HERBAL FORMULA FOR TEENAGER's VIOLENCE

YI GAN SAN (Restrain the Liver Powder)
8g  Bai Zhu  (White Atractylodes rhizhome)
8g  Fu Ling  (Poria fungus)
6g  Dang Gui  (Chinese Angelica root)
6g  Chuan Xiong  (Szechuan Lovage root)
6g  Gou Teng  (Gambir vine)
4g  Chai Hu  (Hares Ear root)
4g  Gan Cao  (Licorice root)


CLASSIC SOURCE:
Yi Gan San (Restrain the Liver Powder) is from Bao Ying Cuo Yao (Synopsis of Caring for Infants) which is a pediatric formula from 1555, Ming dynasty.   


MODERN TEXT:
In Chinese Herbal Medicine: Formulas & Strategies (by Bensky & Barolet), Yi Gan San is categorized under Harmonize LV and SP with related formula, Si Ni San (Four Frigid Powder).

From the Text, Yi Gan San was originally used in treating children for LV Yin deficiency, Heat with spasms, feverishness and bruxism; palpitations with anxiety, fever and chills, or spitting of sputum and saliva; abdominal distention, reduced appetite, and restless sleep due to the LV over-controlling the SP.
Its use has subsequently been expanded to cover a wide variety of chronic deficiency disorders with spasmodic movement including seizure disorders, hysteria, and night terrors. 


INTERPRETATION:
The above information comes directly from the text.  We can further expand its use in modern applications.

Yi Gan San has a Dang Gui Shao Yao San idea inside.  There are two herbs from Si Wu Tang (Dang Gui, Chuan Xiong) and two herbs from Wu Ling San (Bai Zhu, Fu Ling) combined with Chai Hu and Gou Teng.

1. Gou Teng is one of the best herbs to send blood to the blood vessel in the brain.  You can imagine that Gou Teng expands the crooked, (shrunk) brain blood vessels.  To enhance this effect, we use Tian Ma + Gou Teng together.   Therefore Tian Ma + Gou Teng can be added when a Zhi Gan Cao Tang or Bai Wei Di Huang Wan patient has a headache.   If Gou Teng + Huang Qi are combined, narrow cerebral blood vessels expand with greater ease.  This application is seen in Qi Wu Jiang Xia Tang, which can lower blood pressure effectively.
2. Chai Hu calms both the sympathetic nervous system and the heart.
3. Bai Zhu + Fu Ling promote urination to clear stagnated water from the body.
4. Dang Gui + Chuan Xiong circulates blood and fortifies the blood supply.

By facilitating the free flow of blood to the brain, free-flowing Yi Gan San releases emotional or psychological tension, making is supremely useful for psychological concerns.


ABDOMINAL DIAGNOSIS:
Yi Gan San is indicated when there is stress causing tension on the left side of the abdomen.   As you know from abdominal diagnosis, Left refers to Liver, Right refers to Lung, so the left-sided tension is often due to liver-type stress.  In this case, Bai Shao can be added to this formula even though the original formula does not include the herb.


CLINICAL APPLICATION FOR MODERN PRACTICE:
This is a useful formula in modern society particularly for young children, teenagers or adolescents.  They can be very sensitive and dissatisfied with their parents and/or society.  They often do not talk to parents or teachers about the strong emotions they feel inside.  This can lead to some accidental tragedy with violence or gun shooting.  Yi Gan San can help calm the spirit in these patients. 
Yi Gan San can also relieve epileptic seizures, teenage neurosis, psychological disorders, hysteria, tics, bruxism, Terret's syndrome and general seizures.


COMPARISON:
Yi Gan San  &  Yi Gan San + Ban Xia, Chen Pi are two very different formulas although they have the same base formula.  While Yi Gan San is more commonly used for children or young adults, Yi Gan San + Ban Xia, Chen Pi is used more commonly for elderly patients, esp. for women.  It's a very good formula for depression or dementia in elderly women.  Another article about Yi Gan San + Ban Xia, Chen Pi will be written in the next forum.


ACUPUNCTURE:
"Gate Opening" is a good acupuncture treatment to combine with Yi Gan San.  LV3 (human) + LI4 (earth)  or  GB40 (human) + HT7 (heaven) can be combined with Yin Tang and DU20.   For severe symptoms, PC9 and SJ1 can be added for "Great Gate Opening".

1. LOCATIONS OF THE LOWER THREE EMPERORS

Tian Huang Fu (Heaven Emperor Fu) = 1.5 cun below SP9  *
Di Huang (Earth Emperor) = SP7 *
Ren Huang (Human Emperor) = SP6 *

Tian Huang & Tian Huang Fu: The "Lower Three Emperors" combination is very confusing in Master Tung style acupuncture, because of the similar names and proximity to other Spleen channel points.  It may seem like SP9 (Tian Huang), SP7 (Di Huang), and SP6 (Ren Huang) can be a "Lower Three Emperors" combination, but this is incorrect.  Instead of SP9 (Tian Huang), 1.5 cun below SP9 (Tian Huang Fu) is used as part of the "Lower Three Emperors".  Practitioners may make a mistake and use SP9 instead of Tian Huang Fu, which would not be as effective as the correct point combination.

