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C a l i f o r n i a J o u r n a l o f O r i e n t a l M e d i c i n e Vo l . 2 6 N o . 1 • S p r i n g / S u m m e r 2 01 5
Dr. Wang Ju-Yi’s Clinical Case Studies: Treatment of
Eczema with Applied Channel Theory
By Jonathan Chang

A pplied Channel Theory (经络医学 jīng


luò yī xué) is an approach developed
by Dr. Wang Ju-yi in over 50 years of clinical
and scholarly research in Beijing. It involves
the rigorous combination of channel theory
and channel examination technique. More
precisely, Applied Channel Theory requires
that examination of acupuncture channels
be considered in the broader context of
other diagnostic tools. Applied Channel
Theory is a comprehensive system that
includes channel theory, channel differen-
tiation, channel selection, point selection
and various methods of channel regulation
(like acupuncture, moxibustion, hand
techniques, cupping and so on).1
In order to properly evaluate a patient or
case study, one must first understand the
chief complaint and its pattern differentia-
tion. Secondly, the findings from channel
examination are matched with the different of internal dampness. Eczema lesions are nutrients. Working in tandem, the spleen
groups of symptoms.2 Afterwards, channels typically characterized as hypersensitive skin, and lung have the functions of draining
and relevant points can be selected for where the lesions are symmetrical, and are water and transforming dampness. The tài
treatment. As the abnormal channels and often associated with severe itchiness and fluid yīn channel system ensures that nutrients are
symptoms typically differ for each patient, discharge, with a tendency to become chronic provided to all parts of the body, including
the points selected will often vary. in nature.4 Eczema is commonly described in the skin, and that waste products are also
Chinese Medicine according to the affected removed in a timely manner.
region of the body. For eczema that appear In other words, the tài yīn channel system
Symptom Pattern (focus Channel
in all areas of the body the term “(浸淫疮)”or receives and resolves damp qi from the
on chief complaint) Examination
“spreading sores” is used. However, if the natural environment and, within the internal
lesions present all over the body as red and environment, it controls water metabolism.
elevated papules, with itchiness and bleeding, When the tài yīn is impaired in its ability to
Channel Differentiation they are described as “wind-blood sores” transform external or internal dampness,
(风血疮).5 In the Golden Mirror of Medical it leads to the accumulation of dampness.
Channel Selection Tradition, it describes “spreading sores” This excess dampness impairs the irrigation
in the following way: “at the beginning, of nutrients to and removal of metabolites
spreading sores appears like scabies. It can be from the surface of the body, which leads to
Point Selection
itchy at any time of the day, and can spread dermatological symptoms associated with
When treating patients who suffer from throughout the body. When it is scratched eczema.
the same illness one often will discover that yellow liquid can ooze out. The skin eruptions Since the tài yīn channel is the prime
the patients can present distinct symptom can become patch-like. Spreading sores are channel system that is involved with eczema,
patterns as a result of different pathologies a result of heart fire, dampness and exposure it would be easy to assume that, for all such
and furthermore, channel examination to wind6.” However, according to Applied patients, only this channel system should
often reveals the involvement of different Channel Theory, eczema is often rooted in be treated. However, as the following three
channels. Therefore, the channel selected the impairment to the tài yīn channel system. cases will show, although the tài yīn channel
for treatment will vary for each patient. According to the six levels, the tài yīn channel is central to the pathology of eczema, it is
In the following three eczema cases the is the most exterior of the three yin channels, not always the main channel system used
treatments varied and were treated once and the hand tài yīn lung channel governs the for treatment. It is imperative to understand
per week. The patients were treated by skin and body hair. the chief symptoms’ patterns and match
Wang Ju-yi at the Huguosi TCM Hospital3 in The foot tài yīn spleen channel is respon- them with the abnormal channel findings. In
Beijing. sible for the transportation and transforma- essence, one can say that channel examina-
Eczema patients have a shared pathology, tion of grains and water, while lung qi is tion provides a treatment that is tailored for
as the illness is rooted in the accumulation responsible for providing movement of these each individual patient.

