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In Master Tung style acupuncture, the most popular points for gynecological disorders are Fu Ke (11.24 - women department), Huan Chao (11.06 - return to the nest), and Jie Mei (88.04 - sister one, 88.05 - sister two, 88.06 - sister three).  The first two points, Fu Ke and Huan Chao, are used widely and effectively for women's disease as a Dui-Xue (Point pair).  Since the Jie Mei (88.04,05,06) points are located on the thigh area, which is not always easily accessible, the Fu Ke (11.24) + Huan Chao (11.06) combination is often more appropriate for many situations since they are easily located on the fingers.


FU KE  (11.24) - Women department

Location: There are 2 points in all. The patient is supine. Locate these points by first making a line 3 fen to the ulnar side from the dorsal midline of the proximal phalanx of the thumb. Then, measuring 3 fen and 6 fen distally from the metacarpal-phalangeal joint. This is the reaction area of the uterus.

Indications: Inflammation of the uterus, pain of the uterus, uterine tumor, lower abdominal distension, infertility after being married a number of years, menstrual irregularity, menstrual pain, excessive or scanty menstruation.

Functions: Fu Ke (11.24) is located close to the LU channel.  Using the Hand Tai Yin and Foot Tai Yang relationship, this point can treat the uterus and bladder area. In the Shang Han Lun formula, Tao He Cheng Qi Tang (Peach Pit Decoction to Order the Qi) indicates Blood accumulation in the UB and treats gynecological disease. This is similar to the action of Fu Ke (11.24).


HUAN CHAO (11.06) - Return to the Nest

Location: The patient is supine. Locate the point by measuring 5 fen to the ulnar side of the median line of the palm side in the middle of the middle phalanx of the ring finger. This is the reaction area of the liver and kidney.

Indications: Uterine pain, uterine cancer, uterine inflammation, menstrual irregularity, red and white abnormal vaginal discharge, non-free flow of the fallopian tubes, retroversion of the uterus (indicated by back pain), frequent urination, swelling of the yin gate, i.e. vaginal orifice, calms the fetus.

Functions: Huan Chao (11.06) is located very close to the SJ channel, so it can benefit the triple burner.  Using the Hand Shao Yang and Foot Shao Yin relationship, this point is therefore also related to the Kidney. Master Tung also indicated that all points on the ring finger are related to Liver function. In summary, this point can treat gynecological disease by tonifying the Liver and Kidney and benefiting the Triple burner.


COMBINATION & MODIFICATIONS

When using the combination of Fu Ke (11.24) + Huan Chao (11.06), it is important to combine these two points on two different hands.  They are not used on the same hand together.  For example, if you use Fu Ke on the left hand, Huan Chao must be used on right hand, and vice versa.  While Fu Ke (11.24) focuses on the uterus, Huan Chao (11.06) focuses on the fallopian tubes and ovaries. The application of these two points in combination is very broad. A few examples are listed below.

For uterine pain or uterine inflammation, add Men Jin (66.05 - door metal). This point is located a little higher than ST43, close to junction of the 2nd and 3rd metatarsal bones. While the Fu Ke + Huan Chao combination treats the root problem, Men Jin is more effective for analgesic action.

For blockage of the fallopian tubes, add Mu Fu (66.02 - wood woman). This point is located on the second toe by measuring 3 fen lateral from the middle of the center phalanx, a little higher than ST45.

For swelling of the external genitalia, add LV2. Bleeding technique can be applied between the medial malleolus and SP6.

For vaginitis, add Hai Bao (66.01 - sea seal). This point is located between SP1 and SP2, on the center of the phalangeal joint on the medial side of the large toe. For trichomonas vaginitis,  Ku Shen (Rx. Sophorae) 30g, She Chuang Zi (Fr. Cnidii) 30g, Bai Bu (Rx. Stemonae) 15g, and Huang Lian (Rz. Coptidis) 9g can be decocted and used as a external wash.

The subject of pulse diagnosis was first tackled in an organized manner by Wang Shuhe, who lived during the 3rd century A.D. His text on pulse diagnosis became known as the Mai Jing (Pulse Classic). In the Mai Jing, a broad spectrum of applications for pulse diagnosis is delineated, including etiology of disease, nature of the disease, and prognosis.

