TCM REVIEW

TCM REVIEW

Chapter 1

Yin-yang Theory and Five Element Theory

Yin-yang theory:
1. Yin is the __________ for yang. 2. Yang is the ________________ of yin. 3. An excess of yang implies a deficiency of _____ and vice versa, generally characteristic of acute conditions. 4. In chronic conditions, a deficiency of one aspect does not always cause an ____ of the opposite aspect. 5. In extremely chronic conditions there is usually a ________(deficiency/excess) of yin and yang. 6. It is almost impossible to see a case of an _______(deficiency/excess) simultaneously of both yin and yang. 7. In the case of deficiency of both yin and yang, to tonify either aspect will benefit the opposite aspect. (Correct/Wrong)

The function of Yin:

1. _______(Cools): By virtue of its fluidity the yin cools the body, therefore an even temperature is maintained when the yin and yang is in harmony. 2. _______(Nourishes): This aspect of yin, in the form of Ying Qi, supplies the nourishment to the meridians (the body fluids and blood nourish at all levels). 3. ______________[Provides rest (inactivity)]: When this nature is in balance with the yang, it enables us to use our energy better, recover easily from fatigue and preserve a good quality of life for a long time. When this nature is not in harmony, hyperactivity will exist and stagnation can develop.

OM 307 TCM Review Lecture Handouts

By Dr. Li, Dongcheng Fall, 2009

The function of Yang:

1. _________(Warms): warm the body. 2. __________[Transforms (change)]: All transformation of energy relies on yang. This is usually provided by its nature to warm. 3. __________(Moves): Body fluids and blood are dependent on the movement of Yang Qi. 4. __________(Holds): Even though the nature of yang is to move, yang also has the nature to hold blood, body fluids and organs in their proper place.

Yin and Yang Relationships by category

Yin: Zang; Female; Cold; Heavy; Obscured; Earth; Night; Downward/Inward/Stagnation; Autum/Winter; Lower body/Interior/Abdomen; Yin organs/Sinews/Bones; Weakness/Solitude; Blood/Construction; Interior/Deficient(hypofunction)/Cold; Slow/Deep/Rough/Deficient/Small/Fine; Structure; Contraction; Intrasusceptive(absorbing inward); Responsive; Quiescence; Conservation; Earth; Autumn; Winter; Cold; Moist; Dark; Weak; Lower part; Water; 6pm to 6am; Continuous; Sinking; Body; Solid; Blood; Nutritive Qi(Ying Qi); Po(animal spirit); Chronic; Death; Even Numbers; Salty/Sour; Characteristic of Taste

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TCM REVIEW Yang: Fu; Male; Hot; Light; Radiant; Heaven; Day; Upward/Outward/Movement; Spring/Sumer; Upper body/Exterior/Back; Yang Organs/Surface Skin/Body Hair; Strength/Agitation/Qi and Defense; Exterior/Excess/Heat; Rapid/Floating/Slippery/Excess/Large/Surging; Function; Expansion; Extraversive(bring to the surface); Aggressive; Dynamic; Destruction; Heaven; Spring/Summer; Male; Hot; Dry; Exterior; Bright; Large; Powerful; Upper part; Fire; Day; 6am to 6pm; Intermittent; Floating; Back; Head; Hollow; Qi; Protective Qi (Wei); Hun(soul); Excess(hyperfunction); Acute; Birth; Odd Numbers; Sweet/Bitter/Bland/Spicy; Characteristic of Temperature Yin or Yang? Circulation Metabolism Sleep Illness Patterns

TCM REVIEW Stagnation Slow Somolence(excess) Chronic/Long duration Left is stronger than right Deep pulse stronger than superficial Proximal pulse is stronger than distal Pallor/Hands colder than feet Warm feet associated with cool face Normal or rapid circulation Rapid Insomina/Agitation Acute/Sudden onset/High fever/Spasm Right is stronger than left Superficial is generally stronger than deep Distal is generally stronger than proximal Warmth or a sensation of warmth in head or face this is associated with cold feet Extremely cold feet associated with warm head or face

Pulses

Primary Indicators Upper Body Lower Body Yang Deficiency Generalizations

Yin and Yang Deficiency Generalizations:

Yin Deficiency Generalizations Dry mouth and throat Low grade afternoon fever Flushed cheeks Feverish Sensation or flushing in palms, soles and chest, know as: Five Centers Hot Tender sore throat Sores in mouth Loss of weight Night sweats (The Wei Qi protects the external body and at night the Wei Qi goes deep with the yin. When yin is deficient Wei Qi surfaces, the pores then open up and sweat pours out.) Yin or Yang Deficiency? P here?

Yin and Yang Generalization for Symptoms in Disease

Yin Fatigue, drowsiness, likes to lie covered up Likes to curl up Facial pallor Desires heat, no thirst, or likes hot drinks Dull pain, aches, relieved by heat and pressure, acute pain relieved by heat Diarrhea with watery stool& no pain or swelling Likes quiet, no desire to talk, weak voice Copious clear urine, clear or thick white discharge without smell Shallow respiration Yang Restlessness, throw off covers Likes to lie extended Flushed complexion Like cold, thirst for cold drinks Sharp pains with aversion to heat and pressure in the region of the pain Constipation characterized by heat and discomfort Noisy, loud mouthed Scanty dark urine Coarse respiration

Fear of cold Face is pale or grayish Like lots of clothes, fires, hot water bottles

Differentiation between Yin Excess and Yang Excess

Differentiation Altitude Emotions Muscle Tone Complexion Skin Temperature Expression Eyes Speech Gestures Stamina Yin Excess Passive/Apathetic/Listless Sadness/Discouraged Poor/Flaccid Pallid Cold No expression No luster Slow/Weak voice Weak Easily fatigued mentally and physically Yang Excess Self confidence Aggressive Good/Firm Ruddy Warm Vivid expression Bright Rapid/Strong Fast Good physical and mental stamina Yin and Yang Aspects to Time of Day and Night: Utmost yin(midnight); utmost yang(noon); 6pm-midnight(yin within yin); midnight6am(yang within yin); 6am-noon(yang within yang); noon-6pm(yin within yang); spring dawn(yang within yin); summer noon(yang within yang); autumn dusk(yin within yang); winter midnight(yin within yin) 6pm (sunset)?

Five Element Theory and Correspondences

1. Five Elements: woodfireearthmetalwater 2. Five Zang(yin): _______ _____________________________ 3. Fu(yang): _______ _____________________________

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TCM REVIEW 4. Color: _______ _____________________________ 5. Flourishes/manifests: _______ _____________________ ________ 6. Sense organs: _______ _____________________________ 7. Sense: _______ _____________________________ 8. Orifice/opens into: _______ _____________________ ________ 9. Tissue dominated/rules over: _______ ______________ _______________ 10. Tongue: _______ _____________________________ 11. Secretion : _______ _____________________________ 12. Pulse: _______ _____________________________ 13. Emotion: _______ _____________________________ 14. Flavor: _______ _____________________________ 15. Direction: _______ _____________________________ 16. Climate : _______ _____________________________ 17. Season: _______ _____________________________ 18. Development: _______ _____________________________

TCM REVIEW Five element points on the twelve main meridians: well(jing); spring(ying); stream(shu); river(jing); sea(he). Detailed later. Five Element Diagnostic Clssifications: Production Cycle: 1. Wood not generating fire: Liver blood not nourishing Heart fire (Zang/Fu Diagnosis) Symptoms and signs: Weakness, palpitations, poor memory, insomnia, timidity, thin, choppy pulse. 2. Fire not generating Earth: Spleen yang deficiency (Kidney yang not warming Sp yang) Ss: Loose stools, chilliness, cold limbs, distended abdomen, edema, aversion to cold. 3. Earth not generating metal: Spleen not nourishing Lung, Phlegm in Lungs; Ss: Phlegm, cough, fatigue, empty pulse. 4. Metal not generating water: Lung not sending water to the Kidney (Kidney yin deficiency) Kidney not receiving Lung Qi; Ss: Cough, breathlessness, asthma, sore low back, weak knee, SOB, scanty dark urine, short urine flow. 5. Water not producing Wood: Kidney and Liver yin deficiency; Ki yin not nourishing Liv jing. Ss: Tinnitus, low back pain, weak knees, vertigo, tremors. Control cycle: 1. Wood overacts/insults Earth: Liver Spleen Ss: Headache, distension, loose stools, flatulence. 2. Earth overacts/insults Water: Sp damp->Ki function of excretion of fluids is impaired. Ss: Edema, difficult urination, yellow face. 3. Water overacts/insults Fire: No Kidney excess 4. Fire overacts/insults Metal: Full heat in the Lungs; Ss: Cough with profuse yellow sputum, heat, red face. 5. Metal overacts/insults Wood: Tiredness, irritability, abdominal distention, white face. Insulting/Humiliating: 1. Wood insults Metal/Metal humiliated by Wood: Liver stabbing Lung/Liver invade Lungs; Ss: Painful flanks, bitter taste in mouth, cough, irritable. 2. Metal insults Fires/Fires humiliated by Metal: Lung and Heart Qi deficiency/Ht yang def. Lu Qi def. Ss: Palpitations, insomnia, S.O.B, circulatory problems, frequent urination 3. Fire insulting Water/Water humiliated by Fire: Heart and Kidney disharmony/Ki & Ht yin deficiency. Ss: Malar flush, dry mouth, insomnia, dizzy, low back pain, spermatorrhea, jumbago, irritable, insomnia, red tongue, thin rapid pulse. 4. Water insults Earth/Earth humiliated by Water: Spleen and Kidney yang deficiency. Ss: Loose stools, edema, tiered, weak limbs edema, Kidney deficiency signs. 5. Earth insults Wood/Wood humiliated by Earth: Spleen damp->Liver Qi stagnation. Ss: Jaundice, hypochondriac pain and distension.

Mother/Son Law/Production or Promotion Cycle/Creation Cycle/Sheng Cycle: WoodFire-Earth-Metal-Water Disharmony of Production/Promotion Cycle: Wood not promoting/producing Fire; Fire not promoting/producing Earth, etc. Control Cycle or Ko Cycle: Interacts(Normal situation); Overacts(Pathological condition) For example: Wood interacts with Earth; Wood overacts on Earth Fire interacts with Metal; Fire overacts on Metal Counteracting Cycle(Insults, prey upon or humiliated by): Disease conditions For example: Wood counteracts metal; Wood humiliated by Earth *: When the Qi of a given element is in excess, it will overact on the acted element and counteract on the acting element. When the Qi of a given element is in deficiency, it will be attacked by the acting element and counteracted by the acted element.

