CHAPTER 7 Treatment of the Extraordinary Vessels
Introduction
Regulating and tonifying the Extraordinary Vessels is extremely important in gynecology because these vessels influence menstruation, ovulation, conception, pregnancy and childbirth. Some doctors say no specific treatment is necessary to affect the Extraordinary Vessels because they are closely linked to the channel system (as lakes to rivers) and the internal organs. They say that treating the Liver and Kidney automatically implies treating the Directing and Penetrating Vessels (Ren and Chong Mai), and that regulating Yin and Yang necessarily leads to regulation of the Extraordinary Vessels. For example, when harmonizing Yin and Yang in women, to nourish Blood is often important as doing so strengthens the Penetrating Vessel which is the Sea of Blood. However, many doctors, both modern and old (and including myself), would disagree with this view, maintaining that there are specific herbal strategies and acupuncture methods of treatment which affect the Extraordinary Vessels. The formula Yang Jing Zhong Yu Tang Nourishing the Essence and Planting Jade Decoction is an example of such a principle of treatment as it combines tonification of the Kidneys and of the Extraordinary Vessels with nourishing Blood.
Second, regulating and tonifying of Yin, Yang, Qi and Blood should be combined with removing obstructions: the combination of these methods in gynecology also activates the Extraordinary Vessels. For example, tonifying the Kidneys is often combined with moving Blood and eliminating stasis in endometriosis; nourishing Kidney-Yin and eliminating stasis during the mid-cycle phase tonifies and regulates the Extraordinary Vessels, promotes ovulation and regularizes the periods. The formula Yi Shen Tong Jing Tang Nourishing the Kidneys and Penetrating the Menses Decoction is an example of such a treatment method.
With acupuncture, of course, the problem does not arise because it can affect the Extraordinary Vessels directly. For this reason, acupuncture is extremely effective in treating gynecological problems: there is nothing more direct than using points such as Ren-4 Guanyuan to affect the Directing Vessel (Ren Mai) or KI-13 Qixue to affect the Penetrating Vessel (Chong Mai).
There are several ways of using the points of the Extraordinary Vessels, including their ‘opening’ points and points on their trajectory.
The eight Extraordinary Vessels and their opening points are:
They can be grouped in four pairs of the same polarity (both Yin or both Yang) sharing similar pathways, and in pairs in which the opening point of one is the associated point of the other and vice versa, i.e.:
By grouping the vessels in four pairs we get four pairs of points: I shall call the point related to each vessel its ‘opening’ point and the point related to the vessel with which it is paired its ‘associated’ point (which, itself, is the opening point of the paired vessel). For example, the opening point of the Directing Vessel is LU-7 Lieque and its associated point is KI-6 Zhaohai: this latter point is the opening point of the Yin Stepping Vessel with which the Directing Vessel is paired. Thus, if we needle LU-7 Lieque first followed by KI-6 Zhaohai, we open the Directing Vessel: if we needle KI-6 first followed by LU-7, we open the Yin Stepping Vessel.
These points have always been mentioned as pairs in the classics, sometimes even without mentioning the Extraordinary Vessels, and the Extraordinary Vessels were given family members’ names highlighting their use as pairs to achieve harmony:
Because of this arrangement in pairs, the opening point of one vessel is usually used in conjunction with the opening point of the paired vessel. This technique, called ‘host–guest’, was indicated for the very first time in the Guide to Acupuncture Channels (Zhen Jiu Jing Zhi Nan 1295) and later expanded in the Great Compendium of Acupuncture (Zhen Jiu Da Cheng 1601).2 For example, when using the Directing Vessel, one would needle LU-7 Lieque and KI-6 Zhaohai in this order, the former being its opening point and the latter its associated point (and opening point of its paired vessel, Yin Stepping Vessel).
There are two possible ways of proceeding:
Using the opening points achieves two results. First, it reaches the area governed by that vessel (e.g. the Directing Vessel, LU-7 Lieque and KI-6 Zhaohai to reach the mouth and gums). Second, it brings into play the Extraordinary Vessels’ role as reservoirs of Qi, i.e. to absorb and regulate excesses and stagnation. This is particularly necessary when the pulse has the same quality in different positions (see below).
The effect of using a point on the vessel depends on the vessel in question and cannot be generalized. To understand this, we need to distinguish the categories of Extraordinary Vessels:
The Governing and Directing Vessels
These are quite different than the other six because they have their own points. They are at once Extraordinary Vessels and ordinary channels (hence the reference sometimes to the 14 channels). Therefore using a point on these two vessels has a powerful effect on them even without using the opening points.