Pulse diagnosis is one of the original four diagnostic methods that are described as an essential part of traditional Oriental medical practice. However, Today, doctors often deviate from the treatment methods of ancient times. They may not even follow the changes in the four seasons that influence the pulse and other body conditions. Additionally, they often do not know the importance and principles of the pulses.

The aim of pulse diagnosis, like the other methods of diagnosis, has always been to obtain useful information about what goes on inside the body, what has caused disease, what might be done to rectify the problem, and what are the chances of success. According to Eastern theory, the pulse can reveal whether a syndrome is of a hot or cold nature, whether it is of excess or deficiency type, which of the humors (qi, moisture, blood) are affected, and which organ systems are suffering from the dysfunction. In order to make these determinations, the physician must feel the pulse under proper conditions, while following established procedures, and must then translate the unique pulse that is felt into one or more of the categories of pulse form.

The most standard iconography involves 24 different pulse forms, include 15 Primary pulses and 9 Extraordinary pulses.  The 15 Primary pulses are matched with the five elements and three components by their characteristics.  The 9 Extraordinary pulses are matched with the eight trigrams and nine palaces by their characteristics.


15 Primary pulses
Wood pulses:  Wiry (heaven),  Tight (human),  Hidden (earth)
Fire pulses:  Hollow (heaven),  Overflowing (human),  Full (earth)
Earth pulses:  Minute (heaven),  Slowed-down (human),  Slow (earth)
Metal pulses:  Floating (heaven),  Weak (human),  Choppy (earth)
Water pulses:  Soft (heaven),  Slippery (human),  Deep (earth)


9 Extraordinary pulses
Heaven (Long)  -  Earth (short)
Lake (Knotted)  -  Mountain (Moving)
Fire (Empty)  -  Water (Abrupt)
Thunder (Leather)  -  Wind (Fine)
Center (Intermittent)


Feeling the pulse at each of the individual positions on the wrists is necessary to assess the condition of each of the internal organs. However, the association of individual pulse positions with internal organs has changed over time and varies from one traditional system to another. The current understanding is that the left wrist presents information for the heart, liver, and kidney yin, while the right wrist presents information for the lung, spleen, and kidney yang. This classification is consistent with the five element system that depicts five basic viscera; the kidney is subdivided to make the sixth. However, one can alternatively incorporate the pericardium/triple burner system in place of the kidney yang pulse.

Pulse diagnosis is one method of determining the internal conditions of patients with the aim of deciding upon a therapeutic regimen. In order to make use of this diagnostic, the practitioner must learn the proper method of taking the pulse, the factors that influence the pulse, and the categories into which each patient's unique pulse form can be fit. Practitioners must remain especially alert to new factors that influence the pulse readings so as to assure that the results of pulse taking are meaningful.

Most authorities agree that in the modern era one must be able to detect a relatively limited basic group of pulse forms in order to utilize the information for devising a therapy (i.e., acupuncture, herbs). These requisite forms determine whether the focus of the pathological process is at the body's surface or interior, is of a hot or cold nature, or is of an excess or deficiency type. There have been recent attempts to broaden the scope of pulse diagnosis; for example, feeling the pulses immediately after insertion of acupuncture needles has been suggested recently as a means of determining whether the "qi has arrived" as a result of correct point selection and needle manipulation. Pulse diagnosis remains an important part of the practice of traditional Oriental medicine that is still being explored and developed. In conclusion, Pulse diagnosis adds critical information that can greatly alter the treatment strategy, and therefore, practitioners should master Pulse diagnosis because it is an essential part of traditional Oriental medicine.     

Introduction:

Out of the Five Zang organs (LV HT SP LU KD), the most common deficiencies found in children are Lung deficiency, Spleen deficiency, and Kidney deficiency. The best formulas for treating these deficiencies are discussed below. It should also be noted that each of these formulas can be taken in decoction, powder or pill form, regardless of the name of the formula.

A small amount of Lu Rong (deer horn) is in each of these formulas because the Yang Qi in children is not developed enough. This can be a cause of weaknesses.  However, only a small amount of Lu Rong must be used, because overuse can cause an imbalance in yin-yang, due to the primarily yang nature of children in general. 