Lower Three Emperors:  Tian Huang Fu (77.18) + Di Huang (77.19) + Ren Huang (77.21)



2. INDIVIDUAL POINTS INDICATION

(1) TIAN HUANG FU (Heaven Emperor Fu) = SHEN GUAN (Kidney Gate)
Name: Asian practitioners call this point Shen Guan (Kidney Gate) often for two reasons: First, Tian Huang Fu can be confused with Tian Huang, since they are very similar names, and Second, Shen Guan (Kidney Gate) implies the action of the point.

Frozen Shoulder: For frozen shoulder, when the arm can't be lifted, this point is a very good distal point.  This area relates to the shoulder area according to image balancing.  The indication can also be explained by the SP (taiyin) channels ability to communicate with the LU (taiyin) channel contra-laterally (name-sharing relationship), as well as the SI (taiyang) channel (in same-energy balancing).  If the arm can't be lifted forward, then LU5 bleeding technique can be combined, and if the arm can't be lifted backward, Zu Wu Jin (77.25) is combined.

Other Indications: Like the point name suggests, this is an essential KD tonic point, which is used for sciatica, upper/lower back pain, and headache.  Its also used for eyeball disorders when combined with KD7.  It is a good point for excessive urination, and enuresis, and is used for chest pain with perpendicular treatment.  For mental disorders, Shen Guan is used with the Four gates (LI4 and LV3).

*TIAN HUANG (SP9):  SP9 is the Water Point on the Earth channel, which means it can tonify both the SP and KD, and can treat various disorders due to SP/KD deficiency.  Tian Huang (SP9) is usually combined with Shen Guan (1.5cun below SP9) to strengthen this action.  Both points can be used for cases of proteinuria due to dual SP/KD deficiency.


(2) DI HUANG (Earth Emperor)
One might think that Di Huang (Earth Emperor) should be located lower on the body than Ren Huang (Human Emperor) when considering the order of Heaven-Human-Earth.  However, SP6 can treat human circuit issues such as insomnia, which is why it is named Ren Huang (Human Emperor).

In TCM, Di Huang is at the location of SP7.  The name of SP7, "Leaking valley", implies leucorrhea since the 'valley' in this case refers to the genital area.  Wan Dai Tang is the formula which corresponds to this point.  In Tung style acupuncture, Di Huang also can address the genital area, but relates more to the KD aspect than the SP.


(3) REN HUANG (Human Emperor)
In TCM, SP6 is very popular point, as it is the crossing point of the Three Foot Yin channels.  It is indicated for gynecological and urogenital disorders in TCM, and has the same indications in Tung style usage.   However, in TCM SP6 is used as a basic point for insomnia with HT7 and Anmian, which it is not indicated for in Tung style.  Although SP6 is very powerful point itself, it usually combined with Shen Guan and Di Huang as a "Three Lower Emperors" combination in Tung style acupuncture.



3. COMBINATION
In Tung style acupuncture, the above three points are usually combined together rather than used individually.  They are all on the SP channel though they are indicated in KD related disorders.  Therefore, "Lower Three Emperors" can tonify both the KD and SP, but are more famous as a "KD tonic".  They are simply the best KD tonic in Tung style acupuncture.  All of the following KD related disorders are common indications of the "Three Lower Emperors" - Kidney organ disorders, impotence, urinary disorders, diabetes, dizziness, irregular menstruation, and lumbago due to KD deficiency. 



Note:  Tung style Acupuncture uses points distinct from the meridian points and extra points recognized by contemporary TCM.  Solid understanding of the traditional meridians and point functions is necessary in order to implement Tung style acupuncture effectively. 

DEFINITION 
Also known as  "Lou Gehrig's disease". (Lou Gehrig: New York Yankees baseball icon who was diagnosed with the disease in 1939 and died from it in 1941).  ALS is a form of motor neuron disease.  The muscles innervated by the degenerating neurons become weak and eventually atrophy.  The disease usually occurs after the age of 40; it affects men more often than women.  Symptoms are muscle weakness, frequent falls, breathing difficulty, persistent fatigue, spasticity, and twitching.  Death generally results from atrophy of the respiratory muscles. There is no cure or treatment for ALS.



COMMON TCM PATTERNS & TREATMENTS
Basic DU Points for all patterns: DU24, DU20, DU16, DU14, DU10, DU6, DU4, DU1

DEFICIENCY
LV Blood & KD Yin deficiency: Hu Qian Wan + Zuo Gui Wan  (UB17, UB18, UB20, UB23)
SP & KD Yang deficiency: You Gui Wan + Si Jun Zi Tang  (RN4, UB20, ST36)
Qi & Yin deficiency:  Zuo Gui Wan  (UB20, UB23, ST36, KD7)
Yin & Yang deficiency: Jin Gui Shen Qi Wan  (UB23, SP6, KD7, RN4)

EXCESS
Damp-Heat damaging the sinews:  San Miao San  (RN12, RN3, SP9)
Blood Stasis in the network vessels:  Xue Fu Zhu Yu Tang  (SP6, LI4)
Phlegm turbidity:  Wen Dan Tang  (SP9, ST40, ST36)



