Advanced Needling 2 Spring 2009 www.CatsTCMNotes.com Page 1 of 17 Course: Advanced Needling 2Date: J une 2009 Doc: Quiz 2 Study Sheet This Study Guide covers classes 5, 6, and 7. Topics covered are Dr. Tans Balance Method, Dr. Tans Five systems and Master Tong technique and points. Dr. Tans Balance Method Basics Upon what is Dr. Tans method based?TCM meridian theory and the contralateral needling principles of the Neijing. What are the best clinical applications for this method?Mostly for many types of pain and pain-like sensations (numb, tingle, itch, burn, cramp, etc.), but can also be used for some internal diseases and skin diseases. What are the 5 basic steps you employ in a Dr. Tan type treatment?1.Diagnosis of the sick meridian 2.Choose one of the five systems to pick the meridian to be needled 3.Choose Mirror/Reverse Mirror (for limb problems) or Imaging Format (for trunk problems) 4.Palpate chosen area for tenderness and ashi points. 5.Needle How long are the needles retained and how often do you stimulate the needles?Retention is 45 90 minutes, at least 1 stimulation The Five Systems Know the systems by the numbers rather than by the names.In each system, you first identify the sick meridian and then pair it with the meridian you wish to treat. The systems help you pick this meridian and each system has a formula you use to determine the right one. System 1 Chinese Anatomical Imaging Pairs channels of the same Chinese name Yin treats yin and yang treats yang. Hand treats foot, foot treats hand Needle contralateral side. Example:Hand Taiyang to Foot Taiyang, contralateral. Advanced Needling 2 Spring 2009 www.CatsTCMNotes.com Page 2 of 17 System 2 Branching Channel Uses Chinese channel names so that Water treatsFire and vice versa like so Yang treats Yin and vice versa Hand treats Foot and vice versa Can needle either side, but if condition is one sided, needle affected side. System 3 Interior/Exterior Relationship Interior/Exterior related channels,i.e., LU to LI, KI to BL. Yang treats Yin and vice versa Hand treats Hand, Foot treats Foot Needle contralaterally Yang/FireYin/Water TaiyangTaiyin ShaoyangShaoyin YangmingJ ueyin Example:Hand Shaoyang to Foot Shaoyin, either side. Example: Problem on the ST channel (Foot Yangming) would be treated by the Spleen (Foot Taiyin) Advanced Needling 2 Spring 2009 www.CatsTCMNotes.com Page 3 of 17 System 4 Chinese Clock/Opposites Meridian selection based on the Chinese clockwhich follows the flow of the channels (hand taiyinhand yangming, etc) Use the channel opposite the diseased meridianon the clock. Remember that Gallbladder is midnight, Heart is noon. You can figure out the rest from there based on the flow of the channels. Yang treats Yin and vice versa. Hand treats Foot and vice versa. Needle contralateral or same side (ipsilateral) depending on where tenderness is. System 5 Chinese Clock/Neighbor Use the channel next to the diseased meridian on the clock. Yin treats Yin, Yang treats Yang. Foot treats Hand and vice versa. Needle contralateral side. Quick System Comparison chart Look at the patterns below. Its pretty easy this way SystemYang?Upper/lowerWhich side System 1 i.e. ShaoyinShaoyin Yin YinHandFootContralateral System 2 i.e., Shaoyang Shaoyin YangYinHandFootSame side or either side System 3 i.e., Internal channelExternal channel YangYinHandHandContralateral System 4 Clock opposites YangYinHandFootContralateral or either side System 5 Clock neighbors YinYinHandFootContralateral Example:KI channel prob (foot)LI channel (hand), either side depending on tenderness.Example:Liver channel problemLung channel (not gallbladder!) on contralateral side. Advanced Needling 2 Spring 2009 www.CatsTCMNotes.com Page 4 of 17 Mirroring and Reverse Mirroring Mirroring/Reverse Mirroring treats problems on the limbs.Elbows and knees are pivot points for mirroring. Note that in all of the five systems, with the exception of System 3, upper limbs treat lower limbs and vice versa. Mirroring Like to like on the upper and lower limbs: fingers to toes, wrists to ankles, upper arm to thigh, etc. FingerToe HandFoot WristAnkle ForearmLower Leg ElbowKnee Upper