A point on one of these two vessels can tonify, activate or move Qi in that particular vessel. For example, using Ren-4 Guanyuan brings into play the energy of the Directing Vessel and it can tonify its Blood and Essence. Of course, very often we use the opening points and a point on the channel as well. For example, it is very common to needle LU-7 Lieque on the right and KI-6 Zhaohai on the left to open the Directing Vessel, together with Ren-4 Guanyuan to strengthen the vessel and the Kidneys.
To give another example, using Ren-6 Qihai moves Qi in the Lower Burner, even without the Directing Vessel’s opening points.
The Penetrating Vessel (Chong Mai)
Although this vessel does not have its own points in the same way as the Governing and Directing Vessels do, one could say that it almost does. In fact, the Penetrating Vessel is closely associated with the Kidney channel flowing as it does through all the Kidney points between KI-11 Henggu and KI-21 Youmen. Therefore, if we tonify KI-13 Qixue, we have a profound tonifying effect on the Penetrating Vessel (nourishing Blood and Essence). If we needle KI-14 Siman, we strongly invigorate Blood in the Uterus. We achieve these effects also without using the Penetrating Vessel’s opening points.
The other five vessels
The other five vessels do not have their own points and they meander from one channel to the other. The Yang Stepping Vessel (Yang Qiao Mai) is a good example of this as it meanders through nearly all Yang channels from the ankle to the eyes.
In the case of the other five channels, using a point on the vessel without its opening points will not have any influence on that vessel. For example, if we needle S.I.-10 Naoshu (on the Yang Stepping Vessel) without its opening points, we would not influence this vessel in any meaningful way. On the contrary, using BL-62 Shenmai and S.I.-3 Houxi would open the Yang Stepping Vessel to perform its function of absorbing excess of Yang energy in the upper part of the body, whereas using S.I.-10 Naoshu only would have no such effect.
Although several practitioners use the opening and associated point as a couple, not all doctors use the points in this way and the classics sometimes discuss the points as pairs and sometimes not. Thus, some doctors would use only LU-7 Lieque to open the Directing Vessel. The three different ways of using the opening points of the Extraordinary Vessels can be summarized as follows:
Above–Below Unilaterally
This consists in using the opening point of the main vessel and its associated point on the same side. Example: S.I.-3 Houxi on the left, BL-62 Shenmai on the left. This method is suitable for unilateral problems of the back and limbs, or unilateral backache, sprains, Painful Obstruction Syndrome or sequelae of Wind-stroke. When using this method, one needles only the affected side.
Left–Right Crossing
This consists in using the opening point of the main vessel on one side and its associated point on the other. Example: S.I.-3 Houxi on the left, BL-62 Shenmai on the right. This method is suitable for problems of the head and face and internal organs. The technique is especially suitable for children, old people and patients whose body condition is weak or who suffer from anxiety. One should not use too many other needles or the needles on one limb cannot move Qi well (especially if there are scars or boils with pus).
Above–Below Bilaterally
This consists in using the opening points of the main vessel bilaterally and its associated points also bilaterally. Example: S.I.-3 Houxi and BL-62 Shenmai both bilaterally. This method has a very wide application and can basically be used for both types of problems indicated above.
In my practice I use the second method, i.e. using the opening point of the main vessel unilaterally and its associated point on the opposite side. In deciding on which side to use the opening point of the main vessel, I go by the patient’s sex, i.e. the opening point of the vessel being treated is needled on the left side for a man and the right side for a woman, and its associated point (which is the opening point of the paired vessel) on the opposite side. For example, if using the Directing Vessel in a male patient, I needle LU-7 Lieque on the left and KI-6 Zhaohai on the right, inserting the needles in this order, and would withdraw them in the reverse order; in a female patient, I would needle LU-7 Lieque on the right and KI-6 Zhaohai on the left, in this order, and again would withdraw them in the reverse order.
Although this method of needling according to sex and laterality is not mentioned in the Great Compendium of Acupuncture, that book does suggest needling first the opening point of the chosen vessel and then that of its associated vessel (e.g. LU-7 Lieque and KI-6 Zhaohai for the Directing Vessel).3
When used in such pairs, the Extraordinary Vessels’ points also harmonize Above and Below as the paired points are always one from the arm and one from the leg. By using these points as pairs, one transcends the action of the individual points and brings into play the energy of the Extraordinary Vessels: it is as if one needed two keys to open a door. That is why I prefer to use the points of the Extraordinary Vessels in pairs. Some doctors in China studied whether the Extraordinary Vessels work better by using the opening point on its own or with its associated point: they report a case of a woman suffering from mental illness for whom they used S.I.-3 Houxi without good results; when this point was associated with BL-62 Shenmai, results improved.4
Some doctors go so far as saying that there are 360 points in the body with 66 most important ones (the Transporting Shu points); but the eight confluent points of the Extraordinary Vessels control all the 66 Shu points.
