ABSTRACT
Backpain is only a sign or symptom. It may be primary, secondary, or as part of a generalised disorder. In practice, it may be difficult to make a specific diagnosis of the cause of human backpain, unless X-ray, myelography and other tests are carried out routinely. The practitioner may be satisfied with clinical remission.
In hospitalised patients, AP is successful in treating post-operative pain and complications. It can be successful also in backpain which has not responded to surgery.
AP therapy is by stimulation of relevant reflex points in the skin and muscles. Points of tenderness to palpation are important. They are the AhShi or TRIGGER points (TPs). Stimulation is given to the TPs, paravertebral (Shu) points, and points related to specific areas, organs or functions, e.g.local and distant points on Channels through affected area.
Data from over 66 textbooks and clinical articles were stored on a Hewlett Packard Minicomputer. Frequency-ranked prescriptions for >1100 clinical headings were generated from the database. Some of those, of relevance to backpain (primary and secondary), were analyzed. Pain of central origin is not included. The "Top Twenty" points for selected body regions/organs related to the neck and back are given. Points for certain common signs/symptoms (thoracalgia, lumbalgia, sciatica etc) are given.
Appendix 1 comments on the use of the point index and its structure. It lists the codes and names of all the points. The points for regions and signs are in Appendices 2 and 3. Examples of methods of point selection for simple and more complex conditions (syndromes) are given. Advantages and disadvantages of "Cookbook AP" are discussed in relation to traditional AP concepts.
The following combinations are useful guides to pain control:
Neck: TPs, GB20,21,39, GV14, LI04,11, BL10, SI03,15, ST38 (or GB34)
Thoracic back: TPs, GV09,12,13,14, X 35, BL40,60
Lowback/leg: TPs, GV04, BL23,25,31,37,40,60, GB30,34.
Other methods of point selection (Earpoints, Newpoints, Handpoints etc) must be regarded as experimental at this time.
INTRODUCTION
Traditionally-trained acupuncturists generally scorn the idea of Cookbook acupuncture (AP), although they often use their own formulae (poor cookbooks! ). They would be horrified at the idea of computerising AP. They claim that the free availability of prescriptions do AP a disservice, allowing it to fall into the hands of untrained, unqualified people. I do not accept this. There is one medicine. The best people to practice AP would be those trained in conventional medicine as well as AP. TP therapy (see below), even without any knowledge of AP, may give 60-70% clinical success. If one adds classical AP points, the success rate can increase by 10-20%. The use of TP therapy brings more professionals into the active AP field than any other arguments or demonstrations. Storage of data on computer makes its analysis and retrieval very easy. Databases can be updated and re-analyzed periodically. Computers do not forget (assuming that files are copied and backed up every time they are updated). Advantages and disadvantages of computer-generated prescriptions are discussed in detail elsewhere (Rogers 1984 a,b).
Backpain may be primary (paravertebral muscle pain, thoracolumbar disc disease, vertebral, sacroiliac or arthrotic), secondary (referred from irritation of thoracic or abdominal organs), or as part of a generalised disorder.
This paper deals with the selection of points for human backpain, using Cookbook methods, based on computer analysis of textbook and other data. If other symptoms or organs are involved, the selection of points must take these into consideration.
It has taken me more than 11 years to set up the database. I ask each of you to treat the material as copyright, not for commercial publication in text, computerised, microfiche form. You are welcome to use it for your own professional purposes and to give it to colleagues, if they agree to respect the copyright.
