JOURNAL OF CHINESE MEDICINE NUMBER 32 JANUARY 1990

ACUPUNCTURE POINT COMBINATIONS

DR. GU YUE HUA
The combination of points we choose significantly affects the therapeutic results we might expect from a treatment. Some points counteract each other, whilst others promote each others function. For this reason, the appropriate combination of points is of prime importance in our selection of treatment.
These notes, transcribed by Jasmine Uddin, were given by Dr. Gu during the course of clinical practice at The Railway Hospital, Nanjing, in the Autumn of 1989. A number of principal points and their various combinations are discussed. They are: Baihui DU-20, Neiguan P 6, Waiguan SJ-5, Hegu L.I.-4, Zusanli ST-36, Sanyinjiao SP-6 and Yinlingquan SP-9. BAIHUI DU-20 Indications: for the heat/fever stage of various diseases and for disorders of the brain (such as epilepsy or meningitis) or intoxication from chemicals or drugs (i.e. poisons). Vertigo, apoplexy (closed syndrome) and spells of epilepsy. Method: reduce.

4a. Baihui DU-20, Neiguan P-6, Zusanli ST-36, Suliao DU-25 4b. Baihui DU-20, Guanyuan REN-4, Shenque REN-8
Function: These two prescriptions can be used to return the Yang in the case of coma (flaccid type, hypotension), shock or exhaustion of Yang (sweating, cold extremities and hypotension), coma from acute pain or allergic reaction to penicillin, or shock from drug poisons or exhaustion of yang at a severe stage of dysentery (pallor, profuse sweating, hypotension, weak breathing, very weak pulse). Method: 4a. These points are tonified, and moxa is applied at Baihui DU-20. Manipulate the needles continuously until the blood pressure is raised and breathing and pulse improve. Electro-acupuncture may be necessary as stimulation may need to be applied for a long time. Frequency should be less than 30 per minute on dense/disperse wave. 4b: Moxa on salt is applied at Shenque REN-8. Otherwise apply direct moxa with cones slightly larger than normal. The number of cones is determined by how quickuly the colour returns to the face.

1. Baihui DU-20, Taiyang (Extra), Xingjian LIV-2

Function: to calm Liver-Yang and to clear Liver-Fire. Indications: headache, vertigo and hypertension characterised by Liver-Yang Shi type syndromes (where signs of deficiency of Liver-Yin and Kidney-Yin are not obvious). In addition to the above prescription, the following points can be added: i. Quchi L.I.-11 and Zusanli ST-36 for hypertension. ii. Xiaxi GB-43 for Flaring up of LIV and Gall Bladder Fire. Method: reducing.

2. Baihui DU-20, Fengchi GB-20, Taichong LIV-3, Fengfu DU-16

Function: to calm the Liver and extinguish Liver-Wind. Indications: headache, Shi-type Liver-Wind (from hyperactivity of Liver-Yang), vertigo (as a sequela of middle and late stage hypertension), signs of apoplexy and epilepsy. Method: reducing. If the Liver-Wind derives from deficiency of Liver and Kidney Yin (i.e. deficiency in the lower part and excess in the upper part) one must strengthen the foundation and reduce the symptoms in the upper part. In this case one can use the above prescription to treat the Biao (the acute symptoms) and add Ququan LIV-8 and Fuliu KID-7 (both reinforced) for the deficiency of Liver and Kidney Yin. This combination of points will extinguish wind by nourishing water and tonifying wood.

5. Baihui DU-20, Neiguan P-6, Qihai REN-6, Changqiang DU-1

Function: This prescription is used to raise prolapse of the Middle Qi (prolapse of rectum, bleeding haemorrhoids), and for vertigo, fainting, or hypotension (shock). Method: The first three points are reinforced, and even method is applied at Changqiang DU-1. Moxa stick is applied to Baihui DU-20 and Qihai REN-6. NEIGUAN P-6 Neiguan P-6 is the Luo point of the Pericardium channel, and connects with the Yin Wei channel. The Yin Wei channel itself links with the 6 Yin channels of foot and hand which distribute in the chest. Disorders of the Yin Wei channel therefore manifest in the Heart and epigastrium, chest and hypochondrium. Modern studies show that needling Neiguan P-6 can affect the rhythm of the heart.

