STEVEN  AUNG MEMORIAL PAGE
VITAL ENERGY ALIGNMENT PROCEDURES..Dr Steven  Aung

LASERS 96-97
A  summary of the World Congress on lasers. Dr  Roberta Chow

BEYOND ENDORPHINS
Neurochemical basis for Acupuncture ..................Dr  L. Soh

LUO POINTS & THEIR USES ..............Dr  Wellington Tan

CASE  PRESENTATIONS
1.Myocardial Infarction  presenting as musculo- skeletal pain ..............Dr  Charles Cassar
2.The 8 Extraordinary Vessels. .......Dr Paul Chai

Dr Steven  KH Aung is an amazing, gifted teacher and mentor to many  of the world's foremost acupuncturists. His knowledge of  traditional acupuncture is encyclopaedic and his ability  to communicate is legendary. This page is dedicated to  him.

VITAL  ENERGY ALIGNMENT PROCEDURES

Dr  Steven KH Aung

Vital energetic  alignment procedures deserve to be better known in  traditional Chinese medicine and in the discipline of  medical acupuncture, since these procedures have proven  clinically effective in certain difficult cases where the  flow of Qi remains blocked or stagnant for a considerable  period of time following a traumatic injury or major  surgery. The flow of Qi, of course, refers to the  circulation of vital energy throughout the whole human being-body, mind and spirit.

Post-traumatic  vital alignment (PVA) represents an application of Qi  Gong methods to acupuncture. Qi Gong is often referred to  as "acupuncture without needles," and in the  case of PVA it is appropriate to view acupuncture in  terms of "Qi Gong with needles." This serves to  highlight the essential holistic, energetic nature of  traditional Chinese medicine (TCM).

INDICATIONS

Although patients  experiencing post-traumatic syndrome appear to have fully  recovered from the initial acute trauma, their well-being  and quality of life are overshadowed by physical  disequilibrium as well as pervasive feelings of mental  and spiritual enervation and disembodiment. Such patients  are likely to benefit from PVA, the more specific  indications of which are delineated below.

Etiological  Factors

The key  etiological factor is the existence of a mild or severe  traumatic injury that may have resulted in the temporary  loss of consciousness. Major surgery is included as an  injury to the body, and in these cases consciousness has  also been lost through the use of anesthesia. Many PVA  patients have either been in a motor vehicle accident or  suffered a sports injury.

Signs

Physically, the  post-traumatic patient shows signs of lateralization,  notably a tilted head or a deviated walk toward the  affected side of the body. The neck and back muscles tend  to be tense and stiff on the non-injured side. Pupillary  reflex is generally slow, and the eyes are usually dull  and blurry. Psychologically, it is often readily apparent  that the patient cannot concentrate and is both anxious  and depressed.

Spiritually, the  patient manifests a notable degree of Shen attenuation or  emptiness. Shen is the spiritual energetic synthesis of  Essence and Qi, and it is active in each of the Yin  organs, residing in the Heart. It is the first thing the  physician looks for in carrying out the inspection phase  of the comprehensive TCM four-diagnosis. While most  visible in the liveliness and sparkle of the eyes, Shen  is also seen in the overall demeanor of a person:

Symptoms

Patients suffering  from post-traumatic syndrome report a variety of  symptoms, including chronic fatigue and weakness,  inability to concentrate, memory loss, vertigo, tinnitus,  diarrhea and headache as well as feelings of sadness,  fear, anxiety, irritability, non-groundedness,  non-centredness, disorientation and disembodiment. These  appear to be most pronounced in the early evening.

Neurasthenia or  clinical depression are the most common Western  biomedical diagnoses pertaining to the above etiology,  signs and symptoms. Post-traumatic syndrome is recognized  by some family physicians as one of several  "new" biopsychosocial disorders such as  premenstrual syndrome, chronic fatigue syndrome and  temporomandibular joint dysfunction syndrome.

The most widely  applicable TCM diagnosis is Kidney Qi/Yang Deficiency.  This TCM syndrome-when viewed in terms of a  post-traumatic condition-results from a person becoming  frightened or fearful due to the actual or impending  impact of powerful external forces, whether in the form  of an injury or surgery. Fear and fright have an adverse  effect on the Kidney, the source of an individual's  sexual and reproductive original vital energy (Yuan Qi).  This, in turn, may generate problems in the Urinary  Bladder and other organs/meridians.

CONTRA-INDICATIONS

PVA is not  indicated in cases of medical emergency or when the  patient is still in the acute phase of the injury or  surgery. It is also not indicated in the case of a  definite psychiatric disorder. Moreover, before  performing PVA therapy the physician must rule out  undiagnosed brain injury or tumour and any neurological  or structural damage.

PVA PROCEDURES

The six PVAs I  have developed over the past decade of clinical practice  centre around the Ren (Conception Vessel) and Du  (Governor Vessel) extra meridians, since these meridians  act as "information super highways" for the  convergence and regulation of Qi with respect to the 12  regular meridians. Ren controls the circulation of Qi  throughout the Yin meridians and Du performs the same  function for the Yang meridians. I have found that  acupoints located on Ren and Du are of value in bringing  post-traumatic patients back into alignment.

Alignment is not  merely a "mechanical" phenomenon, which is why  I have chosen to name four of the PVA procedures after  four of the seven chakras recognized in traditional  Ayurvedic medicine. Chakras are centers where physical,  mental and spiritual energy are synthesized. Chakras  coincide with TCM acupoints. EX.HN.3 (Yintang), for  example, the famous Third Eye of Eastern mysticism, which  is the primary point in all the PVA procedures, coincides  with the Ajna chakra. It is used in TCM to balance Shen  and in Ayurvedic medicine to awaken "one's own  divine self ... the True Self."

Table 1.  Acupoints Utilized in the PVA Procedures

Table 2.  Specific Indications of the PVA Procedures

CLINICAL  PROTOCOL

The PVA clinical  protocol encompasses the Crown, Vishuddhi, Mingmen,  Anahata, Manipura, and Muladhara vital energetic  alignments (see Table I and Figure). The eight-step  protocol. delineated below. is appropriate after  integrated TCM and biomedical diagnostic assessment has  found which side of the body remains out of alignment as  a result of the previous traumatic injury or surgery.

A positive  response is expected, but if the response is negative the  entire procedure may be repeated with or without the  addition of tertiary acupoints. The needles are retained  for 5-10 minutes.

The follow-up  framework I have found to be effective in sustaining  vital energetic alignment is PVA treatment once a week  for three weeks, then every second week for six weeks  and, finally, once a month for three months. Most  patients, however, do not need such intensive follow-up,  and in many cases one or two PVA treatments is all that  is required.

Dr  Steven KH Aung MD OMD PhD

9904  - 106 St, Edmonton, Alberta T5K 1C4, Canada
Tel  [403]426-2760. Fax [403]426-5650

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LASERS 1996-97
Dr  Roberta Chow

From the First World Congress of Low Power Laser Therapy held in  Jerusalem, Israel, May 5-9th, 1996.

Shalom . . . the ubiquitous Israeli phrase for hello and  goodbye.

When the  World Association of Laser Therapy (WALT)  Congress was being organised two years ago, peace  seemed to be coming at last to this part of the  world. It was regarded as symbolic that, when the  city of Jerusalem was celebrating 3,000 years of  continuous civilisation in 1996, WALT should be  having its inaugural congress but we all know  what happened in the meantime. The Congress had  only 50% of expected attendance and unfortunately  that included speakers! The Japanese group was  advised by the Government not to attend and those  from the USA were notable by their absence. In  the cause of science I braved the potential  dangers and headed off to the Middle East.  I'm not that lucky (or unlucky)!