Patterns and Formulas:

1. Spleen Deficiency: Xiao Er Jian Pi Tang (Children's Strengthen the Spleen Decoction)

Ingredients: Bai Zhu 6g,  Hou Po 4g,  Chen Pi 4g,  Ren Shen 4g,  Fu Ling 4g,  Gan Cao 3g,  Shan Zha 3g,  Mu Xiang 2g,  Sha Ren 2g,  Lu Rong 2g,  Sheng Jiang 3p,  Da Zao 2p.

This formula is created by using herbs from Ping Wei San (Cang Zhu, Hou Po, Chen Pi, Gan Cao) + Si Jun Zi Tang (Ren Shen, Bai Zhu, Fu Ling, Gan Cao) + Digestive Qi-Regulating herbs (Shan Zha, Mu Xiang, Sha Ren).

In children, the Spleen and Stomach are vulnerable and may easily have functional deficiencies. This formula may be used for poor appetite, a weak stomach, indigestion (food retention), abdominal pain with overeating, or in children who are too slim and need to gain weight. To modify this formula for children with obesity and excess patterns, Si Jun Zi Tang can be omitted.


2. Lung Deficiency: Xiao Er Bu Fei Yin (Children's Tonify the Lung decoction)

Ingredients: Huang Qi 8g,  Ren Shen 4g,  Mai Men Dong 4g,  Cang Zhu 4g,  Dang Gui 3g,  Chen Pi 3g,  Wu Wei Zi 2g,  Sheng Ma 2g,  Chai Hu 2g,  Lu Rong 2g

This formula is constructed with herbs from Bu Zhong Yi Qi Tang (Huang Qi, Ren Shen, Bai Zhu, Gan Cao, Dang Gui, Chen Pi, Sheng Ma, Chai Hu) + Sheng Mai San (Ren Shen, Mai Men Dong, Wu Wei Zi) + Lu Rong.

This formula should be used for children who catch cold easily, or have chronic rhinitis, frequent swollen tonsils, adenoiditis, chronic sinusitis, or weak Lung function. It targets the Nose, bronchi, and Lungs.


3. Kidney Deficiency: Xiao Er Shen Qi Wan (Children's Kidney Qi pill)

Ingredients: Shu Di Huang 12g,  Shan Yao 12g,  Gou Qi Zi 6g,  Shan Zhu Yu 6g,  Mu Dan Pi 4g,  Ze Xie 4g,  Fu Ling 4g,  Lu Rong 2g.

This formula is constructed with herbs from  Liu Wei Di Huang Wan (Shu Di Huang, Shan Yao, Shan Zhu Yu, Mu Dan Pi, Ze Xie, Fu Ling) + Gou Qi Zi, Lu Rong.

This formula can be used for children with enuresis, poor endurance/stamina, dry skin, dry atopic dermatitis fatigue, difficulty waking up in the morning, pain in the knee or foot, nose bleeds, or those who are easily wearied or irritated.



General Modifications: If there are heat signs, Hong Shen (Red ginseng) - steam treated Ginseng can be used instead of Ren Shen.

Dosage: When prescribing these formulas to children, use the childs age to determine number of days of treatment. For a 1 yr old - treat for 1 day. For a 2yr old - 2 days, a 5 yr old - 5 days, a 10 yr - 10 days... and so forth.

Introduction

   While acupuncture is a relatively safe procedure, it is likely that a practicing acupuncturist will occasionally encounter side effects of treatment, such as bruising, hematoma, or fainting. Less commonly seen are adverse events, such as stuck needle, or broken needle.  In rare cases, more serious adverse events have been reported, such as pneumothorax or organ puncture, though these are often due to improper needling technique, depth, direction, or location.

   In the acupuncture clinic, the type of side effects encountered varies according to the acupuncture points used. While there are many points listed in the classical texts of acupuncture for possible side-effects, these may not always be applicable in modern practice. The types of acupuncture needles used now are smaller, finer, and of better quality than what were available at the time these texts were written.  However, as an acupuncturist it is important to be aware of classical side-effects in order to manage all possible side-effects properly.

