LV stores the Xue and its Qi controls the smooth flow of menstruation. In LV-Qi-Stasis, menstrual blood may also stagnate. LV08 is indicated in various classical sources for Xue Stasis in the uterus causing infertility, abdominal masses and amenorrhoea. From many sources, one specific indication is the presence of abdominal masses which, when pressed, induce a warm sensation which radiates down the thigh as far as the knee. LV08 is an important point to clear Damp-Heat from the Lower Jiao. Clinically the combination of Damp-Heat and Xue Stasis often occurs in gynaecological disorders, and the action of LV08 on both these pathogens renders very useful to treat such dual disharmony.

GV14 Dazhui: Relevant indications: Nosebleed. After ascending to the vertex, the GV descends through the midline of the nose. GV14 is indicated for nosebleed which does not stop, an indication that mirrors the folk practice of placing a key or other piece of cold metal, or a cold sponge, at the back of the neck to stop nosebleed. Classical combinations: Nosebleed: moxa GV14 and GV15 (Secrets of the Master of Cinnabar Creek).

CV07 Yinjiao: Relevant indications: Uterine bleeding, irregular menstruation, amenorrhoea, leucorrhoea, infertility, ceaseless flow of lochia after childbirth. Due to the close relationship of CV07 to the uterus, it may be used to treat such disorders as uterine bleeding, irregular menstruation, amenorrhoea, lochiorrhagia and infertility due to any aetiology. CV is the "Sea of the Yin Channels"; Chong Mai is the "Sea of Xue". Both begin in the uterus. Their maturation depends on the flourishing of KI; thus the Plain Questions says: "At the age of 14, KI-Qi of the female is strong, the reproductive function matures, the CV flows and the Chong Mai fills, the menses come according to their times, and she can bear offspring". CV07 Yinjiao (Yin Meeting) is a meeting point of the CV, KI and Chong Mai, the 3 Channels that have the strongest relationship with the uterus. Disorders of menstruation may be Yin or Yang, Shi or Xu, due to Cold or Heat, External pathogens (Perverse-Qi), or Internal disharmony (emotional imbalance).

We would especially like to mention:
1. Maciocia G (1994) The Practice of Chin Med. Churchill Livingstone.
2. Flaws B (1994) Master Hua's Classic of the Central Viscera: Excerpts from a Translation of Hua Tuo's Zhong Zang Jing. AJA 22(2).
The material presented in this article is taken from the forthcoming textbook A Manual of AP and originally appeared in CMJ (UK).

Westerman_MP (1994) AP and blood studies in sickle-cell anaemia [letter]. AJCM 22(2):190.

Zorich_OI; Orlova MV (1992) Biotics of human blood after applying microcurrents (letter). Biofizika Mar-Apr 37(2):388-390. Microcurrent-Stimulation of human AP points releases biologically active substances into the blood, which may be accompanied by changes in the composition of microelements. Levels of some microelements of the blood were determined before and after EAP. Levels of elements with alternating valency decreased, while those of alkaline elements increased somewhat in the same blood samples of a healthy man. EAP may regulate homeostasis of microelements in the blood.