OTHER PATTERNS & EMPIRICAL FORMULAS

1. SP and KD deficiency: weak fingers, muscle atrophy, fatigue, shortness of breath, thin tongue coating, thready and weak pulse
6.0g  Dang Gui
9.0g  Shu Di Huang
9.0g  Bai Shao
4.4g  Chuan Xiong
4.8g  Ren Shen
4.8g  Wu Wei Zi
6.0g  Mai Men Dong
6.0g  Huang Bai
3.0g  Zhi Mu
6.0g  Niu Xi
6.0g  Du Zhong
6.0g  Cang Zhu
6.0g  Yi Yi ren
3.6g  Fang Feng
1.8g  Qiang Huo
1.8g  Gan Cao
4.5g  Ji Xue Teng

2. LV & KD deficiency: upper limb atrophy, weak feet, soreness of the lumbar spine and knees, dizziness, tinnitus, thin white coating, thready pulse
3.0g  Huang Qi
3.0g  Shan Yao
3.0g  Wu Wei Zi
3.0g  Bu Gu Zhi
3.0g  Ren Shen
4.5g  Bai Shao
12g   Shu Di Huang
3.0g  Gou Qi Zi
6.0g  Niu Xi
3.0g  Tu Si Zi
6.0g  Dang Gui
3.0g  Bai Zhu
6.0g  Du Zhong
3.0g  Gui Ban
9.0g  Cang Zhu
6.0g  Huang Bai
1.8g  Fang Feng
1.5g  Qiang Huo
1.5g  Han Fang Ji
3.0g  Di Long

3. Yin deficiency leading to Internal Wind: stiffness of the fingers, jerking movements of the feet, trembling muscles, dizziness, tinnitus, irritability, dry mouth, red tongue, no coating, wiry, thready, rapid pulse
9.0g  Bai Shao
4.5g  E Jiao
6.0g  Gui Ban
9.0g  Sheng Di Huang
3.0g  Mai Zi Ren
3.0g  Wu Wei Zi
6.0g  Mu Li
9.0g  Mai Men Dong
6.0g  Zhi Gan Cao
2p     Ji Zi Huang
6.0g  Bie Jia
6.0g  Gou Teng
2.0g  Quan Xie

4. Empirical Formula (A): ALS with Qi/Blood deficiency, Muscles are not nourished
15g  Huang Qi
15g  Ji Xue Teng   
12g  Dang Gui   
12g  Shu Di Huang   
12g  Ren Dong Teng 
  9g  Bai Zhu (Chao) 
  9g  Dang Shen   
  9g  Dan Shen   
  9g  Fu Ling   
  9g  Niu Xi   
  9g  Tu Si Zi   
  9g  He Shou Wu   
  9g  Gou Qi Zi   
  9g  Bu Gu Zhi   
  9g  Gou Ji   
  9g  Chen Pi   
  5g  Zhi Mu 
  5g  Huang Bai   
  3g  Gan Cao

5. Empirical Formula (B): ALS with LV/KD Yin deficiency, Damp-Heat damaging the muscles
30g  Bai Shao
15g  Gan Cao   
15g  Wu Mei   
15g  Mu Gua
  9g  Wu Jia Pi   
  9g  Hai Tong Pi
  9g  Chan Sha



KOREAN STYLE ACUPUNCTURE

Hwa-Chim:  According to Korean style acupuncture, Hwa-Chim (Five Element Harmonizing Acupuncture) is a good treatment for ALS.  After taking the "comparison pulse", the practitioner can determine one of five patterns/types; Wood excess Metal deficiency, Fire excess Water deficiency, Earth excess Wood deficiency, Metal excess Fire deficiency, Water excess Earth deficiency.  Then basic Zang or Fu treatments are applied first, and specific five element points are applied depending on the nature of the points by patterns/types.

SaAm-Chim:  For SaAm-Chim (a.k.a. Four Needle Technique), SP tonification (+HT8, SP2, -LV1, -SP1) is a good treatment because the SP is involved with muscles and motor impairment of the limbs.  The other side of SP tonification Tx., GB tonificiation (+UB66, +GB43, -LI1, -GB44) can be added according to the Heavenly Stem Union theory. 

SaAm-Chim + Point Combination:  If you apply SP tonification on one side, a few TCM points can be applied according to indication.  SI3+UB62 is a good 8 Extra combination to add for governing motor neurons affecting areas in the body.  GB34 can be considered because it's the muscle meridian influential point.  I also like to add some of the Muscle Meridian Meeting Points GB13 (3 Arm Yang), GB22 (3 Arm Yin), ST3 (3 Leg Yang), or RN3 (3 Leg Yin) depending on the area affected.

... Continued from the previous article


2.   GYNECOLOGICAL DISORDERS

The major physiological difference between the sexes is a female's ability to become pregnant. Women have a uterus, ovaries, and breasts that are designed for pregnancy and giving birth.  Additionally women's bodies tend to have a higher percentage of fat than men, which is necessary to support a pregnancy.  Some anthropologists also say women tend to sleep more lightly than man do in order to hear a baby's cries at night.  (*Of course having children depends on each individual woman's desire, but the availability of pregnancy is a main physiological difference between men and women).