   Listed below is a chart of adverse events from the classics, and the treatment points that should be used if such events occur in practice. It should be noted that some of the effects are due to improper needling of a point, such as in the case of UB 13 causing asthma and cough. If a patient today has a medical emergency, such as pneumothorax due to improper needling, or the patient is unresponsive after fainting, the patient should be given prompt medical attention by emergency services rather than additional needling. In these cases this information is given for historical and educational purposes only, and is not a substitute for calling 911.



Initial Point:  Side Effect Experienced  -  Strong Stimulation of Treatment Points

SJ 8:  Breathing difficulty, irregular pulse - Use ST 36, SP 6

LI 3:  Hand or motor impairment of the upper limb  -  Use LI 5

HT 2:  A Stuffy feeling in the chest  -  Use HT 7

GB 21:  Dizziness, vertigo  -  Use SJ 23, then ST 36

GB 18:  Fainting  -  Use UB 23

SJ 20:  Dizziness when using harsh technique  -  Use SJ 8

SJ 19:  Tinnitus or ear pain  -  Use SJ 4

ST 1,2:  Blurred vision  -  Use ST 44

GB 20:  Fast breathing, cold sweat, even vomiting  -  Use ST 36

SI 14:  Intercostal neuralgia  -  Use UB 13

UB 13:  Cough, asthma  -  Use LI 10, ST 36

DU 11:  Possible spinal cord damage (by strong stim.)  -  Use DU 1

UB 15:  Suffocated feeling below the xyphoid process  -  Use ST 20
               
Ren 17:  Breathing difficulty  -  Use UB 17

DU 10:  Weakness of the hands and feet  -  Use UB 40

Ren 9:  Edema of the whole body  -  Use ST 25

Ren 8:  Swelling of the testicles (by moxa)   -  Use Du 4

SP 15:  Difficulty lifting the shoulder  -  Use UB 43

KD 11:  Difficulty urinating  -  Use KD 1

ST 30:  Hernia pain, hypogastric pain and surging pain on the chest  -  Use ST 40

Ren 1:  Needle pain that lasts for many days  -  Needle around the affected area

SP 10:  Fainting  -  Use LI 10, ST 36

UB 56:  Pain of m. gastrocnemius, difficulty walking  -  Use UB 60

UB 57:  Foot cramping  -  Use GB 39

ST 36:  Severe pain due to needling  -  Use the Ba Feng point btw 3rd/4th toes

UB66 (Zu Tong Gu, 足通谷)


1. Foot Passage Valley
UB66 (Zu Tong Gu) is translated to Foot Passage Valley.  This name implies that the point can be used for any problem along the length of the UB channel.  This includes the areas of the corner of the eye,  to the head and occipital area, down to the back and lower back, the back of the leg, and finally to the little toe. In general this is a very sensitive point; however, pain can be minimized by locating the point correctly.

Pyung Chim: According to five element theory, UB66 is the water point of the UB channel.  In Pyung Chim (Korean Yin Yang balancing) style acupuncture, one should sedate the point on the same side as the problem, and tonify the point on the opposite side.


2. Headache
UB 66 is very effective at treating Taiyang occipital headaches; however, it is not limited to this area alone.  The UB channel crosses DU20 at the vertex of the head and travels through the frontal area of the head as well. Additionally, a branch of the UB channel crosses points on the GB channel, GB 7, 8, 10, 11, and 20. Therefore, UB66 can be used for headaches in the occipital, frontal, vertex and temple areas.

Extreme Headache: If you have tried using other channels to treat a severe headache and they have not been successful, try using UB66.

Nervous Headache (cephalalgia nervosa): When treating nervous headaches, first use HT5 (Tong Li: Passage Village) and then UB66 after.


3. Eye pain
UB1, at the inner canthus of the eye, is the crossing point of five channels: the UB, SI, ST, yang qiao, and yin qiao. While the only channels that are said to actually enter the eye are the LV and HT channels, the UB channel is closely related to the eye, and can therefore be used to treat eye pain.  In the brain, the visual information from the eye is processed in the occipital area of the brain, and the UB channel passes through both of these areas. So for severe eye pain, try UB66.