THE BASICS OF AP
The alphanumeric code and name of each point is shown in Appendix 1. As there is no internationally agreed coding system, you should check my codes (Appendix 1) with the codes which you use, to prevent confusion and error. In human AP, the paravertebral Shu (reflex points for all major thoracic and abdominal organs) are located on the inner line of the bladder (BL) Channel as follows:
Lung (LU), Pericardium (PC), Heart (HT), Governor Vessel (GV), Diaphragm = BL13-17, in area T3-T7 respectively; Liver (LV), Gallbladder (GB), Spleen-pancreas (SP), Stomach (ST) =BL18-21, in area T9-T12 respectively; Triple Heater (TH), Kidney (KI), CHIHAISHU, Large Intestine (LI), KUANYUANSHU = BL22-26, in area L1-L5 respectively; Small intestine (SI), Bladder (BL), CHUNGLUSHU, PAIHUANSHU = BL27-30, in area S1-S4 respectively. These points have diagnostic value (when tender). They help to identify the affected organ. They also have therapeutic value in treating the affected organ and local problems near the points. However, local muscle strain or trauma can also cause Shu point tenderness. Thus, Shu point tenderness need not always indicate disorders of the related organs. Points on the outer line of paravertebral BL points (BL41-54) have similar functions to the related points on the inner line. Irritation of the thoracic or abdominal organs can refer pain to related skin and muscle segments, especially in the paravertebral area. This can establish TPs, as detailed by Travell and Simons (1984) and in the TP Therapy Symposium (1981). Long after the visceral pain has gone, the TPs can remain active. Unless TPs in the thoracosacral muscles are "removed" by AP or other physiotherapy, the function of the back muscles is impaired and performance is impaired.
In human AP, the AhShi point is defined as a point, usually in muscle, which is tender on palpation. AhShi means Ouch! or Ah Yes! There are two kinds of AhShi points: those from which palpation elicits only local tenderness and those which radiate pain to the problem area (the area in which the patient complains of pain). The latter type is the true TP of western medicine. It is the most important point in AP therapy and the patient may unaware of TP tenderness until the point is pressed. TPs may occur almost anywhere in muscle. Scars may also act as TPs. TPs in the paravertebral area often correspond with organ Shu points. For example, in coronary disease, patients may have TPs in the area T3-T6. Patients with kidney or ovary problems may be touchy in the area L1-L3 (BL22-24). The reflex point for the ovary and kidney is BL23.
REFERRED PAIN: Pelvic limb lameness is often due to pain referred from thoracolumbar or lumbosacral nerves, as in sciatica. It may arise also in pain referred from abdominal viscera, such as in a painful kidney, ovary, uterus or colon. Thoracic limb lameness may arise in pain referred from cervical or upper thoracic nerves or from pain in thoracic organs (lung, pericardium, heart). Thus, neck- and back-pain often manifest as pain in the thoracic- or pelvic- limb.
ASSESSMENT OF PATIENTS BEFORE TREATMENT
A complete history is taken, together with any findings of previous investigations. In the clinical examination, attention is paid to any lesions or signs related to all major systems or functions. One tries to identify the primary problem(s) and the location(s) of pain. It is essential to probe or palpate the muscles from head to toe, to locate any TPs. Particular attention is paid to the paravertebral muscles and the large muscles of the neck and limbs. The joints and tendons are also palpated. Patients with signs of pain, stiffness or lameness are seldom free of TPs. Their detection is indicated by an expletives or groans or "Ah Yes! " when they are palpated.
Always check for diagonal relationships. Cain stresses that fore-lameness is often accompanied by tenderness at contralateral lumbosacral or hind-limb points in the horse. Also, hind-lameness is sometimes associated with TPs on the contralateral side of the neck. Be careful to check the paravertebral Shu points in relation to the location of limb pathology, for example BL25 (L4-5, large intestine Shu) in radial forearm pain and BL21 (behind last rib, stomach Shu) in anterolateral pain in the pelvic limb etc. In all local problems (neck, shoulder, elbow, back, thoracolumbar, lumbosacral, hip, knee etc), the TPs must be found. They are recorded and marked as they are located. This helps rapid reassessment of the case on later visits. It also makes it easy for the patient to locate them for massage or other physiotherapy (ultrasound, LASER etc) between AP sessions.
DATABASE OR COOKBOOK AP
AP points listed under various symptoms, body parts etc were stored on file. Data under sections on point functions were also stored. The data base was sorted and duplicate entries from specific sources were eliminated. Points were scored by a weighted citation frequency method. Prescriptions were generated for each part and symptom and were output with the highest-scoring points first and the lowest-scoring last.
