Welcome to AASPICON 2020 Event

Mr. Kiran Phalke Presents

Acute Disorders & Emergency Treatments with
acupuncture.
Thank you AASP for inviting for this auspicious
conference.

Welcome to
AASPICON 2020 Event
 ASPICON 2020 18,19 Jan.
Kiran Phalke
@Bombay
Acute disorders

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Hospital

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And treatments

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Chest Pain

Abdominal Pain
Cho
leli
th stone
iasi ey
Urinary s Kidn Sc
iati
Retention ca

diarrhea constipation
 What is meant by acute?
• Sudden onset and lasts for sometime and then
may stop
• It can be very painful like kidney stones pain or
some colicky pain (experiencing or denoting severe pain
in the abdomen (colic) due to wind or intestinal obstruction)
• The reason cannot be quickly found out.
• Generally these are stomach pain or headache or
pain of trigeminal neuralgia.
• Pain of gall bladder stone.
 The Wind

• Wind is said to be the spearhead as it

promotes the opening of the pores and
the penetration of other “Evil” climates
such as Heat, Cold, and Humidity.
 What is exterior?
• Exterior refers to a disease on the defensive
exterior: skin, body hair, flesh. It involves a
battle between defense qi and an evil: wind,
cold, dampness, dryness, fire, or summer
heat. It can also be a battle with some kind of
epidemic qi. The disease is shallow and light
while on the exterior
Mechanism of acute exterior problems

• In exterior disease, the qi of the outside enters

the body through the skin, pores, mouth,
nose, etc. The patient feels feverish because of
the battle between the evil and defense qi. He
feels aversion to wind or cold because defense
qi is having a hard time guarding the surface
of the body.
 Modern explanation of acute pain
• Acute pain, for the most part, results from
disease, inflammation, or injury to tissues.
• This type of pain generally comes
on suddenly, for example, after trauma or
surgery, and may be accompanied by anxiety
or emotional distress. The cause of acute pain
can usually be diagnosed and treated.
However it takes time.
 What does TCA think about acute pain
• Most important two things are Qi and blood.
• These must flow always in the meridians.
• If Qi and blood stop flowing then there will be
stagnation, pain,
• swelling and inflammation.
• This is a normal body reaction and not a
disease. However this must be resolved quickly.
• How?
 QI AND BLOOD
• The Qi and blood keeps our body working
efficiently and gives us a feeling of well being.
• Let us see what can be done about this.
• We must have knowledge about 1) the quantity
or quality of Qi flowing in different meridians of
the body. The qi and blood are not equal in all
the meridians.
• 2) Xicleft points
• 3) ZiTong points
 Amount of Qi and Blood in channels
Channels Balance of Qi and blood

LU and SP More Qi Less blood

HT and KID More Qi Less blood
GB and TW More Qi Less blood
LI and ST More Qi More blood
UB and SI Less Qi More blood
LIV and PC Less Qi More blood
 Qi functions
• Warming

• Protecting

• Transporting

• Transforming

• Holding

• Raising
 Qi pathologies
• Qi sinking
• Prolapse

• Qi deficient
• Difficult breathing

• Qi stagnant
• Pain

• Qi rebellious
• Vomiting
 Directions of Qi of organs
• Lung Qi :Descends and disperses
• Heart Qi :Descends and partly goes up
• Spleen Qi :Goes upwards
• Stomach Qi :Goes downwards
• Large intestine Qi : Goes downwards
• Liver Qi :Goes in all direction but mainly
upwards
• Kidney Qi :Downwards & partly upwards
 Pain due to Qi stagnation
• The pain caused by qi stagnation can be
identified as:
• Dull or aching in nature
• Mobile, moving from place to place within the
body
• Relieved by heat, pressure or movement
 Shock can kill
• Shock suspends Qi and it affects heart yin
and spleen Qi and most of the time it will
cause headache.