What guidelines can be given for choosing to use the Extraordinary Vessels in practice? There are basically three depending on the nature of the imbalance.
1 Problems of internal organs
Use the internal organs identification of patterns. If the clinical condition reflects very clearly the disharmony of one or more organs and manifests with clear-cut internal organ patterns, then it makes sense to treat it according to the internal organs identification of patterns, without using an Extraordinary Vessel. For example, if a patient has clear-cut symptoms and signs of Liver-Qi stagnation, one can simply treat according to the pattern of Liver-Qi stagnation using the relevant points and disregard the Extraordinary Vessels.
2 Problems of head–limbs–Exterior
Use the main channel identification of patterns. This means that a channel problem, distributed clearly along a main channel, is treated according to channel patterns. For example, if a patient suffers from a painful shoulder, with pain radiating clearly along the Large Intestine channel, then it is sufficient to treat this problem mainly according to this channel and not use an Extraordinary Vessel.
3 Problems of several channels simultaneously, complicated conditions, involvement of an internal organ with a different channel, confusing situations of Heat–Cold and deficiency–excess, some mental problems, some neurological problems, the pulse having the same quality in several positions
Use the Extraordinary Vessels. As can be seen from the above list, the therapeutic range of the Extraordinary Vessels is very broad indeed. I shall discuss the above points one by one.
Problems of several channels simultaneously
The Extraordinary Vessels are ideally placed to treat problems involving several channels for two reasons. First and foremost, this is because they absorb excesses and stagnation from several main channels (just as several streams may flow into one lake); for example, the Yang Stepping Vessel absorbs excesses from all Yang channels. Second, the Extraordinary Vessels do not have their own points (with the exception of Governing and Directing Vessels, of course) and their pathways cross several different main channels. For example, the Yang Linking Vessel crosses the Small Intestine, Gall Bladder, Bladder, Stomach and Governing Vessel. To give another example, the Yang Stepping Vessel gives good results in sciatica when the pain seems to be in between the Bladder and Gall Bladder channels.
Complicated conditions
The Extraordinary Vessels are often implicated in complex pathological conditions due to their influencing so many different channels and so many different organs. For example, the Penetrating Vessel affects Blood, the Kidneys, the Kidney-Essence, the Heart, the Sea of Blood, all the channels in the abdomen, the facial hair, rebellious Qi in the abdomen and chest, the inner aspect of the leg and big toe, etc. Therefore, a pathology of the Penetrating Vessel could involve all these different aspects and the clinical manifestations would be very difficult to unravel if we referred only to the internal organ patterns. In fact, very often clinical manifestations that appear extremely complicated when analysed according to internal organ patterns are readily disentangled when seen from the point of view of an Extraordinary Vessel’s pathology.
Involvement of an organ and a different channel
For the same reasons explained above, the Extraordinary Vessels can give rise to symptoms of one organ and a different channel. For example, the Penetrating Vessel arises from in between the Kidneys and can therefore cause symptoms of Kidney deficiency together with symptoms of rebellious Qi in the Stomach.
Confusing situations of Heat and Cold or of deficiency and excess
The pathology of the Penetrating Vessel is largely responsible for conditions characterized by confusing symptoms of Heat and Cold as explained in Chapter 3 on pathology. When the Qi of the Penetrating Vessel rebels upwards, it may cause a feeling of heat in the face and, because of a deficiency of Qi in the descending branch of this vessel, cold feet. The Penetrating Vessel is similarly involved in confusing situations of deficiency and excess: for example, a Kidney deficiency may not only cause the Penetrating Vessel to be Empty in the Lower Burner but also cause Qi to rebel upwards with symptoms of Fullness (stagnation of Qi) in the chest.
Some mental problems
The Extraordinary Vessels are often used for mental–emotional problems, especially the Governing Vessel, the Yang Stepping Vessel, the Penetrating Vessel and the Yin Linking Vessel, as explained in Chapter 3 on pathology.
Some neurological problems
Some of the Extraordinary Vessels may be used to treat neurological problems such as neuritis and multiple sclerosis. This applies in particular to the Governing Vessel and the Girdle Vessel.