3. Baihui DU-20, Shixuan (Extra), Renzhong DU 26

Function: to awaken and tranquillise the mind.

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JOURNAL OF CHINESE MEDICINE NUMBER 32 JANUARY 1990

1. Neiguan P-6, Qimen LIV-14, Xinshu BL-15

Function: This prescription tranquillises the mind by regulating cardiac rhythm and frequency. Indications: sinus tachycardia and arrhythmia due to coronary heart disease and rheumatic cardiopathy. This prescription is most effective for sinus tachycardia and arrhythmia, secondarily effective for coronary heart disease and only thirdly effective for rheumatic cardiopathy. Method: even or reducing method according to to the constitution of the patient. After obtaining deqi, manipulate the needles for 3 minutes (not too strongly) and retain for thirty minutes (manipulate twice during retention of needles).

show that these points can activate the secretion of enzymes to help digest fats and proteins. Mild cases respond readily. Method: Hegu L.I.-4, Zusanli ST-36 and Sanyinjiao SP-6 reinforce, Neiguan P-6 even method. Use even method on all points in constipation. WAIGUAN SJ-5 Waiguan SJ-5 is the Connecting point of the San Jiao channel and the Yangwei channel. It is usually used to expel Yang evils from the body surface (i.e. wind and heat).

1. Waiguan SJ-5, Hegu L.I.-4, Fengchi GB-20

Function: To expel wind evil, to treat superficial symptom complex. Indications: Common cold of wind-heat type, early stage of epidemic febrile diseases (heat type). Can also be used, but with less effect, for common cold of wind-cold type. In this case, also apply moxibustion to Fengchi GB 20 and Dazhui DU-14. Method: Reducing method until the patient begins to sweat slightly.

2. Neiguan P-6, Shanzhong REN-17, Zusanli ST 36

Function: to relax a tight chest, regulate Qi in the chest and ease pain. Indications: costal neuralgia, angina pectoris, chest pain, hiccups, gastralgia, post-operative chest pain. It is good for all angina arising from cardiac causes where there is stagnation of Qi and blood, and for chest pain which may include stagnation of Liver Qi (costal neuralgia, hiccups and stomach-ache) when Taichong LIV-3 and Qimen LIV-14 may be added. Method: Neiguan P-6 and Zusanli ST-36 even method; Shanzhong REN-17 reduce.

2. Waiguan SJ-5, Hegu L.I.-4, Quchi L.I.-11, Dazhui DU-14

Function: To clear heat and restore body fluid. Indications: For the middle (Qi) stage of exogenous diseases; for the accumulation and stagnation of heat evil in the body; the Yangming stage of febrile disease (hence points from the Yangming channel). Waiguan SJ 5 helps to regulate and smooth the circulation of Qi in the San Jiao. Dazhui DU-14 is where all the Yang channels meet and so helps the circulation of Qi and blood in all the Yang channels. Method: reduce.

3. Neiguan P-6, Zhongwan REN-12, Zusanli ST 36

Function: To regulate Stomach-Qi, descend rebellious Stomach-Qi and stop vomiting. Indications: gastralgia of various aetiologies, vomiting, acid regurgitation. Omit Zusanli ST-36 for vomiting in pregnancy (it is not advisable to needle the lower limb in pregnant women). This prescription has a rapid pain reducing function for gastralgia. It is less effective for gastralgia due to excess alcohol consumption (which can damage the Stomach-Yin and stomach mucus membrane). Method: reducing.

3. Waiguan SJ-5, Zulinqi GB-41

Function: to remove obstruction and stagnation from the channels and to promote circulation of Qi and blood. Indications: general numbness and pain, disorders of the outer canthus of the eye, behind the ear, shoulder, neck and face. For disorders usually marked by pain and accompanied by swelling and numbness, including swollen painful disorders of the waist. Good to promote circulation in the legs and to maintain lactation. Method: reducing. HEGU L.I.-4

4. Neiguan P-6, Zhongwan REN-12, Taichong LIV 3, Yanglingquan GB-34, Liangmen ST-21
Function: to regulate the stomach and stop acid regurgitation. For both heat syndrome due to stagnation of Liver-Qi generating endogenous heat which affects the stomach, and cold syndrome due to depression of LiverQi and uprising of dampness in the stomach. Indications: duodenal and stomach ulcer. Method: Heat syndrome: reducing method. Cold syndrome: reinforcing method with moxa stick or moxa box.