• This is according to five elements law

 Stagnant Qi
• Stagnant Qi always tries to burst out from its place
and go somewhere as rebellious Qi
• stagnant qi tries to escape as rebellious qi, coughing
or nausea, with loss of appetite.
• Alternatively, stagnant qi starts to spread into other
areas, causing digestive disturbances such as
burning, or bowel pain with constipation or
diarrhea, or the urge to urinate
 Pain due to blood stagnation
• Acute pain due to blood stagnation differs from
acute pain due to qi stagnation in several ways.
• It is: Sharp, stabbing or throbbing in nature
• Fixed in one part of the body
• Aggravated by heat, pressure or movement.
• Troubles more in night when the blood returns to
liver.
• Must do blood letting.
 How can we treat acute pain
• Acupuncture is an effective way to move qi
and blood, dispersing stagnation and relieving
pain.
• There are special points which have properties
of moving Qi and moving blood or both.
• So let us see the properties of such points

Acu pu nc tu re ward
 The points and their properties
• Hegu LI 4 Yuan : is able to regulate defensive qi*
and hence adjust the pores. (*Qi runs in COULI)
• Hegu LI4 is a primary point to expel windcold or
windheat and to release the exterior.
• Zhizheng SI7 Luo It is able to release the exterior.
It is primarily used in cases of exterior heat
pathogen giving rise to febrile disease, and is
especially indicated when the onset is
characterized by neck and lumbar pain.
• Zhizheng SI7 5 cun above SI5
 Expels pathogens
• Feiyang BL58 Luo, a distal point of the foot
Taiyang channel, is able to expel pathogens
from the channel, release the exterior and
clears the upper portion of the channel. BL58
Feiyang 7 cun above BL60 on the posterior
border of the fibula about 1 cun lateral and
inferior to BL57
 Release the exterior
• LU7 Luo is indicated for chills and fever and nasal
congestion and discharge,
• LU7 Lieque 1.5 cun above the transverse crease of
the wrist, superior to the styloid process of the
radius
 Acute breast swelling
• Liangqiu ST34 acute disorders of the breast as
swelling, pain and abscess.
• acute epigastric pain
• ST34 Liangqiu 2 cun above
• the superior lateral border
• of the patella
• This is a Xi cleft point.
• Now we will see Xi cleft
• theory
 Accumulation (Xicleft) points

• These points are considered gaps or clefts (Xi)

where the Qi of the channels converges and
accumulates and goes deep inside.
• There are sixteen accumulation points: twelve
on the regular channels and four on the extra
channels
 Xi Cleft points

They are effective in acute disorders occurring

in the areas supplied by their respective
channels and those occurring in their
respective related organs.
For example, the points St34 and Lu б are
effective in epigastric pain and haemoptysis
(Haemoptysis is the coughing of blood)
respectively
• The xicleft points are diagnostic.
• They manifest acute disorders
• valuable in diagnosis.
• They diagnose disorders caused by irregularities of
qi and blood of certain zang or fu.
• For E.g. In stomach spasm and acute mastitis,
Liangqiu (ST34) will be tender when pressed.
• Hence, tenderness on Liangqiu (ST34) assist in the
diagnosis of stomach disorders.
• Tender sensation at Kuongzhui (LU6) when it is
pressed assist in the diagnosis of pneumonia and
hemorrhoid. Tender Waiqiu (GB36), the xicleft point
of gall bladder channel, assists the diagnosis of gall
bladder duct infection. Wenliu (LI6), xicleft point of
the large intestine, if tender when pressed, often
reflects digestive tract perforation.
LU6 Kongzui - 7 cun above the
transverse crease of the wrist.
LI6 Pianli - 3 cun above the transverse
crease of the wrist (LI5) on the radial
side of the forearm.
GB36 Waiqui - 7 cun above the tip of
the lateral malleous on the anterior
border of the fibula.
• Most important
quality of XI cleft
points of Yin
meridians is they treat
blood disorders
• Xi Cleft points also act as a diagnostic reflex
point for their pertaining meridian
• They are palpated for sensitivity/flaccidity to
determine excess/deficiency of the
associated meridian
• They are observed for abnormal coloration
to determine if there is Heat (red) or Cold
(blue)
• Xi Cleft points are used in emergency
situations for severe leakage of
qi/blood/body fluids sweating, coughing,
bleeding, diarrhea, etc.
• 2) Indications
• Lu6
• Severe coughing
• Nausea/vomiting
• Coughing up blood
• Nose bleed
• Internal bleeding in the top part of the body
• LI7
• Pain in the mouth
• Tooth ache
• Bleeding gums
• Sore throat
• Pain of the tongue
• Pain when chewing
• St34
• Epigastric pain
• Swelling of the breasts