Conditions in which the pulse acquires the same quality in different positions
This means that the pulse has exactly the same quality, for example, on both Front positions, or on both Guan positions, or on all positions of one side. The Study of the Eight Extraordinary Vessels by Li Shi Zhen describes in detail certain pulse qualities related to these vessels.5 The main pulse findings are detailed below:
Why should a pulse that displays exactly the same quality in more than one position and usually in corresponding ones (such as both Front positions) be linked to the Extraordinary Vessels’ function of reservoirs of Qi? If the main channels are like rivers (each one reflected in individual pulse positions) and the Extraordinary Vessels like lakes which absorb overflowing energy, it is natural that the state of these vessels would be reflected in more than one position, much as an overflowing river loses its shape and floods a whole area of land.
The Extraordinary Vessels are also related to the Four Seas:
Penetrating vessel (chong mai)
The Penetrating Vessel is probably the most important of the Extraordinary Vessels and, in relation to gynecology, it has a deep influence on the menstrual function as it is the Sea of Blood. It is therefore related to the Blood in the Uterus and controls menstruation in all its aspects. If the Penetrating Vessel is Empty there may be amenorrhoea, scanty periods or late periods. If Qi and/or Blood are stagnant in the Penetrating Vessel there may be dysmenorrhoea.
The Penetrating Vessel also controls the breasts in several ways. The pathway of this vessel runs from the lower abdomen along the Kidney channel and then fans out over the breasts and chest on its way to the throat and eyes. The major arteries that feed the breast, i.e. the axillary artery supplying the outer half and the internal mammary arteries the inner half of the breast, are controlled by the Penetrating Vessel in two ways: because this vessel is the Sea of Blood and controls all blood vessels, and because this vessel spreads over the breasts in women. For this reason, the Penetrating Vessel exerts an important influence on pre-menstrual breast distension, breastfeeding and breast lumps. Because the Penetrating Vessel is the Sea of Blood and breast milk is a transformation of Blood, this vessel influences the supply of breast milk in two ways: if the Penetrating Vessel is Empty, the Sea of Blood is depleted and there may not be enough milk. If the Qi of the Penetrating Vessel is stagnant, the breast Connecting (Luo) channels will be blocked and the milk may not flow even though it is abundant. Figure 7.1 illustrates the pathway of the Penetrating Vessel in relation to the arteries feeding the breast.
To open the Penetrating Vessel in a woman, I needle SP-4 Gongsun first on the right followed by P-6 Neiguan on the opposite side: the needles are retained for about 20–25 minutes and withdrawn in the reverse order. Apart from obtaining the needling sensation (deqi), it is not necessary to perform any other needling manipulation. Since the subject is gynecology, I shall assume from now on that the opening point is inserted on the right side and the associated one on the left (Fig. 7.2).
Using SP-4 Gongsun on the right and P-6 Neiguan on the left (in a woman) ‘opens’ and regulates the Penetrating Vessel: this means that the vessel is opened to perform its function of absorbing excesses or stagnation of Qi and also that these two points will affect the area influenced by the Penetrating Vessel, i.e. abdomen, chest, heart and throat.
As indicated in Chapter 3, rebellious Qi is a frequent pathology that affects the Penetrating Vessel. Indeed, the word chong in Chinese is also used as a verb to indicate the pathological rising of Qi towards the top. For example, when the Qi of the fetus rebels upwards and disturbs the mother, it is called tai qi chong yu shang, i.e. the “Qi of the fetus rebels (chong) upwards”. The main symptoms and signs indicating such a syndrome are abdominal pain and distension, a feeling of oppression of the chest and throat, palpitations, a suffocating sensation, a feeling of heat in the head, cold feet, anxiety and a pulse that is Firm on all three positions of the left side. Not all these symptoms need be present to use this vessel, but it is usually necessary to have three or four of these symptoms at different levels of the trunk to diagnose this syndrome.
The opening and associated points of the Penetrating Vessel (SP-4 Gongsun on the right and P-6 Neiguan on the left) are excellent to treat this condition. However, these points are usually associated with points along the Penetrating Vessel, such as ST-30 Qichong, KI-13 Qixue, KI-14 Siman, KI-16 Huangshu, KI-18 Shiguan, KI-19 Yindu, KI-20 Futonggu and KI-21 Youmen.