VOLUME 26 NO. 1 • SPRING/SUMMER 2015 13


Case 1: Mr. Hu, aged 42 Results: The patient received one treatment back, and hypochondriac regions. Between
Chief Complaint: Constant eruptions of skin per week over a period of three months. 1-3am (liver time), the itchiness increases,
lesions on the limbs and trunk of the body After three treatments, the patient’s skin which impacts his sleep. He is easily agitated,
for over 3 years, with associated symptoms lesions and distention in the limbs showed and has a dry mouth with a desire to drink
of itchiness and pain. significant reduction. With an additional 15 fluids. He has a puffy and dusky tongue, with
treatments, abnormal pigmentation from a thin, white, and dry coat. His pulse is wiry,
Medical History: In spring 2009, the
the old lesions gradually dispersed. thin, and slippery.
patient suddenly developed skin lesions on
the abdominal region from no apparent Analysis: This case is typical of a tài yīn Drug History: The patient has taken Chinese
cause. The lesions were red, inflamed, and eczema case, as it includes distention in herbs, and applies a topical corticosteroid
extremely itchy and painful. A local hospital the limbs with fatigue, dry mouth and cream (sicorten).
diagnosed it as eczema and prescribed unquenchable thirst. Upon channel exami- Channel Examination: Hand and foot tài
Chinese herbs, which did not provide any nation, changes (or lumps) were palpated yīn, foot jué yīn, hand and foot yáng míng,
relief. Over time, the eczema spread to the below LU 5 and between SP 6 to SP 9. hand tài yáng and foot shào yáng channels
chest, back, limbs, and groin region. For Chief points for treatment were LU-5 are abnormal.
an eight-month period, the patient was and SP-9, which are both the he-sea points
Channel Differentiation: Tài yīn and
also prescribed steroids and anti-histamine of the tài yīn. Together they have the
jué yīn channels.
medication, which provided minor relief. functions of regulating the qi mechanism
of the tài yīn, with the ability to transform Channel Selection: Tài yīn and shào yáng
The patient had a ten-year history of allergic
dampness and move qi. SP-3 was added channels.
rhinitis, which flared up every fall.
to strengthen the spleen and benefit the Point Selection: LU-5 (chǐ zé), SP-9
Current Symptoms: In addition to skin
lungs. As the tài yīn channel recovered its (yīn líng quán), SJ-6 (zhī gōu), GB-34
lesions throughout the body, characterized
ability to transform dampness, eruption (yáng líng quán).
by dark-purple patches, the patient also
of skin lesions was inhibited. By the fourth
suffers from fatigue, excessive sleepiness, and 2nd Visit: After the treatment the lesions
treatment, the patient complained of
distention of the limbs. He has a dry mouth decreased, particularly in the hypochondriac
lacking the ability to sweat since suffering
and thirst, with an inability to quench his region. Itchiness also decreased in severity,
from eczema. DU-14 was added to the
thirst. His tongue is purple and dusky, and but the patient continued to wake up
point prescription to re-balance the
has a thin-white tongue coating. His pulse is between 1-3am from itchiness. Papules
nutritive and protective qi. The patient
deep and thin. were still present on the limbs, however,
recovered the ability to sweat normally,
they were reduced in number. The patient’s
Channel Examination: Hand and foot tài and pigmentation from the old skin lesions
irritability also decreased. His tongue was
yīn channels are abnormal. began to gradually disappear. By the end of
puffy and dusky, with a thin and slightly
Channel Selection: Tài yīn channel. the treatments his skin returned to a normal
yellow coating. He had a wiry and thin pulse.
complexion.
Point Selection: LU-5 (chǐ zé), SP-9 (yīn ling Point Selection: PC-7 (dà líng), LR-2 (xíng
quán), SP-3 (tài bái) and SP10 (xuè hǎi). Case 2: Mr. Yang, aged 59
jiān), LU-5, SP-9 and SP-6.
2nd and 3rd visits: After the first treatment Chief Complaint: Papules over the entire
3rd Visit: Decrease in the number of papules
the patient’s feeling of distension in the body, with itchiness for 2 years.
on the upper and lower limbs. The patient
body reduced, and the eczema on his back Medical History: Two years ago, as a result feels calmer and less agitated. His tongue is
showed significant reduction. He still had of stress at work and exposure to wind, puffy and dusky, with white-thin coat. He has
itchiness and sharp pain in areas of skin papules began to appear on the patient’s a wiry and thin pulse.
lesions. He felt tired and had a dry mouth lower legs. The papules were hive-like
Point Selection: In and out needling of
with a bitter taste. The tongue was red, and patches that were red and elevated, with
DU-14, with moxa for 20 minutes. Needle:
coating was thick, yellow and dry. His pulse clear borders and excessive itchiness.
LU-5, SP-9, PC-3 (qū zé) and LR-8 (qū quán).
was deep. Scratching would make the lesions spread
into larger patches. Herbs:
Point Selection: Same points, with moxa at
Over time, the papules repeatedly flared- Chan Tui 6 g
DU-14 (dà zhuī) for 15 minutes.
up, and gradually spread throughout the Jiang Can 6g
4th to 8th visits: The patient had not had She Tui 6g
body to the trunk, neck, head, and arms.
any new skin lesions. Pigmentation from the Chi Shao 12g
His symptoms worsened when nervous,
old lesions were gradually disappearing. The Mu Dan Pi 6 g
under stress, and after taking hot showers.
old lesions were dry and itchy with pain. The Xia Ku Cao 6g
A local dermatologist diagnosed him with
patient had mild distension in the hands, Yi Mu Cao 10 g
eczema. For 3 weeks leading up to the
feet, and lower legs. He was easily fatigued, Tu Fu Ling 15g
treatment the patient was under a lot of
and does not sweat much. His mouth was Jing Jie Sui 6g
work-stress, which made his symptoms
dry, tongue was red with a thick, slightly Sheng Gan Cao 6g
more severe.
greasy coat. His pulse was deep and slippery. 7 bags.
Current symptoms: The lesions are red,
Point Selection: In and out needling of 4th - 6th Visits: Tài yīn channel as the main
elevated, and itchy papules, with redness
DU-14. Needle: LU-5, SP-9, SP-3, KI-7 channel of treatment.
in the surrounding skin. They are most
(fù liū), KI-3 (tài xī).
prominently located on the lumbar, upper
continued on page 17