• Sp8
Acute menstrual pain , Dysentery,
Nocturnal emissions and
spontaneous seminal loss
especially Harmonizes
Qi and Blood
• Ht6
• Night sweats, Hot flashes , Chest pain
• Promotes diaphoresis (sweating, especially to an unusual degree as a
symptom of disease or a side effect of a drug.)
• Sweat is the fluid of the Heart due to its relationship with Blood

• SI6
• Pain in the shoulders & neck
• Tonify for longevity
• Bl63
• Acute lower back pain
• Seizures/epilepsy

Ki5
Painful urination
Menstrual pain
Lung Bi-obstruction
Pain of Kidney Stone
• Bl-59:-
• (Xi Cleft point of
• Yangchiao Mai)
• Pain of the lower limbs
• Blindness in one eye
• Eye pain

• Kid-8
• (Xi-Cleft point of
• Yinchiao Mai)
• Uterine and testicular pain
• GB35 (XiCleft point of Yangwei Mai)
• Chest/rib pain radiating
• towards the back
• Lower back pain
• Ki9 (XiCleft point of
• Yinwei Mai)
• Urogenital pain due to
• masses (e.g., kidney stones),
• Shan Pain
• Aids in detoxification
• Moves stagnation
• during
• the detoxification process
• (like constipation)
• P4
• Chest/heart pain
• Vomiting/blood while coughing
• More calming than Ht6

• SJ7
• Acute pain
• in the upper limbs
• Sudden deafness
• GB36
• Acute pain along flanks
• Neck pain
• Sciatica
• Liv6
• Pain related to hernias
• Retention of placenta
• Genital pain
• Kidney stones
• VI) ZhiTong Points
• Points which by themselves have the ability to
relieve pain
• LI11 or LI12
• For stiff (trigger) fingers
• Needle superficially
• Circular dispersal
• Snap muscles
• in that area
• Find where you can get the most “snap”
• St4 and St6
• Analgesic points for the face
• St26
• Relieves pain along the ST6
• trajectory of the
• Stomach meridian
• St31 St37
• All analgesic points
• St37 treats LI pain
• St26 also treats LI pain;
• it is a local point
• St41 and 42
• Analgesic points
• (St42 slightly less)
• Sp6
• Pain along the trajectory
• of the Spleen meridian
• Sp12 and Sp13
• Analgesic points
• Blood letting
• (for tailor position)
• Ht8 and Ht1
• Analgesic for pain
• along the Heart meridian
• (Ht1 slightly less so)
 What did we learn?
• 1) Locate the problem area and understand which
meridian is responsible
• 2) Release the exterior
• 3) Do blood letting ( Acubekam or Hijama therapy)
• 4) Use specific point manipulation
• 5) Use needling on Xi cleft or bleed it
• 6) Use dual points which interact
• 7) Keep the patient in correct position
Acute disorders practical examples at my clinic

• 1) Epilepsy or Vasovagal syncope : K1 and or DU26.