However,  all was not lost. Having a smaller group meant  that there were more opportunities for detailed  discussion among the participants and the  speakers.

US FDA's  position on Laser.

One of the  key-note speakers from the USA, one of the few,  Professor Emeritus Kendric Smith from Stanford  University, Professor of Photobiology, discussed  the United States' FDA, attitude to the use  of Laser. It remains as it has for some time. The  FDA agrees that Laser has proven biological  effects but this has not translated into clinical  studies which the FDA accepts as  "scientific".

Professor  Kendric said the scientific validation of Laser  as an "accepted" modality of treatment  is "as far away as ever". Researchers  in the area, according to Professor Kendric, must  understand some of the basic laws of Photobiology  in order to produce correctly designed studies.  There was disagreement between physicists and  photobiologists as to what the correct principles  were. There was a lot of criticism of clinicians  in the field . . . and so the argument continues.  Professor Kendric said that the only way to get  the studies done is to approach the FDA first and  ask their advisors help in designing what they  think are valid studies. Apparently they will do  that. If the US validates the use of Laser many  other countries would follow.

Visible vs  Infra-red irradiation

This was  one of a number of issues at the centre of  discussion both as part of the formal  presentations and in private discussion between  the participants. As usual, no one can seem to  agree and each will cite different studies to  prove her or his point.

One area  of agreement, at least, is that visible light is  the best for wound stimulation and for more  superficial problems. What is also agreed upon is  that visible light activates the chromophores in  the respiratory chain of the mitochondria,  activating the Ca2+ channels and causing  photochemical oscillations of the Ca2+ pump.

There was  also agreement on the fact that infra-red  irradiation stimulates the outer cell membrane  (not the mitochondria), by physical vibration and  stimulation of the ATPase pathway and then  activation of the Ca2+

pump. Higher powers are  needed to do this.

That's  about all they could agree on. Thereafter there  are very different views.

High power vs  low power.

The  physicists formed two groups. One group believes  that if one photon is all that is needed to  initiate the Calcium pump then very low power  densities, in the order of 1 to 15mW/cm2 , are sufficient to  initiate the cascade of Calcium oscillation. Much  of this work has been done in Israel. It would  seem that the stimulation of an acupuncture point  with very low power operates at this level.

Another  group believes that power as well as the  wavelength is important for penetration so that  the Laser can act at the appropriate depth. This  group believes that higher powers are needed for  "deep" problems.

But this  created another controversy . . .

What is the  correct wavelength to use?

Most of  the physicists agreed that choosing the correct  wavelength for what you wanted to do was  important. There was consensus about visible  light being used for wound healing and  superficial stimulation but which wavelength of  the visible spectrum? 632.8nm was definitely the  most widely used but a group of Israeli  neurosurgeons had found empirically that 780nm  was the best for nerve regeneration. One of the  photobiologists from Austria believes that the  best results are obtainable only with 670nm, for  everything, and with power densities of up to  15mW/cm2. His work has  formed the basis of the Austrian Government  sponsored Laser industry. They only make 670nm  lasers but with a power up to 250mW. By far the  majority of clinicians are using 830nm GaAlAs  lasers. The rationale being that to affect deeper  tissues you need more deeply penetrating lasers.  One controlled study failed to show a significant  difference in symptom control in Rheumatoid  Arthritis treated with HeNe Laser at very low  doses.

What are the  correct parameters of Laser dose?

One of the  newer concepts of Laser therapy which I found  interesting was the use of Power Density as part  of the dosiometry of Laser. I had understood and  had taught that Power Density was more a measure  of potential thermal injury than a useful part of  the dosiometry. Not so it appears . . .  especially if you subscribe to the high power use  of laser. Much of the clinical effectiveness of  the infra-red laser depends on a sufficiently  high power density delivered at the correct  energy density. These two components are  necessary if the correct dose of Laser is to be  applied. One suggestion was to think of the Power  Density ( = power of laser / area of spot size)  as the "drug" in pharmacological terms  and the Energy Density (= Power of laser in W x  treatment time/area of the spot size) as the dose  of the drug. That concept has its limitations but  may be useful to some. The majority of clinicians  at the Congress believe it is necessary to use a  power density for IR Laser of 300mW/cm2 (at least)  delivered with an energy density of between  1 to 4J/cm2 .

The other  fact discussed about Laser dose by the physicists  was that the Laser had to be applied for at least  10 seconds to have a tissue effect. Anything  else was suboptimal. This applied to the use of  very low power laser i.e. under 10 mW, in  particular.

Is timing of  Laser important in wound healing?

Several  studies showed that, in wound healing, the timing  of Laser use was critical to achieving an effect.  If the Laser was given too early or late there  was either no effect or inhibition. How this  relates to clinical practice remains to be  elucidated.

Post-herpetic  neuralgia.

Two papers  were presented on the treatment of Post-herpetic  Neuralgia. One particularly good paper came from  the UK by an anaesthestist, Dr Kevin Moore, who  has used a 60mW, 830nm Laser to treat PHN, in a  pain clinic setting. His results are excellent  and appear very reproducible. A similar paper  came from Japan. This is an area where the  clinical studies are very promising.

What else was  new?

Increased bone healing

Laser can  penetrate bone and is being used for stimulation  of fracture healing. It appears that Laser allows  the osteoblasts to stay active for longer thus  laying down new bone for a longer period of time.  A study in rats showed the maximal stimulation of  bone healing occurred when the fracture site was  irradiated on two occasions only, on the 5th and  7th days. Perhaps someone would like to try this  in clinical practice. It was demonstrated in a  variety of models that Laser penetrates bone  significantly. In Spain there is a group using  fibreoptic needles to deliver Laser to hip and  pelvic fracture sites with very good results.

Treatment of  tinnitus

A German  general practitioner has developed a protocol  using IR laser over the mastoid process in the  management of tinnitus and other inner ear  problems. His technique was validated by the fact  that the bone penetration studies showed that  Laser penetrates to a sufficient depth to have an  effect on the inner ear structures.

Can Calcium  Channel blockers block the effect of Laser?

There was  continual reference to the role of Calcium in the  body's response to Laser. One study in  particular showed that the stimulatory effect of  visible Laser on cells was blocked by the use of  nifidepine. I discussed this with the person who  did the study and he felt that this could very  likely be a problem in a clinical setting.  Perhaps this could be a cause of lack of response  to Laser.

Do we need Laser  at all?

One of the  areas of lack of agreement amongst the physicists  and the photobiologists was whether Laser was  necessary at all. One group believes that any  monochromatic light source would be adequate  provided it was the "correct"  wavelength and power. This group argues that  coherence is lost once the light hits the tissues  anyway and adds nothing at all to the effect. The  other group believes that coherence is necessary  for penetration. This is a theoretical problem at  present, so I was told, as Laser is still the  cheapest source of monochromatic light of  sufficient power.

What the  Russians are doing.

One of the  most unusual uses of Laser presented was work  being done by Russian photobiologists and  clinicians. They are irradiating small volumes of  blood with Laser from patients and then  retransfusing it. They are also irradiating the  cubital vein with Laser to get the same effect.  This work was started in the 1930's in the  USA and the USSR using UV light but they have  started to redo this original work and have added  Laser to the regime. They treat everything from  myocardial infarction to AIDS with this method.  It is used in veterinary medicine too. Professor  Pontinen mentioned this work when he was in  Australia two years ago. The systemic effects of  Laser seem to be mediated by an effect on the  blood cell components, probably macrophages.

Perhaps in  very difficult patients this may be worth trying.

Where to now?