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TCM REVIEW

TCM REVIEW c. The physiological function of heart in propelling the blood relies on the heart qi; Normal blood circulation relies on three factors: Vigorous heart qi, Sufficient volume of blood, unobstructed vessels; d. Physiological function of heart is reflected in pulse: Vigorous heart qi, sufficient blood volume-----regular and strong pulse; Deficient heart qi and blood-----thready and weak pulse; Stagnant heart qi and blood----choppy pulse. ii. Housing the mind (shen): a. Mindspirit, consciousness and thinking; b. Mental activities are the function of brain; In TCM, they are principally related to the heart; c. Heart functions normally in housing mind: full of vigour, healthy consciousness and normal mental activities; d. Dysfunction in housing mind: insomnia, dream-disturbed sleep or unconsciousness; e. Blood is main material basis for mental activities: Dysfunction in dominating blood and vessels---mental activities will be changed (disturbed sleep); Deficiency of heart blood----palpitation, insomnia. iii. Sweat is the fluid of the heart. Blood and sweat have the same source. a. Profuse sweating----damage the heart yang. b. Heart yang deficiency---spontaneous sweating c. Heart yin deficiency----night sweating. iv. Opening into the tongue, manifesting on the face. a. Tongue is sprout (mirror) of heart. b. Tongue is connected to heart meridian interiorly. c. A lot of blood vessels on the tongue and face. So the color and luster of tongue and face reflect functions of heart. d. Heart functions well and blood is plentiful. Complexion and tongue will be rosy. e. Deficient heart blood----tongue and complexion will be pale. f. Heart fire flares up-----tongue tip will be red or ulceration on tongue body, face will be red. g. Stagnant heart blood----dark or purplish tongue and complexion. h. Dysfunction in housing mind----stiff or curly tongue, or aphasia. i. The heart in TCM basically suggests all the functions of the heart and the part of the nervous system in Western medicine. B. Small Intestine (xiao chang) i. Dominating receiving, digesting and transforming: receive initial digested food from stomach and further digest and transform into food essence. ii. Separating the clear from the turbid iii. Small intestine dominates YE. iv. Dysfunction: dysuria, loose stools, diarrhea, abdomen pain, abdominal distention. C. The relationship between Heart and Small Intestine

Chapter 2
i. ii. iii. iv.

Physiology of TCM

A. Zang Fu and Zang Xiang

Five Zang (six zang): Liver, Heart, Spleen, Lung, Kidney and pericardium. Six Fu: GB, SI, ST, LI, BL and Sanjiao. Extraordinary Fu: brain, marrow, bones, vessels, gallbladder and uterus The functions of zang-fu organs: a. The main physiological functions of zang organs: to manufacture and store essential substances. For example essence, qi, blood and body fluid. b. The main physiological functions of fu organs: to receive and digest food, transmit and excrete the wastes. Connection of Zang-fu organs: by the way of meridians and collaterals (jing luo) Concept of meridians and collaterals: qi and blood are circulated in them. The system of meridians and collaterals includes: 12 regular meridians, 8 extra meridians, 15 collaterals, 12 divergent meridians, 12 muscle regions, and 12 cutaneous regions Concept of Zang Xiang: The theory of Zang-fu organs. Zang--- zang-fu organs; Xiang----functional manifestations. Content of Zang xiang: The study of the physiological functions and pathological changes of Zang-fu organs, tissues and their interrelationships. The study of the physiology and pathology of vital essence, qi, blood, body fluid and interrelationships. Zang----yin, interior; Fu-----yang, exterior; Heart---spirit; Lung----animal spirit (daring); Spleen---ideas (though); Liver--soul; Kidney----will; The names of Zang-fu in TCM are basically the same as those used in Western medicine, but all concepts are not the same. The function of zang-fu is more emphasized than the structure.

v. vi. vii.

viii. ix.

x. xi. xii.

B. The Heart and Small Intestine

1. The heart (xin): i. Dominating blood and vessels: Heart is the monarch of all the organs. TCM divides heart into Heart qi, Heart blood, Heart yin and Heart yang. a. Vessels are the mansion of blood. b. Heart is the motive force for blood circulation;

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TCM REVIEW i. External-internal relationship ii. Accumulated heat in heat-- moves to small intestine iii. Excessive heat in small intestine- burns heart. iv. Clear away heart fire and promote diuresis. C. Lung and Large intestine 1. Lung (Fei) i. Dominating qi and controlling respiration: TCM usually divides the lung into Lung yin and Lung qi; Lung is the official as prime minister, who performs jurisdiction and regulation: respiration; qi activities of whole body; blood circulation; body fluid transmission; a. Dominating the qi of respiration; 1) The qi of heaven is communication with the lung; 2) Lung is tender organ. b. Domination the qi of whole body. 1) Taking part in the forming of pectoral qi (zong qi). 2) Operating and regulating the qi of whole body to ascend or descend, enter or exit. 3) All kinds of qi belong to lung: Lung is healthy---even and regular reparation; Lung qi deficiency----weak respiration and weak voice, short breath. ii. Dominating dispersing and descending iii. Regulating (dredge, move, adjust) water passage. (channels) iv. Dominating the skin and hair (Rules the exterior) v. Opening into the nose and leading up the throat. Normal condition----nose moistening; Lung cold---watery running nose; Lung heat----yellow and thick mucus; Lung dry----dry nose; 2. a. b. c. d. 1) 2) 3) Large intestine (Da Chang) Receiving and moving contents sent down from small intestine. Absorbing the water from the contents Turning the remainder into feces Pathological changes: Cold deficiency of the large intestine-- diarrhea, abdominal pain Sthenic heat of the large intestine-- constipation Accumulation of damp-heat in the large intestine- abdominal pain, tenesums (blocks the passage of flow of qi), diarrhea, stools with pus, blood.

TCM REVIEW b. Normal transportation function of large intestine-- benefits the descending of lung qi. c. Dysfunction of lungs in descending the qi and body fluid downwardconstipation d. Constipation and stoppage of the qi of the bowels- affects the descending of lung qi; cough, distension in the chest. e. Lung qi deficiency- constipation. f. Constipation- use some herbs to promote lungs descending function. g. Dyspnea due to stasis of lung qi- use some herbs to relax bowels. D. The spleen and stomach A. The spleen i. Governing transportation and transformation: TCM classifies it into Spleen yin, yang,qi,blood. 1). Transporting and transforming water and food. i. Spleen is the source for manufacture of qi and blood ii. Vigorous spleen qi iii. Deficiency of spleen qi and dysfunction of spleen: indigestion, loose stools, fullness and distention, emaciation, malnutrition. 2). Transporting and transforming dampness (excessive water) i. Promoting water metabolis ii. Spleen is the source for producing of phlegm. iii. All kinds of dampness, swelling and fullness belong to spleen. ii. Dominating ascending 1) Ascending clarity 2) Fixing internal organs at their original location iii. Controlling blood 1) Spleen qi strong. 2) Spleen qi is weak and fails to control blood. 3) Invigorating the spleen qi to control bleeding. iv. Dominating the muscles and four limbs v. Opening into the mouth and manifesting on the lip: Saliva is the fluid of spleen. Manifesting in the lips.

B. The stomach (wei) 1) Receiving and decomposing food 2) Dominating descending C. The relationship between spleen and stomach 1) Exterior and interior relationship 2) Transportation, transformation, and reception. 3) Ascending and descending 4) Yin and Yang 5) Affect each other in pathology.

3. The relationship between lung and large intestine 1). Exterior and interior relationship 2). The transportation function of large intestine is related to the descending function of lung. a. Normal descending function of lungs-- The qi of large intestine will descends normally.

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TCM REVIEW

TCM REVIEW i. The essential qi of kidney includes kidney essence, kidney qi, kidney yin and yang. ii. Dominating growth, development and reproduction. 3). Kidney yin and kidney yang i. Kidney yin: the foundation of yin fluid of the whole body. It nourishes and moistens zang-fu organs and tissues. ii. Kidney yang: The function of yang qi of the whole body. It warms and promotes the function of zang-fu organs and tissues. b. Dominating water metabolism 1). Water metabolism has two aspects: Disseminating nutrient fluid to whole body; Excreting turbid fluid out. 2). Kidney dominates the opening and closing of the gate of water: Kidney is water zang. c. Receiving qi 1). Respiration is controlled by lung, but relies on reception of kidney. 2). Normal receiving function of kidney- respiration is even. 3). Deficiency of kidney qi- fails to receive qi asthma, dyspnea, S.O.B after movement, difficult inhalation. d. Dominating bone, manufacturing marrow to fill up the brain and manifesting in the hair. 1). Kidney stores essence, essence produces marrow, marrow develops bone. 2) Marrow: Bone marrow; Spinal marrow; 3). Teeth are the surplus of bone. 4). Manifesting in the hair: Hair is the surplus of blood; Essence and blood promote and transform each other. e. Opening into the ear and dominating anterior and posterior orifices. 1). Hearing relies on nourishment by the essential qi of kidney. 2). Anterior orifice- urethra and genitalia (urination and reproduction) 3). Posterior orifice anus->excreting the feces f. Supplement: Life gate (ming men); Life gate fire----Ming Men Huo----Kidney yang 2. Urinary bladder (Pang Guang) a. Storing and excreting urine b. Fails to control urine: enuresis, incontinence of urine. c. Dysfunction of qi activities: dysuria, anuria or oliguria d. Damp-heat in the bladder: urgent micturition e. Strength kidney qi and clear damp-heat. 3. The relationship between kidney and bladder a. External-internal relationship b. Deficiency of kidney qi- bladder will lose its power to control urine incontinence of urine, enuresis. c. Dysfunction of qi activity of kidney fails to effectively regulate water metabolism obstructs the bladder in excretion of urine- difficulty in urination, anuria. d. In treating: reinforce the kidney qi

E. Liver and gallbladder

1. The liver a. Maintaining the free flow of qi: TCM classifies liver into Live yin, blood, yang, qi. 1). Regulating emotion activities: Harmonizing the mood; Characteristic of liver is flourish and dislike depression. 2). Promoting digestion and absorption 3). Keeping qi and blood moving normally. b. Storing blood. 1). Liver stores blood and regulates the blood volume in circulation. 2). Deficiency of liver blood-- blurred vision, spasm of tendons, numbness of four limbs, amenorrhea. c. Controlling the tendons and manifesting in the nails. 1). Tendons are nourished by liver blood: numbness of limbs, sluggishness of joint movement, spasm of tendons, tremors of extremities (deficiency of liver blood) 2). Nails are the surplus of the tendons: nails soft, thin, deformed and brittle (deficiency of liver blood) d. Opening into the eye 1). Eyes are nourished by liver blood. 2). Deficiency of liver blood: blurred vision, night blindness; 3). Liver yin deficiency: dry eyes. 4). Liver fire or wind heat in liver meridian: redness, swelling and pain of eyes. 5). Damp-heat in liver and gallbladder: icteric sclera. 2. Gallbladder (Dan) a. Storing and excreting bile to aid digestion. b. Making decision c. Secretion and excretion of bile are obstructed: digestion and absorption of food will be disturbed---- lose appetite, abdominal distention, and diarrhea. d. Upward perversion of gallbladder qi--- bitter taste. e. Pathogenic damp-heat in liver and gallbladder- bile overflows- jaundice, vomiting of bitter fluid. 3. The relationship between Liver and GB a. Exterior and interior relationship: their meridians connect each other. b. The secretion, storage and excretion of bile. c. Liver and GB often involve each other, as a result they both suffer from: stagnation of qi and heat; Dampness and heat. d. In treatment: they are treated together.