• Du26 yin and yang separates K1 is the most yin
point which can treat brain.
• 2) Headache : Bleed corresponding distal points like
GB44,SJ1,BL67,ST45. Distal treats proximal diseases
• 3) Vertigo : Empirical point SI6
• Ask the patient to do

• 4) Urine obstruction : SP6 or ST36 needle moxa

• 5) Chest pain :Almost any type P6
• 6) Heart attack : Bleed Ht9 ( Then call
ambulance)
• 7) Acute asthma : Kid3 or P6
• Kidney holds lung Qi If not then rebellious so
Dyspnea
• 8) Acute abdominal pain: Strong manipulation ST36
(distal point)
• 9) Acute Appendicitis : Painful area near ST37.
This moves the appendix & releases the contents.
• 10) High fever :
Bleed Ear apex
BL40 and Bleed P9
• 11)Acute lumbar pain :
DU26,LU5,SI3, Yaotongxue
• 12) Vomiting & Nausea :
P6 (Distal point)
• 13)Acute diarrhea :
Moxa on REN8, SP1 or ST25
• 14) High and low blood pressure :
Liv3 and groove of posterior ear and LOW BP point
in the auricle
• 15) Acute pulse rate problems very low or high: P7
 Low and high BP points

Low BP point
• Shaoshang LU11 has a particularly strong
action on the opposite end of the channel and
may be needled or pricked to bleed in all
acute disorders of the throat and surrounding
tissues due to excess heat and fire poison.

• The fire poison is a condition that manifests as

reddish color rashes, boils and abscesses
• (The condition tends to develop very rapidly with
severe localized pain, redness and swelling, often
accompanied by fever. )
16) Acute trigeminal neuralgia:
Bleed GB1 or SUN x point.
17)) Whooping cough :
(finger walking in between metacarpals), LU6
18) Acute cold:
Acupressure GB20 (Fengqi) as it is a Feng (wind) point
which can bring cold with it in cold season.
19) Toothache:
Strong acupressure medial ear lobe.
20) Acute calf muscles contraction :
Ear reflex point.
 Some more acute problems
21) Acute Stroke :
Bleed jing well points.
22)Acute shivering, throat pain and fever
sensation:
DU14,LI11,LI4
23)Mouth ulcers:
Bleed SI1 remove 25 drops of blood
24)Acute heart area emptiness:
Bleed DU20 Immediate relief
 Works for sure
• Shaoshang LU11 for acute sore throat, throat
painful obstruction and mumps.
 Works for sure

• Wenliu LI 7 is indicated in the treatment of

acute disorders and pain affecting the Large
Intestine channel, and can clear heat and
detoxify poison in cases of clove sores,
carbuncle and furuncle, throat painful
obstruction, and heat and swelling of the face
Burning sensation due herpes zoster
anywhere
For most types of acute throat pain:
first needle
Baihui DU20 then Taichong LIV3,
Zhaohai KID6
and Sanyinjiao SP6
Thanks to Jeffrey Yuen. Acupuncture in
Emergency Situations and the Treatment of Pain