There were  certainly no dramatic revelations on the use of  Laser at this world congress. It seems that  progress is being made in small steps and with  painstaking research. There is still a chasm  between what the scientists are doing with cells  and what clinicians are doing in their practices.  It seems a world wide phenomenon that Laser is  still regarded with suspicion by  "orthodox" medicine. Until "the  studies" are done it looks like things will  remain the same.

You may be  interested in joining the Association and  receiving the journal Laser Therapy in  which much of this latest research is published.  It is to go on to Index Medicus in 1997.

Shalom . .  .

Dr  Roberta Chow, M.B. B.S. F.R.A.C.G.P.

103 Malton Road, Beecroft  , N.S.W. 2119

Ph:  (02) 484 8333. Fax: (02) 875 2077

.BEYOND ENDORPHINS IN ACUPUNCTURE ANALGESIA
The Science Behind The Art
Dr. Linus Soh F.A.M.A.S.

In the last 20 years much  has been written about acupuncture and its efficiency in  relieving pain. The ancient Chinese clinicians practised  acupuncture based on Traditional Chinese Medicine (TCM)  principles using well established guidelines. Their  reasoning were based on empirical responses rather than  scientific principles. This discussion hopes to bring to  highlight some recent research findings. Acupuncture  research however cannot stagnate as we move towards the  next century in pursuit of a better understanding of its  mechanics.

Since the discovery of  enkephalins from pigs' brains (by Hughes, Kosterlitz at  Aberdeen) in 1975, the scientific community has tried to  explain scientifically how acupuncture's pain relieving  mechanisms really works. When Beta-endorphin was  discovered (by C.H. Li at Stanford University) in 1976  and dynorphin ( by Goldstein) in 1979 it began to become  clear that electro-acupuncture (EA) will increase the  levels of B-endorphin at 2-4Hz and dynorphin at  100-200Hz. Enkephalins will be released at frequencies

2-200Hz. Based on the tail  flick latency response in rats, Professor Han (Beijing  University) also found that naloxone will even block EA  response to high frequency stimulation. This was  previously unknown as the dose of naloxone used was  1-2mg/kg whereas Han used 10-20mg/kg. In his experiments  on rats Professor Han also used Captopril (a commonly  used ACE inhibitor in general practice). When injected  into the peri-aqueductal grey (PAG) Captopril prolongs  the analgesic effects of EA as it is also an  enkephalinase inhibitor.

Anti-opioid substances  (AOS) were also described. These are released due to  excessive EA and are thought to account for acupuncture  tolerance. Indeed GABA and CCK8 have also been found to  be increased after excessive morphine usage. Morphine  tolerance hence often equated to EA tolerance. Whether  the biochemical interaction are similar needs  clarification. Recent studies show that the two main  morphine metabolites are morphine-3-glucuronide (M3G) and  morphine-6-glucuronide (M6G). M3G antagonises morphine  analgesia while M6G is an agonist. This relationship  needs to be translated to EA tolerance but much research  needs to be done. It may also help us understand the  difficulty in treating patients addicted to opiates with  EA.

At the last IASP conference  in 1993, researchers have mentioned the discovery of  morphine within the human body. This endogenous morphine  (not endorphins) was found in patients who were taking  L-Dopa for Parkinson's disease. As these patients were  not on morphine medication the plasma levels of morphine  must have been produced by the body itself. However, so  far no details are known of the exact pathways involved.  Perhaps in the future EA responses may have to be  interpreted in a different manner in the light of this  new knowledge.

The 1993 IASP Conference in  Paris also produced evidence of a new pain pathway. The  French team described this new pathway, called the  spino-ponto-amygdaloid pathway. Noxious stimuli have been  shown to project to the lateral parabrachial (PB) nucleus  at the pontine level, and then directly to the central  nucleus of the amygdala. Morphine needed to depress the  noxious signals in the PB and amygdala are lower than  that required at the spinal levels. This new pathway  which have been implicated in the affective emotional  aspects of pain. It seems to be highly sensitive to  morphine. The amygdala has also been researched by  Professor Han and has been found to involve serotonin and  endorphins. When tested with cinanserin (a serotonin  receptor blocker) and naloxone, EA analgesia was  attenuated. This nucleus seem to play a big role in  facilitating EA responses for pain relief. The discovery  of this new pain pathway should add impetus for more  research.

Serotonin (5HT) receptors  sites have also been the subject of intense scrutiny over  the last few years. There are now many subtypes of 5HT  receptors namely 5HT, 5HT2, 5HT3, 5HT4 etc. 5HT1 is  further subdivided into 5HT1A, 5HT1B, 5HT1C, 5HT1D.  Research into the latter has given us sumatriptan which  is a currently clinically used for migraine. The effect  of EA on release of monoamines (down the descending  inhibitory pathway) is well documented. Research using  cinanserin (a 5HT receptor antagonist) and  parachlorophenylalanine (PCPA - a 5HT synthesis  antagonist) have shown EA to be decreased markedly.  Conversely, Tryptophan (the precursor of 5HT) would  enhance EA. However the many subtypes of 5HT receptors  add a new challenge to acupuncture research. It is  interesting to speculate if different frequencies will  stimulate different 5HT receptors. If this is more  clearly understood perhaps TCM may one day be explained  along scientific paradigms.

Research into naloxone have  shown that ultra-low doses (in nanograms) can have an  analgesic effect. This seemingly paradoxical effect have  mystified and at the same time excited scientists around  the world. Various experiments performed in rat models of  clinically induced arthritic pain have shown that  extremely low doses of naloxone can have a paradoxical  analgesic effect, while high doses induce hyperalgesia.  It must be remembered that we often use naloxone for  reversal of opiate toxicity.

Recent research into spinal  receptor systems have revealed an important receptor  which is currently the centre of great scientific  interest. The NMDA (N-methyl-D-Aspartate) receptor  reflects Aspartate and Glutamate activity in nociception.  Ketamine (a NMDA antagonist) has been shown to produce  analgesia when introduced to the dorsal horn. Glutamate  and GABA seem to have opposing effects on neuronal cells.  GABA anti-sera has been used to reverse acupuncture and  morphine tolerance as well as non-responders to EA. Quite  clearly the NMDA receptor should be more thoroughly  researched in relation to acupuncture induced analgesia.

It can be seen from the  above discussion we may have to rethink how acupuncture  works. More and more research have enabled us to  understand the complexities of nociceptive afferent  stimulation of the dorsal horn, especially laminae I  & II. It is to be hoped that acupuncture researchers  will keep up with the new knowledge and perhaps unravel  the mechanics of how acupuncture works in pain relief.

References
Pharmacological  Approaches to the Treatment of Chronic Pain: New Concepts  and Critical Issues - Progress in Pain Research and  Management Volume 1. IASP Press 1994
Editors - H.L. Fields, J.C. Liebeskind

Proceedings of the 7th  World Congress on Pain - Progress in Pain Research  and Management Volume 2. IASP Press 1994
Editors - G.F. Gebhart,D.L. Hammond & T.S. Jensen

The Neurochemical Basis  of Pain Relief by Acupuncture
Professor J.S. Han - 1987

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Luo Points And Their  Uses
Dr Wellington Tan

Among  the Acupoints of the Channels, the Luo  points constitute one of the most  important groups of Acupoints that can be  used in therapy. The Luo points are found  on the 12 pairs of the Principal Channels  and the 2  Extraordinary Channels  (Governor and Conception Vessels).

