Dispel, Drain, Disinhibit

Acumoxa Treatment Principles for Dampness

We’re circling back to acupuncture treatment principles this week. Previously we discussed methodology for constructing an acupuncture treatment and looked at points to quicken blood and dispel stasis. This time around, we’ll examine acupuncture treatment of dampness.

Acupuncture Principles from Fluid Physiology and Pathology

For English-language readers, probably the most thorough discussion on the treatment of dampness has for many years been Fluid Physiology and Pathology in Traditional Chinese Medicine by Steven Clavey. Originally published in 1995, the first edition focused on pharmacotherapeutics exclusively. The second edition (Clavey, 2004) did include a section on acupuncture treatment of dampness. I will summarize the section here.

Clavey gives three basic principles for acupuncture treatment of dampness, with recommended points for each:

·       Transforming damp: SP9, ST36*, UB20*, CV12*, CV6*, DU14 [if damp-cold use moxa at asterisked points]; if damp heat use SP9, ST44, PC6, LI4, CV12, ST36, UB28

·       Facilitating urination: CV3, UB22, SP6, SP9

·       Expulsion: UB22, CV6, CV9, SP9, ST36, UB13

Transforming damp is primarily accomplished by fortifying the spleen. Damp-cold is addressed by warming the spleen yáng, and damp-heat is treated by incorporating heat-clearing points. Facilitating urination is conceptually the equivalent of using sweet bland substances like Fú Líng [Poria] to percolate dampness. Expulsion is indicated for more serious accumulation of pathologic water-damp, with edema being an imprtant indication. As can be seen, there is a considerable amount of overlap between the points chosen for each of the three principles.

Expanding Our Point Selection

In a similar way to our previous exploration of blood-quickening points, we did an internet search of the Chinese Medicine Database [abbreviated CMDB], and then a manual search of the Ellis et al, Fundamentals of Chinese Acupuncture (2004) [abbreviated FCA]. The CMDB search term was simply "damp". As in our earlier review, this cannot be considered an exhaustive list, but it gives us a lot more possibilities of points to consider than are to be found in Clavey’s discussion. Similar to the blood points search, the focus was on distal points, which is to say those below the elbow and knee, thus avoiding an overwhelming number of choices, and facilitating use for community acupuncture clinics, among others. The number of points turned out to be a bit more limited than anticipated, however, and so I have included body points in the comments for each channel and sections for the dū mài and rèn mài .

A quick note on terms: CMDB appears to use a variety of term sets, where Ellis et al. (2001) use the Wiseman gloss. My understanding of some of the terms used is as follows: The character used for "resolve" is jiě 解, with the meaning of breaking something up, dividing, loosening, untying or dissolving. “Transform” dampness 化濕 is similar in that the word comes with a sense of dissolving, changing the more turbid dampness into something easier for the body to expel [as opposed to transforming it into physiologic fluid]. So “resolving” and “transforming” dampness are very similar in meaning.  "Disinhibit" is lì 利, which is to promote or facilitate; the character contains a blade radical, which gives the sense of removing an obstacle to something. "Drain" is usually expressed as xiè 瀉, with the image of drawing something down quickly. "Clear" is generally qīng 清, which is most often applied when heat is a pathogenic factor [or co-factor, in the case of damp-heat].

Hand Yángmíng Large Intestine Channel

·       LI6: regulates the waterways [FCA]

·       LI11: drains damp [CMDB]; eliminates water-damp [FCA]

Comment: LI6 is usually indicated for facial swelling, or attack of wind-water in the upper burner. Thus it is not so useful as a point for systemic dampness. LI11 is much better known as a heat-clearing point, but both sources consulted listed functions related to dampness as well.

Foot Yángmíng Stomach Channel

·       ST36: resolves/transforms damp [CMDB / FCA]

·       ST37: clears damp-heat [CMDB / FCA]

·       ST39: clears damp-heat [CMDB / FCA]

·       ST40:  resolves damp [CMDB] transforms phlegm-damp [FCA]

·       ST41: transforms damp [FCA]

·       ST42: transforms damp [FCA]

·       ST43: disinhibits damp [FCA]

·       ST44: clears damp-heat [CMDB]

Comment: In FCA, ST25 and ST28 are also indicated for damp conditions; ST25 transforms damp and ST28 clears damp-heat and disinhibits the lower burner.