• I) Invasion Pathway of Pathogenic Factors

• External Pathogenic Factor (EPF)  Yuan
source points  Luo points  Xicleft points
• At the Xicleft points, Qi and Blood
accumulate, causing pain
• Yuan points are Shu stream points on Yin
meridians
• They store EPFs
• On Yang meridians, the Shu stream points are
more turbulent, so they have separate Yuan
source points
• The Kidney meridian never allows the EPF to
get past the Jing River points.
• The Bladder meridian (Taiyang) is the body’s
attempt to get all EPFs out
• II) Emergency Conditions (Ji Zheng)
• Intractable fevers
• Seizures/convulsions
• Chronic pain from longstanding diseases (in
which case, analgesics are best used)
• Collapse of Yang
• Coma
• Fainting
• Shock
• Collapse of Yin
• III) The Nature of Pain
• 1) The Common Instigators of Pain
• Climate
• Hot or Cold Biobstruction
• Qi/Blood Stagnation
• Use XiCleft points
• ZangFu
• Pain is a “dragging” discomfort (due to lesions) in
the torso
• Profuse sweating (cold sweat, as in heart attacks)
• Severe bleeding
• High blood pressure
• Stroke
• For any of the above conditions, you can always use the
Xicleft points
• These are also known as Zhi Tong points or points which
by themselves have the ability to relieve pain
• For Zhi Tong point to relieve pain, you must employ
certain needling techniques…
• 2) Location of Pain
• The 4 limbs
• Acute conditions manifest first in leg channels
• Along meridians
• Head; throat; chest; abdomen; visceral; lower
back; uterine; psychosomatic
• All due to Bi Obstruction
• 3) Treatment
• Use Ahshi points
• Also, to free stagnation of Qi and Blood, use:
• Xicleft points
• Luo points
• Shu stream points
• Meridian analgesic points
• Empirical points for pain in that location
• Some pain is referred, so the point needled
will be based on empirical findings or
theoretical approaches
• For pain along the meridians or on the 4
limbs:
• Use XiCleft points
• Use dispersal technique
• The shaking method is often used in cases of
joint pain
• IV) Needling Methods for Emergency Situations
Dispersal Method: relative to the midline of the
body, twirl the needle quickly counterclockwise first,
then twirl it clockwise slightly slower, and/or a lesser
number or times.
– Tonification Method: relative to the midline of the
body, twirl the needle first clockwise, then
counterclockwise slightly slower and/or a lesser
number of times.
• Even Method: A patient displays a case of fluid deficiency
with accumulation of Dampness (edema), which is
predominant. This is due to Stomach and Spleen
Deficiency.
• You’d needle Ren12, twirling it rapidly
counterclockwise 9 times, in order to disperse
the Damp,
• clockwise just as quickly, but only 6 times, as
ridding the excess Damp was more important in
the treatment.
• Shaking Method: vibrate the needle after
inserting it, this is especially indicated for joint
pain
• SI4 and SI11
• Analgesic points
• SI14
• Pain along the SI meridian
• Pain in the SI
• SI16
• Local point for neck pain
• Bl10 and Bl39
• Relieves pain along the meridian
• Bl61, Bl64 and Bl58
• Relieve pain (Bl58 to a lesser extent)
• Ki16
• Only point of Kidney meridian that relieves pain/stagnation along
the Kidney meridian
P3
Relieves pain along the meridian
Chest pain
Heart pain
Palpitations
SJ8 and SJ12
Relieve pain along the San Jiao meridian
GB1, GB5, GB7 (and GB4 and GB8 to a lesser extent)
Head and facial pain
• GB33, GB35, GB38, GB39, and GB43
• Relieves pain along channel
• Find which point to needle by palpation (it will be more
tender)
• Lr6
• Pain in nipple
• Lr7
• Pain in groin
• Vertex headache
• Pain along Liver meridian
• VII) Points for Pain on the Torso
• St38
• Acute shoulder pain
• SI6
• Chronic shoulder pain
• GB10 and GB39
• Neck pain
• Bl59 and Bl60
• Acute lower back pain
• Bl40
• Command point for lower back
• Ki7
• Chronic lower back pain
• SI1
• Pain in the breasts
• Regulates milk ducts
• St34 and GB21
• Pain of the breasts
• Swelling of the breasts
• Bl51
• Painful fibrocystic breasts
• St28
• Uterine pain
• Swellings during period
• Bl60
• Uterine pain
• Lr5 and Bl55 (also Lr8 when dispersed)
• Genital pain