The  Spleen Channel uniquely has another extra  Great Luo point instead of the usual one  Luo point located on the limbs at the  periphery, as in the main Principal  Channels. The importance of the Luo  points is that from these points one can  influence many levels of the body's  energetic functions. This ranges from the  superficial dermal layer to the deep  Principal Channels and even involving its  coupled Yin and Yang Channels. Some even  control the Extraordinary Channels. Thus  the use of these Luo points alone or in  combination with other Acupoints will  allow many problems to be treated.  However, a clear understanding the  theories of the Luo Channels and Luo  points will allow us to apply it  effectively in the multitude of  conditions it can treat.

The  Chinese Classic Ling Shu on Febrile  Illness has good descriptions of  conditions with painful and dry  lack-lustre skin of the limbs which are  painful to touch. These repond to  treatment using the Luo points of the  Yang Channels of the legs. This sounds  like Reflex Sympathetic Dystrophy or  Peripheral Neuropathy of some sort, or  even Allodynia. Many febrile illnesses  have been described as being responsive  to treatment using the Luo points which  induces perspiration, especially when the  perverse Qi are still in the Channels.  Luo points are very good at extracting  and dispersing the Perverse Qi, and  exteriorising it from the deep channels  for easy dispersion.

Fu  and Sun Luo Channels

According  to the theory of the Channels, there are  a multitude of minute channels that  branch and sub-branch out into a lacy  network covering the skin subdermally,  subcutaneously and in the fascial layer .  This network of interlacing minute  Channels consists of the Fu Luo and Sun  Luo Channels. Beneath these are the  Musculo-tendinous Channel.

The  Fu Luo are the Floating Luo Collaterals  which are the most superficial of the  Channels. Sun Luo are the small Minute  Grandson Collaterals. This superficial  network of Channels with its branching  would look much like the peripheral  nervous system on the skin.

They  are outside the Main Principal Channels  and do not depend on it for Qi and Blood.  They are independent of the Main Channels  points and effects. Defensive Qi,  Nutritive Qi and Blood flow in these  Channels to nourish the skin, filling it  up to give a firm tissue texture,  allowing the proper opening and closing  of the pores, warming up and helping to  strengthen the muscles.

These  Collaterals and their minute branches  help to link up the anterior, posterior  and lateral sides of the body that cover  the 12 cutaneous zones of the body.

They  also help to link and strengthen the  related corresponding Yin and Yang  Channels linked in a exteriorly and  internally (Biao-Li) related manner.  Through them the whole body can be  covered and nourished. Some of the  Collaterals do enter the abdominal and  thoracic cavities to connect with the  vicera, although there is no major  controlling relationship between the  Collaterals and the organs.

These  Fu and Sun Luo Channels can be accessed  by needling the Luo point, which is the  entry point of these Fu and Sun Luo  Channels to connect with the main  Principal Channels.

Knowing  the theory of the Wei Qi (defensive Qi)  flowing in the Luo Channels and the  Cutaneous Layer allows treatment to be  targeted at this Cutaneous area. Problems  seen clinically are those that are  superficial, on or in the skin and still  at the peripheral nerves or at the  channel level. These include  parasthesiae, hyperalgesia of the skin,  sensitive scars, numbness and burning  sensation of the limbs; post stroke with  tight gripping and burning pain on parts  of the affected side. Entrapment of the  nerves with neuralgias, superficial  referred pains and Carpal Tunnel  Syndrome.

The  nerves affected are the peripheral  cutaneous nerves. Some component of the  autonomic nervous system is also involved  as there is always some degree of tissue  change, excess sweating or dryness of the  skin with perception of burning or cold  or even a confused sensation of both.

A  form of Bi Syndrome described as  "Mah Bi" (Numbing Bi in the  skin) is due to Deficiency or blockage of  Defensive Qi and Blood in the superficial  capillary type of Channels i.e.Fu Luo and  Sun Luo of the skin, tissues and the  muscles. This Defensive Qi protects the  body from any external pathological and  perverse agents like Cold and Wind.

Treating  the affected region via the 15 Luo Points  influences the respective Channels and  Cutaneous regions. The Luo points are the  site where one can access the Sun Luo and  Floating Fu Luo channels. Local points  like the "Dragon's Mouth  points" surrounding the lesion may  also connect to these Luo Mai.

Needle  with a filiform needle in a superficial  way, subcutaneously, towards the affected  area. Manipulate the needle with an  initial dispersion to clear the  obstruction by any stasis or Pathogenic  Qi (e.g wind, cold, etc.), followed by  tonification to bring the Defensive Qi,  Nutritive Qi and Blood to the Fu and Sun  Luo to nourish the Skin.

The  perception, by the patient, of the  cutaneous sensation in the meridian  towards the area is important. It takes  an average of 5 or 6 treatments to clear  the problem. Deep needling is not needed  to get at the peripheral cutaneous  nerves, as deep needling will miss the Fu  and Sun Luo. Remember to treat the  aetiology by using the Main Channels  points.

The  conditions that I have treated with this  technique are:

· Post  traumatic injury including nerve  lesions.

·  Entrapment neuropathy, post  stroke burning and tightness of  limbs.

·  Radiculopathy from disc prolapse  and spinal stenosis.

· Toxic  drug and diabetic or traumatic  peripheral neuropathy.

· Post  herpetic Zoster neuralgia,  unusual burning feet or itching  (of unknown cause).

You  will be able to extend this to other skin  problems like: dermatitis, cosmetic  wrinkles, painful scar problems.

Case  histories:

1.  76 year old with Spinal Stenosis, tight  aching burning feet and toes with L4/L5  involvement. Treated usingLR 5  and KI 4 with LR 2, KI 17,  SI 3, BL 62. Residual numbness  left in L4 zone of first and second toes.

2. Painful and tight tingling feet  secondary to drug induced neuropathy.  Treated using SP 4, LR 5,  GB 37, ST 40 plus SP 6 and  KI 7.

3. Entrapment of Right Lateral Cutaneous  Nerve of the thigh of 30 years duration.  Treated using ST 40 & GB 37. Three  treatments only were required leaving  only a numb patch on GB 31.

4. Same patient as above with Post  Herpetic Neuralgia in the Opthalmic  division of Trigeminal nerve. Treated  using BL 58, GB 37 plus LR 3, GV 20,  GB 14, BL 2.

5. Carpal Tunnel - like Syndrome. Treat  Cervical 6, 7 Dermatomes, PC 6  deeply and superficial needling of LU 7.

What  is the medical rationale for this? There  are many possible explanations, but many  questions remain unanswered. Parasthesia  in the LR 3 region, between the toes, is  innervated by L4 and LR 5 is on the L4  dermatome . The sole under the toes is  innervated by L5 and can be treated with  KI 4 also on the L5 dermatome. The  lateral side of the sole of the foot is  on the S1 dermatome and BL 58 is on the  S1 dermatome, etc.

By  stimulating the skin on the same  dermatome as the affected area, one can  block the nocioceptor sensation by the  afferent input as explained by the Gate  Theory of Pain. However the problem  cannot be cleared by needling another  point on the same dermatome if it were  not at the Luo point or if deeper  needling is used. How can one explain the  relief of problems more proximally on the  head and neck, with leg points, that are  not on the same dermatome?

The  answer needs to come from the Channel  Theory of Acupuncture in the Cutaneous  Layers served by the Fu and Sun Luo  Channels.

Longitudinal  or Collaterals Luo Mal

There  is another connection from the Luo Points  of the Channels. These are the Collateral  Channels, having their own pathways and  these are often detailed in books. Again  it is fairly superficial, more at the  level of the fascia near the muscle.  These channels are nourished by the main  Principal Channels, thus symptoms are  more of the Channel type. They can be  used to treat many symptoms and as well  as affecting the organ with which it  connects via its small branches. There  are 15 of these Collaterals which include  the Governer and Conception Vessels and  the Greater Spleen Luo.