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Treatment of Eczemz continued from page 15 Though the patient would have occasional and decreased in the night before falling
eruptions of papules, they were mild and asleep. Her armpits and groin region were
Results: After three treatments the patient’s
less severe. still clammy. After eating she would belch
eczema showed significant improvement.
Case Study 3: Ms. Yang, aged 39 a number of times in succession. She also
The area of lesions, and itchiness were
felt a surge of heat after eating (like a hot
reduced, while emotionally he also felt Chief Complaint: Eczema on the face,
flash), which made the itchiness worse. Her
calmer. After the sixth treatment the elbow, armpits (axillary), groin, and lateral
tongue was no longer dusky but pale, with
patient continued to receive acupuncture side of the lower legs for over twenty years.
a white-thin coat. Her pulse was thin.
treatments as maintenance to stabilize his
Medical History: Since the patient was 18
condition. Point Selection: PC-3, PC-7, LR-8, ST-37,
she has suffered from eczema throughout
LI-10 (shǒu sān lǐ), and ST-36 (zú sān lǐ).
Analysis: Channel examination found the the body, but particularly located on the
tài yīn, jué yīn, and shào yáng channels medial side of the limbs, on the neck, 8th Visit: The itchiness decreased, and
were abnormal, with the tài yīn changes and face. The lesions are itchy, flaky, feel the complexion in her face was less dark
more significant. Changes on the tài clammy, and the skin in the affected regions and purple. Later treatments focused on
yīn and jue yīn channel were physically are thickened. When the patient is nervous, regulating the yáng míng channel.
palpable, those on the shao yang were sleeps poorly, eats high-protein food, and in Point Selection: LI-4 (hé gǔ), LI-11 (qū chí)
visible in the form of red papules and the fall/spring the eczema flares up. Twenty and ST-36.
patches. Focus of the treatment was on years ago the patient was prescribed topical Results: Over a course of 13 treatments the
regulation of the tài yīn channel, with a corticosteroid medication, which made the patient’s eczema, flaky and thickened skin,
secondary focus placed on regulating the eczema on her face worse. In the past year, and abnormal pigmentation significantly
jué yīn. As the tài yīn’s ability to transform the patient has been taking Chinese herbs reduced. Other related symptoms, such as
dampness was impaired, the distribution and undergoing acupuncture treatments at irritability, poor sleep, constipation, and
of nutritional products throughout the another local hospital in Beijing. fluctuating dry/loose stools all showed
body was also inhibited, which, in turn,
Current Symptoms: In addition to the marked improvement.
prevented the nutrition to the jué yīn. As
eczema, the joints on the limbs feel Analysis: Channel examination found
such, the action of the jué yīn to foster
clammy. She has difficulty falling asleep, changes to the tài yīn, jué yīn, yáng míng
yin-blood was also impaired, such as its
with many dreams, and wakes up early. and shào yáng channels. The tài yīn’s
functions of purifying and maintaining the
She has scanty menstrual blood, with dark ability to transform dampness is impaired,
quality of blood.
menses and clots. The patient also has which can lead to less nutrients to the jué
The patient had symptoms related to
strong pre-menstrual emotional changes, yīn. As the jué yīn’s ability to purify and