The larger the database, the more points are filed under any given region, symptom or condition. However, the first 6-10 points listed (in order of descending citation score) are the most important for routine use. For example, in the most recent summary of the database, 401 points were listed from a base of 44 texts for the treatment of sequelae (hemiplegia, paralysis) of CVA or polio. The Top Ten points were:
Ranking 1 2 3 4 5 6 7 8 9 10 Point LI04 LI11 ST36 GB34 ST06 GB30 ST04 LI15 TH05 GB39 Score .86 .79 .77 .74 .73 .72 .68 .66 .62 .62
The Maximum score possible was .964. The bottom 10 points were:
Ranking 392 393 394 395 396 397 398 399 400 401 Point CV13 CV17 BL65 LI01 ST23 BL07 KI20 GB06 GB43 LV06 Score .02 .02 .02 .02 .02 .02 .02 .02 .02 .02
The scores have been rounded up or down to the second decimal place. Clearly, the first list would be expected to give better therapeutic results than the second list above.
However, selection of the Top Ten points in the above list would not necessarily be the best selection for a CVA sequel which was primarily mutism or aphasia. For such cases, the top 10 points are:
Ranking 1 2 3 4 5 6 7 8 9 10 Point CV23 GV15 HT05 LI04 Z 21 TH03 GB02 TH17 NZ32 SI19 Score .82 .72 .44 .37 .27 .23 .23 .21 .20 .18
(From a total of 71 possible points listed by 27 texts, maximum possible score was .952)
The computer allows one to COMBINE data, to retrieve ALL points used for ALL conditions of (say) the "thoracic back" or "abdomen" etc. In this way, the entire database was summarised by amalgamation of data for major body areas, functions, subregions and combinations of similar conditions. Appendix 2 gives examples. Regional points, however, do not supplant the need to consider points for specific symptoms. For example, in the selection of points for FACIAL PARALYSIS (OPTIC NERVE), one could search under "Head", "Face", "Facial paralysis", "Facial paralysis, optic branch"(see below). Many of the points are common to all those headings, but the specific heading is probably the best source.
020000 HEAD, ITS ORGANS AND FUNCTIONS LI04 GB20 ST06 ST07 ST36 LI20 TH17 LI11 TH05 LV03 .946 .927 .896 .896 .852 .787 .-779 -.7-77 -.7-77 .-758 (54 references, 458 possible points, max possible score .963) 020-500 FACE, CHEEK (GENERAL POINTS FOR) LI04 ST06 ST04 ST07 ST02 LI20 BL02 GB14 TH-17 ST03 .860 .86-0 .780 -.780 .595 .581 .547 -.532 .513 .487 -(49 references, 198 possible points, max possible score .963) 020507 FACE: FACIAL N. PARALYSIS; BELL'S PALSY; FACIAL HEMIPLEGIA; NUMB ST06 ST04 LI04 ST07 TH17 ST02 LI20 GB14 SI18 ST03 .886 .829 .803 -.717 .606 .586 .-529 .529 .4-43 .414- (36 references, 111 possible points, max possible score .972) 020508 FACE: FACIAL N. PARALYSIS; BELL'S PALSY, UPPER (OPTIC) BRANCH LI04 LI20 ST04 ST07 ST06 TH17 GB14 SI18 BL02 Z 09 .664 .664 .588 .580 .504 .504 .504 -.420 .336 -.24-4 (12 references, 46 possible points, max possible score .992) 020509 FACE: FACIAL N.PARALYS-IS; BELL'S PALSY, MIDDLE (MAXILLARY) BRANCH ST04 ST06 CV24 ST07 ST03 GV26 SI18 LI04 LI20 Z 09 .645 .645 .526 .513 .395 .355 .263 .250 .250 .250 ( 8 references, 24 possible points, max possible score .950) 020510 FACE: FACIAL N. PARALYSIS; BELL'S PALSY, LOWER (MANDIBULAR) BRANCH ST06 CV24 LI04 ST04 ST07 ST03 ST05 TH17 ST18 LI02 .743 .527 .500 .365 .338 .257 .216 .203 .135 .122 ( 8 references, 25 possible points, max possible score .925)
The CVA (aphasia) and Head (optic area paralysis) examples show the necessity of specific (as well as general) searches of the database. Where it is possible, one should search the database for general region (neck area, thoracic back, lumbar area etc), specific region (shoulder, hip, knee, etc), specific nerve (where applicable, e.g. radial, sciatic). Where specific symptoms are marked, they should be searched (e.g. insomnia, dysmenorrhoea, polyuria etc).