Xiang Fu is one of the most important herbs for pregnancy, the uterus, and ovaries by regulating both Qi and menstruation.  Because of this, it is used for various kinds of gynecological diseases routinely. This includes dysmenorrhea, irregular menstruation, PMS, functional infertility, uterine fibroids, ovarian cysts, and even thyroid disorders and breast diseases.

Dui-Yao
For most gynecological disorders, Xiang Fu can be used in the formula.  Use Xiang Fu as a king herb, and combine with one of the following Dui-Yao depending on the pattern being treated: <Dang Gui Wei + Chi Shao>, <Shu Di + Dang Gui>, <Dang Gui + Chuan Xiong>, <Si Wu Tang>, <Chuan Xiong + Wu Yao>, <San Leng + E Zhu>, <Ai Ye + Rou Gui>, <Gan Jiang + Rou Gui>, <E Jiao + Ai Ye>, <Tao Ren + Hong Hua>, <Dan Shen + Su Mu>, <Bai Zhu + Huang Qin>, <Tu Si Zi + Lu Rong>, <Shu Di + Tu Si Zi>, <Yi Mu Cao + Mu Dan Pi>, <Yan Hu Suo + Mu Dan Pi>.

Caution
For chronic Qi stagnation with Blood or Yin deficiency, Xiang Fu is used for 4-6g only and can be combined with Tonify HT Blood herbs (Long Yan Rou / Suan Zao Ren / Dang Gui) or Tonify LV Yin herbs (Bai Shao / He Shou Wu).  Especially when the tongue is very dry and contracted, which means severe Blood/Yin deficiency, use Xiang Fu with caution or infrequently.

Preparation
There are three most common ways of using Xiang Fu: Raw Xiang Fu, Xiang Fu fried with vinegar, and Xiang Fu prepared with wine and salt.  To strengthen the Qi regulating effect, use Raw Xiang Fu; for chronic Qi stagnation, use Xiang Fu fried with vinegar to increase its nourishing nature; for gynecological disorders, use Xiang Fu prepared with wine and salt.

As many practitioners use raw herbs in Asia, Herb Suppliers say they can tell which clinic has more female patients by the amount of Xiang Fu they buy. Xiang Fu is not limited to use in females, but it is especially good for Qi stagnation and gynecological diseases in females.



3.   CASE STUDY

Case: A 40 year old, female patient has a main complaint of difficult inhalation while breathing, accompanied by shoulder pain, hypochondriac pain, occipital headache, and a plum-pit sensation in the throat. She also has constipation, a quick-temper, hot-flashes once in a while, profuse sweating, irregular menses, severe dysmenorrhea, a tongue with teethmarks, and a pulse that is weak in the LU position, and floating in the HT position.

Analysis and Herbs:
Chronic Qi stagnation, sweating: HT Blood deficiency - Suan Zao Ren
Hot flashes, constipation: HT heat - Huang Lian
Difficult inhalation, plum-pit, occipital headache, shoulder pain, hyponchondriac pain: Qi stagnation - Xiang Fu, Chai Hu, Chen Pi

Prescription: Suan Zao Ren 12g / Long Yan Rou 12g / Xiang Fu 6g / Chen Pi 6g / Chai Hu 4g / Huang Lian 2g 

Commentary:  Difficulty in inhalation is not always KD not grasping the LU Qi.  Liver Qi has a tendency to rise and chronic Qi stagnation can lead to rebellious Qi, causing difficult inhalation, sighing, and even asthma.  For this case, use LI4, SJ3, and RN23 combination, which can calm down the breathing.  For chronic Qi stagnation like the above case, you should use HT Blood Tonics as a king rather than Qi regulators.

XIANG FU (Cyperi Rhizome)
English name: Nut Grass Rhizome
Nature: acrid, sly bitter, sly sweet / neutral
Channel: LV, SJ, GB
Dosage: 4-6g (chronic); 8-12g (acute)


Introduction
If your clinic has a large number of female patients, as many do, you may find that the herb, Xiang Fu, will be very useful to you in practice. 

The classic book, "Treasury classic of Oriental Medicine," says "Male belongs to Yang, Qi disperses easily; female belongs to Yin, Qi stagnates easily."  According to this, we can assume that men have a propensity for Qi deficiency, while Women tend to get Qi stagnation instead.  Due to the menstrual cycle, a basic treatment principle for many female diseases is to "Regulate Blood and Soothe Qi."  The best herb for this is Xiang Fu.

Indications
The indications of Xiang Fu can be categorized into two groups. The first group relates to the function of soothing the Qi for conditions of Qi stagnation, while the other relates to the function of regulating blood and menstruation for Gynecological disorders.

Dui-Yao
For Qi stagnation, the most popular Dui-Yao is <Xiang Fu + Chen Pi> or <Xiang Fu + Zi Su Ye>.  For gynecological disorders, the most popular Dui-Yao is <Xiang Fu + Chuan Xiong>.  Xiang Fu moves Qi in the Blood level, while Chuan Xiong or Yi Mu Cao moves Blood in the Qi level.

