Intersection Atop the Summit
Dū Mài Points for Eye Diseases
Recently I have been focusing on the treatment of the sensory orifices, especially traditional ophthalmology. For those new to the mulch (welcome and thanks for signing up!), you can find some examples here and here.
Traditional Ophthalmology Texts
Chinese medicine ophthalmology is a whole specialty in itself, with some important works dedicated to it. For example, we have a very good published translation in English of Yín Hǎi Jīng Wēi [銀海精微, Essential Subtleties on the Silver Sea] (Kovacs & Unschuld, 1999), a Sòng era manual on eye diseases. One of the most frequently cited ophthalmology texts in the literature is Mì Chuán Yǎn Kē Lóng Mù Lùn [秘傳眼科龍木論, Nāgārjuna 's Secret Ophthalmology], also originally from the Sòng, though the e-text I have is said to be from the Míng era. The text was attributed to the daoist adept Bǎoguāng [葆光道人], though the title refers to the purported original source of the work, the bodhisattva Nāgārjuna.
Mì Chuán Yǎn Kē Lóng Mù Lùn, often shortened in discussion to Lóng Mù Lùn, may be held as an example of the Indian contribution to Chinese medicine, which is particularly strong in ophthalmology. Some of the most important methods received from India were the various techniques of eye surgery, which are discussed in Lóng Mù Lùn. Much of the text is made up of descriptions of 72 different pathoconditions of the eye, and medicinal prescriptions to treat them. There is also a section on acumoxa therapy; I’ve been working on a functional translation of this chapter, of which I include an excerpt here.
More information on the Lóng Mù Lùn may be found in the introductory section of Kovacs & Unschuld (1999). It is a very interesting fusion of Indian and Chinese medicine, though by the Ming – the edition I have been working with – its primary basis is the medicine of correspondences that come from the canonical texts Huángdì Nèi Jīng [Yellow Emperor’s Inner Classic] and Nán Jīng [Classic of Difficulties].
Acumoxa in Lóng Mù Lùn
The acumoxa section of Lóng Mù Lùn is mostly devoted to brief descriptions of the location, indications, and acumoxa methods for points which are deemed useful in treating eye diseases. This excerpt is the first subsection, with some commentary.
一·偃伏頭部中行
1. Supine Center Line of the Head
凡十穴
10 points total.
神庭 一穴。在鼻直入髮際五分。督脈足太陽陽明三脈之會，治頭風目眩。鼻出清涕不止。目淚出。可灸二七壯止。
岐伯曰，凡欲療風。勿令灸多。緣風性輕。多即傷。宜灸七壯。至三七壯止。禁不可針。針即發狂。忌生冷雞豬酒面動風物等。
Shén Tíng [GV24, Spirit Court]: 1 point. Located from the nose vertically into the hairline 5 fēn. Confluence of the three vessels of the dū mài, foot tàiyáng, and yángmíng, treats head wind and dizzy vision. Clear snivel from the nose that won’t stop. Tears coming from the eyes. One can moxa 2x7 rounds [i.e., 2 rounds of 7, or 14 total] to stop it.
Qí Bó said, anyone wishing to cure wind, do not use too much moxibustion. The reason is that the wind has a light mobile nature and excessive [moxibustion] will quickly injure. It is appropriate to moxa 7 to 3x7 [i.e., 7 to 21 total] rounds and then stop. Needling is prohibited, as needling [the point] can trigger mania. Avoid raw cold food, chicken, pork, wine, wheat flour, the types of things that stir wind.
Comment: Qí Bó is one of the physicians who makes up the cast of the Huángdì Nèi Jīng. It is interesting that GV24, which is indicated in TCM texts (such as Ellis et al., 2004) to treat mania, is said in some classical sources to instead cause it.
上星 一穴。在鼻直上入髮際一寸陷中。督脈氣所發。治頭風目眩。睛痛不能遠視。以細三稜針刺之。即宣泄諸陽熱氣。無令上衝頭目。可灸七壯。不宜多灸。若頻灸即拔氣上。令目不明。忌如前法。
Shàng Xīng [GV23, Upper Star]: 1 point. Located directly above the nose 1 cùn in the hairline in a depression. It is a place where the dū mài qì emerges. Treats head wind and dizzy vision. Eye pain and inability to see distant objects [i.e. nearsightedness]. Use a thin three-edged needle to promptly diffuse and discharge all the yáng heat qì and prevent it surging upward to the head and eyes. One can moxa 7 rounds; it not appropriate to do too much moxibustion as frequent moxibustion draws qì upward and makes the eyes lose clarity. Avoid the same as in the previous method.