Foot Tàiyīn Spleen Channel

·       SP2: resolves damp, resolves damp-heat [CMDB]

·       SP3: resolves damp, resolves damp-heat [CMDB]

·       SP4: resolves damp [CMDB]

·       SP5: resolves damp [CMDB]; disinhibits damp [FCA]

·       SP6: resolves damp [CMDB]

·       SP7: resolves damp [CMDB]; disinhibits damp [FCA]

·       SP8: resolves damp [CMDB]

·       SP9 - drains damp, eliminates damp-heat, expels damp cold, regulates water passages [CMDB / FCA]

Comment: No surprise here that virtually every spleen channel point on the lower limb treats dampness. FCA also lists SP11-12 and SP15-17 as all having functions to transform or disinhibit damp.

Hand Tàiyáng Small Intestine Channel

·       SI3: resolves damp [CMDB]

·       SI4: clears damp-heat [CMDB / FCA]

Comment: Hand channels in general have few points with damp-transforming functions. SI4 is indicated for jaundice, which is often seen as a damp-heat pattern, thus its function here.

Foot Tàiyáng Bladder Channel

·       UB39: disinhibits the triple burner and courses the waterways [FCA]

·       UB40: resolves damp [CMDB]

·       UB60: transforms damp [FCA]

Comment: Back-shu points have damp functions related to their associated organ: UB18 and UB19 clear damp heat from the liver and gallbladder for example. More systemic dampness functions are found in FCA among points such as UB20, UB21, UB22 and UB23, as well as UB46, 49, 50 and 52. UB58 and UB59 are associated with wind-damp, implying a somewhat different mechanism that we will get to in a minute.

Foot Shàoyīn Kidney Channel

·       KD7: drains damp, clears damp-heat [CMDB]; disinhibits the bladder [FCA]

·       KD8: drains damp [CMDB / FCA]

·       KD10: clears damp-heat from lower burner [CMDB]; dispels damp and frees urine [FCA]

Comment: KD14, KD15, and KD17 are all listed in FCA as having functions to disinhibit the lower burner or promote flow through the waterways. Some kidney channel points such as KD3 have functions that include supplementation of processes that help transform pathologic water, and so indirectly treat dampness.

Hand Shàoyáng Triple Burner Channel

·       TB9: frees and regulates the waterways [FCA]

·       TB10: resolves damp [CMDB]

Comment: Hand shàoyáng points have more functions related to heat pathogens, though one might guess that they are also related to the water passages of the body; but from the findings of the lit review here, only TB9 was listed with that action.

Foot Shàoyáng Gallbladder Channel

·       GB34: clears LR/GB damp-heat [CMDB / FCA]

·       GB40: clears damp-heat [CMDB / FCA]

·       GB43: clears damp-heat [CMDB]

Comment: GB25 abducts water-damp as the mù point for the kidney [FCA]; points along the belt vessel GB26-28 may be used for dampness as well. GB37-39 have functions for dispelling wind-damp [CMDB / FCA].

Foot Juéyīn Liver Channel

·       LR3: discharges damp-heat from lower burner [FCA]

·       LR5: drains damp-heat from lower burner [CMDB / FCA]

·       LR6: drains damp [CMDB]

·       LR8: clears damp-heat from lower burner [CMDB / FCA]

Comment: Liver points for dampness are most likely in urogenital diseases, which can often be classified as liver-gallbladder damp-heat.