The data base covers >1100 headings. Only a few are given here, mainly relating to neck, back, associated parts and common symptoms. Appendix 2 covers the parts and Appendix 3 the symptoms.
The data base has 452 headings under abdomen/functions/organs/symptoms. The major headings are listed below.
06---- ABDOMEN AND BACK, ITS ORGANS AND FUNCTIONS 0601-- ABDOMEN GENERAL 060101 ABDOMEN: GENERAL POINTS FOR ABDOMEN AREA AND ORGANS 060102 ABDOMEN: APA FOR SURGERY OF ABDOMEN AREA AND ORGANS 0602-- THORACOLUMBAR SPINE AND AREA 060201 BACK, POSTERIOR TRUNK: GENERAL POINTS 060202 THORACOLUMBAR: (AREA, SPINE AND SPINAL CORD) GENERAL POINTS 0603-- LIVER (INFLAMMATION, CALCULI, JAUNDICE, ACETONAEMIA ETC) 060301 LIVER: GENERAL POINTS 060302 LIVER: HEPATITIS; PAIN 0604-- SPLEEN 060401 SPLEEN: GENERAL POINTS 060402 SPLEEN: (AREA) APA FOR SURGERY OF 0605-- GASTROINTESTINAL TRACT: GENERAL SYMPTOMS 060501 STOMACH, INTESTINE AND GASTROINTESTINAL FUNCTION: GENERAL POINTS 060502 MALABSORPTION: WEIGHT LOSS**XS; EMACIATION etc 0606-- STOMACH AND DUODENUM 060601 STOMACH: GENERAL POINTS 060602 STOMACH: (AREA) APA FOR SURGERY OF 0607-- SMALL INTESTINE, APPENDIX, CAECUM, COLON, RECTUM 060701 INTESTINE: GENERAL POINTS 060702 INTESTINE: OBSTRUCTION; P-AIN; VOLVULUS; PAIN##ADHESIONS 0608-- UROGENITAL (GENERAL CONDITI-ONS) 060801 URINARY-GENITAL FUNCTION: GENERAL POINTS 060802 URINARY-GENITAL FUNCTION: PAIN OR PAIN REFERRED FROM 0609-- URINARY TRACT AND FUNCTIONS 060901 URINARY TRACT: GENERAL POINTS FOR URINARY TRACT FUNCTION 060902 URINARY TRACT: (AREA) APA FOR SURGERY OF 0610-- GENITALIA FEMALE AND REPRODUCTION 061001 GENITAL-IA, FEMALE: GENERAL POINTS 061002 GENITALIA, FEMALE & MALE: PAIN; NEUR-ALGIA; SENSATION**BURNING etc 0611-- PREGNANCY 061101 PREGNANCY: FORBIDDEN POINTS; MAY INDUCE MISCARRIAGE 061102 PREGNANCY: MORNING SICKNESS; NAUSEA; VOMITING; FAINT 0612-- MAMMARY FEMALE 061201 BREAST, MAMMARY GLAND, NIPPLE: GENERAL POINTS 061202 MAMMARY GLAND, NIPPLE: APA FOR MASTECTOMY OR COSMETIC SURGERY 0613-- MENSTRUAL CYCLE, CONTRACEPTION 061301 REPRODUCTIVE FUNCTION & GENITALIA (FEMALE): MENSTRUAL DISORDE-RS e-tc 061302 MENSTRUATION: PSYCHOGENIC UPSETS DUE TO; PREMENSTRUAL SYNDROME 0614-- REPRODUCTION MALE (IMPOTENCE, SPERMATORRHOEA ETC ) 061401 REPRODUCT-IVE FUNCTION & GENITALIA (MALE): GENITAL PROBLEMS etc 061402 ERECTION: POOR OR ABSENT; IMPOTENCE; PREMATURE EJACULATION etc 0615-- GENITALIA MALE 061501 GENITALIA, MALE: (REPRODUCTIVE FUNCTION) GENERAL POINTS 061502 GENITALIA: (AREA) APA FOR SURGERY OF
CHOICE OF POINTS IN AP THERAPY
The points for treatment depend on the organs and parts involved. In classical AP, there are many Laws or guides to the choice of points. An examination of most of the listings in Appendices 2 and 3 shows that the Top Ten points obey the basic laws of choosing AP points. In summary, these laws suggest a choice of points from:
a. AhShi points (including Trigger Points, tender scars, fibrositic nodules etc)
b. Local points (which also meet condition (d)).