Dosage
Xiang Fu can soothe Qi stagnation strongly, though it consumes Qi in the process, and can lead to Qi deficiency. Therefore, if Qi stagnation has been present for 6 months or less, you can use Xiang Fu up to 8-12g. However, if Qi stagnation becomes chronic, use only 4-6g.



1. QI STAGNATION (esp. for females)

There is a saying "In the treatment of men, start from the Essence and finish with the Essence, while in the treatment of women, start from the Qi and finish with the Qi."  From this quote, we can tell how important Qi is for women as a group.

If you see Qi stagnation in women, Xiang Fu should be your first choice of herbs, especially when treating headache, plum-pit sensation, chest discomfort, indigestion, numbness of the hands/feet, coldness of the hands/feet, various pains, and other related symptoms.  For all kinds of Qi stagnation manifestations, think about Xiang Fu 4-6g.

Liver or Chong/Ren
For women, Qi stagnation starts from either the Liver or Chong/Ren meridians.  If it starts from the Liver there will be symptoms of depression, indigestion, abdominal bloating, or epigastric discomfort. If the stagnation starts from the Chong/Ren, there will be symptoms of dysmenorrhea, irregular menstruation, and PMS. In more severe cases there may even be thyroid disorders, infertility, or uterine fibroids.

Dui-Yao
If Qi stagnation starts from the Liver, <Xiang Fu + Chai Hu> are used; while if Qi stagnation starts from the Chong/Ren, <Xiang Fu + Chuan Xiong> are used.

If Liver Qi stagnation affects the Upper burner, add <Jie Geng + Zhi Ke> or <Huang Lian + Zhi Zi> together; if it affects the Middle Jiao, add  <Hou Po + Cang Zhu> or <Huo Xiang + Zi Su Ye> together; if it affects the Lower Jiao <Mu Xiang + Bing Lang> are added; if it affects the Blood level with blood stasis, <Chuan Xiong + Chi Shao> or <Su Mu + Hong Hua> can be used together.

Use in a Formula
If you want to treat Qi stagnation in a female with many symptoms, you can use <Si Wu Tang - Shu Di + Xiang Fu, Chen Pi>. This combination: Xiang Fu, Chen Pi, Chuan Xiong, Dang Gui, and Bai Shao, is especially helpful for female patients that are sensitive to stress, nervousness, and anger.

Combination: Xiang Fu / Chen Pi / Chuan Xiong / Dang Gui / Bai Shao



2. GYNECOLOGICAL DISORDERS
... To be continued in the next article

Overview
Acupuncture treatments are usually 15-45 minutes in length.  The 15-20 minute treatment length originated from The Classic of Difficulties (Nan Jing).  The 30 minute minimum length originated from the Spiritual Axis (Ling Shu).  The 45 minute suggested maximum length has evolved with some modern practitioner's experience.


Three Theories on Treatment Time

1. The Nan Jing, Chapter 23: 15-20 minutes
It was discovered through Daoist meditation practices that Qi and Blood move through the meridians at the rate of six cun* for each complete inhalation and exhalation.  The total length of the Meridians and Collaterals equals 1620 cun (Nan Jing, Chapter 23).  1620 divided by 6 equals 270, so it is said that 270 breaths are required for Qi to make one complete cycle through the body.  However, this number could vary based on a person's breath rate.  If a person breathes 14 times/minute, it will take 20 minutes (270/14) for Qi to make a complete cycle.  If a person breathes 18 times/minute, only 15 minutes (270/18) will be needed for Qi to make the complete cycle.  Therefore, according to  the  Nan Jing, treatment time can be calculated around 15-20 minutes. 
*Cun is a Chinese proportional unit of length; pronounced "chun".

2. The Ling Shu, Chapters 15 & 18: 30 minutes
There are two chapters in the Ling Shu that talk about Qi and Blood circulation.  In Chapter 15, it says that each circulation takes 2 units of the clock.  When the Ling Shu was written, one day was divided into 100 units of the clock, and therefore the Qi and Blood circulated through the channels 50 times per day. To calculate the time of one circulation, we calculate using the ratio of 2:100 = X:24 hours, and determine that X=0.46 hours.  Converted to minutes, this equals 28 minutes and 48 seconds.  Chapter 18 directly states that Qi and Blood flow through the meridians 50 times per day.  Since 24 hours equals 1440 minutes, you can divide 1440 by 50 to get the same calculation of 28 minutes and 48 seconds. This is where we get the guideline for approximately 30 minutes of treatment.

3. Modern Acupuncture: 45 minutes
In China, some practitioners report that the best results where achieved after 45 minutes of retaining the needles.  Master Tung style acupuncture also used a treatment time of 45 minutes, in which he stimulated the points every 15 minutes.  Sometimes Tung-style acupuncturists might leave the needles 60-90 minutes, such as is cases of Bell's palsy.


Factors that Influence Treatment Time
Treatment time may be altered based on a variety of factors.  The type of acupuncture theory used, body constitution of the patient, excess or deficiency condition, and hot or cold environment or season may influence the total treatment time.   In cases of pain, cold, or pain due to cold, it is better to leave the needles in for longer periods.  A treatment time of 45 minutes is recommended for these cases due to the hypofunction of the channel.  It may take time to activate the channels, so a longer treatment time is appropriate.  After 45 minutes, the Qi activation is less effective, so you do not want to leave a patient with needles in for longer than that.