Rèn Mài / Conception Vessel

·       CV1: disinhibits damp [FCA]

·       CV3: disinhibits bladder [FCA]

·       CV4: dispels cold-damp, separates clear from turbid [FCA]

·       CV6: dispels damp turbidity [FCA]

·       CV8: transforms cold-damp, moxa only [FCA]

·       CV9: disinhibits water-damp [FCA]

·       CV11: transforms damp [FCA]

·       CV12: disinhibits damp [FCA]

Comment: The lower conception vessel is loaded with points whose function is to dispel [祛 qū, expel, disperse, exorcise], transform or disinhibit dampness.

Dū Mài / Governing Vessel

·       GV3: dispels damp-cold from lower burner [FCA]

·       GV6: disinhibits damp [FCA]

Comment: GV4 banks the origin and supplements the kidney, so it can be considered a key point for regulating water-damp. GV6 is more commonly used for jaundice, and the damp function is likely related to that particular condition.

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Additional Treatment Principles for Dampness

Based on my own studies, particularly of the warm disease school [wēn bìng xué pài], I add a couple of additional treatment principles. The first one I learned as “lifting the lid from the teapot” or 提壶揭盖, tí hú jiē gài [Wiseman: lift the pot and remove the lid], which in terms of pharmacotherapy means to use acrid surface-resolving medicinals, such as one would find in the wind-cold or wind-damp categories, much like venting a teapot to enhance outflow. In terms of point selection this means adding points like LU7, TB5, and LI4. For dampness in the flesh, I am particularly fond of SP5, which is the metal point; borrowing from Ikeda Masakazu sensei’s application of the five tastes (Ikeda, 2004), metal points have an acrid, effusive character. SP5 is also commonly indicated for damp bì patterns (Deadman et al., 2007) and is the child point of the spleen, thus applicable for conditions of damp encumbrance.  

Venting/ Outhrusting/ Exterior

Some points which may be used for venting [CMDB search action: "exterior"]:

Hand Tàiyīn Lung Channel

·       LU6: resolves exterior

·       LU7: releases exterior, expels exterior wind, circulates wèi qì [CMDB]

·       LU11: expels exterior wind [CMDB]

Hand Yángmíng Large Intestine Channel

·       LI4: releases exterior, expels exterior wind [CMDB]

·       LI5: releases exterior [CMDB]

·       LI11: expels exterior wind [CMDB]

Hand Tàiyáng Small Intestine Channel

·       SI4: courses tàiyáng channel pathogens [FCA]

·       SI7: resolves ext heat, clears spirit disposition [FCA]

·       SI8: disperses tàiyáng channel pathogens, dispels wind qì, clears spirit disposition [FCA]

Foot Tàiyáng Bladder Channel

·       BL58: dispels tàiyáng channel pathogens, [FCA]

·       BL59: dispels tàiyáng channel pathogens, [FCA]

·       BL60: dispels tàiyáng channel pathogens, [FCA]

·       BL62: expels exterior wind [CMDB]

·       BL64: dissipates wind and clears heat [FCA]

·       BL66: dissipates wind and clears heat [FCA]

Hand Shàoyáng Triple Burner Channel

·       TB5: releases exterior, expels wind heat [CMDB / FCA]

Rectify the Qì Dynamic

The second principle I typically add is rectification of the qì dynamic [also known as the qì mechanism]; Clavey (2004) does mention this in passing under the principle of transforming dampness. Rectifying the qì dynamic most often means the activation of the spleen’s upbearing and stomach’s downbearing functions. For the latter, ST36 is a reliable choice. For the former, I frequently use SP8, which is a non-standard choice but one that experience has borne out.

SP8 has a name (dì jī 地機) which contains the same character as qì dynamic (qì jī 氣機).  Yuè Hánzhēn of the Qīng era wrote “drain the point that is the crux of the mechanism (jī guān) within the spleen” to treat disorders such as those caused by stagnation of spleen qì (Yuè, 2019).

In palpating to locate the point, I often find a boggy pit that my finger falls into quite handily. In treating dampness will insert the .12x30 needle until I find resistance at the tip, then pluck the handle to vibrate the needle until the vibration begins to feel tight, then back the needle off and retain it. This is my take on Nán Jīng (Classic of Difficulties)-style dispersion technique. If SP8 isn’t reactive, or if I can’t get to it (tight pant legs, for example), I will check SP3 and/or SP4, both of which are cited in Ellis et al. (2004) as rectifying the qì dynamic.