ArmThigh ShoulderHip Reverse Mirroring Still upper limb to lower limb, but spin one of em around using the knee or elbow as a pivot point so that you are matching the finger to the top of the hip, elbow to knee, shoulder to ankle, etc. FingerTop of hip HandHip WristHip joint ForearmThigh ElbowKnee Upper ArmLower leg ShoulderAnkle Advanced Needling 2 Spring 2009 www.CatsTCMNotes.com Page 5 of 17 Imaging Format Choose imaging for problems affecting the head and trunk. Imaging matches the area of sickness on the head/trunk onto the four limbs of the body. (Actually, imaging can be done anywhere auricular acupuncture is an example of imaging) Points on the limbs that reflect the sick portion of the head/trunk will often be tender, weak or tight.Overlay a leg or arm on the trunk from perineum to top of head with the elbow or knee at the umbilicus/L2 area.Like mirroring, there is imaging and reverse imaging.J oints match up to joints. For example: wrist/ankle matches up to sacral area in imaging or neck/neck joints in reverse imaging. Imaging Sick areaNeedled area Testicle/anusFinger/toe Genitals/coccyx/sacrumHand/foot Bladder/lumbo-sacralWrist/ankle Lower ab/lower backForearm/lower leg Umbilicus/L2Elbow/knee Upper ab/rib cage/chest or mid to upper back Upper arm/upper leg Neck, jaw, base of skullShoulder/hip joint Top of headTop of shoulder/top of hip Reverse Imaging Sick areaNeedled area Top of the headFinger/toe Head/base of skullHand/foot Neck/neck jointWrist/ankle Upper ab, rib cage, chest, mid/upper back Forearm/lower leg Umbilicus/L2Elbow/knee Lower ab/lower backUpper arm/upper leg Genitals, coccyx, sacrumShoulder/hip joint Testicles, anusTop of shoulder/top of hip Advanced Needling 2 Spring 2009 www.CatsTCMNotes.com Page 6 of 17 Master Tongs Orthodox Acupuncture Uses 12 principle areas rather than 12 meridians, numbered to match parts of the body.Know these! Body area pointsNumber Finger points11 Palm/dorsal hand22 Forearm33 Arm44 Sole of foot55 Dorsal foot66 Leg77 Thigh88 Ear99 Head/Face1010 BackDT Chest/AbdomenVT DT stands for Dorsal Trunk VT stands for Ventral Trunk Some characteristics to know about the use and theory Tong Points: Tong techniques use very strong stimulation. Analogous Correspondence Like tissue treats like tissue treat the bone for bone problems with strong stimulation, muscle for muscle problems. Holographic Correspondence Kind of like imaging theory or principles behind auricular acupuncture using the ear as a hologram for the whole body. Example: Picture a sitting Buddha superimposed over the face for instance with the top of his head at the top of the face and the sitting part at the mouth/chin area. 1010.19 and 1010.20 for instance just below the mouth are the reflex area of Kidney and treat lower back problems and asthma due to Kidney not grasping Qi. Da Mao Needling Method Many identified points are actually sets of multiple points (i.e. Mu is actually a 2 point combination, often referred to as wood anger by Tong-iansby the Tong-ese?) These combinations give greater punch to the effect. Many points use between 2 and 4 needles. This is from the Nei jing. Advanced Needling 2 Spring 2009 www.CatsTCMNotes.com Page 7 of 17 Activating Qi or De Qi method Contralateral insertion plus movement of the affected area to move or activate the Qi. Inducing Qi or Chien Yin method Contralateral insertion plus same-side (ipsilateral) distal needling at the Shu Stream point to guide the Qi. Distal Bloodletting Master Tong techniques use it not just distally, but all over, often combined with cupping.This is referred to as treatment of vascular pathology as blood stagnation induces many ailments. This may not shake out like you think, by the wayyou can use bleeding on the back in the Tong system to treat knee problems! There are 7 lines on the back: the two UB lines, the two J iaji lines, and the Du line. Some of the points (like Liver 2 and 3) in the Tong system may be slightly different than you learned them in Point Locations. The original Master Tong system does not focus on tonifying or reducingthough some of the disciples of Tong do add this. Different depths give different