The following is an example of point combinations to open the Penetrating Vessel for the Empty type of syndrome of rebellious Qi, i.e. one that derives from a Kidney deficiency: SP-4 Gongsun on the right (inserted first), P-6 Neiguan on the left (inserted second), L.I.-4 Hegu on the right, LIV-3 Taichong on the left, KI-13 Qixue, KI-16 Huangshu, KI-21 Youmen, the last three all bilateral (Fig. 7.3). In this combination, SP-4 and P-6 regulate Qi of the Penetrating Vessel; L.I.-4 and LIV-3 help to regulate the ascending and descending of Qi; KI-13 tonifies the Kidneys and the Penetrating Vessel; KI-16 harmonizes Kidneys and Heart and helps to subdue rebellious Qi; KI-21 helps to subdue rebellious Qi.
An example of point combination for the Full type of Rebellious Qi of the Penetrating Vessel is as follows: SP-4 on the right, followed by P-6 on the left, L.I.-4 Hegu on the right, LIV-3 Taichong on the left, KI-14 Siman, KI-16 Huangshu, KI-21 Youmen, the last three all bilateral (Fig. 7.4).
I shall now discuss the actions and indications of the most important Penetrating Vessel points on the abdomen and chest with particular emphasis on gynecological problems intended in a broad sense: that is, I shall include symptoms that, whilst not strictly ‘gynecological’, are frequently associated with gynecological symptoms and that are very common in women, such as urinary problems, oedema, abdominal pain, etc.
ST-30 Qichong (Rushing Qi)
ST-30 is an extremely important point of the Penetrating Vessel because it is here that the vessel emerges from the Interior, descending from the space between the kidneys and the uterus.
The chong within the name of this point can be translated as ‘rushing’ or ‘penetrating’ and is the same character as that for chong mai, i.e. Penetrating Vessel; thus, its name clearly indicates its relationship with this vessel and, at the same time, it suggests the energetic movement as the Qi of this vessel rushes outwards towards the surface from this point.
The word chong can also be translated as ‘infuse’ and, in this sense, it indicates that this point is the place where the three Yang channels (of the leg) infuse outwards, and the three Yin Essences (of the Yin channels of the leg) infuse inwards.
The fact that the crossing of the Yang and Yin Essences on their way out and in is on a large artery (femoral) contributes to the name of ‘Infusing Qi’. This point is also frequently called Qijie which means ‘Avenues of Qi’: this is a clear reference to the Penetrating Vessel’s control of all the channels of the abdomen (hence its name of ‘Sea of the 12 Channels’). In fact, at this point, the Stomach channel goes in, the Gall Bladder channel goes out, the Penetrating Vessel emerges; the Liver and Spleen channels also go through this point; it is thus a real crossroads of channels on their way to or from the abdomen and inwards or outwards. All the old books describe this point as being on a ‘big artery’ (the femoral artery) where a strong beat can be felt. Its location on a major artery is not a matter of chance as the Penetrating Vessel, which emerges from this point, is also the Sea of Blood and controls all channels and blood vessels.
The actions of this point are very wide-ranging. It:
As can be seen, apart from its action on Stomach-Qi, all its other actions are of great relevance in gynecology.
The indications are very many indeed and I shall list only those relevant to the Penetrating Vessel’s pathology and gynecology: infertility, abdominal pain and distension, Qi of the fetus surging upwards to harass the Heart (of the mother), swelling and pain of external genitalia, irregular periods, retention of placenta and dysmenorrhoea.
ST-30 Qichong is an important and powerful point of the Penetrating Vessel. The main thrust of its action is related to its being the point from which the Qi of the Penetrating Vessel emerges from the Interior, hence its dynamic nature. Furthermore, since ST-30 is a point of the Sea of Food of the Stomach, it represents an important connection between the Stomach and the Penetrating Vessel, i.e. between the Post-Natal and Pre-Natal Qi, and it can be used to strengthen both the Pre-Natal and Post-Natal Qi.
Looking at the actions and indications, we can deduce that this point can be used in Empty conditions to tonify Qi, Blood and Essence, and in Full conditions to subdue rebellious Qi and Blood in the Penetrating Vessel and to invigorate Blood. In its former function, it can treat infertility; in its latter function, it can treat dysmenorrhoea, abdominal pain and irregular periods.
The point ST-30 Qichong is frequently combined with the opening points of the Penetrating Vessel, i.e. SP-4 Gongsun and P-6 Neiguan, for both Empty and Full conditions as described above. It may also be combined with ST-39 Xiajuxu and LIV-3 Taichong for numbness and cold feet, due to deficiency of Qi and Blood in the descending branch of the Penetrating Vessel.
KI-11 Henggu (Horizontal Bone)
‘Horizontal Bone’ indicates the pubic bone, over which this point lies.