Needle  these points obliquely in the direction  of the Longitudinal Collaterals. I  commonly use these points singly for  acute symptoms in general practice in the  following situations:

LI 6 Deafness, Eustachian dysfunction, secondary to air travel

BL 58 Stuffiness and head fullness from acute URTI

LR 5 Puritus vulvae, or pain with no infections

KI 4 Dysuria, but with no infections, irritable bladder

15 Luo Mai

Shi problems Xu problems

LU 7 Heat in Palms, Respiratory problems

LI  6 Deafness Hypochondrial fullness

ST  40 Mental illness Sore throat/aphonia

SP  4 Abdominal pain Abdominal distension

HT  5 Pericardial fullness Aphonia

SI  7 Flaccid paralysis Furunculosis

BL  58 Rhinorrhoea Epistaxis

KI  4 Dysuria Lumbar pain

PC  6 Chest pain Stiff neck

TE  5 Stiff arms Flabby arms

GB  37 Cold limbs Weakness

LR  5 Excess urination Vulva/Vaginal itch

CV  15 Pain in abdom. wall Itching abdomen

GV  1 Stiff spine Heavy head

SP  21 Pain all over Painful joints

Use  of the Transverse Luo Point

At  a deeper level of needling at the Luo  point one can use the ability to couple  the action of the Biao-Li Channel related  to the Luo point being used.

This  is a combination using Yuan and Luo  points in a Host-Guest Channel  relationship. The Channel which had the  problem first, the Host, may pass on the  perverse Qi and affect the coupled  Channel, the Guest, e.g. Cold invasion  causing Nasal/ Head cold of the Large  Intestine then affecting the Lung Channel  with bronchial symptoms. Use the Yuan  point of the Large Intestine, Hoku, LI 4,  as the Host Channel Point and the Luo  point of the Lung Channel, LU 7  (Lieque), as the Guest Channel Point.  This allows the Perverse Qi (XieQi) to be  treated in the Large Intestine Channel  using the Qi and Blood from the Yuan  Source Point as well as being able to  affect the Lung via the Luo connecting  point to exteriorise the Perverse Qi from  the Yin Lung Channel. If treated early  the use of LU 7 alone is sufficient.

In  a different condition, when the excess  Xie Qi starts in the Yin channel like the  Lung and it has affected the Large  intestine, using the Yuan-Source point of  the Lung channel and the Luo Point on the  Large Intestine Channel will fortify the  Lung Qi, drain the Lung's Xie Qi to  the Yang channel for dispersion. The  transverse Luo point is also especially  good in trauma distally in the limbs or  distal to the site of the trauma. It will  promote healing and improve circulation.  It will also drain any heat in the Yin  Zang to disperse it out on the Yang  channel.

Qi  distension in the chest, heart, hot  palms, dyspnoea, phlegm, supraclavicular  fossa pains, dry and swollen throat,  excess sweating, anterior shoulder pain,  aching breast.

Pain  in nasal fold, face, teeth; swollen mouth  & throat sore, red and dry, nasal  discharge, anterior shoulder pains, thumb  and finger pains.

Fullness  of abdomen, epigastrium, heart, sorrowful  thoughts, disturbed thoughts of hate,  anxiety, epistaxis, feeling of internal  heat, phlegm, leg ulcers, ascites, aching  chest, thighs.

Stiff  tongue, vomiting, rebellious stomach and  inversion of Qi flow, aching abdominal  organs, heavy body, forgetfulness and  dulled mind, fevers and chills,  constipation, jaundice, weak legs, aching  and swollen knees, and thighs,  parasthesia in legs.

Chest  pains dry throat, thirsty, dysaesthesia  of arm, red dry mouth, dirty sclera of  eyes, hot palms, palpitations,  hemetemisis, jing-ji (ie. fright with  palpitations).

Swollen  cheeks, aching stiff shoulders scapula  and weak arms, elbow and arm pains, stiff  and aching neck deafness.

Darkened  facies, loss of appetite, fatigue and  loss of eye sparkle, feverish, mental  disturbances, lumbago, aching feet, gait  problems chest aches, sallow look,  palpitations

Bladder  symptoms, neck problems, headaches with  retro-orbital ache, waist, leg and foot  pains and walking problems, diarrhoea,  fevers, psychiatric illnesses, heat in  heart and gall bladder, backache, weight  of problems on the mind, epistaxis,  muscle spasms, cloudy sclera, anal  prolapse, fistulae, piles, upper  abdominal swelling

Sore  and dry throat, deafness, red and swollen  eyes, sweats, mastoid area aches and  pains, elbow aches, pain in the back of  thorax, neck, shoulder, arm pains,  constipation, urinary dysfunction.

Hand  contractures, flexion, chest and  hypochondrium fullness and axillary  swellings, weak heart, red facies,  cloudy-yellow sclera, laughs  uncontrollably, heart is disturbed and  restless, angina, hot palms.

Chest  and hypochondrium pains, dropped foot,  dull facies and colour, headaches, eye  aches, fevers, chills, sweats, axillary  lumps, goitre or tumours of neck, chills  and bone aches.

Male  genital pains, severe lumbar pains,  female pelvic swelling and pains, dry  throat, dry flaky skin, chest fullness  and vomiting, diarrhoea, abdominal pains,  urinary retention or incontinence,  genital swellings.

These  Points are on the Principal Channels and  so must be needled deeply to get the  usual De Qi. Tonifying the Yuan point and  gently dispersing the Luo point  initially, then tonifying it at the end  of the treatment. This allows the Guest  channel to get some nourishing Qi back  into it.

Luo  Point affecting the Extraordinary  Channels

The  importance of the Luo points is also  stressed here in that the Master point  for 4 of the Extra ordinary Channels also  use the Luo point to access its reservoir  of energy.

The  Conception vessel is controlled by  LU 7, Lieque. Thus when this point  is used the Lung and its coupled channel,  Large Intestine, can also tap into the  energy of the Conception Channel.

Yin  Wei Channel is controlled by PC 6,  Neiguan. This will act on the whole  chest, abdomen and pelvis - the  three Jiaos and its link with the Spleen  Channel and Chong Mai Channel. Thus the  greatness of the Luo point, Neiguan.

Gongsun,  SP 4, is just as important as it will  control the very important Chong Mai and  can work to great advantage for the  patient. Remember that it couples with  the Yinwei Channel using PC 6, thus  2 Luo points controlling the major  Extraordinary Channels.

The  Extra Channel, Yangwei, also is mastered  by Weiguan, TE 5, covering a large part  oft he legs, hypochondrium (TCM), back,  neck and head.

I  found by experience, to get these points  to work well, you need to needle deeply  and tonify slowly and well until the DeQi  and radiation of the Qi are felt, by the  patient, to warm up the target area.

The  Luo point is thus a most versatile and  important point for use in clinical  situations when other points do not work  as well. The different depths of needling  need to be remembered to get the best  results according to the level of Channel  conditions to be treated.

The  Luo point will treat:

1. Cutaneously & superficially via  Fu and Sun Luo Mai.

2. Longitudinally Luo Collaterals to  target tissues and viscera.

3. Biao-Li Coupled Channels via the  Transverse Luo - Yuan Channel.

4. Main  Principal Channel to exteriorise Evil  Qi.

5. Some  Extraordinary Channels via Lu 7,  PC 6, TE 5, SP 4.

An  interesting observation of mine is that  the use of Luo points for accessing Fu  and Sun Luo is reflected in the  superficial needling of the Helix points  of the ear for treating superficial skin  problems and pain. According to French  Auricular Therapy the Helix represents  the Peripheral Nervous System.