F. The kidney and Urinary Bladder

1. The kidney (shen) a. Storing essence and dominating development and reproduction: TCM classifies kidney into Kidney yin, yang, essence, qi; 1). Essence and kidney essence: Kidney essence consists of congenital essence and acquired essence. 2). The essential qi of kidney and its functions:

G. Pericardium and Sanjiao

1. Pericardim

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TCM REVIEW a. Concept: Xin Bao Luo or Tan Zhaong; Tan Zhong is like the palace wall of the heart. b. Function: To protect the heart. 2. Sanjiao: a. Concept: Sanjiao is a particular term in TCM; A large bowel containing all the internal organs; Solitary fu; Upper jiao (heart and lung); Middle jiao (spleen and stomach); Lower jiao (liver, urinary bladder, kidney, intestine, uterus) b. Function: 1). Governing qiji (qi activities, movement of qi) and qihua of whole body. i. Sanjiao is the pathway of flow of qi (ascending, descending, exiting and entering of qi) 2). Serving as the passage for the flow of body fluid. c. The functions of upper, middle and lower jiao 1) Upper jiao: dominates respiration and distribution 2) Middle jiao: dominates digestion, transportation and transformation 3) Lower jiao: dominates the separation of clarity from turbidity and the discharge of urine and stool.

TCM REVIEW 3) Ying qi: nutrient qi, ying blood, or ying yin; From food essence. Its function are to transform and produce blood and circulated with it, provide nourishment to the whole body. 4) Wei qi: defensive qi or wei yang; From food essence; Its functions are to protect the muscular surface and defends the body against exogenous pathogenic factors, controls the opening and closing of the pores and the excretion of sweat to readjust body temperature, warm and nourish the zang-fu organs, muscles, skin and hair. c. The function of qi 1). Promoting function 2). Warming function 3). Defending function 4). Checking function 5). Qihua function 6). Nourishing function d. Movement of qi (qi ji) 1). Four basic movement of qi: ascending, descending, exiting, entering 2). Harmonious functional activities of qi 3) Disharmonious functional activities of qi: Collapsed qi (qi xian); Stagnant qi(qi zhi); Rebellious qi (qi ni); Escape of qi (qi tuo); Depressed qi or close qi (over accumulation) e. Other type of qi: organ qi, meridian qi, zhen qi, zheng qi, xie qi, gu qi, water qi, jing qi, middle qi et ac. 2. Blood a. Concept: a red liquid circulating in the vessels. b. Formation of blood: Ying qi and body fluid. From food essence and kidney essence. Spleen is the main source for producing blood. c. Circulation of blood d. Function of blood 1). Nourishing an moistening the whole body. 2). Blood is the material basis for mental activity. e. Insufficiency of blood: impaired vision, dryness of eyes, motor impairment of joints, numbness of four limbs, skin dryness and itchiness. 3. Body fluid a. Concept: all normal liquids of the body called jin ye. Including jin and ye. b. Formation, distribution and excretion of body fluid: from water and food. Distribution involving spleen, lung, kidney, sanjiao, liver, heart. Discharged by lung, kidney and bladder, etc. c. The function of body fluid 1) Moisturizing and nourishing 2) As a component of blood. d. Deficiency of body fluid: thirst (stomach heat), constipation (intestine heat), dry cough (dryness of lung) 4. Retention of phlegm fluid

H. The extraordinary fu organs (Qi Heng Zhi Fu)

1. The brain: is a sea of marrow. a. Controlling mental and thinking activities b. Guiding sensory and language activities c. Mental faculties and feeling result from zang-fu organs 2. The uterus a. Presides over menstruation b. Nourishes the fetus (reproductive function) c. The function of uterus is related to three factors: i. The function of kidney: Tian Gui ii. The functions of chong meridian and ren meridian: Chong is a sea of blood; Ren is a sea of yin meridians. iii. The functions of heart, liver and spleen.

I. Qi, Blood and Body fluid

1. Qi a. Concept: 1) The essential substance comprising the human body and maintaining its vital activities. (such as the qi of food essence, the qi of breathing). 2). The physiological functions of zang-fu organs, tissues and meridians. (such as heart qi, lung qi and so on) 3) Characteristic of qi: strong activities, continuously changes and moves b. Formation of qi: Congenital qi and acquired qi (food essence and clear qi) c. The classification of qi: 1) Yuan qi: primary qi, genuine qi; From congenital essence and acquired qi; Its functions are activating growth and development of human body; promoting the functional activities of all the zang fu, tissues, meridians and other organs. 2) Zong qi: accumulated in the chest; From qing qi (nature) and food essence; Its functions are promoting lungs function of controlling respiration; filling heart channel to promote and adjust the circulation of qi and blood.

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TCM REVIEW a. Concept: Phlegm fluid (pathological products resulting from disturbance of water metabolism); Classify phlegm and retention fluid; Phlegm divides concrete phlegm and formless phlegm. b. The formation of phlegm fluid: 1) Pathogenic factors: six exogenous factors, improper diet, seven emotional factors. 2) pathogenic mechanism: pathogenic factors---dysfunction of lung, spleen, kidney, sanjiao---disturbance of water-fluid metabolism---accumulation of fluid----phlegm fluid 3) Symptoms of phlegm fluid: different symptoms in different organs. 5. The relationship between Qi and Blood a. Qi is the commander of blood 1) qi can produce blood 2) qi can promote blood 3) qi can check blood b. blood is the mother of qi 6. The relationship between Qi and Blood a. qi can make body fluid b. qi can promote body fluid, transform and excrete water. c. qi can guide body fluid d. body fluid can carry qi. 7. The relationship between blood and body fluid a. Blood and body fluid have the same source. b. Blood deficiency---body fluid becomes less---dry skin, even dry nails

TCM REVIEW 1). Rules Xue & Xue Mai (Blood & Vessel) 2). Stores Shen (mind). 3). Sweat is the fluid of heart. 3). Opens into tongue, manifests in face. Gan (Liver) 1). Rules free-flowing of Qi. 2). Stores Xue (blood). 3). Rules tendons. 4) Opens into eyes, manifests in nails. Pi (Spleen) 1). Rules transportation & transformation. 2). Rules muscles & limbs. 3). Governs Xue (blood). 4). Holds up organs. 5). Opens into mouth, manifests in lips. Fei (Lung) 1). Rules Qi & governs respiration. 2). Governs dispersing & descending. 3). Regulates water channels. 4). Rules exterior of body. 5). Opens into nose, manifests in body hair. Shen (Kidney) 1). Stores Jing, rules reproduction & growth, rules bones. 2). Foundation of Yin Yang. 3). Rules water. 4). Rules water. 5). Opens into ears, manifests in hair. 2. Functions of the six Fu Xiao Chang (Small intestine) 1). Dominating receiving, digesting and transforming 2). Separating the clear from the turbid. Dan (Gallbladder) 1). Storing and excreting bile to aid digestion 2). Making decision. Wei (Stomach) 1). Receiving and decomposing food. 2). Dominating descending Da Chang (Large intestine)

J. Jing and shen

1. Jing a. Concept: All kinds of essential substances (broad meaning); Essence (narrow meaning) b. Origins of Jing: Prenatal Jing (xian tian zhi jing): Postnatall Jing (hou tian zhi jing) c. Function of Jing: Dominating the growth, development and reproduction d. Disharmony of Jing: improper maturation, sexual dysfunction, inability to reproduce and premature aging. 2. Shen a. Concept: 1) Shen is vitality (mind): Shen is general manifestation of vital activities. 2) Material base of Shen----qi, blood, essence, body fluid. 3) Shen is generated by the functional activities of zang-fu organs. b. Manifestation of shen: 1) Having strong shen (favorable prognosis) 2) lack of shen (serious illness or unfavorable prognosis) 3) Pseudo shen (impending death)

K. Sum up
1. Functions of the five zang Xin (Heart)

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TCM REVIEW 1). Receiving and moving contents sent down from small intestine. 2). Absorbing the water from the contents. 3). Turning the remainder into feces. Pang Guang (Urinary Bladder) Storing and excreting urine.

TCM REVIEW 2. Tends to rise and disperse, can exhaust Qi and body fluid easily 3. It is apt to disturb mind 4. Usually is accompanied by dampness A. Summer heat: high F, restless, flushed face B. Dampness: tired limbs, distress, sticky BM

Dampness: Chapter 3 Etiology and Pathogenesis of TCM

1. It is heavy and turbid in nature A. Heavy manifestation: heaviness of head, body and distension and soreness of the trunk and extremities. B. Turbidity: The secretions and excretions are turbid. e.g: discharge, urine (turbid), BM (mucous) , leukorrhea 2. It is viscous and lingering in nature. 1). The nature of stickiness: e.g. sticky dejecta and secretions, greasy tongue coating, sticky BM, Urination 2). Difficulty to cure due to their long course and frequent recurrence, e.g such as conditions as damp blockage (Bi), eczema, damp warm disease. 3. Tends to go downward It is a yin pathogenic factor which often attacks the lower portion of the body. Clinical manifestations are ulceration and edema of the lower extremities, soreness of muscles, and joint pain of the lower limbs, stranguria with turbid urine, diarrhea, dysentery etc. 4. A Yin pathogen, tends to impede the flow of Qi and impair Yang Qi and Sp. Spleen is susceptible to the dampness. If spleen yang is checked by pathogenic damp, it will cause a dysfunction of transportation and transformation, and obstruct the functional activity of qi. The following symptoms will occur: distension and fullness of the epigastric and abdominal regions, anorexia , sweetish taste in the mouth, loose stool, cold extremities, etc

1. Etiology: Study of causes of diseases 2. Pathogenesis: Study the mechanism of occurrence, development and change of a disease.