Like the previous point, ST-30 Qichong, and like many of the Penetrating Vessel’s points on the abdomen, this point can be used to tonify in Empty conditions and to clear in Full conditions, hence the apparent paradox that it can both tonify Yang and clear Heat. ‘Tonify Yang’ means that it can tonify Kidney-Yang when used with direct moxa cones. ‘Clear Heat’ means that it can clear Heat or Damp-Heat of the Bladder in Painful-Urination Syndrome. Thus this point is used for urinary problems in women more often than for menstrual problems.
Its indications, with particular reference to gynecology, include genital pain, lower abdominal pain, urinary difficulty and Painful-Urination Syndrome.
The point KI-11 Henggu can be combined with ST-27 Daju and LIV-14 Qimen for fullness of the lower abdomen, urinary difficulty and prolapse of the vagina; with SP-2 Dadu for backache with inability to straighten up from Qi stagnation; and with KI-16 Huangshu for chronic Painful-Urination Syndrome.
KI-12 Dahe (Great Flourishing)
Other names include Yinwei (‘Linking Yin’) and Yinguan (‘Gate of Yin’). The word he means ‘flourishing, luminous, awe-inspiring’: the point is so called because Yin Qi flourishes here and the Essence accumulates, and also because after conception the uterus enlargement starts at this place.
The actions of KI-12 are as follows. It:
As explained above, this point too can treat either Empty or Full conditions although it is particularly indicated for Empty ones. In fact, its indications, with particular reference to gynecology, include genital pain, vaginal discharge, prolapse of the uterus, irregular periods, dysmenorrhoea and infertility. This point is frequently encountered in modern prescriptions to promote ovulation.
It can be combined with KI-2 Rangu for contraction of the genitals.
KI-13 Qixue (Qi Hole)
Other names include Baomen (‘Door to the Uterus’) and Zihu (‘Door of the Baby’). There are three explanations for the meaning of this name: the point is situated near the opening of the bladder, hence ‘hole’; the Kidneys control the grasping of Qi and this point is the ‘hole’ into which Qi is anchored; and the Essence accumulates in this ‘hole’.
The actions of this point are as follows. It:
The indications specific to gynecology include: irregular periods, white vaginal discharge, Uterus Empty and Cold, and Directing and Penetrating Vessels Empty.
Like the other points on the Penetrating Vessel, KI-13 also has a dual function: it can both supplement a deficiency and clear a Fullness. In Empty conditions, it is probably the most important tonifying point on the Penetrating Vessel: it tonifies the Kidneys (Yin or Yang), nourishes the Essence, strengthens the Original Qi (Yuan Qi) and fills the Directing and Penetrating Vessels. It also strengthens the Kidney’s grasping of Qi and is an important point in treating allergic asthma from Kidney deficiency or nourishing Kidney-Yin in menopausal problems.
In Full conditions, KI-13 Qixue is used for rebellious Qi of the Penetrating Vessel causing an upsurge of energy from the lower abdomen to the chest and throat. It should be noted, however, that in such conditions it need not necessarily be reduced: if the condition of rebellious Qi is secondary to a Kidney deficiency and an Emptiness in the Lower Burner as described above, then this point should be tonified. The Great Dictionary of Chinese Acupuncture compares this point with the keys of a wind musical instrument. It says that it moves Blood through Qi (Qi being compared with the air in a wind instrument and the Kidney points on the abdomen presumably corresponding to its keys), and that it treats the running piglet surging upwards and the beng lou (Flooding and Trickling) leaking downwards.6
KI-14 Siman (Four Fullnesses)
This point’s other names include Suifu (‘Fu of Marrow’) and Suizhong (Central Marrow). There are many explanations for the name ‘Four Fullnesses’:
The actions of KI-14 Siman are as follows. It:
Indications in gynecology include: metrorrhagia, irregular menstruation, retention of lochiae, vaginal discharge, infertility and lower abdominal pain.
This point also can be used for both deficiency and excess but more frequently for the latter. Thus, in a deficiency, one would prefer KI-13 Qixue but in an excess KI-14 Siman. From this point of view, KI-14 is a very important point for stagnation of Qi and/or Blood in the lower abdomen in women. I use it frequently in combination with the opening points of the Penetrating Vessel for stagnation of Qi or Blood in the abdomen causing such problems as dysmenorrhoea, abdominal pain or menorrhagia. Bearing in mind its name, this point is specific for a feeling of fullness of the abdomen: this differs from a feeling of distension insofar as the latter is merely a subjective symptom while the former is objective too as the abdomen feels hard on palpation.
As its alternative names indicate, this point can be tonified to nourish Marrow: for this reason, it is used during and after the menopause to prevent osteoporosis.