c. Distant points on the Channel through the affected area or on the Channel of the affected organ. A chain of points on the affected Channel is said to be specially powerful.
d. Points on the affected nerve, the nerve supply related to the affected organ or area, or in the same or a nearby spinal nerve segment.
e. Encircling the problem area; "Fore and Aft" points; combination of Yin side and Yang side points (medial/lateral; anterior/posterior).
f. Combination of Mu and Shu (Front Alarm + Back Association) points.
g. Combination of affected Yuan and Luo of Mate (Source Point of the affected Channel plus Passage point of its Phase-Mate Channel (LU-LI; ST-SP; HT-SI; BL-KI; PC-TH; GB-LV).
h. Xi-Cleft point of affected Channel.
i. One or more of the Five Phase Points (Energetic balancing points).
j. Symptomatic points (traditionally known to have marked effect for the specific symptoms, for example, GV26 in shock, emergencies; PC06 in nausea or vomiting).
k. Extra-Channel points ("New" or "Strange" points, points not on the Main Channels), especially those effective for the condition, e.g. NX04 (TingChuan) in asthma.
l. Points on the Phase-Mate of the affected Channel (e.g.) ST points in spleen diseases; SP points in stomach diseases.
m. TianYing point (OT02, centre of the goitre etc).
n. One point on each of the 4 limbs (e.g. LI04 and ST44, both bilateral, in tonsillitis or toothache).
Let us examine the top ten points for some of the prescriptions in the database (Appendices 2 and 3) in detail, under 3 categories:
1. Local areas or regions
2. Conditions of specific organs or their functions
3. Generalised conditions and complex syndromes.
In each of the following prescriptions, codes (a)-(n) above are used to show the Laws observed by the "Top Ten" points in the database.
1. LOCAL AREAS OR REGIONS (Examples from Appendix 2).
NECK: GB20 (b); GV14 (b); LI04 (c, g, i); BL10 (b); SI03 (c, i, j); LI11 (c, i, j); OT01 (TP, a); GB21 (b, c, depending on site of pain); GB39 (c, j); SI15 (b). Combination GB20,21, BL10, GV14, SI15 also meets Law (e). 5/10 of the points are LOCAL.
SHOULDER AREA: LI15 (b, j); LI11 (c, i, j); TH14 (b, j); SI11 (b); SI09 (b); LI04 (e.g.j); OT01 (TP, a); SI10 (b); OT05 (Local points, b); BL11 (d, j). Combination of SI09, LI15 and a New Point 1" above the anterior axillary crease is known as the "Shoulder Triplet" (e). That is a powerful combination in shoulder pain. 6/10 points are LOCAL.
ELBOW: LI11 (b, i, j); TH05 (c, j); LI04 (c, g, i); HT03 (b, i); LU05 (b, i); LI10 (b); OT01 (TP, a); LI12 (b); TH10 (b); SI07 (c). 6/10 points are LOCAL.
THORACIC SPINE, BACK AREA: GV14 (b); BL40 (c); OT01 (TP, a); GV12 (b); OT05 (Local points, b); GV13 (b); X 35 (b, k); GV09 (b); BL60 (c); OT06 (c). 6/10 points are LOCAL.
DORSOLUMBAR SPINE AND AREA: BL40 (c, j); BL23 (b, j); X 35 (b); BL60 (c); OT01 (TP, a); BL37 (c); GB30 (c- via BL link); GV14 (b, c); OT05 (Local points, b); OT06 (c). 4/10 points are LOCAL (2 out of the first 3).
LOWBACK: BL23 (b, j); BL40 (c, i, j); GB30 (c- linked to lowback via BL Channel, d, j); BL60 (c, i, j); GB34 (c- via BL link-, i, j); BL25(b); BL37 (c); GV04 (b); BL57 (c); BL31 (b). 4/10 points are LOCAL.
COCCYGEAL AREA: BL34 (b); BL40 (c, j); SI06 (g, j); BL30 (b); OT01 (TP, a); BL37 (b); X 35 (b, k); OT05 (Local points, b); OT06 (c); BL35 (b). 6/10 points are LOCAL.