effects(i.e., 77.18 at cun =SP, 1 cun =KI) Slightly funky matching of collaterals: LungBladder SpleenSmall Intestine HeartGallbladder KidneySan J iao Pericardium Stomach Advanced Needling 2 Spring 2009 www.CatsTCMNotes.com Page 8 of 17 30 Most Common Master Tong Points Know the point number (not the name), what indications the point has, and the imaging principles as to why that point is for that indication. Finger Points 11.06 Location: center of ulnar aspect of ring finger.Indications:oGynecology: Uterine pain, tumors Irregular menstruation Leucorrhea with redish cast Fallopian tube blockageRetroversion of uterus Vaginal swelling Frequent miscarriage 11.24 Location: 2 points ulnar margin of thumb. Divide proximal phalanx into 3 equal parts, points lie on dividing lines.Indications: oGynecology: Uteritis Pain (ac or chron) of uterus Hysteroma Female sterility Irregular menses, dysmenorrhea, menorrhea, scanty menses oOther:Distention of lower abdomen 11.17 (this is the Mu or Wood anger point) Location: 2 points on ulnar aspect of index finger. Divide proximal phalanx into 3 equal parts, points lie on dividing lines. (Draw a tic-tac-toe board. Insert on the crossings on theulnar side.) Indications:oLiver stuff Hyperactivity of Liver fire Irritability (Used clinically for almost any emotional instability) Advanced Needling 2 Spring 2009 www.CatsTCMNotes.com Page 9 of 17 11.27 Five Tigers Location: 5 points on the radial border of the thumb. Divide the proximal phalanx in half to find the mid point. Then find the and marks. The other two lie inbetween. Indications: oBone swelling and pain of the whole body.Point 1 is for hands Point 2 is for assistant for 1 and 3 Point 3 is for toes Point 4 is for dorsal ankle Point 5 is for heel o1, 3 and 5 are most often used. Hand Points 22.01 Location:In thenar area, about 1 cun from skin fold, between 1st and 2nd MCs. You can use the edge of the index finger, draw a linestraight down, measure 1 cun from that skin fold. This isthe flip side of Ling Gu, 22.05.Indications: oBack Pain oRespiratory: Pneumonia (great point) Common cold Cough Asthma (great for kids with asthma) 22.02 Location: At the joint between 1st and 2nd MCs, about 1 cun distal and parallel with the edge of the 1st MC from 22.01.Flip side of Da Bai, 22.04.Indications oHigh fever oPneumonia oPain Knee Pain Back Pain Advanced Needling 2 Spring 2009 www.CatsTCMNotes.com Page 10 of 17 22.04 Da Bai Location: 1.2 cun distal to the bony junction of the 1st and 2nd MCs.Indications: oAsthma in childhood (use blood letting) oHigh fever (most effective) oSciatica due to Lung xu. 22.05 Ling Gu Location: At bony junction of 1st and 2nd MCs, can deep insert through to 22.02 Indications oPain Sciatica, Lumbago Leg pain Migraine oHearing problems Tinnitus Hearing impairment oParalysis Bells Palsy Hemiplegia oGynecological Hyper or oligo-menorrhea Amenorrhea Difficult delivery Polyuria Advanced Needling 2 Spring 2009 www.CatsTCMNotes.com Page 11 of 17 Lower Arm Points 33.10 intestine gate Location: 3 cun proximal to pisiform bone on medial side of ulna.Right on the edge of the bone.Indications: oLiver stuff: Enteritis caused by hepatitis Dizziness Blurred vision 33.11 liver gate Location: 6 cun proximal to pisiform bone on medial side of ulna.Right on the edge of the bone. Indications: oVery effective for acute hepatitis! 33.12 heart gate Location: 1.5 cun distal to the olecranon on the medial side of the ulna Right on the edge of the bone.Indications: oHeart stuff: Carditis Palpitations Chest oppression oDry heaves/dry vomiting oInguinal region pain Insert +movement plus Shu point of Liver (LV3) on affected side. Advanced Needling 2 Spring 2009 www.CatsTCMNotes.com Page 12 of 17 Upper Arm Points 44.06 Location: Center of deltoid muscle, center lateral aspect of arm.Indications: oPain Knee: most effective - contralateral insert Shoulder: contralateral insert oSkin disorders, esp of neck oParalysis Hemiplegia Poliomyelitis and infantile paralysis oArteriosclerosis oEpistaxis Dorsal Foot Points 66.05 Location: 2 cun proximal to the webbing between 2nd and 3rd toes. J ust prox to ST 432 cun prox from ST 44. Indications: oStomach/Intestine stuff: Enteritis Gastritis Abdominal pain (combine with Ling gu) Dysentery Appendicitis Rectal prolapse oMenstrual cramps oTemporal migraine oNasal congestion 66.06 Location: 1.5 cun proximal to the webbing between 3rd and 4th toes.Single point treatment! Indications: oSplenomegaly oLiver disease oCholecystitis oPoliomyelitis oLeukemia oIndigestion oFatigue Advanced Needling 2 Spring 2009 www.CatsTCMNotes.com Page 13 of 17 66.07 Location: 1 cun proximal to the webbing between the 3rd and 4th toes Indications: Same as above minus leukemia oSplenomegaly oLiver disease oCholecystitis oPoliomyelitis oIndigestion oFatigue 66.10 Location: 1.5 cun proximal to the medial side of 1st MTP Single point treatment! Preggers contraindication! Indications: oDizziness/Vertigo oPalpitations oHeart weakness due to hypertension Lower Leg Points 77.01 Location: On Achilles tendon 3.5 cun directly above heel. Right between 2 malleoli. Relax the tendon first, use a 2 cun needle,touch the bone.Indications: oNeck and back Pain:Spinal pain Lumbago Neck pain (herniated disc, spinal stenosis) Occiput pain oHydroencephalus 77.02 Location: 2 cun above 77.01 or 5.5 cun above the heel.Indications: oSame as 77.01, combine with this point for best effect. Advanced Needling 2 Spring 2009 www.CatsTCMNotes.com Page 14 of 17 77.09 middle four flowers Location: 4.5 cun distal to ST 36.Indications: oInsert 2 3 cun for these:Asthma Opthalmalgia oBlood let for these:Carditis Arteriosclerosis Chest oppression/restlessness Acute stomach ache Bony swelling The lower 3 emperors are:Heaven is SP 9 and then 77.18 is 1.5 cun below the assistant to heaven.Earth point SP 7.5 Human - 77.21=SP 6 77.17 heavenly emperor Location: J ust below medial condyle of tibia.No moxa, no preggers!Indications: oStomach Hyperchlorhydria (excess stomach acid) Esophageal reflux oKidney Glomerulonephritis Diabetes 77.18 kidney gate Location: 1.5 cun below 77.17 Indications: oStomach Hyperchlorhydria (excess stomach acid) Esophageal reflux oEyes Squinting Astigmatism oAnemia oIdiopathic epilepsy oHysteria oFrontal headache Advanced Needling 2 Spring 2009 www.CatsTCMNotes.com Page 15 of 17 oNasal pain oVertigo 77.19 Earth emperor Location: 7 cun proximal to medial malleolus beside medial border tibia.Not for preggers! Indications: oEdema oGlomerulonephritis oDiabetes oEarly ejaculation oImpotence oGonorrhea oHematuria oUterine myoma oLumbago due to KI xu 77.21 Human Emperor Location: 4 cun below 77.19 (3 cun above medial malleolus) on medial posterior border of tibia.Basically, SP 6 Not for preggers! Indications: oGonorrhea oImpotence oEarly ejaculation oLumbago oHand numbness due to diabetes oDizziness oAcute neck pain 77.22 Location: 1.5 cun lateral to ST 36 on a horizontal line.Indications: oToothache due to gingivitis oFacial nerve palsy 77.23 Location: 2 points first one is 2 cun below 77.22, 2nd one is 2 cun below that.Indications: oSame as 77.22. Advanced Needling 2 Spring 2009 www.CatsTCMNotes.com Page 16 of 17 Thigh Points Use only these 3 in one leg. And only pick one or two for treatment.Use one point each leg to tx hypertension. 88.01Location: Midline of the anterior thigh, 5 cun superior to upper border of the patella.Indications: oHeart stuff Heart disease Coronary disease Acute pericarditis Cardiac rheumatism Palpitations oFloaters in vision oStomach ache oCerebral ischemia 88.02 Location: Midline of the anterior thigh, 2 cun above 88.01 (7 cun superior to upper border of the patella). Indications: oSame as 88.01 88.03 Location: Midline of the anterior thigh, 4 cun above 88.01 (9 cun superior to upper border of the patella). Indications: oSame as 88.01 Advanced Needling 2 Spring 2009 www.CatsTCMNotes.com Page 17 of 17 Face Points 1010.19 Location: 0.4 cun directly below corner of the mouth.Indications: oFibromyalgia and CFS due to KI xu oVertigo oBlurred vision oLumbago, low back sprain/strain due to Qi blockage 1010.20 Location: 0.5 cun medial to 1010.19.Indications: Same as above plus asthma/cough oFibromyalgia and CFS due to KI xu oVertigo oBlurred vision oLumbago, low back sprain/strain due to Qi blockage oAsthma, cough