• VIII) Points for Fevers
• 1) Fevers
• Due to:
• Childhood infectious diseases
• Epidemics (due to LiQi, i.e., Pestilent Qi)
• These tend to penetrate to the Blood
• Also curious organs
• Can cause deformities in uterus
• Wei atrophy syndrome due to Heat or Damp Heat
• Area becomes hot, swollen and inflamed, as in
rheumatism
• Neuropathy begins to take place
• 8 out of 10 have Damp Heat as their pathology
• 1 has childhood infectious disease
• 1 has Li Qi (Pestilent Qi) that’s come out of latency
• Lr Fire  Ht Fire  St Fire  Lu Fire  Ki Fire
• Fever attacks the generation cycle
• Yin organs tend to have more intense Heat/Fire
• Yang organs tend to get stagnant due to Damp
• Also, Blood stasis gives rise to Qi stagnation which
gives rise to Heat
• This often happens in martial arts when a person
gets hit hard
• 2) Fever Needling Techniques
• Use a lot of distal points in treating fevers
• Bleed Ying spring points
• Use lifting (done relatively fast, brings EPF to
Exterior) and thrusting (done relatively slow,
• gets into the Interior) technique, then circular
technique (reduction)
• 3) Points for Releasing Heat
• Lr8
• Lift and thrust, then circular reduce to get rid of Liver Fire
• GB43
• For Gall Bladder Damp Heat
• GB7, 9, 11, 34, 38 and Dannangxue
• Also for Damp Heat
• GB36
• Good to use on a child right after a vaccination
• Helps with the Dampness that ensues
• This point is bled if there are signs and symptoms of Dampness
• SJ5, 7
• Clear Heat
• SJ5 is used for childhood infectious diseases causing fever
• SJ19
• Heat in the ear
• P7
• Clears Heat in the Pericardium
• P3
• Clears Heat from the Qi, Nutritive and Blood levels
• SI4
• Only SI point that intrinsically clears Heat
• Bl38
• Clears Heat in Small Intestine
• Used for hot urination
• Knotted Qi in the Large Intestine
• Bl66
• Only intrinsic point that clears Heat from the Bladder
meridian
• Ki1
• Descends Excess from the head causing things like sore throat
• Ht8
• Only Heart point that clears Heat
• Can also use Ki9 (Yinwei Mai association)
• Or P8
• St12
• Clears Heat and stuffiness in chest
• Irritability
• St6
• Clears Heat
• Used if parotid gland is swollen
• Sp12
• Clears Heat in Spleen
• LI7, 11
• Clears Heat
• LI7 gets rid of Fire toxins.
• Lu10
• Clears Heat in throat
• Used in cases of coughing up Blood
• Lu5
• Clears Heat from the Lung channel
• Lu2
• Clears Heat in cases of more Internal conditions
• Du9, 14
• Bleed either one of these, then cup to clear Heat
• Done in cases of intractable fever
• Du10
• Clears Heat and detoxifies poison
• Can be bled
• Du13, GB36, and GB22 or Sp21, depending on
which one is more tender
• Used in the treatment of malaria
• If healing crisis does not occur fairly quickly, cup
these points
• IX) Miscellaneous Analgesic Points
• LI3
• Needle then pull their finger, dragging your fingers
and squeezing their bone
• Relieves headaches
• Bl2
• Use for trigeminal neuralgia (TMJ)
• Lu10
• Bleed this point for:
• Throat pain making it hard to swallow
• Laryngitis
• Swelling of the parotid gland
• Ren17
• Needle and thread it to Ren15 (pinch up their skin
with your fingers squeezing medially) for chest pain
• Also use distal points like P6
• SJ6
• Flank pain
• Pain along the ribs and in the sternal area
• Pain in the hypochondrium
• Dannangxue (12 cun inferior to GB34)
• Pain due to gall stones
• Jaundice
• Also cup Du9
• Sp4 and St34
• Abdominal pain
• Also use a local point like St25
• Needling stimulation of these two points
must be simultaneous
• Needle lower Hesea points for intestinal pain
• Du26, SI3 and Bl40
• For low back/lumbar pain
• You can use moxa or the hot needle technique
at Bl40
• The hot needle technique is where you needle
the point, then hold a lit moxa stick next to it till
the patient feels hot, after a minute you warm
the point again
• Sp9
• For kidney stones
• The hot needle technique can be used
 XiCleft Points
Lung & Large Intestine
XiCleft Points
Stomach & Spleen
 XiCleft Points
Heart & Small Intestine
 XiCleft Points
Urinary Bladder & Kidney
 XiCleft Points
Pericardium & Triple Warmer
 XiCleft Points
Urinary Bladder & Kidney