1. Hegu L.I.-4, Zusanli ST-36, Weishu BL-21

Function: To regulate the stomach, calm rebellious Qi and stop spasm. Indications: spasm of the stomach, stomach ulcer and gastritis; both for endogenous or exogenous (attack by wind and dampness) types. Method: reduce for stomach spasm. Note: Radiographic research has shown that acute stomach spasm will be relieved during manipulation of the needles. Conversely, it has been shown that if a patient has a relaxed stomach, leading to retention of food, this combination of points will also bring relief. Reinforcing or even method is applied clinically for relaxation of stomach and reducing method for stomach spasm.

5. Neiguan P-6, Hegu L.I.-4, Zusanli ST-36, Sany injiao SP-6

Function: To invigorate the Spleen and regulate the Stomach. Indications: Chronic gastritis (marked by reduced stomach acid), atrophic gastritis, dyspepsia, constipation (due to Spleen and Stomach Qi-Xu giving rise to slow intestinal movement). This prescription is used to activate the secretion of stomach acid. Many acupuncture studies

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JOURNAL OF CHINESE MEDICINE NUMBER 32 JANUARY 1990 has shown that Zusanli ST-36 in combination with other points, can both promote the secretion of stomach acid, and also control it. Zusanli ST-36 can also strengthen body resistance.

2. Hegu L.I.-4, Taichong LIV-3

Function: to open the Four Gates, regulate Qi and blood, ease pain and stop spasm. The Four Gates refers to the joints of the hands and feet where the Qi and blood of the 12 channels flows. Together these points regulate Qi and blood, with Taichong LIV-3 having a greater emphasis on promoting the blood, nourishing the Liver and helping subdue Liver wind, spasm and pain. Hegu L.I.-4 has a greater action on promoting the Qi and easing pain. Indications: for different kinds of Bi syndrome such as rheumatoid arthritis and polyneuritis; for tremor due to CNS disorders and rheumatic chorea. Both endogenous and exogenous pathogenic evils will cause poor circulation in the Four Gates, hence this prescription is used for sore joints, muscles and tendons, spasms, extreme cold sensation in the skin and muscles, and numbness. Method: reducing.

1. Zusanli ST-36, Tiantu REN-22, Shanzhong REN 17, Juque REN-14

Function: to calm rebellious Stomach-Qi, relieve spasm and ease pain. Puncturing these three points can promote peristalsis of the Stomach and widen the diameter of a spasmodic upper alimentary tract. Indications: hiccups, spasm of the upper alimentary tract , early and middle stage of carcinoma of the upper alimentary tract and carcinoma of the cardiac orifice of the stomach (reduce with strong stimulation). Method: reducing.

2. Zusanli ST-36, Guanyuan REN-4, Qihai REN-6

Function: To tonify Yuan Qi and Yang. To strengthen the immune system. Indications: senility, carcinoma, chronic nephritis. Method: reinforcing; apply moxa stick to Guanyuan REN-4 and Qihai REN-6. If Yang-Qi is severely deficient, apply 5-7 moxa cones at each point.

3. Hegu L.I.-4, Fuliu KID-7

Function: to regulate sweating. Indications: for profuse sweating, absence of sweating and spontaneous sweating. i. For a patient with fever where the pores are closed, reducing Hegu L.I.-4 will open the pores and induce sweating and help clear heat, whilst reinforcing Fuliu KID-7 will produce fluid and moisten dryness. ii. Where there is profuse sweating because the body surface is weak (i.e. disharmony of Ying and Wei Qi), tonifying Hegu L.I.-4 will consolidate the Wei Qi, and reducing Fuliu KID-7 will regulate Ying and Yin. Method: In absence of sweating reduce Hegu L.I.-4 and reinforce Fuliu KID-7. In case of profuse or spontaneous sweating, reduce Fuliu KID-7 and reinforce Hegu L.I.-4.