KI-16 Huangshu (Transporting Point of Membranes)
‘Huang’ means ‘membranes’ and ‘Shu’ means Transporting point (as in the Back-Transporting points). The point is situated at the border between the upper and lower abdomen and it therefore lies at the centre of the ‘membranes’: these include the connective tissue structures lying in the abdomen, i.e. mesentery, omentum and fascia. This point is therefore the Transporting (Shu) point of these structures. It is also the point from where the Kidney channel penetrates deeply into the membranes. These penetrate upwards to the chest and diaphragm and connect with the Girdle Vessel. This point, being near the umbilicus which connected the fetus to the mother, controls the origin of membranes and is like the Original point of all internal organs. ‘Transporting point of membranes’ also means that the point is at the centre of membranes, it connects downwards with the Kidneys and upwards with the Heart, the throat and tongue.
The actions of this point are as follows. It:
The main gynecological indications are irregular periods. Other indications, which help us to understand the nature of this point, include umbilical pain, abdominal distension, constipation, hernia, vomiting, diarrhoea, Cold in the Large Intestine and a feeling of ‘cold under the heart region’.
As can be seen from the indications, this point is mainly used for Full conditions characterized by rebellious Qi in the Penetrating Vessel: in gynecology, principally for dysmenorrhoea and irregular periods. However, there is a deeper significance in that this point belongs to the Penetrating Vessel and is situated next to the umbilicus. Through this point, the baby’s umbilical cord connects with the mother’s placenta; the Penetrating Vessel is the precursor of all other Extraordinary Vessels and therefore related to the Pre-Natal Qi. At conception, the Governing, Directing and Penetrating Vessels are formed, representing the spark and organizing force that will give shape to the human form. In the fetus, the umbilicus, the Original Qi and the Gate of Life (Ming Men) lie on the same energetic axis and KI-16, lying right next to the umbilicus and being on the Penetrating Vessel, is like a Transporting point not only for the membranes but also for all the internal organs. Thus, this point can affect the Pre-Natal Qi, the Kidney-Essence and the Original Qi.
KI-18 Shiguan (Stone Gate)
‘Stone’ here indicates fullness, hardness: this refers to the main indication for this point, i.e. fullness and hardness of the epigastrium. ‘Gate’ refers to the pyloric sphincter of the stomach through which the digested food passes on its way to the small intestine. The Great Dictionary of Acupuncture gives a different interpretation of this name, saying that shi can sometimes mean ‘water’: hence shi here would indicate the Water of the Kidneys, and the name would mean ‘Gate of the Kidneys’.7 Yet another interpretation given in the same dictionary is that ‘Stone Gate’ here refers to the blockage of stools (the point treats constipation) and to infertility, i.e. two stone gates are blocking the passage of stools and sperm.
The main actions of this point are as follows. It:
The main gynecological indications are: post-partum abdominal pain, abdominal pain, infertility, a sensation of fullness and hardness under the heart region, ‘evil’ blood in the Yin organ (i.e. old, stagnant Blood).
Thus, although this point can be used to tonify the Kidneys and promote fertility in deficiency conditions, its more common use is for Full conditions characterized by stasis of Blood in the abdomen and retention of food in the Stomach and Intestines. The fullness and hardness can also extend to the Heart because the Penetrating Vessel flows to the heart region, causing a feeling of fullness and hardness in this region with a corresponding mental–emotional state of worry, anxiety and bitterness. On a diagnostic level, an important sign for the use of this point is a feeling of hardness of the epigastrium and/or abdomen.
KI-19 Yindu (Yin City)
The abdomen is Yin and this point is on the Kidney channel which also pertains to Yin: it is Yin within Yin, hence the name ‘Yin City’. Du indicates an important city, but also a place where water collects; the Kidneys govern Water, hence the name means also ‘Yin-place-where-Water (Kidneys)-collects’.
The actions of this point are as follows. It:
The indications of KI-19 Yindu in the gynecological sphere include: infertility, sensations of heat and cold (as in menopausal problems), a feeling of vexation of the heart and old, stagnant Blood in the viscera.
Because of this point’s action on sensations of heat and cold and a feeling of anxiety and vexation of the heart, it can be used, combined with the Penetrating Vessel’s opening points, in menopausal problems.