both the tài yīn and jué yīn channels.
typically feeling sad. Her tongue is dusky maintain the quality of blood is impaired,
Symptoms directly related to eczema
and red, while her coating is white-thin. it leads to blood-dryness, which can
including skin lesions, puffy tongue, and
Her pulse is thin. enhance symptoms like itchiness. The
wiry-slippery pulse were rooted in the tài
yīn, however, symptoms such as irritability Channel Examination: Hand and foot tài patient also had symptom patterns related
and waking up at 1-3am from itchiness yīn, hand and foot jué yīn, hand and foot to the jué yīn yin-blood deficiency, such as
were related to the jué yīn. Itchiness was yáng míng, and hand and foot shào yáng poor sleep, scanty menses, irritability and
exacerbated by the jué yīn’s inability to channels are abnormal. nervousness. Whenever she was agitated
foster blood. Channel Differentiation: The illness is or nervous the eczema worsened. For the
For the first treatment, LU-5 and SP-9 located in the tài yīn and jué yīn channels. first treatment, the objective was to first
were selected to transform dampness. Since regulate the jué yīn. In order to foster yin
Channel Selection: Jué yīn channels.
the eczema was prominent on the shào and calm the spirit, the source and he-sea
Point Selection: PC-3 (qū zé), LR-8 (qū points of this channel were selected, PC-3,
yáng pathways along the hypochondriac
quán), PC-7 (dà líng) and LR-3 (tài chōng) PC-7, LR-3 and LR-8. Paired together these
region, including the lateral part of the
thigh, SJ-6 and GB-34 were used to dredge 2nd Visit: After the treatment, the patient’s points can regulate the qi mechanism and
the shào yáng. It must be noted that the quality of sleep showed significant improve- warm-replenish the jué yīn.
shào yáng is the interior-exterior paired ment. She was able to sleep longer for the Over the course of the treatments, as
channel of the jué yīn. After the first first three days after the treatment, but the patient’s emotions became calmer
treatment, as the hypochondriac lesions during the final three days her sleep was and her sleep improved, her eczema also
disappeared, focus shifted to regulating poor again. The skin lesions were reduced showed improved, including the abnormal
the tài yīn and jué yīn channels, with LU-5, in severity. She had constipation, with pigmentation and itchiness reduced. Focus
SP-9, PC-3 and LR-8 as the chief points to stools that fluctuated between dry and then shifted to regulating the yáng míng
transform dampness and foster yin-blood. loose. Her tongue was dusky and red, with channel.
Over the course of the treatments, the a thin-white coat. Her pulse was thin. Point The yáng míng was selected as the
symptoms linked to the jué yīn, such as Selection: PC-3, PC-7, LU-5, SP-9 and ST-37 eczema was most prominent on the face,
the agitation, irritability and poor sleep, (shàng jù xū). especially on the cheeks where there was
exhibited substantial relief, which suggested itchiness, dark-purplish, thickened and
3rd to 7th Visits: Sleep was significantly
that the jué yīn’s qi transformation had flaky skin. The facial region is also mainly
improved and her stools were normal. The
recovered. For the last phase, treatment related to the yáng míng channel pathways.
patient still had no change to the itchiness,
concentrated on regulating the tài yīn. In addition, the patient had yáng míng
which was more severe during the day,