3. Zusanli ST-36, Hegu L.I.-4, Dazhui DU-14, Mingmen DU-4

Function: to reinforce Yang and activate body resistance. Indications: for hypofunction of the adrenal cortex and pituitary due to severe Spleen and Kidney Yang deficiency. Research has shown that this syndrome corresponds to decreased secretion of certain hormones and that acupuncture and moxibustion at these points increases the hormonal level. Also for asthma, especially if accompanied by extreme deficiency of Yang and low body resistance. Method: reinforce, moxa cones (7) may be used instead of needling.

4. Hegu L.I.-4, Quchi L.I.-11, Xuehai SP-10, Sanyinjiao SP-6

Function: to expel wind evil and relieve superficial symptom complex; to clear heat from the Ying. For: i. invasion of exogenous wind and heat; ii. heat from wind and cold which has accumulated in the muscles and entered the blood; iii. accumulation of heat evil in the stomach and intestines leading to unsmooth and unregulated evacuation of stools which therefore leads to accumulation of heat evil in the skin and muscles and hence psoriasis. Indications: urticaria (from food or drugs), psoriasis, tinea and herpes zoster before the blisters form. This prescription is also good for urticaria which appears just before menstruation and disappears after the period (from heat due to Liver-Qi stagnation - often accompanied by dysmenorrhoea). Method: reducing.

4. Zusanli ST-36, Shangjuxu ST-37, Tianshu ST 25

Function: to clear and expel dampness and heat evils, to dredge the intestines in order to stop pain. This prescription has a strong function to counter intestinal infection and can strengthen the phagocytic function of white blood cells. Indications: acute appendicitis and acute dysentery and enteritis. Method: reducing. SANYINJIAO SP-6 Sanyinjiao SP-6 in different combinations with other points can treat the digestive, urogenital and reproductive systems. Digestive system relates to the the lower portion of the digestive system - the area below the stomach. The function of the Spleen is reflected in intestinal function and Sanyinjiao SP-6 is rarely used to treat the Stomach.

5. Hegu L.I.-4, Neiting ST-44

Function: to clear heat and reduce fire. Indications: toothache due to Stomach-fire, swelling and pain in the throat, diabetes. For upper and middle jiao diabetes - clears heat from Yang Ming channels. Method: reducing. ZUSANLI ST-36 Zusanli ST-36 regulates the Stomach and Spleen, regulates Qi and blood and tonifies Xu syndromes. Research

1. Sanyinjiao SP-6, Tianshu ST-25, Zusanli ST-36

Function: to regulate Qi in order to ease pain. Indications: for acute and chronic enteritis, constipation,

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JOURNAL OF CHINESE MEDICINE NUMBER 32 JANUARY 1990 abdominal pain (from spasmodic enteritis) and intestinal paralysis. Method: Reinforce for Xu syndromes and reduce for Shi syndromes. This combination can regulate the function of the intestines in two ways. Reducing will ease intestinal spasm and reinforcing will strengthen peristalsis.

1. Yinlingquan SP-9, Shuifen REN-9, Shuidao ST28, Weiyang BL-39

Function: to resolve oedema and reduce swelling by expelling water. Indications: retention of urine, abdominal oedema and general oedema caused by nephritis. For Bi syndrome accompanied by swollen joints due to accumulation of dampness in the peripheral tissues of the joints. This is a basic prescription for Damp Bi although it is not necessary to use all the points. Often Yinlingquan SP-9 and Weiyang BL-39 in combination with local points will be sufficient. According toTCM theory, the Spleen is in charge of transportation and the Kidney is in charge of water metabolism and the three jiaos, so both abdominal and other oedema is caused by deficiency of both Spleen and Kidney and obstruction of the three jiaos. For abdominal oedema, use Yinlingquan SP-9, Shuifen REN-9, and Shuidao ST-28. Shuifen REN-9 affects the Small Intestine function of dividing the clear and turbid fluid - the clear going to the Bladder and the turbid to the Large Intestine. Shuidao ST-28 is where the Bladder and ureter join. These points can play an important role in water metabolism. Since water is Yin, the therapeutic effect is better with moxibustion. Method: reducing; moxa may be applied if there are no feverish signs.

