Mobilize Yáng to Raise the Will
A brief acupuncture case
This week has been eventful here at Mulch HQ. Among the many things that happened this week, I had a case study published in the latest issue of the Journal of Chinese Medicine. I have been recently working on translating old cases, but I haven’t posted one of my own to the mulch since the lurking pathogen ghost case back in the fall. So I thought I might share a brief case study here. I had already hinted at this one in the lurking pathogens series but the same treatment strategies can be used in miscellaneous internal diseases as well.
A case of low spirits
The patient was a middle aged female, with the chief complaint of feeling “very depressed”.
She presented with a flat affect, speaking slowly and quietly. She seemed to be listless, to lack energy. Her eyes showed a lack of shén, no sparkle. She complained of dizziness, with a feeling as if her ears had been stuffed with cotton. She had been coming to the clinic for treatment of back pain, which was much improved after a few treatments.
Pulse: slow; deficient proximal (chǐ) positions.
Tongue: pale, swollen, scalloped sides, somewhat dry white coat.
Abdomen: soft, somewhat slack surface, weakness subumbilical.
Pattern: Kidney deficiency. Because of the failure of clear yáng to ascend, there were low spirits with a lack of will and clouding of the upper burner.
Treatment
Treatment principle: Mobilize yáng to raise the will, open orifices.
Step 1: Supine on table, all needles inserted and retained 20 minutes.
Points selected:
· KD3 (tài xī)
· KD7 (fù liū)
· LU7 (liè quē)
· ST36 (zú sān lǐ)
· LI11 (qū chí)
· yìn táng
Step 2: Needles from step 1 removed, and patient turns over to lie prone. Needles are inserted and retained for 15 minutes.
Points selected:
· SI3 (hòu xī)
· UB62 (shēn mài)
· DU4 (mìng mén)
· DU20 (bǎi huì)
· UB52 (zhì shì)
All needles used were #02 (.12)×15-30mm, inserted 3-5 millimeters in depth.
After the treatment, the patient remarked, “Incredible, such a difference, I feel WELL!”
Discussion
I tend to select points based on a wide data set: five-phase relationships (including mother-child, systematic correspondence of tissues/tastes/pathogenic factors/etc), point actions and indications from TCM-oriented sources, some of the more empirical sources from Japan and elsewhere, and just plain old treating what’s under my fingers at the time. The rationale for choosing points often represents that diversity; after 30 years, there is a lot bouncing around in my head. I will cite some sources at the end, but there are really more than I can list at this point.
KD3 is the yuán source point, so is intended to gather the yuán qì. KD3 resonates with Earth and the sweet taste (see for example Ikeda, 2004). The sweet taste is the taste of tonic herbs: it supplements and banks up. KD3 is needled to marshal the essential qì to support the will.
KD7, the metal point, also is the mother or supplementing point according to the principle put forth in Nán Jīng (Classic of Difficulties) chapter 69. KD7 resonates with the acrid taste. Both sweet and acrid are yáng in nature and ascend. Acrid effuses and scatters accumulation; sweet safeguards the essence. KD7 reaches to the exterior to assist the wèi qì in regulating sweat, yet it also supplements yáng and transforms downpouring dampness. It can thus be seen to connect the depths with the surface, and lower with upper.
LU7 has an effusive nature which aids KD7 in its ascending, opening qualities. As jiāohuì point for the Rèn mài, also has a powerful effect on raising the jīng-qì from lower to upper. The Rèn mài connects the dān tián with the face, where the florescence of the shén may be seen.
LI11 and ST36 together make up a key component of Sawada Ken’s Taikyoku treatment (see for example Manaka, 1995), a whole-body regulation approach originally using moxibustion. Both are important points on the yángmíng channels, which are replete with qì and blood.
Yìn táng is chosen to clear the orifices and brighten the eyes.
SI3 and UB62 are jiāohuì points of the Dū mài and Yángqiāo mài respectively. I find the access to them easier when the patient is lying prone; in this position I can also needle the Dū mài directly.
DU4 activates the life gate (mìng mén).
DU20 is the hundred meetings (bǎi huì) at the top of the head and is chosen to ascend clear yáng.
UB52 is the residence of the will, zhì shì, chosen specifically to engage the spirit aspect of the kidney.
After the initial root treatment creates a tide of ascending motion, the Dū mài is opened to lift the will and nourish the sea of marrow.
These are all intended effects, of course. Intention is, I believe, an important part of treatment – especially needling. If possible, like to have a clear idea of the pathomechanism involved, and a concept of how the vital substances (qì, blood, fluids, even shén) and/or the pathogenic factors are moving through the body. This can clarify my intention, though of course there are times when I am not so clear on what is happening with the patient and the treatment will still prove satisfactory. Given a little encouragement, the zhèng qì always seeks to rectify the harmonious state of the body.
Note: this newsletter 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
Ellis, A., Wiseman, N., Boss, K., & Cleaver, J. (2004). Fundamentals of Chinese acupuncture (Revised ed). Paradigm Publications.
Hayden, R. (2021). Five phases, four levels, three burners: Building resistance in the pandemic era. North American Journal of Oriental Medicine. 27(83). 5-6.
Hayden, R. (2023). Treatment of vertigo with Japanese-style acupuncture: A case report. Journal of Chinese Medicine, 132. 55-60.
Ikeda, M. (1997). Point selection for root treatment. North American Journal of Oriental Medicine (NAJOM), 4(10), 16-20.
Ikeda, M. (2004). Herb flavor properties and meridian therapy. North American Journal of Oriental Medicine, 11(31), 7-8.
Maciocia, G. (2006). The channels of acupuncture: Clinical use of the secondary channels and eight extraordinary vessels. Elsevier Health Sciences.
Maclean, W., Lyttleton, J., Bayley, M., & Taylor, K. (2018). Clinical handbook of internal medicine: The treatment of disease with traditional Chinese medicine. Eastland Press.
Manaka, Y. (1995). Chasing the dragon's tail: Theory and practice of acupuncture in the work of Yoshio Manaka. Paradigm Publications.
Shudo, D. (2003). Finding effective acupuncture points (S. Brown, Trans.). Eastland Press.