VOLUME 26 NO. 1 • SPRING/SUMMER 2015 17


symptoms, such as constipation, and stools this does not mean to suggest that
that fluctuated between dry and loose. all abnormal channels should be
There was a direct relationship between the treated. Only the channels that are
eczema symptoms and the yáng míng as directly related to the chief complaint
the itchiness worsened after ingesting food. and associated symptoms should be
Although the root of the illness was in the selected.
inability of the tài yīn to properly transform As an example, for case 1, palpa-
dampness, her symptoms were primarily tion found that the patient had tài
related to its interior-exterior paired yáng yīn channel changes, and also tài yīn
míng channel. According to the six levels channel symptom patterns, such as
theory, the yáng míng is the most interior of skin lesions from eczema, distension
the three yang channels. It has the func- in the limbs and fatigue. The tài
tions of digesting food, transporting fecal yīn channel was then selected for
matter, fostering stomach qi and warming treatment. For case 2, though the
the skin. patient had tài yīn channel changes,
In relation to the external environment, palpation also found abnormalities on
the yáng míng receives and resolves dry qi. the jué yīn channels. The patient had
The tài yīn channel receives and resolves symptoms directly linked to the skin
external dampness, while it transforms disorder and both the tài yīn and jué
internal dampness. The tài yīn and yáng yīn channels, such as irritability that
míng work in tandem to maintain the worsened his itchiness. In the first
balance between dryness and dampness. phase of the treatment, the tài yīn
They have another normal physiological and jué yīn channels were the regu-
relationship: clear qi from the tài yīn gener- lated together. Once the patient’s jué
ally rises, while turbid qi from the yáng yīn symptoms were under control, Dr. Wang in his office in Beijing
míng descends. For this patient, there was the tài yīn was the main channel selected
an imbalance between rising clear qi and for the last phase of the treatment.
There are two important steps to follow:
descending turbid qi, which was exhibited For case 3, tài yīn and jué yīn channels
by her constipation. As turbid qi was not were found to be abnormal, including their 1. T
 hrough the patient intake, isolate
descending, the yáng míng heat accumu- interior-exterior paired channels, the yáng the chief complaint, and symptoms
lated in the middle jiao, and percolated míng and shào yáng. Although the root of directly related to the chief complaint.
upwards to the face, manifested by the the illness was in the tài yīn, the jué yīn was The patient might also present other
symptoms of increased itchiness after first selected to foster yin-blood and calm symptoms, which can be separated into
eating food, burping and eczema on the the spirit. Once her jué yīn symptoms of other categories, but they are separate
face. Points were selected to regulate the irritability and sleep improved, the patient’s from the chief complaint. For example,
yáng míng channel so that it could recover skin also showed significant improvement. a person can suffer from eczema as the
its normal state, with points such as LI-11, However, for the next step, the tài yīn’s chief symptom, but might also have
LI4, ST-36 and ST-37. While the yáng míng paired yáng míng channel was selected for shoulder pain or suffer from the
was being treated, her symptoms, such as treatment. Yáng míng channel symptoms common cold.
itchiness, dark-purple facial complexion, were also related to the skin disorder, while 2. A
 fter making a detailed intake of the
dry-flaky-thick skin, constipation and palpable changes were also found on the patient’s symptoms, the patient’s channel
irregular stools all showing remarkable yáng míng. After regulating this channel, must be carefully examined. Through
improvement. By the end of the treatments the patient’s symptoms related to eczema channel examination, in particular by
her skin was a normal, healthy complexion. significantly reduced. palpating the channel spaces, discover
These three cases emphasize that channel which channels have irregular changes.
Discussion:
examination is important to attaining a Links have to be established between
As mentioned in the introduction, the clear diagnosis. However, another essential the symptoms and abnormal channel
root cause of eczema is often related to aspect is the matching of symptoms to changes. Once these links are made, it
the tài yīn. However, the presentation of the abnormal channels, to discover which helps to clarify which channel or chan-
eczema in a clinical setting is not always channel or channels are primarily involved nels are primarily involved with the chief
so clear-cut, which shows the importance with the chief complaint. When these symptom.
of using channel examination to guide connections are accurately made, the
the practitioner’s diagnosis. One must not From a broader perspective, the applica-
diagnosis is precise and results effective.
make the assumption that only the tài yīn tion of channel examination to one’s
channel should be treated for all eczema Conclusion: practice also emphasizes its importance to
patients. There is always the potential that These three eczema cases emphasize the understanding Chinese medical principles.
other channels are involved and, at times, approach practitioners of Applied Channel For example, for these eczema cases
these channels have to be regulated first Theory must follow, namely making links channel examination provides evidence
or in tandem with the tài yīn (if the tài between the symptom patterns and the for the TCM concept of 同病异治 (tóng
yīn is found to be abnormal). However, channel changes. bìng yì zhì), which simply means “same
illness, different treatment.” In the Chinese