Dr  Wellington Tan
MBBS (S'pore);  Dip. M.S. Med(Otago);  C. Acp(Nanjing)

Medical  rooms, 2 Blackett crescent, Meadowbank,  Auckland 5, New Zealand.  Tel: 528 4242

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Three Cases of Myocardial  Infarction Presenting as Musculo-Skeletal Pain.
Dr.Charles Cassar  M.B.,B.S.(N.S.W.),F.R.A.C.G.P.

ABSTRACT:

These cases  describe patients who presented initially with a  convincing history of musculo-skeletal pain but  who were, in fact, having atypical cardiac pain.  The pain pattern was so non cardiac in  distribution that it could trap the unwary  acupuncturist. These cases call to mind the  common nature of cardiac and musculo-skeletal  pain and their possible coexistence, and they  raise neurological questions about  viscero-somatic and somato-visceral reflexes.

Key Words: pain,  cardiac, acupuncture, viscero-somatic,  somato-visceral

CLINICAL RECORDS

CASE 1

A 30 year old male  had been working for two weeks in a tanning  factory doing extremely heavy work after being  previously unemployed. His new job involved  lifting wet cow hides out of a vat and stacking  them. When wet these skins weighed up to 70 kilo  each. He was doing this for up to four hours at a  time without a break. He was woken the night  before presenting, at 2 a.m. with severe pain  across the top of both shoulders, radiating up to  the neck. When he was woken by this pain he went  to the toilet to vomit, he also had some sweating  with this. The next day he presented to the  surgery with persistent neck pain radiating  anteriorly across to both his shoulders. He was  in no obvious distress. Examination revealed a  heavily built man with restricted neck movements,  movement was restricted by pain and quadrant  testing reproduced his pain when his neck was  extended and rotated to the right. He was  extremely tender over the C4 /C5 spinous process.  Cardiovascular exam was normal, chest was clear,  blood was taken for cardiac enzymes. Clinically,  his history and physical findings suggested  either a cervical disc lesion, or a cardiac  cause. In view of the nature of his new job, the  constant, persistent nature of the pain, and the  positive musculo-skeletal signs, a diagnosis of  cervical problems seemed most likely; however, in  view of the initial sweating and vomiting, a  cardiac cause was considered as a possibility.  His neck pain was treated that day with neck  traction resulting in some relief of his pain.  That night, however, he had another bout of pain  waking him from his sleep; he returned to the  surgery the next day rather pale and sweaty, his  cardiac enzymes from the previous day showed an  elevated CK of 606 and normal values for AST and  LDH. He was taken to hospital by ambulance where  he was admitted to the C.C.U. His serial ECG's  remained normal and his enzymes rose sequentially  indicating a subendocardial infarction.  Angiography showed a 70% stenosis of the dominant  right coronary artery, all other arteries were  well.

CASE 2

A 76 year old woman  was a front seat passenger in a motor vehicle  accident where another vehicle collided into the  rear end of the patient's car. She had had a  whiplash injury with associated thoracic and  lumbar pain ever since the accident and had been  attending the surgery on a regular basis for  acupuncture. She was an extremely depressed  personality in almost constant pain. Two months  after the accident she presented complaining that  "her back pain " had been very severe  the day before especially between the shoulder  blades and that this had been associated with a  feeling of nausea. It was only on further  questioning that she admitted to having some  chest pain of a few minutes duration. This pain  was of a pleuritic nature. Examination revealed a  well looking elderly lady, in no more distress  than you might usually see in a patient in  chronic pain . She was normotensive, with a  normal radial pulse, dual heart sounds, and a  pansystolic murmur at the LSE, and a soft left  sided carotid bruit. An ECG showed mild ST  elevation in the anterior leads, and a Q wave in  lead III. Echocardiography revealed a small  pericardial effusion, and a V/Q scan was negative  for pulmonary embolism.

A diagnosis of  pericarditis was entertained , but was dismissed  as over the next few months she continued to have  chest pain, and a coronary angiogram showed a  narrowed major coronary artery. This was treated  with balloon angioplasty; however, several months  later she started having nocturnal angina and she  eventually came to coronary artery bypass  surgery. This was a success.

CASE 3

A 58 year old  executive for a large Australian Company  presented to the surgery with left inner elbow  pain which had been gradually getting worse over  a period of some weeks, but the day before he had  moved a heavy garden trellis which greatly  aggravated the elbow pain. On the day he  presented this pain was associated with some  nausea but no diaphoresis and no chest pain. He  had had myocardial infarctions in the past.  Examination revealed a typical frozen shoulder on  the left, with severe restriction of movement;  cardiovascular exam was normal, ECG showed no  acute changes. Cardiac enzymes were taken. He was  treated with GB 34 and his left elbow pain  improved significantly. The cardiac enzymes came  back elevated, and he was admitted to Ashford  Private Hospital for ongoing treatment of his  myocardial infarct, which consequently proved to  be an inferior infarction.

DISCUSSION

The classic  symptoms of cardiac muscle infarction are well  recognised...central chest pain radiating down  the left arm which may or may not be associated  with nausea, vomiting, sweating and collapsing.  However, the atypical pain is not uncommon as  these three cases collected in an average  acupuncture / general practice over an eighteen  month period indicate.

These cases  illustrate the following points:

1. Musculo-skeletal  pain is common, cardiac disease is common, they  can co-exist and some patients with cardiac  disease have a distribution of pain that suggests  a musculo-skeletal diagnosis in the first  instance. These three cases had histories all  highly suggestive of a musculo-skeletal origin.  Case 1 had a new job that required enormous  demands on his untrained body, a cervical nerve  root lesion would have been more than likely.  Case 2 attributed her interscapular pain to the  recent car accident, and interscapular pain is  not unusual in rear end collision. Case 3 was  happy to blame his pain on moving the trellis. As  Kannel and Abbott point out 25 % of all  myocardial infarctions may be unrecognised, with  50 % of these being completely silent and the  other 50% symptomatically atypical. These carry  poor prognosis independent of any other markers  of ischaemia, and therefore need to be looked out  for by the primary care physician /  acupuncturist.

2. Somato-visceral  reflexes are clearly at play in these cases, the  nature of these reflexes need to be studied in  closer detail. Case 2 had the classic frozen  shoulder associated with cardiac disease.

3. Acupuncture was  effective in two of these cases ( 1 and 3 ) .  This suggests that acupuncture is somehow  altering the endorphin release resulting in pain  relief, certainly there was some alteration of  the afferent nocioceptive pathways. This is a  great testimony for the efficacy of acupuncture  and equally it shows that the acupuncturist can  mask symptoms of visceral pathology quite easily;  clearly this is not a desirable situation, and  raises the question of whether non medically  trained acupuncturists should be doctors of first  contact. All of these cases would have been quite  prepared to deny a cardiac cause for their pain,  and it is tempting for the therapist to do  likewise.

4. Cases 1 and 3  illustrate the value of evaluating cardiac  enzymes in the absence of cardiac signs and in  the presence of a normal ECG. In Case 1, when the  CK was markedly elevated it was not entirely  clear, at first, whether this was cardiac or  skeletal CK. When desktop, immediately sensitive  markers of myocardial infarction are available I  think this will make distinction in these type of  cases much easier; at the same time this will  create management and therapeutic dilemmas for  the asymptomatic patient.