KI-20 Futonggu (Abdominal Penetrating Valley)
‘Fu’ means ‘abdomen’ and is used here only to distinguish this point from BL-66, which is also called ‘Tonggu’. ‘Tong’ means ‘penetrating’ or ‘passing through’. ‘Gu’ can mean both ‘valley’ or ‘grains’ and, by extension, ‘food’. Thus the name of this point can be interpreted in two ways. The ‘valley’ is the space between the muscles of the abdomen (rectus abdominis) where the point lies. The Qi of the Kidneys and Penetrating Vessel passes through this space as if through a mountain valley. If we interpret ‘Gu’ as ‘grains’ or ‘food’, the name of the point means ‘easing the passage of food through the digestive system’, a clear reference to the many digestive indications of this point.
The actions of KI-20 Futonggu are as follows. It:
The indications relevant to gynecology include abdominal pain and distension, palpitations and mental confusion. The main use of this point in gynecology is for palpitations, mental confusion and anxiety occurring in menopausal problems. Again, this point would be used with the opening points of the Penetrating Vessel (SP-4 Gongsun and P-6 Neiguan) and, if the problem stems from a Kidney deficiency, also with such points as Ren-4 Guanyuan and KI-13 Qixue.
KI-21 Youmen (Dark Door)
‘You’ means ‘dark’ and ‘men’ means ‘door’. ‘Dark’ denotes the fact that at this point the Penetrating Vessel goes deeper and disappears into the chest cavity, hence into ‘darkness’. ‘Door’ indicates that it is the border between the more superficial abdominal branch and the deeper thoracic branch of the Penetrating Vessel. ‘Dark’ also refers to the Yin character of this point pertaining both to the Kidney channel and to the Penetrating Vessel.
The actions of KI-21 Youmen are as follows. It:
The indications of KI-21 Youmen in the gynecological sphere include palpitations, anxiety, poor memory, abdominal fullness and chest pain in women. The book Acupuncture reports the last symptom from an old classic: this is interesting as it confirms that this point treats the Penetrating Vessel in women in conditions of rebellious Qi.8
Penetrating Vessel: summary and case histories
To summarize, the major pathology of the Penetrating Vessel in gynecology is Qi rebelling upwards from the lower abdomen to the chest and throat, with stagnation of Qi and/or Blood. The condition of Qi rebelling upwards may be due to a deficiency of the Kidneys and an Emptiness of the Penetrating Vessel in the lower abdomen. The deficiency below and rebellious Qi above account for contradictory symptoms of heat and cold in women, especially after the age of 40. Since the Penetrating Vessel is the Sea of Blood, this vessel is extremely important in the treatment of dysmenorrhoea from stasis of Blood. Because it controls all Blood Connecting Channels, a deficiency or stasis of Blood in this vessel may cause aches in the muscles and joints resembling Painful Obstruction Syndrome.
A 45-year-old woman had been suffering from tiredness, blurred vision, palpitations, a panicky, anxious feeling in the chest with a feeling of energy rising, insomnia, headaches during the periods, pre-menstrual tension with abdominal distension, a feeling of heat in the face but cold hands and feet. Her tongue was Bluish-Purple and her pulse was Fine but also slightly Firm in all three positions of the right side (Plate 1).
This patient was treated along these lines for four sessions achieving a complete recovery from her symptoms.
A 23-year-old woman suffered from painful periods. The pain occurred during the period and was very intense and cramp-like. It was relieved by the application of a hot-water bottle. Her tongue was Pale Purple.
This is an example of obstruction of the Penetrating Vessel by Cold. The obstruction of the Uterus by Cold has led to stasis of Blood.
This patient was treated for 9 months along similar lines after which her periods ceased to be painful.
A 65-year-old woman complained of hot flushes every 50 minutes after a total hysterectomy 10 years previously. She could not have hormone replacement therapy as she had developed breast cancer (and underwent a mastectomy) 2 years previously. With the hot flushes, she also experienced anxiety with a suffocating feeling in the chest and throat. She suffered from night sweating and insomnia. Her urination was frequent and pale and her feet were generally cold. Her pulse was Deep, slightly Slippery on the right side and slightly Wiry on the left. Her tongue was of a normal colour, Swollen, with a yellow coating and Stomach cracks.
This is an example of rebellious Qi in the Penetrating Vessel causing the feeling of heat and anxiety. It is not a typical Empty-Heat pattern as the tongue is not Red. The cold feet are due to the derangement of Qi in the Penetrating Vessel, rebelling upwards and failing to warm the legs in its descending branch. The pathology is also complicated by the presence of Phlegm, as evidenced by the Swollen tongue and Slippery pulse.
This patient required a lengthy treatment for about 18 months due to her age and also to the hysterectomy. This surgical procedure always somewhat hinders treatment in gynecological problems as it removes the uterus which stores Blood.
Full access? Get Clinical Tree