Etiology:
1. Concept of pathogenic factors: The factors that break up the state of relative balance in the body and lead to diseases are etiological factors. 2. Various factors that cause disease primarily include: External factors: six exogenous pathogens, epidemic pathogens Internal factors: seven emotion, and improper diet, maladjustment of work and rest, and traumatic injury. 3. Six External Pathogens: wind, cold, summer heat, dampness, dryness and fire. i. Under normal circumstance they will not cause disease. ii. When the climate changes suddenly, violently, or abnormally, disease may occur. Under these conditions, the six environmental factors transform into six external pathogens. 4. General characteristics six external pathogens A. Attack from outside of the body, through skin, muscles or nose and mouth. B. Are related to season, environment. C. May attack the human body alone or in combination. D. May transform into another pathogens. 5. Five endogenous pathogens: interior wind, cold, dampness, dryness, heat (fire).

Dryness:
1. Tends to impair the body fluid. It leads to dryness of the mouth, lips and nose, dryness of the tongue, dry, rough and chapped skin, dry stool. 2. Tends to impair the lung The lung is considered a tender organ which prefers moisture, cleanliness, and descent. If pathogenic dryness attacks the body from the mouth and nose, the yin fluid of the lung is likely to be consumed. It may lead to the dysfunction of dispersion and descent, and manifest as dry cough with scanty sputum, sticky mucus causing difficult expectoration, or bloody sputum, etc.

A. Six exogenous pathogens: Wind:

1. 2. 3. 4. A Yang pathogen, tends to rise, disperse, and attack at the Yang level. Rapid onset, tend to migrate and change Leads to mobility Acts as the leading pathogen: The other evils invade body dependent on the wind.

Fire
1.Fire tends to burn and scorch Clinical manifestations are fever, thirst, profuse sweating, etc. If pathogenic fire travels inward to attack the mind, it causes irritability, anxiety, insomnia, or even mania, unconsciousness, and delirium in severe cases. 2. Tends to flare up Since pathogenic fire is likely to flare upward, the clinical manifestations may be mostly on the head and facial regions, such as a swelling and pain of the gums due to

Cold:
1. A Yin pathogen, tends to impair Yang Qi 2. Causes coagulation and obstruction 3. Causes contraction and constriction

Summer Heat:
1. A Yang pathogen, scorching in nature

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TCM REVIEW extreme stomach fire, ulcers of the tongue and mouth, headache, and redness, pain and swelling of the eyes. 3. Tends to impair the body fluid and the Qi 4. Tends to create endogenous wind Symptoms and signs: high fever, convulsion, opisthotonus, tremor 5. Tends to accelerate blood circulation and cause bleeding. (disseminated intravascular coagulation ) 6. Tends to cause carbuncles and sores Heat and fire goes in blood, stays in local, burns the tissues, leading to sores, carbuncles, and pus. 7. Tends to irritate the heart and spirit Heat and fire correspond to Ht, if heat & fire are too excess, they lead to heat in blood and bleeding due to heat, also causing mania, anxiety, restless, delirium. Pathogenic Factors Wind Pathogenic Characteristics It is of Yang nature; tends to disperse and rise; tends to attack the upper part of the body; tends to migrate and changes; leads mobility; acts as the leading pathogens. It is a Yin pathogen; tends to impair Yang Qi; tends to cause coagulation, obstruction and constriction. It is a Yang pathogen and scorching in nature; tends to rise and disperse; is apt to impair body fluid and exhaust Qi; is apt to disturb mind; is usually accompanied by dampness. It is a Yin pathogen; is heavy and turbid in nature; is viscous and lingering in nature; tend to go downward and attack the Yin part; tends to impede the free flow of Qi and impairs spleen Yang. Its dry and tends to impair body fluid; is apt to attack the lungs. They are Yang pathogens; tend to flare up; tend to consume Qi and body fluid; tend to create endogenous, accelerate the blood circulation and cause bleeding; are liable to cause painful swelling of the body; tend to irritate the heart and mind.

TCM REVIEW D. Strong infectivity & strong epidemicity (eg: typhoid, cholera,). 3. Factors related to outbreak of diseases due to epidemic pathogen A. Unusual climate B. Water or food contamination C. Failure of timely effective prevention and isolation C. Seven emotions 1. Concept of seven emotions: Refers to seven kinds of emotional reactions, namely: joy, anger, melancholy, sadness, worry, fear and terror, which are the different responses of human body to environmental stimuli. 2. Certain Zang Fu organ is related to certain emotion, i.e. Heart------Joy, Liver-----Anger, Lung------Sadness/Melancholy, Spleen------Worry, Kidney------Fear/Fright 3. The pathological characteristics of seven emotions i. Directly affecting the internal organs The following three organs are most likely affected by seven emotions. The following 3 organs and Qi blood are major effected: Heart, Liver, Spleen. 1). Overthinking & worrying often impair Qi & blood deficiency of Ht & Sp: 2). Suppression & anger often impair Liv. Qi stagnation in Liv: 3). The factors may transform into fire, lead to deficient Yin, dampness, undigested food, phlegm: ii. Causing diseases by disturbing the flow of Qi. 1). Rage causes adverse upward flow of Qi: . i.e. red face & eyes, spitting blood, or even coma. 2). Excessive joy relaxes the heart Qi. i.e. failure of concentrating attention, and in critical cases, mental disarrangement. 3). Excessive sadness leads to the consumption of Qi. i.e. leads to suppression of the Lung Qi, consumption of Lung Qi. 4). Fear causes the sinking of Qi. i.e. Leads to Ki Qi to become unfixed and to go downward, which produce urinary and fecal incontinence. 5). Fright causes derangement of Qi. i.e. leads to mental disrrangement, confusion of thought and reaction to reality. 6). Worry causes stagnation of Qi. i.e. When one is overly thinking, the Qi will be obstructed, affects Ht & Sp, manifestations are: iii. Seven emotions may influence the condition of a disease Impaired Disorders of Seven Pathogenic Mechanism Emotions Organs Functional Activity of Qi Joy Heart Slowness Heart Qi is relaxed. Blood circulation is slowed Anger Liver The liver does not work well Upward flow in smoothing and regulating the flow of Qi and blood. Blood is brought up with the ascending Qi.

Cold Summerheat

Dampness

Dryness Fire and Heat

B. Epidemic Pathogenic Factors

1. Concept: Epidemic pathogens are pathogens with strong infectivity. Pestilential evil is a kind of pathogenic factor with intense infectivity. Attacks of pestilential evils are usually related to unusual climates such as droughts, floods, extreme heat as well as pollution and unsanitary conditions. Epidemics occur suddenly with severe symptoms and are highly contagious. 2. Pathological characteristics A. Sudden onset B. Severe condition of illness C. Similar manifestation( major syndrome is heat: ) Page 19 of 113

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TCM REVIEW Overthinking Spleen Stagnation Qi is obstructed. The spleen fails to effectively transform, distribute and transport nutrients. Lung Qi is consumed, and one is despondent Kidney Qi is unconsolidated and sinking The kidney can not store the memory. The mental activities are attached to nothing.

TCM REVIEW a. Concrete phlegm/Substantial phlegm: Refers to phlegm that has form and is visible, palpable, and audible. b. Formless phlegm/non-substantial phlegm: Refers to phlegm without form. It manifests only as the disorder it causes, and the disorder can be relieved or cured by the method of eliminating phlegm. (3) The pathological characteristics a. Tends to obstruct Qi b. May cause various disorders c. Some diseases caused by phlegm are lingering in course, complicated and difficult to treat Strange disorders are most likely attributed to phlegm. d. Tongue: Slippery or/and greasy coating. e. Pulse: Slippery or wiry. (4) Classification of phlegm: Heat phlegm, Cold phlegm, Damp phlegm, Dry phlegm, Wind phlegm 2. Blood stasis (1) Concept: Blood stasis refers to the pathological state in which blood circulation is slow or blocked, as well as blood outside of the vessels that remains in the body and fails to disperse. (2) Causes: A. Qi deficiency B. Qi stagnation C. Blood heat D. Blood cold E. Traumatic injury (3) Pathological characteristics of blood stasis: A. Tends to impede the flow of Qi, blood and body fluid. The newly is hard to generate if the blood stasis is not removed. B. May cause various disorders. (4) General manifestation related to blood stasis A. Pain B. Swelling or mass C. Bleeding D. Cyanosis E. Tongue: Purple tongue or a tongue with purple spots F. Pulse: Choppy 3. Stone (1) Cause Improper diet, abnormal emotionDamp-heatStone (2) Pathological Characteristics A. Tends to obstruct Qi B. May damage vessels

Grief Fear Fright

Lung Kidney Kidney

Consumption Sinking Disturbance

C. Diet
1. Abnormal ingestion a. Excessive hunger b. Excessive eating 2. Unsanitary food 3. Food preference a. Preference for cold food----impairs spleen yang. b. Preference for hot food-----cause heat in the stomach and intestine c. Preference for alcohol-------cause heat and injures the vessels; leads to the production damp-heat and phlegm.

D. Improper work and rest

Yellow Emperors Internal Classics contains the following summary: Excessive use of the eyes injures the blood Excessive lying down injures the Qi Excessive sitting injures the muscles Excessive standing injures the bones Excessive walking injures the tendons 1). Mental overwork: will most likely impair heart and spleen. 2). Physical overwork: consumes Qi. 3). Excessive sexual activity: may impair the kidney essence. 4). Excessive rest: i. Impedes the flow of Qi and blood, leading to flaccidity and fragility of the tendons, muscles and bones. ii. Weakens spleen and stomachs function

Pathological Products
1. Retention of phlegm and Fluid (1) Causes: Six external pathogens, abnormal seven emotions, improper diet, work or rest Dysfunction of lung, spleen and kidneyDisordered water metabolismRetention of body fluid. (2) The concept of phlegm in TCM:

E. Miscellaneous Pathogens
1.Trauma: Physical traumas include gunshot, incision, contusion, sprain, etc. The basic pathogenesis of traumas is stagnation of Qi and blood, which give rise to pain, bruise and swelling. Page 22 of 113

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TCM REVIEW 2. Parasites 3. Poisons 4. Wrong treatment Acupuncture a. Injure internal organs (Lu 1, St 12, UB 15, Ren 3, UB 22) b. Injure central nervous system (Du 15) c. Injure big arteries, nerves (Lu 9) d. Harm the fetus

TCM REVIEW 2). Abnormality in the movement of Qi: Stagnation of Qi; Reversed flow of Qi; Closed Qi; Exhaustion of Qi; 3). Pathogenesis of blood abnormality: Deficiency of blood; Impaired of blood; Blood heat; Overflow of blood; 4). Pathogenesis of body fluid abnormality: Body fluid deficiency; Accumulation of fluid; 4. Five endogenous pathogens refer to endogenous wind, cold, dampness, dryness and heat. Internal Movement of wind: A. Liver Yang transforming into wind B. Extreme heat producing wind C. Deficiency Yin stirring up wind D. Deficient blood producing wind 5. Dryness of the blood producing wind Internal production of cold Internal production of Dampness Insufficient body fluid transforming into dryness Internal production of fire and heat