Use Fire to Drive Out Water

An important technique in treating dampness is moxibustion. It is primarily indicated for cold-dampness but can also be used in cases of heat (Hayden, 1999). Tiny direct moxa can be quite powerful when done repeatedly; we have seen some dramatic reduction in edema after intensive sessions of moxibstion.

Intradermal Needles

Intradermal needles can be helpful as well, in our experience they work especially well in CV9. The straight 3mm intradermals seem to work best, ideally pointed downward, against the flow of the rèn mài, and taped into place. If there is a skin fold going through the point, then it is best to orient the needle along the fold so it doesn’t stab the patient and become uncomfortable. We have seen it increase the patient’s urination for 24-72 hours.

A Case Report

The patient was a middle-aged female with a 6 year diagnosis of fibromyalgia syndrome [FMS]. The condition had flared for about 4 months before she decided to come in for acupuncture. She was taking gabapentin for the pain; her doctor had increased the dosage in response to the flare.

Her chief complaints were severe muscle pain and fatigue. She had exercise intolerance that mainly produced dizziness on exertion. Simple home tasks were all she could do. The pain increased with exertion. She suffered digestive bloating & reflux, which drinking water made worse. Anything cold and damp made the pain worse where heat would improve it. She had disturbed sleep.

Tongue: Scalloped, thick dry coat

Pulse: Soggy, slightly slippery

Abdomen: cold, glomus at CV12, weak navel wall

TCM pattern: Cold dampness encumbering the spleen and inhibiting the channels

5 Phase pattern: Spleen repletion [treat spleen and lung]; though there are signs of underlying spleen vacuity, the dampness is the crucial factor.

Treatment principle: Transform dampness, restore qì dynamic

Points: LU7, TB5, SP8-5, S36, ST25, CV12, CV6; BL43-17-20-25-57

SP8, SP5, and ST36 were used to transform dampness and rectify the qì dynamic. LU7 and TB5 were used to vent the surface in order to “lift the teapot lid”. The four abdominal points were used to regulate the center, and the back points were primarily areas of tight tissue and/or pain.

Plan: Treatment once a week for 6 sessions and re-evaluate.

By the 3^rd treatment, the doctor had reduced the gabapentin, the patient had dropped weight, her energy level was up and pain level was down.

After the 5th treatment, she was able to travel internationally without any detrimental effects. Her pain was down, she had much more energy and strength since starting acupuncture.

After 6 treatments she felt well enough to discontinue therapy.

Conclusion

There are some conditions that Chinese herbal medicine is clearly better suited to treat than acupuncture. In our opinion, dampness is not one of them. While medicinals can be quite helpful, acupuncture and moxibustion alone are capable of almost miraculous effects in cases of dampness; this has been shown repeatedly in our experience over three decades.

Okay, that’s it for now. As always, thanks for reading.

Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.

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References

Clavey, S. (2004). Fluid physiology and pathology in traditional Chinese medicine, 2^nd Ed. Churchill Livingstone.

Deadman, P., Al-Khafaji, M., & Baker, K. (2007). A manual of acupuncture, 2nd ed. Journal of Chinese Medicine Publications.

Ellis, A., Wiseman, N., Boss, K., & Cleaver, J. (2004). Fundamentals of Chinese acupuncture (Revised ed). Paradigm Publications.

Hayden, R. (1999). Thoughts on using chinetsukyu in meridian therapy. North American Journal of Oriental Medicine (NAJOM), 6(17), 18-19.

Ikeda, M. (2004). Herb flavor properties and meridian therapy. North American Journal of Oriental Medicine, 11(31), 7-8.

The Chinese Medicine Database. http://cm-db.com/ (Retrieved April 12, ‎2024)

Yuè, H. (2019) Explanations of the channels and points, vol.1 (M. Brown, Trans.). Purple Cloud Press.