REFERENCES:
Kannel WB, Abbott  RD. Incidence and prognosis of unrecognized  myocardial infarction: an update on the  Framingham Study.N Engl J Med 1984;311:  1144-7

Glazier JJ, et al.  Importance of generalised defective perception of  painful stimuli as a cause of silent myocardial  ischaemia in chronic stable angina pectoralis. American  J ofCardiology58: 667,1986

Weidinger F, et al.  Role of beta-endorphins in silent myocardial  ischaemia. Am. J ofCard.58 : 428, 1986

Cailliet R.: Soft  Tissue Pain and Disability, F.A. Davis,  Philadelphia, 1977(pp.161,162)

Mattingly S.: The  Painful Shoulder, Chapter 20. In Progress in  Clinical Rheumatology, edited by  A.St.J.Dixon. J.&A.Churchill,London,1965  (pp.334-336)

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The  Eight Extraordinary Vessels (Meridians) EM
Dr  Paul Chai

The eight  extraordinary vessels, the Qi Jing Ba Mai, constitutes a  powerful acupuncture energetic system which can reinforce  our treatment of diseases. The "Qi" in Chinese  is translated as "strange",  "extraordinary". "Strange" refers to  "unusually shaped or deformed body, someone hunched  over" (1). Dr. Manaka, a modern Japanese physician,  has been able to use EM treatment to correct structural  imbalances - hence internal organs imbalances.  "Extraordinary" conveys an idea of  different - different from the twelve  "ordinary" meridians in the following manner.

(a) EMs are not  ruled by the law of Yin and Yang. They are coupled Yin  with Yin, Yang with Yang.

(b) EMs do not  penetrate Zang-Fu.

(c) They are mere  conductors of Jing (essence) since they derive their  energy from the kidney.

(d) Except for Dai  Mai, their energy takes an ascending route which is  different from the continuous cyclic flow of energy in  the twelve "ordinary" meridians.

(e) They act as  "regulators" and "reservoirs" of  energy. "In ancient literature, the eight extra  vessels are compared to the canals and drains provided  for the excess of the floods (the fifteen Luo). In  ordinary times, the waters flow in the streams and rivers  (the 12 meridians) but when the waters and illness  overflow, the extra vessels begin to fill. At that stage,  since the twelve meridians will not respond, it is  advisable to use the points of crossing reunion."  (2) The EM acts as reservoirs into which surplus energy  can be drained, but also conversely from their store they  can replenish any deficiency of energy.

THE EIGHT EM  ARE:-
Opening Points

Governor Vessel  (Du Mai) SI3

Conception vessel  (Ren Mai) LU7

Penetrating vessel  (Chong Mai) SP4

Girdle vessel (Dai  Mai) GB41

Yang heel vessel  (Yang Qiao Mai) BL62

Yin heel vessel  (Yin Qiao Mai) KI6

Yang linking  vessel (Yang Wei Mai) TE5

Yin linking vessel  (Yin Wei Mai) PC6

SYMMETRY OF EM

The trajectories  of the 3 EMS display certain symmetry. A single branch  originates from the right kidney, or the moving Qi  between the kidneys, pass through the uterus to CV and  divides into three branches, "Yin Yuan Sanqi"  or three branches from the same origin and forms the Du,  Ren and Chong Mai's. The Ren Mai passes up the front  of the body on the midline and the Du Mai passes up the  back of the body on the midline. A horizontal vessel  encircles the body at the waist, the Dai Mai. Dr. Manaka  develops this idea of symmetry further, discussing these  patterns in relation to the right and left side of the  body, the upper and lower, front and back sections. (3)  This divides the body into eight sections or  "octants".

These eight  surface areas where 12 regular meridians lie, act as  "fields" which govern the particular meridians  which lie on that particular surface or field. Li Yan  stressed that "The Essentials of Ling Gui Ba-Fa are  the eight points which are the confluence locals of extra  channel and regular channels". "366 points of  the whole body are dominated by 66 points (Five Shu  points), 66 points are dominated by eight confluential  points". The Zhen Jiu Da Cheng also divides EMS into  certain topographic areas.

"Among the  eight marvellous vessels there are four yang, which  respond to the shoulders, back, lumbar, thighs and  disorders of the exterior. They are Yang Qiao, Yang Wei,  Dai and Du Mai. In addition, there are four Yin, which  respond to the heart, abdomen, sides, ribs and illness of  the interior. They are Yin Qiao, Yin Wei, Chong and Ren  Mai". (4)

THE EIGHT  CONFLUENCE (OPENING) POINTS

The eight opening  points, namely SI3, BL62, LU7, KI6, GB41, TE5, PC6, SP4  are described by Zhen Jiu Da Quan (1439 AD) and Zhen Jiu  Da Chong (1601 AD). Xu Feng, author of Zhen Jiu Da Quan  described the eight extraordinary vessels with reference  to the temporal sequence of the Trigrams and to their  eight treatment points. According to the legend, the  Emperor saw a tortoise with marking of the magic square  arranged on its shell. From this diagram came the I Ching  (the book of change). This established a new type of  chrono-acupuncture called Ling Gui Ba Fa, the eight  techniques of this mysterious turtle. Xu Feng also  indicated that by combinations of these eight points, one  can treat many diseases and illnesses.

TRAJECTORIES OF  EXTRAORDINARY VESSELS

There has never  been a precise consensus concerning the  "Pathways" of the EMS in the classic. But as a  student of acupuncture, we have to have some sort of  "standard" descriptions of the pathway as an  organised aid to our learning. One has to start  somewhere. With this in mind, I will attempt to piece  together the trajectories of EMS which I find clinically  useful. I will divide them into trunk and branches.

1. Trunks -  These are the "deep" pathways that affect the  "core" or the basic constitution of a person.

2. Branches-  These are more superficial vessels connecting to the  trunks which will affect the more superficial energetic  layers of the body.

I will also  attempt to describe the symptomatology of each EM and  co-relate this with its trajectory.

GOVERNOR VESSEL  (Du Mai)

Main trunk : Du Mai commences in the right kidney and passes  downwards to CV1 backwards to emerge at GV1 ascend along  the middle of the spine until it reaches point GV16 (Feng  Fu) where it enters the brain, ascends to the vertex and  follows the midline of the forehead, nose, upper lip into  the mouth and terminates at GV28 in the labial frenum.

Branches 1 : From CV2, 2 branches are given off. The anterior branch  rises directly across the navel, passes through the  heart, trachea, terminating BL1. The posterior branch  travels backwards, descends to the genitals and perineum,  tip of the coccyx, up the spinal column then joining the  kidneys.

Branches 2 : The origin of the third branch is common with that of  the bladder channel at the inner canthus of the eyes. The  two (Bilateral) branches ascend across the forehead and  converge at the vertex where the channel enters the  brain. Emerging at the lower end of the nape of the neck,  the channels again divide into two branches which descend  along the opposite side of the spine to the waist. Here  they join the kidneys.

Function of GV  - Opening Point SI3

1. The GV vessel  unites the yang energy of the body and rules the back of  the body. In a case of deficiency : bent walk, the  head falls forward, lack of strength, weakness of  character. In case of excess : stiff back and neck,  headache, hallucinations, hyperexcitation, epilepsy.

2. Pathogenic wind  can enter GV channel through GV16 (Feng-Fu the wind door)  and hence to the bladder and small intestine meridians  causing early stages of catches cold-shang Han Lun Tai  Yang disease with stiffness of neck, chills and fever,  aversion to cold/wind etc. Puncturing SI3 will relieve  the stiff neck, induce diaphoresis to dispel heat.

3. The internal  pathway of GV enters the brain at GV16 also explains the  use of GV vessels for psychological problems and  epilepsy. GV24 (Shenting) GV21 (Qianting) GV20 (Baihui)  GV19 (Houding) GV18 (Qiangjian) - all clear the mind,  lift moods and stimulate memory and concentration.