Pathogenesis
Concept: Pathogenesis describes the mechanism of the occurrence, development and change of a disease. 1 The Condition of Vital Qi and Pathogenic Factors A. The condition of vital Qi and evil Qi determines the occurrence of disease. B. The condition of vital Qi and evil Qi determines the deficiency and excess a. real excess with false deficient manifestation ex. Heat accumulated in the stomach and intestines (interior heat) constipation, abdominal fullness, pain and hard mass in abdomen, doesnt like to be pressed, tidal fever, manic Yang Qi was trapped inside the body pt present pale manifestation, aversion to cold, cold limbs, fatique , looks like deficient cold symptoms. b. real deficiency with false excess manifestation ex. Vital Qi is deficient, insufficient Qi, blood of Zang Fu organ, clinical manifestation is fatique, poor appetite, since vital Qi is deficient, it causes stagnation like abdominal distention (not all the time) and pain (like to be pressed), looks like excess symptoms. C. The condition of vital Qi and evil Qi determines the outcome of disease. 2. Imbalance between Yin and Yang 1). Excess of Yang leads to heat syndrome 2). Excess of Yin leads to cold syndrome 3). Mutual damage (injury) of Yin and Yang: Yin damage involves Yang; Yang damage involves Yin. 4). Repellence between Yin and Yang i. Repellence of Yin is the pathogenesis of real heat syndrome with false cold manifestations() ii. Repellence of Yang is the pathogenesis of real cold syndrome with false heat manifestations() 4). Exhaustion of Yin and Yang 3. Pathogenesis of Qi, blood and body fluid 1). Pathogenesis of abnormality in Qi: Deficiency Qi; Sinking of Qi;

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TCM REVIEW

TCM REVIEW B. Transmission of needling sensation: Soreness, heaviness or numbness transmits along a certain route to distal areas. if an acupoint is accurately punctured the needling sensation will transmit just as people travel along streets and lanes 2) Nomenclature of Twelve regular channels is based on three factors. LUNG----------------- -------- Hand Taiyin (Greater yin) PERICARDIUM --------------- Hand Jueyin (Ending or Absolute yin) HEART--------------------------- Hand Shaoyin (Lesser or Young yin) LARGE INTESTINE --------- -Hand Yangming (Yang Brightness) SANJIAO------------------------ Hand Shaoyang (Lesser yang) SMALL INTESTINE-----------Hand Taiyang ( Greater yang) SPLEEN---------------------------Foot Taiyin (Greater yin) LIVER------------------- ----------Foot Jueyin (Absolute yin) KIDNEY---------------- ----------Foot Shaoyin (Lesser yin) STOMACH------------ -----------Foot Yangming (Yang Brightness) GALL BLADDER----- ----------Foot Shaoyang (Lesser yang) URINARY BLADER------------Foot Taiyang (Greater yang) 3) Eight Extra Meridians Du meridian (Governing or Governer) Ren meridian (Conception) Chong meridian (Vital Pass) Dai meridian (Girdle) Yang Qiao ( Yang Heel) Yin Qiao (Yin Heel) Yang Wei (Yang Connecting) Yin Wei (Yin Connecting) Eight extra meridians have important links with regular channels. They supervises functions of meridians. They drain and stores blood from main meridians. They drain when there is excess and supply when deficient. Clinically used for the gynecological problems. 4) Twelve Divergent meridians They go out from the regular meridians and are named after them. Organs of Yin and yang regular meridians are connected by divergent meridians. They run deep in the body entering the thoracic and abdominal cavities. Yang divergent meridians enter organs in the abdomen or thoracic cavity from their point of origin on limbs. They resurface on neck where they join yang channels. Yin meridians go to yang divergents and finally join yang regular meridian. Strengthen Yin-yang relationship. They connect with organs as well as yin yang meridians. Divergent meridians distribute the bodys Qi to the head. 5) Fifteen Collateral: The fifteen collaterals are the branches arising from the regular meridians and also named after the regular meridians. Du and Ren and major Spleen have collateral. These branches are distributed superficially over the body.

Chapter 4 Introduction to Acupuncture

1 History of Acupuncture & Moxibustion Before the creation of Chinese characters and at least 3000 years ago; Available data on the history of TCM showed that acupuncture and moxibustion originated at different times, and moxibustion probably came maybe before acupuncture. 2 Origin and Development of Acupuncture and Moxibustion 1) Bian Stones: new Stone Age to warring states period (10,000-475 B.C.) 2) Yin-Yang Theory (475 B.C.) 3) Warring states times (475-221 B.C.): Huangdis Internal Classic 4) Eastern Han dynasty to three Kingdom period (25-265 A.D.): Dr. Hua, Tuo, and Dr. Zhang, Zhongjing (Treatise on febrile and miscellaneous disease) 5) Jin dynasty (265-581): Compiled Systematic Classic of Acupuncture and Moxibustion; 6) Tang dynasty (618-907): Dr. Sun, Simiao (Prescriptions worth a Thousand Gold for Emergencies); Dr. Wang, Tao (Medical Secrets of an Official) 7) Song and Yuan dynasty (960-1368): Dr. Wang, Wei-yi (Illustrated Manual on the points for Acupuncture and Moxibustion on a New Bronze Figure); Dr. Hua, Shou (Exposition of the Fourteen Channels); 8) Ming dynasty (1368-1644): Acupuncture and moxibustion were at their peak. 9) Qing dynasty (1644-1840): started declining 10) Acupuncture and moxibustion in China and World: 3 Basic Concepts of Acupuncture and Moxibustion (Classification of Channels & Collaterals) 1) JING LUO (Meridians/channels and Collaterals): Meridians (Jing); Collaterals (Luo) A. This system of meridians and Collaterals includes the twelve regular meridians, eight extra meridians, fifteen Collaterals, twelve divergent meridians, twelve muscle regions and twelve cutaneous regions.

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TCM REVIEW They connect Yin and yang meridians. (Divergent connect organs as they are deep) Distribute Qi and blood to the superficial layer of body like skin. 6) Twelve Muscle regions They are named after regular meridians and also according to hand, foot, yin or yang. Muscle regions originate from the extremities and ascend to the head and the trunk, but do not reach the Zang-fu organs. They connect with muscles, tendons and ligaments. They extend or flex joints. They are used to treat muscular problems such as Bi syndrome, contracture, stiffness, spasm and muscular atrophy. 7) Twelve Cutaneous regions This is the part of the meridian system located in the superficial layers of the body. They connect with the superficial layer of the body i.e. skin. These are the sites through which Qi and blood of the meridian is transferred to the body surface. 4 Cyclical Flow of Qi in Twelve Regular Meridians Three yins of hand meridians circulate from the chest to hand. Three yang meridians of hand run from the hand to head. Three yin meridians of foot circulate from the foot to chest (abdomen). Three yang meridians of foot run from the head to foot. Zang organs (Yin meridian) (Interior) Fu organs (Yang meridians) (Exterior)

TCM REVIEW a) Anterior aspect from the radius to ulna. (Medial) Anterior- Lung (Hand Taiyin) Middle Pericardium (Hand Jueyin) Posterior- Heart (Hand Shaoyin) b) Posterior aspect from radius to ulna (Lateral) Anterior- Large Intestine (Hand Yangming) Middle- Sangyo (Hand Shaoyang) Posterior- Small Intestine (Hand Taiyang) Lower Extremities: a) Medial aspect Anterior- Spleen (Foot Taiyin) Middle- Liver (Foot Jueyin) Posterior- Kidney (Foot Shaoyin) b) Lateral aspect Anterior- Stomach (Foot Yangming) Middle- Gallbladder (Foot Shaoyang) Posterior- Bladder (Foot Taiyang) 2) Distribution in the body/trunk On the front: Ren meridian is on the midline. Kidney is the first line lateral to the midline. Stomach corresponds to second line.

Lung (1)-------------------------- (2) Large Intestine Spleen (4)------------------------- (3) Stomach Heart (5)-------------------------- (6) Small Intestine Kidney (8)------------------------ (7) Bladder Pericardium (9)------------------- (10) Sangyo Liver (12)--------------------------- (11) Gallbladder 5 Functions of the Meridians and Collaterals 1) Transporting Qi and blood and regulating Yin and Yang 2) Resisting pathogens and reflecting symptoms and signs 3) Transmitting needling sensation and regulating deficiency and excess conditions 6 Outline of Distribution of the 14 Meridians 1) Distribution in the extremities In general, the medial aspect Yin; Lateral aspect- Yang Upper extremities: Page 27 of 113

Spleen meridian corresponds to the third line On the back: Du meridian is on the midline. Bladder meridian is both the first and second lines lateral to the Du meridian. 3) Distribution in the Head, Face and Neck Stomach and Large Intestine are in the facial region. Sanjiao and Gallbladder in the lateral aspect of the head. Du meridian goes along the midline of the neck and the head. Bladder meridian runs on both sides of the midline in head and neck.

7 Introduction to Acupoints Nomenclature of Acupoints Acupoints of the fourteen meridians have their definite locations and names, which have their own meaning.