4. Sprain of the Little Toe
This type of injury often occurs when the patient is walking barefoot or jumping, or the foot is caught in part of a shoe during movement. As UB66 is a local point on the little toe, it can be effective for sprain of this area. In treatment, follow the pyung chim rule that was discussed above.


5. Brain
UB66 can be used to treat any problem in the internal head and brain, especially heavy head, dizziness, and cerebral anemia. This is mentioned in the Ling Shu (Spritual Axis), where it says that for chaotic Qi in head, one should first try the local points, UB 10 and 11, but if they are not effective, then the distal points UB 65 and 66 should be selected.

WHAT IS LIPOMA?

Definition: A lipoma is a slow-growing benign tumor which is not cancer and is usually harmless. They are the most common form of soft tissue tumor and are most often located between the skin and the underlying muscle layer;  Shape: They are soft and doughy to the touch. They are usually movable with slight finger pressure and are generally painless. They commonly occur in the neck, shoulders, back, abdomen, arms and thighs;  Size: Many lipomas are typically less than 1 inch in diameter, but they can grow to larger than 2 inches;  Age: The most common age group lipomas are found in is between 40 and 60 years old. They can be found in children but this is rare;  Cause: The exact cause of lipomas is unknown but genetic factors likely play a role in their development. Additionally, there are theories that lipomas are caused by trauma or injury to the site of origin, or that dietary factors play a role, such as fat and sugar consumption.



TCM PATTERNS & HERBAL FORMULAS

1. Qi & PHLEGM ACCUMULATION
Signs & Symptoms:  lipoma, chubby body, slippery-full pulse
Tx principle:  move qi and dissipate nodule, dry damp-phlegm
Formula:  Er Chen Tang + Bai Jie Zi, Dan Nan Xing, Qing Meng Shi, Hai Zao, Kun Bu, Zhi Shi
Ingredients:  Ban Xia 12g,  Chen Pi 12g,  Fu Ling 9g,  Zhi Gan Cao 4.5g,  Bai Jie Zi 4.5g,  Tian Nan Xing (prepared) 4.5g,  Qing Meng Shi 4.5g,  Hai Zao 4.5g,  Kun Bu 4.5g,  Zhi Shi 4.5g

2. QI DEFICIENCY WITH PHLEGM
Signs & Symptoms:  increase in size of a lipoma, indigestion, poor appetite, easily fatigued, possible edema, loose stool, white-greasy tongue coating, soft-moderate pulse
Tx principle:  strengthen SP and benefit Qi, transform Phlegm
Formula:  Gui Pi Tang + Dao Tan Tang
Ingredients:  Bai Zhu 12g,  Fu Shen 12g,  Huang Qi 12g,  Long Yan Rou 12g,  Suan Zao Ren (fried) 12g,  Ren Shen 6g,  Mu Xiang 6g,  Zhi Gan Cao 3g,  Ban Xia 6g,  Tian Nan Xing (prepared) 12g,  Chen Pi 12g,  Chi Fu Ling  12g

3. LV & SP DISHARMONY
Signs & Symptoms:  lipoma, chest fullness, hypochondriac fullness, irritability, easily angered, no appetite, white tongue coating, wiry-thready pulse
Tx principle:  Soothe LV Qi, harmonize the SP, Move Qi and activate Blood
Formula: Shi Quan Liu Qi Yin
Ingredients:  Chen Pi 9g,  Chi Fu Ling 9g,  Wu Yao 9g,  Chuan Xiong 9g,  Dang Gui 9g,  Bai Shao 9g,  Xiang Fu 6g,  Qing Pi 4.5g,  Gan Cao 3g,  Mu Xiang  2g



EMPIRICAL FORMULAS

1. FORMULA A
Indications:  multiple lipoma syndromes
Tx principle:  Benefit Qi and nourish Blood, Open the channels and regulate the Ying level
Ingredients: Dang Gui 12g,  He Shou Wu 12g,  Bai Shao 4.5g,  Chi Shao 4.5g,  Zhi Gan Cao 4.5g,  Chuan Xiong 3g,  Bai Ji Li 9g,  Huang Qi 18g,  Hu Ma Ren (sesame) 7.5g,  Rou Cong Rong 7.5g