HIP: GB30 (b, j); GB34 (c, i, j); GB29 (b); GB31 (c); BL40 (c- via GB30 link-, i, j); BL60 (c, i, j); OT01 (TP, a); GB39 (c, i, j); ST36 (d, i); LV08 (g). Although only 2/10 points are LOCAL, 2 of the top 3 are LOCAL.
THIGH, FEMUR: GB30 (b, j); GB31(b); GB34 (c, j); LV08 (c); ST36 (c); BL23 (j); LV11 (b); BL40 (b, c); BL37 (b); SP06 (c, l). 5/10 points are LOCAL.
KNEE AND POPLITEAL AREA: GB34 (b, i, j); BL40 (b, i, j); L 16 (b, k); ST35 (b); SP09 (b); ST36 (b, c, i); ST34 (b); LV08 (c); OT01 (TP, a). 9/10 points are LOCAL. The first 5 points are the most commonly used and obey Law (e).
In most local problems (joint, muscle, superficial organ etc), as in the 10 examples above, the best prescription combines TPs plus LOCAL points plus DISTANT points on the affected or related Channel. It is important to check the location as regards the nerve supply and the Channel. The best points for the anterior of the shoulder may not be the best ones for the posterior of the shoulder. Furthermore, some local points are more often recommended than others.
2. CONDITIONS OF SPECIFIC ORGANS OR THEIR FUNCTIONS (Examples from Appendix 2).
PLEURA: 7/10 points (BL13,42,43,47, KI22,23, GB32) are on the thorax or dorsal/paravertebral area (e.g. are LOCAL points). Two of the other 3 (ST12, BL11) are at the thoracic inlet and one (GB44) obeys Law (c).
HEART, PERICARDIUM: Only 3 of the top 10 (BL14,15, CV17) are over or near the organs. They obey Laws (b, d, e, f). Six more (PC04,05,06,07, HT05,07) are on the PC or HT Channel (Laws c, i, j). The 10th point (ST36) is a master point, with many functions, including effects on PC and HT.
COUGH, GENERAL: 5 of the top 10 points (BL12,13, CV17,22, GV12) are over the thorax, trachea or dorsal paravertebral area. They obey Laws b, d, e, f, j. Three points (LU05,07,10) are on the LU (lung) Channel (Laws c, i). The last two points (ST40, GV14) obey Laws c, i.
LIVER PROBLEMS: 6/10 points (BL18,19,20,48, GV09 LV13) are over or near the liver. They obey Laws b, d, e, f, j. The other four (LV03, ST36, GB34, SP06) are master points. They obey Laws c, g, i, j.
FEMALE GENITALIA/REPRODUCTION: 6/10 points (CV03,04,06, GV04, GB26, BL32) are in the lumbosacral innervation area (low abdominal or lumbosacral paravertebral area). They obey Laws b, d, e, j. The other 4 points (SP06,10, LV03, ST36) are master points, with major effects on the low abdomen and its functions. They obey Laws c, i, j.
In disease of internal organs, the most important points lie near the organ. The paravertebral points (Shu and X 35), local GV points, the abdominal Mu points and local CV points are the most important. If the organ has a named Channel (LU, LI, ST, SP, HT, SI, BL, KI, PC, GB, LV), one or more local and distant points on that Channel are included. In genital and lower abdominal conditions, distant points on LV, KI, SP Channels can be added, as these Channels pass the inner thighs and the groin area.
If the organ or function has no named Channel, points can be chosen from combinations relating to the nearest Organs/Channels. For example, if there were no data for Thymus, Appendix, Oesophagus, Adrenal etc, one could construct combinations of points:
Thymus, oesophagus: points for heart, lungs, stomach (nearest organs) and immunity (a thymus-related function).
Appendix: points for lower right abdomen, large intestine, immunity.
Ovary, tubes, uterus: points for kidney, bladder, low abdomen, large intestine etc.
Vagina, vulva, scrotum, testicles, penis: points for low belly. Also, the 3 YIN Channels of the feet (SP, KI, LV) pass near the groin- use distant points on them.