囟會 一穴。在上星後一寸陷中。可容豆。督脈氣所發。治目眩。可灸二七壯至七七壯。初灸即不痛。病去即痛。痛則罷灸，針入二分。留三呼。得氣即瀉。針訖。以末鹽生麻油相和。揩髮根下。頭風即永除，若八歲以下。即不得針。忌如前法。
Xìn Huì [GV22, Fontanelle Meeting]: 1 point. Located 1 cùn behind Shàng Xīng in a depression of the size that would hold a small bean. It is a place where the dū mài qì emerges. Treats dizzy vision. One can moxa 2x7 rounds up to 7x7 rounds. At first the moxa is not painful but when the disease is removed it causes pain. When it is painful then stop the moxibustion, needle to a depth of 2 fēn. Retain for 3 breaths. Obtain the qì [dé qì] to drain, then the needling is complete. Use ground salt and raw sesame oil mixed together, and rub it from the hair root downwards, it will always get rid of head wind in one of eight years of age or less when it is not allowed to needle them. Avoid the same as in the previous method.
Comment: As stated by the name, GV22 is a point at the bregma, or meeting of the coronal and sagittal sutures of the skull, which is the site of the anterior fontanelle in the first 2-3 years of life. The text here says to avoid needling it in the first 8 years, which may be prudent.
I use this point often, especially in cases of dizziness and vertigo. This is an indication I picked up from Shudō Denmei sensei, and is discussed in his book Finding Effective Acupuncture Points. I usually palpate it in any cranial-related pathology, as it is an intersection of bony structures and treating it can give a bit more space for the vital substances to circulate to and from the sea of marrow. Shudō sensei says that “treatment here is not indicated when there is no depression and it feels hard like a piece of wood” (Shudo, 2003). I usually retain the needle for about 15 minutes, but if the patient is sensitive, I will use contact needling or a teishin. Again, the point should not be pressed hard in infants.
前頂 一穴。在囟會後一寸五分骨陷中。督脈氣所發。療頭風目眩。針入一分。可灸三壯至七七壯即止。忌如前法。
Qián Dǐng [GV21, Before the Vertex]: 1 point. Located 1.5 cùn behind Xìn Huì in a bony depression. It is a place where the dū mài qì emerges. Treats head wind and dizzy vision. Needle to a depth of 1 fēn. One can moxa 3 rounds up to 7x7 rounds and then stop. Avoid the same as in the previous method.
百會 一穴，一名三陽五會。在前頂後一寸五分。頂中央旋毛中。可容豆。督脈足太陽交會於巔上。針入二分。得氣即瀉。可灸七壯。至七七壯即止。唐秦鳴鶴刺微出血。頭痛立愈。凡灸頭頂。不得過七七壯。緣頭頂皮膚淺薄。灸不宜多。
Bǎi Huì [GV20, Hundred Convergences]: 1 point, also named Sān Yáng Wǔ Huì [Three Yáng Fivefold Convergence] . Located 1.5 cùn behind Qián Dǐng. At the center of the vertex in the middle of the hair whorl, of the size that would hold a small bean. The dū mài and foot tàiyáng intersect atop the summit. Needle insertion 2 fēn. Obtain the qì then drain. One can moxa 7 rounds up to 7x7 rounds and then stop. In the Táng [era], Qín Mínghè pricked to let a few drops of blood, and the headache was immediately cured. Any moxibustion to the crown of the head must not exceed 7x7 rounds. The reason for this is that the skin at the vertex is shallow and meager, and it is inappropriate to do large amounts of moxibustion.
Comment: The text refers to a story of the Táng era physician, Qín Mínghè, who famously cured the Gāozōng emperor in this manner.
GV20 is, of course, one of the most commonly used points of the body. Like GV22, it is in a depression at a convergence of bony structures along the sagittal suture. In both points, I generally feel for the depression rather than measuring the distance.
後頂 一穴，一名交沖。在百會後一寸五分枕骨上，督脈氣所發。治目眩。頭偏痛。可灸五壯。針入三分。
Hòu Dǐng [GV19, Behind the Vertex] : 1 point, also named Jiāo Chōng [Intersection Surge]. Located 1.5 cùn behind Bǎi Huì above the pillow bone [occiput], it is a place where the dū mài qì emerges. Treats dizzy vision. Hemilateral head pain. One can moxa 5 rounds. Needle insertion 3 fēn.
強間 一穴。一名大羽。在後頂後一寸五分。督脈氣所發。治腦旋目暈。頭痛不可忍。可灸七壯。針入二分。
Qiáng Jiān [GV18, Unyielding Space]: 1 point. Also named Dà Yǔ [Great Feather]. Located 1.5 cùn behind Hòu Dǐng. it is a place where the dū mài qì emerges. Treats spinning brain and dizzy vision. Insufferable headache. One can moxa 7 rounds. Needle insertion 2 fēn.
Comment: Deadman et al (2001) gives the location as the midpoint between GV16 and GV20. This is the approximate location of the junction of the sagittal suture with the lamboid suture, and, as above, I generally will palpate for the depression at this joint and apply similar methods as described in the comment under GV22.