2. FORMULA B
Indications:  multiple lipoma syndromes, chronic lymphadenitis
Tx principle:  Benefit Qi and nourish Blood, Open the channels and regulate the Ying level
Ingredients:  Dang Gui 12g,  He Shou Wu 12g,  Bai Shao 4.5g,  Chi Shao 4.5g,  Zhi Gan Cao 4.5g,  Chuan Xiong 3g,  Bai Ji Li 9g,  Huang Qi 18g,  Hu Ma Ren (sesame) 7.5g,  Rou Cong Rong 7.5g,  Sheng Di Huang  9g



ACUPUNCTURE SESSION

1st Tx:  Great Gate opening
LI4, LV3, Yintang, DU20 + PC9, SJ1

2nd Tx:  Meridian connecting (Yin)
ST36, GB41, SP4, PC6, LV14, RN12, Yintang

3rd Tx:  Four needle technique
RIGHT: SP tonficiation (+HT8, +SP2, -LV1, -SP1)
LEFT:  ST40

4th Tx:  Four needle technique
RIGHT: SP tonification (+HT8, +SP2, -LV1, -SP1)
LEFT: GB tonification (+UB66, +GB43, -LI1, -GB44)

5th Tx:  Four needle technique
LEFT:  LU tonfication (+SP3, +LU9, -HT8, -LU10)
RIGHT:  SJ tonification (+GB41, +SJ3, -UB66, -SJ2)

6th Tx:  Meridian flow
GB41, LV8, PC3, SJ5, GB24, RN5, Sishengchong (2 side points)

7th Tx:  Meridian connecting (Yang)
ST36, GB41, SP4, SJ5, LV14, RN12, Yintang

8th Tx:  Gate opening
SP4, SJ4, Yintang, DU20

1. Left-Right Balancing
In Left and Right side balancing, if the pain is on the left side, we can needle points in the same location on the right side, and vice versa. For example, in the treatment of left LI11 pain, needle right LI11. If the patient has pain at right LI4, needle left LI4. 


2. Hand and Foot, Arm-Leg Balancing
In this type of balancing, the shoulder and hip can be used to treat each other, the elbow area and knee area can be used to treat each other, the wrist and ankle can treat each other, and the fingers and toes and be used to treat each other.

After choosing the appropriate body part to treat (ex. knee for elbow pain), the treatment channel must be chosen. In this system, channels of the same name are often chosen to treat each other. Therefore the ST channel can treat pain in the LI channel.

For example, if the patient has pain in the hip joint (GB channel), you can needle opposite SJ14.  If there is pelvis pain on the ST channel, needle LI15 contralaterally. If there is Knee pain, especially on the Spleen channel, needle LU5. 


3. Hand-Foot, Arm-Leg Mirror
In this type of balancing, the two limbs are facing opposite directions. In this method, the hand relates to the pelvis, the elbow to the knee, the upper arm to the lower leg and the shoulder to the foot.

For example, Ling Gu and SI3 can be used to treat sciatica, and SJ5 and SJ6 can treat thigh pain


4. Upper Limb-Trunk
In this style of balancing the hand and forearm from the fingertips to the elbow, is balanced with the torso from the head to the groin area.  The forearm relates to the chest, the elbow to the umbilicus, the lower arm to the lower abdomen, and the hand to the genital area.

An example of this type of balancing is the use of the Tung points, Da Jian and Xiao Jian, located on the fingers, to treat genital pain. 


5. Upper Limb-Trunk Mirror
This method is the reversal of the previous method, where now the hand relates to the head and neck, the forearm to the chest and upper back, the elbow to the umbilicus, the upper arm to the lower abdomen and sacral area, and the shoulder to the genital area.

There are many examples for this method. PC6 is often used for pain in the chest area, while Tian Zong and Yun Bai, located on the shoulder, are used for problems in the genital area.  In Korean Hand Acupuncture, the top of the middle finger is related to DU20, and is used in the treatment of headache.   This method is also the reason why LI4 is used to treat wind in the head and brain area or headache.