18 C A L I F O R N I A J O U R N A L O F O R I E N TA L M E D I C I N E
OM C LINIC AL M E DI C I NE

Medical Dictionary it defines the term as can easily disregard point protocols the 8. 同
 病异治:同一病证,可因人、因时、因地的不同,或由
于病情的发展,病型的各异,病机的变化,以及用药过程
meaning that “a specific disorder must be moment channel examination is applied in 中正邪消长等差异,治疗上应根据不同的情况,采取不同
treated according to the unique conditions the clinic. 的治法 (《中医大词典》,人民卫生出版社,2005)。

that are presented, as such, treatment


References
methods applied will differ for each
1. F or more information on Applied Channel Theory, please
individual. Factors that can influence the read Applied Channel Theory in Chinese Medicine, by
Jonathan Chang (张侨文) is a graduate of
expression of an illness are multi-faceted, Wang Ju-Yi and Jason Robertson. Eastland Press, 2008. the Beijing University of Chinese Medicine
2. T
 here are five methods of channel examination, which
such as seasonal and regional variances, are observation (审), feeling temperature and moisture
(2012). He has studied with Wang Ju-yi in
including the unique state of each person’s (扪), pressing(按), palpation of pulses (切, and Beijing since 2008, and was recognized as
palpation of channels(循)For more information on
constitution. A patient can also be in channel examination, please see Applied Channel Theory an official apprentice in 2013. Along with
different stages of a particular disorder, in Chinese Medicine, by Wang Ju-Yi and Jason Robertson. Mei Li, he helped compile and analyze
Eastland Press, 2008, and Dr. Wang’s article, On the
and even medication or other treatments Nature of Channels, translated by Jason Roberston, The over 100 of Dr. Wang’s clinical case studies,
can affect the person’s symptoms, and, Lantern, Vol 7-3.
which was published as Wang Ju-yi’s Case
as such, determine the treatment method 3. T
 he full name of the hospital is the Huguosi TCM
Hospital affiliated with the Beijing University of Chinese Studies in Applied Channel Theory
adopted.”8 One additional comment should Medicine(北京中医药大学附属护国寺中医医院).
(China Press of TCM, 2014). He is
be added to the end of this definition, 4. T
 CM Dermatology, China Press of TCM, 2009. (《中医
皮肤性病学》,中国中医药出版社,2009)。 currently translating this book into English
through channel examination the practi-
tioner is able to find objective, and palpable
5. T
 CM Dermatology, China Press of TCM, 2009. (《中医 with Mei Li. Originally, from Canada;
皮肤性病学》,中国中医药出版社,2009)。
evidence for the distinct physiological and 6. 《
 医宗金鉴·外科心法要诀》: “浸淫疮,此证初生如疥, Jonathan is based in Beijing where he
pathological constitutions each patient
瘙痒无时,蔓延不止,抓津黄水,浸淫成片,由心火、脾 works as an instructor and translator at
湿受风而成。“
presents. Channel examination provides the 7. F or the following cases, channel abnormalities refers the Wang Ju-yi Applied Channel Theory
TCM practitioner with a precise diagnosis mainly to changes determined by the method of Research Center. Currently, he is assisting
observation of the channel pathways (and appearance of
and more effective treatment approach. eczema), and from channel palpation. Channel palpation Wang Ju-Yi along with a team of other
It allows for a myriad of possibilities when involves palpating along the channel spaces of the 12
main channels, and also the ren and du vessels. Palpable
students in writing a Chinese book on
treating patients. At the same time, it findings can include nodules, lumps, graininess, and Applied Channel Theory, which will be
focuses the treatment and makes it more stick-like changes. For more detailed information please
read Mei LI’s article, The Clinical Significance of Palpable published later this year by the China Press
tailored to each individual’s condition. One Channel Changes, Journal of Chinese Medicine, of TCM.
June 2012.

VOLUME 26 NO. 1 • SPRING/SUMMER 2015 19

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