3. GENERALISED CONDITIONS AND COMPLEX SYNDROMES
Generalised conditions include metabolic, hormonal, toxic, autonomic upsets (as in gout, diabetes, food poisoning, shock, neurasthenia etc). Although one symptom may be dominant, it is usual for a number of signs or symptoms to occur together. For example, in gout, the presenting symptom may by PAIN IN THE BIG TOE, but on examination, liver enlargement, headaches, irritability, blurred vision, tiredness etc may be present also. The comprehensive treatment would entail advice on diet (possibly involving food allergy/intolerance tests), alcohol and fluid intake. AP would be aimed at the more severe symptom (say toe pain) but the prescription should also help the other symptoms.The LIVER is central in gout and many allergies. Treating LV and GB points (LV03,14, GB34, BL18,19, GB14,20) would help ALL the symptoms.
Neurasthenic patients often complain of backache. Their symptoms may include depression, headache, generalised aches and pains, insomnia, weakness etc. The PC and HT Channels control the spirit, in Chinese belief. Symptoms of neurasthenia can be helped by LOCAL points plus PC/HT points (HT07, PC06, BL14,15) and general points like ST36, LV03, LI04.
In treating complex cases, choose point combinations which influence all the major symptoms and the affected organs. If symptoms or signs can be traced to a Channel function, treat that Organ/Channel. In complex cases other methods (conventional medicine, homoeopathy etc) may be needed also.
Analysis of the entire database for all parts and functions shows that certain points are very commonly cited. They are:
LI04,11, ST25,36, SP06, HT07, BL23,40, PC06, TH05, GB20,34, LV03, CV06,12, GV04,12,14,26. These are Master Points in traditional AP. In complex cases, if one has difficulty in selecting points, it may help to include a few points from the master list.
Example of syndrome related to scar tissue/Channel block
Beginning 2 years after right pulmonectomy, the following symptoms occurred intermittently, or in combinations, over a 6-year period:
recurrent haemorrhagic nephritis and cystitis (BL, KI)
right-sided sciatica (BL)
right-sided paravertebral pain (C6-T4) (BL)
right-sided headache (BL)
right-sided bouts of acute conjunctivitis (BL)
right-ear tinnitus (SI)
waking up at night with right arm in spasm and severe pain along SI Channel to the 5th finger (SI)
Cookbook prescriptions would have been as futile as western medicine in that case. All symptoms related to BL Channel or the Channels upstream (SI) or downstream (KI) from BL in the Channel circuit. All were right-sided, except (possibly) the nephritis/cystitis. There was an obvious connection. The thoracotomy scar was badly twisted, with adhesions on the right BL line. Blockage of "Channel energy" flow in the BL channel could be related to the signs. In western terms, reflex irritation effects could be involved. Treatment was procaine injection of the adhesed part of the scar plus a few sessions of AP on BL points, plus physiotherapy. All symptoms were successfully cleared and did not recur. Cookbooks have their limitations! But cookbook recipes must include TP- (and scar-) therapy.
POSTOPERATIVE PAIN
Janssens (see Rogers 1987) reported that AP has controlled pain in dogs which did not respond to surgery for disc disease. He has also used AP successfully to control pain and other complications arising after abdominal and other surgery. Papers by Russian workers, in press to Scandinavian J. Acup., confirm that AP has similar effects in humans.
Points used in post-operative pain/complications are chosen by the same principles as any other AP point combinations. In addition, one may run long needles subcutaneously, parallel to the wound.
CONCLUSIONS
In practice, it is difficult to make a specific diagnosis of the cause of backpain, due to the difficulty of routine X-ray, myelography and other tests. Many patients presenting with backpain also have other signs or symptoms. One aims to help the patient towards self-healing, not to "heal the backpain". The general practitioner may be satisfied with clinical remission.
Palpation of the muscles, to locate TPs is an essential part of the clinical examination.
The combination of TPs, GB20,21, GV14, BL10, SI15 covers most neck pain. LI04,11, SI03, ST38 (or GB34) are useful distant points.
The combination of TPs, GV09,12,13,14, X 35 covers most thoracic backpain. Local BL points can be used instead of GV points. BL40,60 are useful distant points.
The combination of TPs, GV04, BL23,25,31, covers most backpain below the ribs, including radiating sciatic pain. BL37,40,60, GB30,34 are useful distant points.