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TCM REVIEW a) Names bearing analogy to water flow, mountains and valleys. Flow of Qi and blood were compared with flow of water. Mountains and valleys represented prominence and depressions of tendons and bones. e.g. GB 34-Yanglingquan (Yang mound spring) LU9- Taiyuan (Great deep pool) b) Names bearing analogy to animals, plants and utensils. e.g. ST35- Dubi (Ox or calf nose) LU10- Yuji (Fish border) ST12- Quepen (Depression basin) c) Names bearing analogy to the architectural structure. e.g. SI19- Tinggong (Hearing palace) HT7- Shenmen (Spiritual gate) d) Names bearing analogy to astronomical phenomena. e.g. DU23- Shangxing (Upper star) e) Points named according to anatomical terms. e.g. REN 12- Zhongwan (Middle stomach) ST31- Biguan (Thigh joint) f) Points named according their therapeutic properties. e.g. UB13- Feishu (Lung point) SP10- Xuehai (Sea of blood) 8 The Classification of Acupoints 1) Regular Acupoints These are the points in twelve regular channels plus Du and Ren meridians. All the regular points can be used to treat disorders according to practical experience. Nei Jin 160 points Jin dynasty 349 points Song dynasty 354 points Ming dynasty 359 points Qing dynasty 361 points The number of the Acupoints in the 14 meridians respectively: Lung 11 Large Intestine 20 Stomach 45 Spleen 21 Heart 9 Small Intestine 19 Urinary Bladder 67 Kidney 27 Pericardium 9 Sanjiao Gallbladder Liver Du Ren Total 23 44 14 28 24

TCM REVIEW

361 Acupoints

2) Extra points Extra points are experimental points with specific names and definite locations. But they are not attributed to regular meridians. They are effective in treatment of certain disease and are scattered all over the body. Some regular points were developed from the extra points. They clinically supplement regular points. They increase all the time. 3) Ashi points Ashi points are the tender spots or sensitive reflex points. These sensitive points are present in certain diseases. They are the primary method of point location without specific names or locations. They represent early stage of acupoint evolution. They have neither definite location nor name. 4) Specific points The specific points are among the acupoints of the 14 meridians. They have specific therapeutic properties and are grouped under special names. a) Five Shu points Each of the twelve regular meridians has five specific points. These points are located below elbow or knee joint. They are as follows: Jing= Well (Bubble); Ying= Spring (Gush); Shu= Stream (Flourish); Jing= River (Pouring abundantly); He= Sea (Confluence of river to sea); Flow of Qi flourishes gradually from these points. They belong to five elements respectively. (Wood-Fire-Earth-Metal-Water-Wood) Yang meridians Metal Water Wood Fire Earth Yin meridians Wood Fire Earth Metal Water

Jing-well Ying-spring Shu-stream Jing-river He-sea

b) Yuan-primary points Each of the twelve regular meridians has a Yuan-primary point, which is located in the extremities near the wrist and ankle joints. In Yin meridians it overlaps with Shu-stream points while Yang meridians have separate points. c) Luo-connecting points Each of the14 meridians (12+Du and Ren) has a Luo connecting point to link its exteriorly-interiorly related meridians. Spleen has an extra Luo point. These points are used to treat meridians. Luo points treat meridian problems of both its own meridian and its internal-external related meridian.

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TCM REVIEW
4) Between two midlines of clavicles---------------------------8 cun 1) First thoracic vertebrafourth sacral vertebra------21 verterbrae 2) Medial border of the scapulaposterior midline----3 cun 3) Lower angle of the scapula is about at the same level of the 7th thoracic vertebra 4) Iliac spine is about at the same level of the 4th lumbar vertebra 1) Anterior axillary foldcubital transverse crease--------- 9 cun 2) Cubital transverse creasewirst transverse crease---------12 cun 1) Upper boder of pubic symphsis---medial epicondyle of femur18 cun 2) Lower margin of the medial condyletip of the medial ankle---13 cun 3) Tip of the medial ankle---sole------------------------------------------3 cun 4) Greater trochanter of femurmiddle of knee----------------------19 cun 5) Buttock creasepopliteal crease-------------------------------------14 cun 6) Middle of kneetip of the lateral ankle-----------------------------16 cun 7) Tip of the lateral ankle---sole-------------------------------------------3 cun

d) Xi-cleft points These are points where the Qi and Blood of meridian are deeply converged. Each of the twelve regular meridians and four extra meridians have Xi-cleft points. These are used to treat the acute disorders of the areas supplied by the meridian or pertaining Zang-fu organs. e) Back-shu points Back shu points are located on the back. They are the specific points where the Qi of the respective Zang-fu organ is infused. Totally, there are 24 back-shu points. They are located on each side of vertebral column on the Bladder meridian. They are located 1.5 cun lateral to the vertebral column. f) Front-mu points These are the points located on the front of the trunk. These are the tender spots when pressure is applied to those specific points it relieves the pain or the discomfort of the patient. They correspond to the Zang-fu organs. g) Eight confluent points It refers to the eight points on the extremities. Through these points, the extra meridian can be active. At these points the regular meridian communicates with the extra meridians. These points are used to treat the disorders of the eight extra meridians. h) Crossing or intersecting points Crossing point is a point where two or more meridians intersect. Briefly stated, these intersections expand the function of the point by allowing it to affect more than one meridian. E.g. Du14, SP6. i) Eight Hui-meeting (influential) points These are the specific points which have particular effects in the treatment of disorders relating to the Zang, fu organs, Qi, blood, tendon, pulse, vessels, bones and marrow. Each influential point overlaps other points. They have systemic effects on a particular tissue or organ. 9 Method of Locating Acupoints The location of acupoints is very important as it affects the therapeutic results. At present basically three methods are used for the location of acupoints. They are as follows: 1) Proportional body measurements
Body parts Head Starting and terminating points and bone measurements 1) Anterior hairline--posterior hairline-----------------------12 cun 2) Yintanganterior hairline------------------------------------3 cun 3) Dazhuiposterior hairline----------------------------------- 3 cun 4) Between two frontal angles along hairline------------------9 cun 5) Between the two mastoid processes------------------------- 9 cun 1) Sternocostal angleumbilicus center-----------------------8 cun 2) Umbilicus center---upper margin of pubic symphysis----5 cun 3) Between two nipples-------------------------------------------8 cun

Back and waist

Upper limbs Lower limbs

2) Anatomical landmarks Various anatomical landmarks on the body surface are the basis for locating points. These landmarks fall in two categories. a) Fixed landmarks Fixed landmarks are those that would not change with body movements. They include hair, nails, nipple, umbilicus and prominence and depression of bones. Proportional measurements are based on the anatomical landmarks. E.g. Ren8 in umbilicus. b) Moving landmarks It refers to the landmarks that will appear only when a body part is kept in certain position. E.g. LI11 end of cubital crease; SI6 ulnar process when forearm rotated toward body. 3) Finger Measurement The length or the width of patients finger is taken as a standard for point location. The following three methods are used in the clinic. a) Middle finger measurement When patients middle finger is flexed, the distance between the two medial ends of the crease of the interphalangeal joints is taken as 1 cun. b) Thumb measurement The width of the interphalangeal joint of the patients thumb is taken as 1 cun. c) Four finger measurement The width of the four fingers (index, middle, ring and little) close together at the level of ht dorsal skin crease of ht proximal interphalangeal joint of the middle finger is taken as 3 cun.

Chest and abdomen

Specific discussions of the meridians and acupoints

The twelve meridians

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TCM REVIEW 1. Lung meridian of hand-tai yin Cyclical flowing and distribution: The Chapter "Discussion on the Meridians" in Miraculous Pivot: the Lung Meridian originates from the middle energizer, running downward to connect with large intestine. Winding back, it goes along the upper orifice of the stomach, passes upward through the diaphragm, and enters the lung, its pertaining organ. From the lung, it comes out transversely from the axilla, running downward along the medial aspect of the upper arm, it reaches the cubital fossa, then it goes continuously downward along the anterior border of the radial side in the medial aspect of the forearm and enters Cunkou. Passing the thenar eminence, and going along its radial border, it ends at the medial side of the tip of the thumb. The branch emerges from the posterior wrist and runs along the dorsum of the hand onto the radial side of the tip of the index finger. Indications: Disorder of the chest, lung, throat and the regions the meridian running by. Acupoints: 11 acuponts Zhongfu (Lu1); Yunmen (Lu2); Tianfu (Lu3); Xiabai (Lu4); Chize (Lu5); Kongzui (Lu6); Lieque (Lu7); Jingqu (Lu8); Taiyuan (Lu9); Yuji (Lu10); Shaoshang (Lu11)
Jingqu (Lu8) Taiyuan (Lu9) Yuji (Lu10) Shaoshan g (Lu11) 1 cun above the transverse crease of the wrist;

TCM REVIEW
Jing-River Cough, asthma, sore throat, pain in the chest and back as well as the wrist Cough, asthma, sore throat, pain in the chest and back, feverish sensation in palms, pain in the wrist, etc. Cough, hemoptysis, aphonia, aphonia, sore throat, feverish sensation in the palms and febrile disease. Cough, asthma, sore throat, epistaxis, abdominal fullness, mania and febrile disease Avoid radial pulse; Perpendicular 0.3-0.5 cun Avoid radial pulse; Perpendicular 0.3-0.5 cun Perpendicular 0.5-0.8 cun

The radial end of the transverse crease of the wrist; Radial side of the midpoint of the first metacarpal bone and junction of red and white skin. About 0.1 cun lateroposterior to the corner of the nail

Shu-Stream; Yuan-Source; Vessel-confluent; Ying-Spring

Jing-Well

Shallow pricking 0.1 cun or spot pricking

Acupoint Zhongfu (Lu1) Yunmen (Lu2) Tianfu (Lu3) Xiabai (Lu4) Chize (Lu5)

Location Parallel to first intercostals space; 6 cun lateral to the midian line 1 cun above Zhongfu

Special points Front-Mu Crossing point of hand tai-yin and foot tai-yin

Indications Cough, asthma, pain in the chest, and pain in the shoulder and back, etc. Same with Zhongfu

Radial side of arms; 3 cun below axillery fold Radial side of arms; 4 cun below axillery fold Radial side of the tendon of m. biceps brachii; on the cubital crease; He-sea acupoint

Asthma, dyspnea, hemoptysis, pain in the shoulder, etc Same with Zhongfu

Note Horizontal or lateral oblique insert 0.5-0.8 cun Lateral oblique insert 0.5-0.8 cun Perpendicular insert 0.5-1 cun Perpendicular insert 0.5-1 cun Perpendicular insert 0.8-1.2 cun; or spot pricking; Perpendicular insert 0.5-1 cun

Kongzui (Lu6)

Lieque (Lu7)

Palmar aspect of the forearm on the line joining Taiyuan (Lu9) and Chize (LU5) and 7 cun above the transverse crease of the wrist 1.5 cun above the transverse crease of the wrist;

Xi-Cleft acupoint

Cough, dyspnea, hemoptysis, afternoon fever, sore throat, pain of the elbow and arm, vomiting and infantile convulsion, etc Hemoptysis, cough, dyspnea, sore throat, aphonia, hemorrhoids, pain of the elbow and arm, etc

2. The large intestine meridian of hand-yang ming Cyclical flowing and distribution: the Large Intestine Meridian starts from the tip of the index finger, running upward along the radial side of the index finger and passing through the interspace of the 1st and 2nd metacarpal bones, it enters the depression between the tendons of m.extensor pollcis longus and brevis. Then,running on along the anterior aspect of the forearm, it reaches the lateral side of the elbow. Then it ascends along the lateral anterior aspect of the upper arm to the highest point of the shoulder, then along the anterior border of the acromion, it goes up to the cervical vertebra and descends to Quepen(ST12) and connects with lung. Then it passes through the diaphragm and enters the large intestine, its pertaining organ. The branch from Quepen(ST12) runs upward to the neck, passes through the cheek and enters the lower gums. Then it turns back to the upper lip and crosses the opposite meridian at Renzhong(the philtrum). The left meridian goes to the right and the right meridian to the left, to the contralateral sides of the nose. Indications: Disorders of the mouth, teech, nose and throat as well as diseases involving the lateral border of the upper limbs, anterior part of the shoulder and neck. Acupoints: Shangyang (LI 1)Erjian (LI 2)Sanjian (LI 3)Hegu (LI 4) Yangxi (LI 5)Pianli (LI 6)Wenliu (LI 7)Xialian (LI 8) Shanglian (LI 9)Shousanli (LI 10)Quchi (LI 11)Zhouliao (LI 12)Shouwuli (LI 13)Binao (LI 14)Jianyu (LI 15)Jugu (LI 16) Tianding (LI 17)Futu (LI 18)Kouheliao (LI 19)Yingxiang (LI 20)

Luo-connecting

Cough, asthma, hemoptysis, migraine, stiff neck, sore throat, toothache, pain in the penis and feverish sensation in the palm, etc.