6. Lower Limb-Trunk
In this style, the lower limb relates to the torso from the head to the groin area. The thigh relates to the chest, the knee to the umbilicus, the leg to the lower abdomen and sacral area, and the foot to the genital area.

A few examples of this in practice are the use of ST44 in the treatment of dysmenorrhea, the use of SP1 and LV1 in the treatment of leukorrhea, and the use of SP6 for lower abdominal pain.


7. Foot-Trunk Mirror
This style is a reversal of the previous one, and now the foot relates to the head, the ankle to the neck, the leg to the chest and upper back, the knee to the umbilicus and lower back, and the thigh to the lower abdomen and sacral area.

Examples of this in Tung's acupuncture are the use of ST43/44 (Men Jin in Tung's acupuncture) in the treatment of frontal headache. Also, two Tung points at the Achilles tendon, Zheng Zong and Zheng Jin, are used for the treatment of neck pain.

In TCM there are additional examples. GB41 is used for temporal headaches, UB65 and UB60 are used for occipital headaches, and LV1 and KD1 are used to treat vertex headaches at DU20. Because the foot relates to the brain in this style, SP1 and ST45 are used for sleep issues, and LV1 can be used for Alzheimer's disease. This style is also the basis for UB40's use in lower back pain. 


8. Upper-Lower
There are a few variations of this relationship. In one, the head can be related to a mirror image of itself, where DU20 can treat the throat and vice versa.

In another variation, the head can relate to the sacrum, where DU1 can treat disorders of the brain, and DU20 can treat hemorrhoids.

A third variation of this is the relationship of the head and foot, where KD1 treats vertex headache, and DU20 treats pain on the sole of the foot.


9. Front-Back
In this style of balancing, the front of the body may be used to treat the back and vice versa. Pain at L2, near UB23, is level with the umbilicus, and therefore needling 0.5 cun medially to ST25 can treat low back pain.

Additionally, Ren23 can be used to treat neck stiffness, and DU15 can treat aphasia, voice disorders, and difficulty swallowing.

*Please refer to p.378 in the <Minibook of Oriental Medicine> to see the pictures.




When applying these balancing techniques, you must consider not only the related anatomical areas, but the channel relationships as well.  Treating channels are often channels of the same name as the effected channel, or channels of an interior-exterior relationship to the effected channel.

1. Meridian Name Sharing
For example, if treating shoulder pain in the LI channel, one choice might be the LI channel on the opposite arm, or another is the ST channel on the opposite leg. If the pain is in the SI channel on the shoulder, you may choose SI on the opposite arm, or the UB channel on the opposite leg.  In another example, for the treatment of hernia pain (ST channel), you may chose LI points, such as Ling Gu, because both channels are Yangming and so can balance each other. 

2. Interior and Exteriorly Related Channels
Channels with interior-exterior relationships can also balance each other, so LU5 could be used for pain around LI11 as well. 

3. Treatment of the Ren and DU
When there are issues with the Ren channel, the Shaoyin channels, HT and KD, may be used to balance the Ren. When there are problems with the Du channel, then the Taiyang channels, SI and UB, may be used.  Additionally the Ren and DU channels can be used to balance each other in the front-back style. 

1. INTRODUCTION

The point combination LI4 (union valley) + LV3 (great surging) is well known as the "four gates".  However, it is only one possible combination out of 12 four gate pairs.  If needling order is considered, it can be expanded to 24 pairs.

"24 Gate Opening" is one of the essential acupuncture theories in Korean medicine.  Gate opening exhibits the unique function of synchronizing the body in time and space, and aligning the body with the environment.  It is an excellent choice for the first treatment in a course, as it increases the body's receptiveness to acupuncture's benefits.



2. TREATMENT PRINCIPLES

A) Order of insertion:  According to the theory, the order of needling has a significant impact on the treatment.  The needling order should be modified according to the time of day.  (Refer to p.360 of Minibook of Oriental Medicine).  Otherwise, 4 gates → Yintang → DU20 can be used as a universal order anytime of the day.   