HB's note
Although I accept all the theories from the Classics and clinical experience as true, I personally believe the location of the points are the most important factor for the treatment.  Locating acupuncture points can be compared to the hitting the target in archery.  The archery target is marked by different colors from the center out, for example: yellow, red, blue, black, white.  If you needle the target (yellow), the result is more dramatic and you don't have to retain the needle as long.  However, if you needle on "blue" or further out, you may have to retain the needle for a longer time or even stimulate the needles to reach the desired effect.  Precision of needling location is one of the most important factors in obtaining results with acupuncture. 

Overview
Here are five types of Tissue Correspondence mentioned in the Yellow Emperor's Inner Classic (Huang Di Nei Jing).  These relationships are part of the holographic theory and they are: 1. In diseases of the bones, treat bones, 2. In diseases of the muscles, treat muscles, 3. In diseases of the vessels, treat vessels, 4. In diseases of the flesh, treat flesh, and 5. In diseases of the skin, treat skin.


A. In Diseases of the Bones, Treat Bones

1. Ling Gu and Da Bai
In this type of correspondence, you needle close to a joint or the junction of multiple bones in order to treat joint or bone issues. An example of this type of treatment in Tung's acupuncture is needling Ling Gu and Da Bai in the treatment of sciatica. These two points are located close to the second metacarpal bone and its junction with the first metacarpal.

2. GB 31, DU26, SI3, UB65, LI11
Another example seen in TCM acupuncture points, is the use of deep needling of GB31 to the bone level to treat Bi syndrome pain, or neck and back pain. GB31, known in Tung's acupuncture as Zhong Jiu Li, is needled to the bone level to treat pain and hemiplegia. You can combine this point with DU26, SI3, and UB65. Each of these is located close to a bone and should be needled close to the bone to treat neck pain, back pain, and degenerative disorders. The combination of Ling Gu and UB65 is also used in this way to treat heel pain.

3. LI11, LV3 / Hou Zhu
LI11 needled close to the bone instead of at the end of the crease (an alternate location) is used to treat tennis elbow. LV3 or Hou Zhu (which is a Tung point located higher than LV3) is needled close to the joint to treat knee pain.


B. In Diseases of the Muscles, Treat Muscle (Including Tendon)

1. GB34, LU5
In this correspondence there are two ways to needle to affect the muscles and tendons.  You can needle on the muscle or next to the muscle. GB34 is the influential point of the muscles and tendons, and is located on a muscle. LU5, located on the medial side of a large muscle, the biceps brachii, can affect all the muscles of the body, and is used for atrophy, frozen shoulder, and hemiplegia.

2. Zheng Zong and Zheng Jin
Two Tung points, Zheng Zong and Zheng Jin, are located on the Achilles Tendon and in imaging and holography are therefore used to treat lumbar sprain and neck muscle stiffness.


C. In Diseases of the Vessels, Treat Vessels

1. LU9
In this correspondence, you may bleed a small vessel, or needle next to a large vessel. Bleeding technique shall be covered more in depth in another section. LU9, the influential point of the vessels, is located on the radial artery, a major vessel, and can be used to treat vascular problems.

2. Huo Ying and Huo Zhu, Di Zong, Tian Zong, and Ren Zong
Huo Ying and Huo Zhu, located close to LV2 and LV3, are close to the dorsal pedis artery, and can treat diseases of the blood. Di Zong, Ren Zong, Tian Zong are located near the radial collateral artery. They can treat disorders of the Heart, atherosclerosis, and blood circulation issues. 


D. In Disorders of the Flesh, Treat Flesh

1. Si Ma (Shang, Zhong, Xia), Jian Zhong
In this correspondence, needle in locations of abundant flesh, such as in the upper thigh, where the three Si Ma points are located. These are Si Ma Shang, Si Ma Zhong, and Si Ma Xia. Jian Zhong, at the shoulder, is another location of abundant flesh. These two points can be used to treat flesh problems in the body, such as atrophy.

2. LI4, LI11, LI10, ST36, UB57, LI15
The regular acupuncture points LI4, LI11, LI10, and ST36, are also good for disorders of the flesh, and skin disorders as well. Flesh is more related to the Earth element, while skin is related to metal, according to five-element theory. Therefore, by treating flesh / earth, in the generating cycle of five-element theory, this will generate metal / skin. UB57 and LI15 are another example of points that are located in areas of abundant flesh or muscles.


E. In Diseases of the Skin, Treat Skin

In this correspondence, you can needle very superficially, and sometimes remove the needle without retaining it, like plucking a chicken's feather. This can be used to treat neuropathy, dermatitis, loss of hair, and rosacea. By needling superficially, it only affects the skin level and not the muscle or flesh levels. In five-element theory, treating the flesh level can be used to generate metal and influence the skin level as well. 