Upward oblique insert 0.3-0.5 cun

Acupoint Shangyan g (LI 1)

Location Radial side of the index finger, 0.1 cun posterior to the corner of the nail

Special points Jing-Well point

Indications Toothache, sore throat, numbness of fingers, febrile diseases, apoplexy, coma, etc

Note Puncture 0.1 cun or spot pricking

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TCM REVIEW
Erjian (LI 2) Sanjian (LI 3) Hegu (LI 4) Distal to the 2nd metacarpal joint. Proximal to the head of 2nd metacarpal joint. Between 1st and 2nd metacarpal bones, middle of 2nd metacarpal bone on the radial side Ying-Spring point Blurring of vision, epistaxis, toothache, sore throat, febrile diseases Toothache, ophthalmalgia, sore throat, swelling of finger Headache, pain in the neck, redness, swelling and pain of the eye, epistaxis, nasal obstruction, toothache, deafness, swelling of the face, sore throat, facial paralysis, febrile disease,etc Headache, redness, pain and swelling of the eye, toothache, sore throat, pain of the wrist Redness of the eye, tinnitus, deafness, epistaxis, aching of the hand and arm, sore throat, edema Headache, swelling of the face, sore throat, borborygmus, abdominal pain, aching of the shoulder and arm. Abdominal pain, borborygmus, pain in the elbow and arm, motor impairment of the upper limbs Aching of the shoulder and arm, motor impairment of the upper limbs, numbness of the hand and arm, borborgumus, abdominal pain Abdominal pain, diarrhea, toothache, swelling of the cheek, motor impairment of the upper limbs, pain in the shoulder and back Sore throt, toothache, redness and pain of the eye, scrofula, motor impairment of the upper extremities, abdominal pain, vomiting, diarrhea, febrile disease Pain, numbness and contracture of the elbow and arm Contracture and pain of the elbow and arm, scrofula Pain in the shoulder and arm, rigidity of the neck, scrofula Perpendicular0.2 -0.3 cun; moxibustion Perpendicular 0.5-0.8 cun; moxibustion Perpendicular insert 0.5-1 cun; moxibustion; contraindicated in pregnant women Perpendicular insert 0.3-0.5 cun; Perpendicular insert 0.5-0.8 cun Perpendicular insert 0.5-1 cun (LI 14) Jianyu (LI 15) 11) and Jianyu( LI 15) Arm is full abduction, in the depression appearing at the anterior border of the acromioclavicular joint Upper aspect of the shoulder; depression between the acromial extremity of the clavicle and the scapular spine Lateral side of the neck; poster border of sternocleidomastoid muscle midpoint between Futu(LI 18) and Quepen(ST 12) Lateral side of the neck, between the sternal head and clavicular head ofm. Sternocleidomastoideus Right below the lateral margin of the nostril, level with Renzhong In the nasolabial groove, at the level of the midpoint of the lateral border of ala nasi.

TCM REVIEW
upward 0.8-1.5 cun Perpendicular or obliquely upward 0.8-1.5 cun Perpendicular 0.5-0.7 cun

Shu-Stream point

Pain in the shoulder and arm, motor impairment of the upper extremities, rubella, scrofula

Yuan-Primary point

Jugu (LI 16)

Pain and motor impairment of the upper extremities, pain in the shoulder and back

Tianding (LI 17)

Yangxi (LI 5) Pianli (LI 6) Wenliu (LI 7)

Radial side of the wrist; between the tendons of m. extensor pollcis longus and brevis 3 cun above the crease of the wrist. Between Yangxi (LI 5) and Quchi (LI 11) 5 cun above the crease of the wrist. Between Yangxi (LI 5) and Quchi (LI 11) 4 cun below the cubital crease. Between Yangxi (LI 5) and Quchi (LI 11) 3 cun below the cubital crease. Between Yangxi (LI 5) and Quchi (LI 11)

Jing-River point

Sudden loss of voice, sore throat, scrofula, goiter

Perpendicular 0.3-0.5 cun

Luo-Connecting point

Futu (LI 18) Kouheliao (LI 19) Yingxiang (LI 20)

Cough, asthma, sore throat, sudden loss of voice, scrofula, goiter Nasal obstruction, epistaxis, deviation of the mouth Nasal obstruction, hyposmia, epistaxis, rhinorrhea, deviation of the mouth, itching and swelling of the face

Perpendicular 0.3-0.5 cun

Xi-Cleft point

Obliquely 0.20.3 cun Obliquely or subcutaneously 0.3-0.5 cun

Xialian (LI 8) Shanglian (LI 9) Shousanli (LI 10) Quchi (LI 11)

Perpendicular insert 0.5-1 cun

Perpendicular insert 0.5-1 cun

2 cun below the cubital crease. Between Yangxi (LI 5) and Quchi (LI 11)

Perpendicular 0.8-1.2 cun

Zhouliao (LI 12) Shouwuli (LI 13) Binao

Lateral end of the transverse cubital crease, midway between Chize(LU 5) and laterl epicondyle of the humerus. 1 cun above Quchi(LI 11)

He-Sea point

Perpendicular 11.5 cun

Perpendicular 0.5-1.0 cun Perpendicular 0.5-1.0 cun Perpendicular or obliquely

3 cun above Quchi(LI 11); Between Quchi (LI 11) and Jianyu( LI 15) 7 cun above Quchi(LI 11); Between Quchi (LI

3. The stomach meridian of foot yangming Cyclical flowing and distribution: The Stomach Meridian starts from the lateral side of ala nosi. It ascends to the bridge of the nose, where it meets the Bladder Meridian, turning downward along the lateral side of the nose, it enters the upper gum. Reemerging, it curves round the lips, descends to meet Chengjiang(CV24), then it runs posterior laterally across the lower position of the cheek at Daying(ST5). Winding along the angle of the mandible-Jiache, it ascends in front of the ear and traverses Shangguan(GB3) then it follows the anterior hairline, and reaches the fore head. The branch emerging in front of Daying(ST5) runs downwards to Renying(ST9), it goes along the throat and enters the supraclavicular fossa. Descending, it passes through the diaphragm, enters the stomach, the pertaining organ, and meets the spleen. The branch emerging from the supraclavicular fossa runs downward passing through the nipple. It descends by the umbilicus and enters Qichong(ST30)on the lateral side of the lower abdomen. The branch from the lower orifice of the stomach descends inside the abdomen and joins the previous portion of the meridian at Qichong(ST30), running downward, traversing Biguan(ST31), and reaching Futu(ST32) and then the knee. It continues downward along the anterior border of the lateral aspect of the tibia, passes through the dorsum of the foot and enters the medial side of the middle toe.

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TCM REVIEW The tibial branch emerges from 3 cun below the knee and enters the lateral side of the middle toe. The branch from the dorsum of the foot rises from the dorsum and terminates at the medial side of the tip of the great toe and comes out at the tip. Indications: Diseases involving the stomach, intestines, head, face, nose, mouth and tooth as well as mental problems and disorders involving the regions through which the meridian runs. Acupoints: Chengqi (ST 1) Sibai (ST 2) Juliao (ST 3) Dicang (ST 4)Daying (ST 5)Jiache (ST 6)Xiaguan (ST 7)Touwei (ST 8)Renying (ST 9)Shuitu (ST 10)Qishe (ST 11)Quepen (ST 12)Qihu (ST 13)Hufang (ST 14)Wuyi (ST 15)Yingchuang (ST 16)Ruzhong (ST 17)Rugen (ST 18)Burong (ST 19) Chengman (ST 20)Liangmen (ST 21)Guanmen (ST 22)Taiyi (ST 23)Huaroumen (ST 24)Tianshu (ST 25)Wailing (ST 26) Daju (ST 27)Shuidao (ST 28)Guilai (ST 29)Qichong (ST 30)Biguan (ST 31)Futu (ST 32)Yinshi (ST 33)Liangqiu (ST 34)Dubi (ST 35)Zusanli (ST 36)Shangjuxu (ST 37)Tiaokou (ST 38)Xiajuxu (ST 39)Fenglong (ST 40)Jiexi (ST 41) Chongyang (ST 42)Xiangu (ST 43)Neiting (ST 44)Lidui (ST 45)
Acupoint Chengqi (ST 1) Location Below the pupil, between the eyeball and the infraorbital ridge Special points Indications Redness, swelling and pain of the eye, lacrimation, night blindness, twitching of eyelids, facial paralysis Note perpendicularl y and slowly 0.5-1 cun along the infraoribital ridge Perpendicular0 .2-0.3 cun; Perpendicular 0.3-0.5 cun; Subcutaneousl y 1.0-1.5 cun with the tip of the needle directed towards Jiache Obliquely 0.30.5 cun Qishe (ST 11) Shuitu (ST 10) Xiaguan (ST 7) Touwei (ST 8) Renying (ST 9) Anterior to the ear, in the depression between the zygomatic arch and mandibular notch Lateral side of the head, 0.5 cun above the anterior hairline, 4.5 cun lateral to the midline of the head Anterior border of m. sternocleidomastoideus where the pulsation of common carotid artery is palpable Midpoint of the line joining Renying(ST 9) and Qishe(ST 11). Anterior border of m. sternocleidomastoideus Superior border of the sternal extremity of the clavicle, between the sternal head and clavicular head of m. sternocleidomastoideus Midpoint of the supraclavicular fossa, 4 cun lateral to the anterior midline Lower border of the middle of the clavicle, 4 cun lateral to the anterior midline First intercostal space, 4 cun lateral to the anterior midline Second intercostal space, 4 cun lateral to the anterior midline Third intercostal space, 4 cun lateral to the anterior midline Fourth intercostal space, centre of the nipple, 4 cun lateral to the anterior midline is palpable m. masseter is prominence when the teeth are clenched