4. Because it  originates from the kidney, the GV vessel is used to  tonify K energy, especially kidney yang.

· To tonify K  yang moxibustion to GV4 & CV4

· To tonify K  yin, needle BL23 and CV4.

5. The GV vessel  is also important in mobilising Wei Qi (defensive Qi)  which is transformed from kidney Yang Qi which in turn is  nourished by stomach and spleen and spread outwards by  the lung dispersing functions. That is why in case of Wei  Qi deficiency where a person catches cold frequently we  have to tonify GV4, CV4, GV14 beside tonifying stomach  and spleen.

6. The individual  points on the GV vessel have an effect on the same organs  as the "back shu" points with which they are  one level. e.g. GV8 (Jin Suo) and BL18 both affect the  liver. That is why GV8 is important for treatment of  stiff neck and shoulders and any tendon contracture or  muscle spasm.

GV4 (mingmen -  GATE of life)

This point and CV4  are best used with moxibustion. It primarily nourishes  the kidney yang (Yuan Qi), and the essence (Jing) and  benefits the lumbar spine. It is indicated for - lower  back pain, enuresis, spermatorrhoea, impotence,  infertility (cold uterus).

GV14 (Dazhu)

Meeting point of  all foot and hand yang meridians. That means this point  has an immense potential to regulate the Yang Qi of the  body by tonifying or purging it. For example, one can  disperse wind and heat whether exterior or internal by  dispersing method. Moxibustion of this point tonifies  Yang Qi and increases the immunological Wei Qi.

GV12 (Shen Zhu)

This point is  situated at the same level as Fei Shu (BL13) and the GV  runs through it and enters the brain at GV16. It is an  important point, especially with cupping or moxibustion  for treatment of asthma. When used with reducing method  it eliminates interior wind, calms spasms, convulsions  and tremors or epilepsy.

GV20 (Bai Hui)

Bai means one  hundred, Hui means meeting. This point is the meeting  place of a hundred energies! It can be used for lots of  things. It clears the mind, lifts the spirit, tonifies  Yang. Being on top of the head, it can cure diseases  below, like prolapse of internal organs, haemorrhoids  etc. Caution the use of the point with moxa if there is  excessive heat in the body or the patient suffers from  high blood pressure.

GV23 (Shang  Xing - upper stair)

According to Arnie  Lade in "Images and Functions" (5) "the  name is an indirect reference to the nasal cavity, the  orifice associated with the lungs, which receive cosmic  Qi from the air. The cosmos is the abode of the  stairs". This point is mostly used for nose  diseases, such as allergic rhinitis or sinusitis and it  is usually tender on palpation in upper respiratory tract  infections. Moxa or needle this point will open the nose  and resolve phlegm.

REN MERIDIAN -  Opening point LU7

Main Trunk

The Ren Meridian  originates in the pelvic cavity and emerges at the  perineum at point CV1 from where it runs anteriorly up  the middle of the body, neck and chin to CV24 in the  centre of the mental labial groove.

Branches

1. From CV24 it  splits into two, curves around the lips, passing through  ST4 to enter the eyes at ST1.
2. Abdominal  vessels arise from CV15 and ramifies the surface of the  abdomen.

Function

The upper third  predominantly controls the respiratory functions: the  middle third on the epigastrium, digestive functions: the  lower third on the abdomen urogenital functions.

1. Upper 1/3 - It can be used for asthma, tightness of chest, chest  pain, breast pain, cough for which CV17, LU7, CV22 are  important points.

2. Middle 1/3 - For problems of the middle burner. At the level of the  stomach, there are 3 points that have actions on its  three different aspects. CV13 (Shang Wan) controls the  fundus which subdues rebellious stomach Qi: CV12 (Zhang  Wan) the body of the stomach which mainly involves in  digestion. CV10 (Xia Wan) pylorus which relieves stagnant  food.

3. Lower 1/3 - Because Ren Mai originates from the kidney and passes  through the uterus, it predominantly nourishes Yin and  blood energy of a woman. It can be used for menstrual  irregularities, labour problem, post-menopausal problems,  dysmenorrhoea, amenorrhoea, menorrhagia. Important points  are LU7, CV6, CV4, CV3.

CV17 (Shan  Zhong)

As Dr. Tran Viet  Dzung pointed out (6) :

a) CV17 stimulates  the upper burner where the Zhong Qi is stored. The Zhong  Qi governs the heart and lung - CV17 can be used for lung  problems such as asthma and heart problems like angina  pectoris (due to blood stasis in TCM)

b) CV17 is used  for all types of mental disorders. The internal branch of  triple warmer goes to CV17 before it reaches the  "San Jiao". CV17 is the front mu point of  pericardium (the ministerial fire), the San Jiao is water  metabolism. As water and fire meet at CV17, you can  restore the balance between water and fire by needling  CV17. If the water of the kidney cannot control the fire  of the heart, it will blaze upwards causing anxiety,  headaches, nervous breakdown, insomnia, mental disorder  etc.

CV4 (Guan Yan):  Gates to source QI

The source Qi from  the kidney passes through this point, the  "GATES". That's why to tonify kidney Yin  & Yang, we have to use CV4 as well.

CV6 (CV8 with  Moxa): Use for general lack of vital energy

The ancients  believed that the source Qi is stored between CV7 &  CV4, CV5 (Shi Men - the stone door) which opens into this  region or field, the Dan Tian, a region which contains  sperm or uterus. In order for this field to be fertile  and productive, CV6 (the sea of Qi) provides the sun or  Yang energy. Therefore, it is mandatory to tonify CV6  & CV4 in case of infertility.

CHONG MAI

Main Trunk

The Chong Mai  originated from the right kidney. The central focus of  the energetic body, the root of life and movement, the  moving Qi between the kidneys. It passes through the  uterus in woman to CV1 (straight to CV1 in man). From CV1  it ascends to CV4 and thence to the kidney meridian at KI  11 whence a branch is given off towards ST30. From KI 11  it ascends to KI 21, distributing its energy to ZangFu  enroute and then passes into the throat upwards via CV23  to ramify around the mouth.

Branches

From ST30, it  sends a descending branch which runs down the inside of  the thigh and legs to join with the kidney meridian  behind the medial malleolus and splits into two, one  branch travelling via KI 2 to SP1 and the other  travelling to LR1, thus uniting the three foot Yin  meridian.

Some authorities  believe that Chong Mai is the main connection to the  moving Qi between the kidneys, Ren & Du main are but  branches from Chong Mai. Wang Bing commented in Su Wen -  "This is why we can say the Du Mai, Ren Mai and  Chong Mai have different names, but are all the  same".

Function

1) Chong Mai is  most important for rebellious Qi conditions. e.g.  Rebellious Qi in chest causing tightness of chest and  chest pain. Rebellious Qi abdomen causing abdominal  swelling with gas, wind of flatus. Painful abdomen,  belching, abdominal rumbling.

2) Chong Mai is  "sea of blood" because together with Ren Mai  governs menstruation. Giovanni Maciocia states that  "The main difference between the directing vessel  (CV) and the penetrating vessel (Chong) in relation to  menstruation is that the former controls Qi whereas the  latter controls blood and is mostly used to move Qi and  blood and remove obstruction. It is indicated for  uterine, tubal ovarian disorders, sexual dysfunction,  menstrual obstetric problems, including infertility and  abdominal masses" (7)

3) It is also  involved in circulatory and thermoregulation, especially  cold feet. Moxa SP4 is indicated in such cases.

4) Chong Mai is  also related to alcohol consumption, affecting the liver  with jaundice. This is probably due to the fact that  Chong Mai meets at "the heart, chest and  stomach", the middle warmer, an area generally  affected by alcohol consumption. (8)