BASIC INDICATIONS OF SHALLOW/DEEP INSERTION
1. Shallow Insertion: Acute / Heat / Itching / Pain relieved by pressure / Weak pulse / Summer / Superficial level (skin, muscle, meridian, qi) / Yang Part (head, neck, chest and upper part) / Delicate patient (use shallow, shorter, fewer, thinner needles)

2. Deep Insertion: Chronic / Cold / Pain / Pain aggravated by pressure / Excess pulse / Winter / Deep level (tendons, bones, internal organs, blood) / Yin Part (abdomen, lumbosacral area, hips, extremities) / Strong patient (use deep, longer, more, thicker needles)



NEEDLE DEPTH & TREATMENT AREA
Sometimes, even when the practitioner has chosen the right point and location, a treatment may not work due to an incorrect needle depth.  A saying in TCM that demonstrates this principle is that "The Secret of an herbal formula is the dosage, while the secret of an acupuncture treatment is the depth."  Superficial needling will treat the local area, while needling to a middle depth will the send the treatment effect further away. Needling deepest will send the treatment effect the farthest. These depths are also referred to as heaven, human, and earth in TCM.

Example 1: ST36
When using ST36, if you needle superficially (heaven), you will be treating the local area and leg pain. If you needle a little deeper (human), you can treat the middle Jiao and digestive problems. If you needle to the deep level (earth), you can treat respiratory and heart issues. Finally, if you needle further, at more than 2 cun, you can treat Bell's Palsy and the face. 

Example 2: LING GU
If you want to treat Ling Gu to affect a problem with sciatica, then needle the point deeper than if you were trying to affect a problem in the upper Jiao.

Example 3: SI3
If you want to treat SI3 for vertex headache or back pain, needle deeper for the back pain and more superficially for the head issues.

24 Gate Opening Combinations
There are 24 different Gate Opening combinations.  Yuan-source points are used in the practice of Gate Opening treatment.  The Yuan-source points are paired by opposite polarity of both Yin and Yang channels, as well as hand and foot channels.  (For more information, refer to HB's Minibook p.360) 


Three Locations of the Four Gates
LI4+LV3 is the most popular combination among the 24 Gate Openings.  There are seven reasons why this combination is the most useful combination among them all.  (See forum #228 for details.)

There are three distinct locations of the LI4+LV3 Four Gates combinations, and their functions and indications should be distinguished from each other.

1. Regular Four Gates: LI4 + LV3
This version of the Four Gates is the standard version, and is very popular for treating pain or Internal Wind such as Parkinson's disease and hand trembling. This combination is also good for calming.  Both LI4 and LV3 are Yuan Source points, with one located in the hand and one in the foot.  One point is the closest Yuan Source point to the thumb, and the other is the closest Yuan Source point to the big toe.  This is important because the big toe and thumb have the greatest collection of energy in the hand and foot.  In reflexology, the big toe and thumb are very close to the areas that pertain to the head and brain.  This is why these points are used to treat Internal Wind and pain.

2. Anterior Four Gates: Jian Gu + LV2
If someone has insomnia, the anterior Four Gates is the better choice to treat it.  Jian Gu* (Between Valley) is used to treat the chest in holographic theory and is very good for insomnia, and LV2 is also good for insomnia.  Jian Gu is for the chest, and LV2 can treat the head, so if someone has insomnia with a stuffy feeling in the chest or too much going on in their mind, then this combination can take care of both issues.

3. Posterior Four Gates: Ling Gu + Huo Zhu
This combination is used for musculoskeletal problems because the location is close to the junction of the 1st and 2nd metacarpal and metatarsal bones.  Ling Gu* (Spiritual Bone) is at the junction of the metacarpal bones, and Huo Zhu* (Fire Govern) is located at the junction of the two metatarsal bones.  This combination can be used for pain in any part of the body, knee pain, elbow pain, pain of the whole body, hand and foot pain, rheumatoid arthritis, or osteoarthritis.


Location descriptions*
Jian Gu (Between Valley): Midway between LI3 and LI4
Ling Gu (Spiritual Bone): At the joint of the 1st and 2nd metacarpals on the posterior side of the hand; above LI4 
Huo Zhu (Fire Govern): At the joint of the 1st and 2nd metatarsals on the posterior side of the foot; above LV3

TREATMENT FOR INSOMNIA

A.   Regular Points 

1. HT7
HT7 works similarly as the herb Suan Zao Ren or Long Yan Rou to treat insomnia.  They both nourish HT Blood and calm the Shen.  The name "Shen Men" means "Spirit Gate," and this point nourishes the Heart and calms the Shen.  HT7 and the auricular point Shen Men have the identically same name, so they are often combined as a Dui-Xue (point pair) to increase the calming effect. 
HT7 has other applications besides insomnia.  Clinically, HT7 is good for constipation caused by stress-induced qi stagnation.  The constipation caused by qi stagnation from retaining the needle too long at ST34 can also be relieved by HT7.  In this way, we can say that HT7 is the "antedote" for misuse of ST34.
For pain on the calcaneal aspect of the sole of the foot, needle HT7 on the opposite side.  It can treat heel pain because it resembles the heel, and it can balance the KD Foot Shao Yin channel since it is the Hand Shao Yin channel.