腦戶 一穴。一名合顱。在枕骨上強間後一寸五分。督脈足太陽之會。禁不可針。針之令人啞不能言。治目晴痛*。不能遠視。可灸七壯。亦不可妄灸。令人失喑。
Nǎo Hù [Brain’s Door]: 1 point. Also named Hé Lú [Skull Union]. Located above the pillow bone 1.5 cùn behind Qiáng Jiān. Confluence of dū mài and foot tàiyáng. Prohibited to needle. Needling may cause one to become mute, unable to speak. Treats clear painful eyes*. Inability to see distant objects [i.e. nearsightedness]. One can moxa 7 rounds, but do not be reckless with the moxibustion lest it mistakenly cause muteness.
Comment: *May be a misprint for目睛痛 “eyeball pain”
風府 一穴。一名舌本。在項髮際上一寸。大筋內宛宛中。疾言其肉立起。言休立下。督脈陽維之會。禁不可灸。不幸使人失喑。治頭痛目眩。針入三分。
Fēng Fǔ [GV16, Wind House]: 1 point. Also named Shé Běn [Tongue Root]. Located at the nape, 1 cùn above the hairline, in the middle of the concavity between the big sinews. When one speaks quickly, the flesh [at the point] stands up, and when one stops speaking, it stands down. Confluence of the dū mài and yáng wéi. Prohibited to moxa. Unfortunately it can cause one to become inadvertantly mute. Treats headache and dizzy vision. Needle insertion 3 fēn.
啞門 一穴。一作喑。一名舌橫。一名舌厭。在頂中央。入髮際五分宛宛中。督脈陽維之會。入系舌本。仰頭取之。禁不可灸。灸之令人啞。治頭痛。針入二分。一作五分。
Yǎ Mén [GV15, Mute’s Gate]: 1 point. Also makes one mute. Also named Shé Héng [Tongue’s Horizontal]. Also named Shé Yàn [Tongue Repression]. Located in the center of the nape, 5 fēn within the hairline in a concavity. Confluence of the dū mài and yáng wéi. Enters the tongue root connector. Take with the head raised. Prohibited to moxa. Moxibustion [at this point] can make one mute. Treats headache. Needle insertion 2 fēn, also can do 5 fēn.
Comment: GV15 and GV16 are both points that need special attention in terms of needle depth. They can be powerful points to use.
I had a patient many years ago with spinocerebellar ataxia (SCA), which is a chronic neurodegenerative condition mainly affecting the cerebellum. Among the patient’s symptoms were constant nystagmus (oscillation of the eyeballs from side to side) and difficulty speaking due to ataxia of the tongue.
When I began treating her, acupuncture with needles was outlawed in my home state of Illinois, and I would basically treat everything with either a teishin or Pointer Plus (which is kind of an electric teishin). I found the best way to treat the nystagmus was to treat points on the earlobe, especially around the eye point in the center, along with the brain points and so on. Using the stim would stop the nystagmus completely, and to hold the effect of the treatment I applied ear seeds at each of the points I treated. After a few days, as usual, the effects would wear off, but pressure on the seeds would temporarily reactivate the points and the nystagmus would stop again for a while.
The motor control of the tongue responded well to stim at GV15. The effects would quickly deteriorate, however, so I decided – against all traditional wisdom, and with the informed consent of the patient – to use direct half-rice grain moxibustion, 7 rounds if I remember correctly. It worked quite well and her speech was much clearer for days following each treatment. I didn’t know at the time about the tongue root connector and GV15, but it makes sense in hindsight. Her tongue was generally pale and quite swollen and likely affected by cold, dampness and phlegm, and the moxibustion would be enough to clear the connection for several days, while minimizing the possibility of scorching it entirely. The tiny size of the gold moxa was likely a very different stimulus with much less heat than direct moxa would have been in pre-modern times. I’m not saying that one should ignore traditional prohibitions – there is the possibility that the method could have made matters worse – but under the circumstances the patient and I figured we hadn’t much to lose. Fortunately, the outcome was quite favorable.
Okay, that’s all for now. 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.
References
Bǎoguāng, D. (n.d.). Mì chuán yǎn kē lóng mù lùn. Retrieved April 23, 2024 from https://jicheng.tw/tcm/book/%E7%A7%98%E5%82%B3%E7%9C%BC%E7%A7%91%E9%BE%8D%E6%9C%A8%E8%AB%96/index.html
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.
Kovacs, J., & Unschuld, P.U. (1999). Essential subtleties on the silver sea: The yin-hai jing-wei: A Chinese classic on ophthalmology. University of California Press: Berkeley.
Shudo, D. (2003). Finding effective acupuncture points (S. Brown, Trans.). Eastland Press.