2. Sanyinjiao SP-6, Shenmen HE-7

Function: to tranquillise the mind and promote sleep. Since Sanyinjiao SP-6 regulates the Spleen, Liver and Kidney, it can be used for various types of insomnia. Indications: insomnia, neurasthenia, forgetfulness, dream-disturbed sleep, psychosis, hysteria. Method: If both Heart and Spleen are Xu, reinforce both points. If there is disharmony of Heart and Kidney, reinforce Sanyinjiao SP-6 and reduce Shenmen HE-7.

3. Sanyinjiao SP-6, Hegu L.I.-4

Function: to regulate Qi and accelerate labour Indications: this combination can induce abortion at various stages of pregnancy, induce abortion of a dead foetus, and help in difficult labour. Method: apply strong stimulation and electro-acupuncture (intermittent wave). Electro-acupuncture can promote contraction of the womb.

4. Sanyinjiao SP-6, Pangguangshu BL28, Zhongji REN-3,

Function: to regulate the function of the Bladder. Indications: enuresis, retention of urine, incontinence. In incontinence caused by tension of the Bladder these points can decrease pressure, and for retention of urine caused by relaxation of the Bladder these points can increase internal pressure. Method: reinforce for Xu syndromes and reduce for Shi syndromes.

2. Yinlingquan SP-9, Qihai REN-6, Shuidao ST28, Daju ST-27 or Tianshu ST-25
Function: to regulate Qi in order to ease pain, to aid urination and treat urinary disorders. Indications: urinary calculi, renal colic or colicky pain of the ureter. Method: Reduce and apply electro-acupuncture, retaining needles for 30-45 minutes. Clinical experience and tests conducted at the radiography department show that these points can activate peristalsis of the ureter to alleviate pain and expel stones, especially stones in the lower and middle portion of the ureter. The effect of activating peristalsis and expelling stones will be weaker if only manual manipulation is used.

5. Sanyinjiao SP-6, Fuliu KID-7, Zhaohai KID-6

Function: to tonify Kidney-Water. Indications: hypertension, diabetes, serious insomnia, the final stage of exogenous febrile disease. For diabetes and hypertension due to deficiency of Kidney-Water. Serious insomnia refers to the impairment of the mutual assisting and controlling relationship of Heart and Kidney. If the deficiency of Kidney-Water is accompanied by deficiency of Kidney-Essence we can add Shenshu BL-23 and Zhishi BL-52. Method: reinforcing.

3. Yinlingquan SP-9, Pishu BL-20, Zusanli ST-36, Sanyinjiao SP-6

Function: to invigorate the Spleen, eliminate damp and clear the lower jiao. Indications: for enteritis, eczema (in the genital area), urinary tract infection, leucorrhoea, seminal emission. For enteritis add Tianshu ST-25 and Xiajuxu ST-39. For dysentery add Tianshu ST-25 and Shangjuxu ST-37. For accumulation of damp and heat evils in the lower jiao, the prescription can be changed according to the patient: For urinary tract infection - exclude Pishu BL-20 and add Zhongji REN-3. For leucorrhoea add Guilai ST-29 and Qugu REN-2. For seminal emission add Dahe KID-12 and Qugu REN 2, making the sensation at Qugu REN-2 go downwards, or alternatively use Ciliao BL-32, also making the sensation descend.

6. Sanyinjiao SP-6, Shuidao ST-28, Shenshu BL 23

Function: to treat Lin and ease pain. These three points can activate peristalsis of the ureter in order to expel stones. Indications: stones in the ureter, acute urethral infection, cloudy urination, renal colic. Method: strong stimulation and electro-acupuncture (dense-disperse wave) is needed for up to 30 minutes. YINLINGQUAN SP-9 inlingquan SP-9 is the Water point of the Spleen channel. It is used to smooth and regulate water metabolism and help urination. Yinlingquan SP-9 expels water and dampness.

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