2. SP6
SP6, a famous gynecological and yin-nourishing point, can treat insomnia due to hormonal imbalance (which is usually associated with Kidney yin). 
Although it's one of the basic points for insomnia, it is more famous for treating gynecological disorders.  It can simply be used for most gynecological disorders including amenorrhea, dysmenorrhea, leukorrea and difficult labor.  However, it shouldn't be used in cases of excessive uterine bleeding or pregnancy since it has a strong descending energy.  Some texts note that ST36 is the "Upper San Li" while SP6 is the "Lower San Li," which makes these points a good combination for lower abdominal pain.

3. An Mian & GB12
An Mien and GB12 are very close in location, and both treat insomnia effectively.  An Mien is a famous empirical point for the treatment of insomnia, while GB12 is described as a "hypnotic" point.  GB12 acts like a sink to drain away disturbing thoughts, help to forget bothersome things and fall asleep more easily.  Some texts even warn that long term use of GB12 may cause some loss of memory.
Besides the treatment of insomnia, GB12 can treat certain types of pain.  The pinyin name of GB12 is "Wan Gu," which is the same name as SI4.  If there is a pain in the GB12 area, SI4 can treat it and vice versa.  GB12 is also used for neck area pain or pain at the root of the eye.

4. GB31
Lastly, GB31 is the only lower-body point with "Wind" in its name. "Wind Market" (GB31) reflects its ability to treat internal or external wind, such as skin issues or wind-related insomnia.  Clinically, GB31 is more famous for treating lower leg or foot weakness and insomnia.  Moxa on GB31 is also good for increasing energy and combating fatigue.  GB31 is usually located where the tip of the middle finger touches the thigh when the patient is standing erect,  but you can also use the tender spot above or below the traditional location.


B.   Master Tung Points
1. Lower Three Emperor + Zhen Jing (Yin Tang)
The Lower Three Emperor points include Tian Huang Fu, Di Huang, and Ren Huang.  Tian Huang Fu is located 1.5cun below SP9 and is called the "heaven emperors Fu".  Di Huang is located at SP7 and is called the "earth emperor", while Ren Huang is located at SP6 and is called the "human emperor".  These three points are famous for KD tonification, can tonify the SP as well because they are on the SP channel, and have strong calming properties.  In herbal medicine, these points are similar in effect to Tian Wang Bu Xin Dan (KD and HT) and Gui Pi Tang (SP and HT).  Zhen Jing (Yin Tang), which shares the same location as the third eye and the Brow chakra in the Indian system, is called the upper Dan Tian in Oriental philosophy, and is very effective as a calming point.  The grouping of Lower Three Emperors and Zhen Jing together is a strong point combination for the treatment of insomnia.  Three points in the lower body on a yin channel balance well with one in the upper body on yang channel.

2. Jian Gu
Jian Gu is located midway between LI3 and LI4.  Ling Gu is at the junction of the first and second metacarpal bones.  Jian Gu is less well known than Ling Gu, He Gu, and Da Bai.  LI3 (Da Bai) is used to treat the face area, LI4 (He Gu) is more for middle Jiao and intestinal problems, and Ling Gu is used to treat the lower Jiao and sciatica.  In holography, or holographic theory, one part of the body represents the entire body.  The second metacarpal bone can represent the entire body in a holographic relationship, and therefore the points along this bone can be used to treat those areas.  As LI3 treats the face, and LI4 treats the middle jiao, Jian Gu is between these two points and so can treat the space between the face and middle jiao on the body, the chest.  This point, Jian Gu, is a great choice for patients with insomnia and stagnation or stuffiness in the chest, where there are no particular symptoms in the head or brain area. The combination of Jian Gu + LV2 is an "anterior version" of the Four Gate treatment which addresses insomnia well.

3. Wu Ling
These 25 points on the back are used for chronic insomnia, and are needled with a bleeding technique.  Chronic insomnia often involves blood stasis, so bleeding technique is used because it is good for treating the blood stasis.  A description and the location of these points will follow in a later article.


C.   Formulas For Chronic Insomnia
If someone has insomnia for 20-30 years, they have chronic insomnia, and usually either blood stasis or phlegm is involved.  Typically any chronic diseases will have blood stasis or phlegm as part of the diagnosis, and so it is very important to treat these problems.  Xue Fu Zhu Yu Tang is good for blood stasis patterns for chronic insomnia; Gui Pi Tang +  Wen Dan Tang is a great combination as well for chronic insomnia.  Additionally, ST40 bleeding can take care of phlegm and stasis in chronic cases or difficult diseases, because ST40 is indicated for phlegm, and bleeding technique can be used to treat blood stasis.


D.   Concurrent Pain and Insomnia
If the patient has pain and insomnia together, including fibromyalgia, arthritic pains, and traumas with insomnia, then GB31 is a good choice.  GB31 has a calming and analgesic action at the same time.  Yan Hu Suo, Corydalis, is also a good treatment for that as well.  It does not directly calm the shen, but by relieving the pain, it treats insomnia.  So in this case, Jian Gu plus GB31 is a good combination.  Jian Gu is a Tung style point, and GB31 (Zhong Jiu Li) is another Tung point.  The combination of these two points is quickly effective, and the patient will be able to sleep longer and will be able to fall asleep easier.