B) Combination principle:  Yuan source points are used in the practice of Tong Gi Chim.  Yuan source points are paired by opposite polarity of both yin and yang channels as well as hand and foot channels.  For example: LI4 (E), a hand yang channel, is combined with LV3 (M) or KD3 (H), which are foot yin channels. Points within the same circuits (Heaven, Earth, HuMan) cannot be combined. (Channels in the Earth (E) circuit are LU, LI, ST, and SP. Channels in the Heaven (H) circuit are HT, SI, UB, and KD. Channels in the  Human (M) circuit are PC, SJ, GB, and LV.) 2 possible combinations for each point x 12 Yuan source points = 24 Gate Opening treatments.  While there is some overlap of pair combinations, the treatment is considered different depending on which point is used as the primary or secondary point.

C) Clinical application:  Gate Opening is not limited to the use of LI4+LV3.  Depending on the presenting symptoms, different Gate Opening pairs may be more appropriate.  For example, HT7+GB40 targets the HT and GB for Wen Dan Tang (warm the gallbladder decoction) type conditions.  KD3+LI4 should be used for Si Shen Wan (four miracle pill) type conditions. 



3. INDICATIONS

Some basic indications of the 12 gate opening pairs are listed below but are not limited to these.  Gate opening has a wide range of actions.  The best Gate Opening combo is chosen based on Zang-Fu theory.  If uncertain, the use of LI4+LV3 is never a bad choice.  (Refer to the HB's forum article - (228) Four Gates)

1   LU9 + GB40:   Cough, asthma, shortness of breath, gallstone
2   LI4 + LV3:   Yin-yang imbalance, pain, internal wind, dysmenorrhea
3   ST42 + PC7:   Disorders in the chest, diaphragm, epigastric area
4   SP3 + SJ4:   Fatigue, tiredness due to overwork, diabetes
5   HT7 + GB40:   Insomnia, palpitations, anxiety, lack of courage
6   SI4 + LV3:   Liver disorders, hepatitis, cirrhosis, blood stasis
7   UB64 + PC7:   Urinary tract infection, dribbling urination, poor memory
8   KD3 + SJ4:   Essence deficiency, KD Yang deficiency, adrenaline deficiency
9   LU9 + UB64:   Lower back pain, external wind, skin disorders
10   LI4 + KD3:   Diarrhea, constipation, irritable bowel syndrome, colitis
11   ST42 + HT7:   Indigestion from emotional imbalance, gastritis, gastric ulcers
12   SP3 + SI4:   Blood deficiency, nutrition deficiency, amenorrhea



4. GREAT GATE OPENING

A treatment called Great Gate Opening is used in addition to a Gate Opening treatment for more severe conditions.  Two more needles are added: PC9 on one side, and SJ1 on the other.  Note that both the PC and SJ exist only as functions, not as true physical organs.  Therefore, the PC/SJ primary channels are more closely related to the eight extra vessels while the other ten primary channels are closely related to the organs.

Great gate opening  =  Gate opening + PC9, SJ1

Definition
In this theory, channels that share the same name attract/relate to the other channel of opposite hand/foot polarity.  For example, the Shaoyang Hand SJ channel can be used to treat the Shaoyang Foot GB channel, and vice versa.  If you want to treat the Hand Taiyin channel, you can therefore use the Foot Taiyin channel.


1. Regular point examples
If the patient is having pain at LU10, you can needle the area around SP3 or SP4 to treat it.  The chart shown here gives many more examples of point balancing with this theory. 

(1) Yin channel example: Taiyin (LU - SP)
LU11 - LU1
LU10 - SP3
LU9 - SP5
LU7 - SP6
LU5 - SP9

(2) Yang channel example: Taiyang (SI - UB)
SI1 - UB67
SI3 - UB65
SI5 - UB62
SI8 - UB40
SI10 - UB36

*Please refer to p.377 in the <Minibook of Oriental Medicine> to see all the channels.


2. Tung point examples
Many of the Master Tung points have indications that reflect this theory.  Wan Shun Yi and Wan Shun Er, located in the SI3/SI4 area, are used to treat UB channel lower back pain and lateral foot pain on the UB channel.  Another example is the set of Wu Hu points on the thumb, along the LU channel, which are used to treat big toe pain on the SP channel.