The most common combination of points is: all TPs, plus 1-2 LOCAL points (near the affected organ or part). If an organ is thought to be involved, its Shu point is used, whether tender or not. To this can be added the Mu (abdominal alarm) point. This includes the use of Shu points in superficial problems which may not have direct organic involvement. For example, BL13 and 25 (Shu points for the LU and LI Channels) as part of a prescription to help resolve pain of an inside-forearm pain (in the Channel area of LU and LI). Similarly, BL23,28 (Shu of KI and BL) would be indicated in Achilles/heel pain (Channel area of KI and BL). One or two DISTANT points on a Channel passing through or near the problem area, on the Channel of the affected organ, or a CHAIN of points along an affected Channel or nerve are also helpful.
Many point combinations are possible. Points with special or general action may be considered. Useful points are:
Neck GB34, LU07
Thoracic limb LI04,11,15, TH05,15, GB21
Spinal column BL16
Lumbosacral and pelvic limb BL21,23,40,60, GB30,34, ST36
Muscles, tendons TH15, GB34, BL19,20
Bones, joints BL11,23
General effects LI04, ST36, BL23
Immunostimulation LI04,11, GV14, ST36
Lung BL13,43
Liver BL18, GV09
Stomach, appetite BL21, ST36
Hind gut BL25,30
Adrenal, stress conditions, urogenital, bones BL23,52, GV04
There are other methods of point selection (Earpoints, Face points etc) but these methods are not as well documented as bodypoint AP. They must be regarded as experimental until adequate documentation and comparative clinical trials are available.
Meanwhile, the database method gives points very similar to those which traditional AP would suggest. The computer has merely re-invented the wheel.
The use of other physiotherapies (massage, ultrasound, LASER etc) on the points (between sessions) helps to ensure high success rates.
ACKNOWLEDGEMENTS
I thank Dr. Pekka Pontinen, Tampere, Finland and the organisers of the Nordic Acupuncture Congress for financing my trip to the Congress.
REFERENCES
ANON (1974) The Barefoot Doctor's Manual. Running Press, Philadelphia. 948 pp.
ANON (1975) Newest Illustrations of the AP points. (Charts and booklet). Medicine and Health Publishers, Hong Kong.
ANON (1980) The Essentials of Chinese AP. College of Trad. Chin. Med., Beijing, Shanghai, Nanking. Foreign Languages Press, Beijing. 422 pp. Reissued 1993: Essentials of Chinese AP. (Coll. TCM, Beijing, Shanghai, Nanking) Foreign Languages Press, Beijing 432pp.
CHUNG, C. (1983) The Ah Shih Point. Chen Kwan Books, 5-2 1-F Chung Ching South Road, Section 3, Taipei, Taiwan, R.O.C. 212 pp.
PONTINEN, P. (1982) AP Seminar for Swedish Physicians. Contact AP and Pain Research Dept., University of Tampere, Finland.
ROGERS, P.A.M. (1984a) Computer applications in the study and clinical use of AP. IVAS Annual Congress, Austin, Texas. 13pp.
ROGERS, P.A.M. (1984b) Traditional versus Cookbook AP. Ibid 40 pp.
ROGERS, P.A.M. (1987) Treatment of backpain in the horse and dog by AP. Nordic Acupuncture Congress, Oslo, Norway, September 1987.
TRAVELL, J.G. & SIMONS, D.G. (1984) Myofascial pain & dysfunction: the TP manual. Part 1. Williams & Wilkins, London & Baltimore, 713pp.
TRIGGER POINT THERAPY: Symposium on myofascial TPs (1981) Arch. Rehabilitation Med., March, 97-117; Dorrigo et al (1979) Pain, 6, 183-; Kajdos (1974) Amer. J. Acup., 2, 113-.; Kellgren (1939-42) Clinical Sci., 4, 35-; Khoe (1979) Amer. J. Acup., 7, 15-; Lewit (1979) Pain, 6, 83-.; Melzack et al (1977) Pain, 3, 3-.; Macdonald (1983) Annals of Royal Coll. Surg. Eng., 65, 44-,; Rogers, C. (1982) Amer. J. Acup., 10, 201-.
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