TCM REVIEW

Jiache (ST 6)

Facial paralysis, toothache, swelling of the cheek and face, mumps, trismus

Deafness, tinnitus, otorrhea, toothache, facial paralysis, pain of the face, motor impairment of the jaw Headache, blurring of vision, ophthalmalgia, lacrimation

Perpendicular insert 0.3-0.5 cun; or subcutaneousl y with the tip of the needle directed towards Dicang Perpendicular insert 0.3-0.5 cun Subcutaneousl y 0.5-1 cun

Sore throat, asthma, goiter, dizziness, flushing of the face

Sore throat, asthma, cough

Avoid the common carotid artery, perpendicularl y 0.3-0.5 cun Perpendicular 0.3-0.5 cun

Sore throat, pain and rigidity of the neck, asthma, hiccup, goiter

Perpendicular 0.3-0.5 cun

Quepen (ST 12) Qihu (ST 13) Hufang (ST 14) Wuyi (ST 15) Yingchuang (ST 16) Ruzhong (ST 17)

Cough, asthma, sore throat, pain in the supraclavicular fossa

Perpendicular 0.3-0.5 cun

Sibai (ST 2) Juliao (ST 3) Dicang (ST 4)

Directly below the pupil, in the depression at the infraorbital foramen Directly below the pupil, at the level of the lower border of ala nasi Lateral to the corner of the mouth, directly below the pupil

Redness, pain and itching of the eye, facial paralysis, twitching of eye lids, pain in the face Facial paralysis, twitching of eyelids, epistaxis, toothache, swelling of lips and cheek Deviation of the mouth, salivation, twitching of eyelids

Fullness in the chest, asthma, cough, hiccup, pain in the chest and hypochondrium Sensation of fullness and pain in the chest, cough Fullness and pain in the chest and costal region, cough, asthma, mastitis Fullness and pain in the chest and hypochondrium, cough, asthma, matitis Contraindicated in acupuncture and moxibustion

Obliquely 0.30.5 cun

Obliquely 0.30.5 cun Obliquely 0.30.5 cun Obliquely 0.30.5 cun Contraindicate d

Daying (ST 5)

Anterior border of the attached portion of m. masseter where the pulsation of facial artery

Facial paralysis, trismus, swelling of the cheek, pain in the face, toothache

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TCM REVIEW
Rugen (ST 18) Burong (ST 19) Chengman (ST 20) Liangmen (ST 21) Guanmen (ST 22) Taiyi (ST 23) Huaroumen (ST 24) Tianshu (ST 25) Directly below the nipple, 5th intercostal space, 4 cun lateral to the anterior midline 6 cun above the umbilicus, 2 cun lateral to Juque(CV 14) 5 cun above the umbilicus, 2 cun lateral to Shangwan(CV 13) 4 cun above the umbilicus, 2 cun lateral to Zhongwan(CV 12) 3 cun above the umbilicus, 2 cun lateral to Jianli (CV 11) 2 cun above the umbilicus, 2 cun lateral to Xiawan (CV 10) 1 cun above the umbilicus, 2 cun lateral to Shuifen(CV 9) 2 cun lateral to the centre of the umbilicus Front-Mu Pain in the chest, cough, asthma, mastitis, insufficient lactation Obliquely 0.30.5 cun Yinshi (ST 33) the anterior superior iliac spine 3 cun above the laterosuperior border of the patella, on the line joining the laterosuperior border of the patella and the anterior superior iliac spine 2 cun above the laterosuperior border of the patella Lower border of the patella, in the depression lateral to the patellar ligament 3 cun below Dubi (ST 35), one finger-breadth (middle fingle) from the anterior border of the tibia

TCM REVIEW

Abdominal distension, vomiting, gastric pain, anorexia Gastric pain, abdominal distension, vomiting anorexia. Gastric pain, vomiting, anorexia, abdominal distension, diarrhea Abdominal distension and pain, anorexia, borborygmus, diarrhea, edema Gastric pain, irritability, mania, indigestion Gastric pain, vomiting, mania

Perpendicularl y 0.5-0.8 cun Perpendicularl y 0.5-1.0 cun Perpendicular 0.8-1.0 cun Perpendicular 0.8-1.0 cun Perpendicular 0.7-1.0 cun Perpendicular 0.7-1.0 cun Perpendicular 0.7-1.2 cun

Numbness, soreness, motor impairment of the leg and knee, motor impairment of the lower extremities

Perpendicular 0.7-1.0 cun

Liangqiu (ST 34) Dubi (ST 35) Zusanli (ST 36)

Pain and numbness of the knee, gastric pain, mastitis, motor impairment of the lower extremities Pain, numbness and motor impairment of the knee, beriberi

Perpendicular 0.5-1.0 cun Perpendicular 0.7-1.0 cun

He-Sea point

Wailing (ST 26) Daju (ST 27) Shuidao (ST 28) Guilai (ST 29) Qichong (ST 30)

1 cun below the umbilicus, 2 cunlateral to Yinjiao(CV 7) 2 cun below the umbilicus, 2 cun lateral to Shimen (CV 5) 3 cun below the umbilicus, 2 cun lateral to Guanyuan(CV 4) 4 cun below the umbilicus, 2 cun lateral to Zhongji(CV 3) 5 cun below the umbilicus, 2 cun lateral to Qugu(CV 2)

Abdominal pain and distension, borborygmus, pain around the umbilicus, constipation, diarrhea, dysentery, irregular menstruation, edema Abdominal pain, hernia, dysmenorrhea Lower abdominal distension, dysuria, hernia, seminal emission, premature ejaculation Lower abdominal distension, retention of urine, edema, hernia, dysmenorrheal, sterility Abdominal pain, hernia, dysmenorrheal, irregular menstruation, amenorrhea, leucorrhea, prolapse of the uterus Abdominal pain, borborygmus, hernia, swelling and pain of the external genitalia, impotence, dysmenorrheal, irregular menstruation Pain in thigh, muscular atrophy, motor impairment, numbness and pain of the lower extremities

Shangjuxu Perpendicular 0.7-1.2 cun Perpendicular 0.7-1.2 cn Perpendicular 0.7-1.2 cun Perpendicular 0.7-1.2 cn (ST 37) Tiaokou (ST 38) Xiajuxu (ST 39) Fenglong (ST 40) Perpendicular 0.5-1.0 cun Jiexi (ST 41) Perpendicular 1.0-1.5 cn Chongyang

6 cun below Dubi (ST 35) and one finger breadth from the anterior border of the tibia. 8 cun below Dubi and one finger breadth from the anterior border of the tibia 9 cun below Dubi and one finger breadth from the anterior border of the tibia 8 cun superior to the tip of the external malleolus, lateral to Tiaokou(ST 38) about two finger-breadth lateral to the anterior border of the tibia Dorsum of the foot, midpoint of the transverse crease of the ankle joint, at the level of the tip of the external malleolus Dome of the instep of the foot, pulsation of the dorsal artery of foot is palpable Depression distal to the

Lower He-Sea point of the large intestine

Lower He-Sea point of the small intestine LuoConnecting point

Jing-River point

Biguan (ST 31)

Futu (ST 32)

On the level of the perineum when the thigh is fixed, in the depression lateral to the Sartorius muscle. 6 cun above the laterosuperior border of the patella, on the line joining the laterosuperior border of the patella and

Pain in the lumbar and iliac region, coldness of the knee, paralysis or motor impairment and pain of the lower extremities, beriberi

Perpendicular 1.0-1.5 cun

(ST 42)

Yuan-Primary Point

Gastric pain, vomiting hiccup, abdominal distension, borborygmus, diarrhea, dysentery, constipation, mastitis, enteritis, aching of the knee and leg, beriberi, edema, cough, asthma, emaciation due to general deficiency, indigestion, apoplexy, hemiplegia, dizziness, insomnia, mania Abdominal pain and disresion, borborygmus, diarrhea, dysentery, constipation, enteritis, paralysis due to stroke Numbness, soreness and pain of the knee and leg, weakness and motor impairment of the foot and should, abdominal pain Lower abdominal pain, backache referring to the testis, mastitis, numbness and paralysis of the lower extremities Headache, dizziness and vertigo, cough, asthma, excessive sputum, pain in the chest, constipation, mania, epilepsy, muscular atrophy, motor impairment, pain, swelling or paralysis of the lower extremities Pain of the ankle joint, muscular atrophy, motor impairment, pain and paralysis of the lower extremities, epilepsy, headache, dizziness and vertigo, abdominal distension, constipation. Pain of the upper teeth, redness and swelling of he dorsum of the foot, facial paralysis, muscular atrophy and motor impairment of the foot Facial or general edema, abdominal

Perpendicular 0.5-1.2 cun

Perpendicular 0.5-1.2 cun

Perpendicular 0.5-1.0 cun

Perpendicular 0.5-1 cun

Perpendicular 0.5-1.0 cun

Perpendicular 0.5-0.7 cun

Xiangu

Shu-Stream

Avoid puncturing the artery, perpendicular 0.3-0.5 cun Perpendicular

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(ST 43) Neiting (ST 44) junction of the second and third metatarsal bones Proximal to the web margin between the second and third toes, depression distal and lateral to the second metatarsodigital joint Lateral side of the 2nd toe, 0.1 cun posterior to the corner of the nail. point Ying-Spring point pain, borborygmus, swelling and pain of the dorsum of the foot Toothache, pain in the face, deviation of the mouth, sore throat, epistaxis, gastric pain, acid regurgitation, abdominal distension, diarrhea, dysentery, constipation, swelling and pain of the foot, febrile disease Facial swelling, deviation of the mouth, epistaxis, toothache, sorethroat and hoarse voice, abdominal distension, coldness in the leg and foot, febrile diseases, dreamdisturbed sleep, mania 0.3-0.5 cun Gongsun Perpendicular 0.3-0.5 cun (SP 4) the red and white skin Depression distal and inferior to the base of the first metatarsal bone, at the junction of the red and white skin

TCM REVIEW
sluggishness, beriberi Gastric pain, vomiting, abdominal pain and distension, diarrhea, dysentery, borborygmus.

Lidui (ST 45)

Jing-Well point

Subcutaneous 0.1 cun Shangqiu (SP 5) Depression distal and inferior to the medial malleolus, midway between the tuberosity of the navicular bone and the tip of the medial malleolus 3 cun directly above the tip of the medial malleolus, posterior to the medial border of the tibia

LuoConnecting; eight convergent acupoint associating with the Chong meridian Jing-River

Perpendicular insert 0.5-0.8 cun

Abdominal distension, constipation, diarrhea, borborygmus, pain and rigidity of the tongue, pain in the foot and ankle, hemorrhoid Abdominal pain, borborygmus, abdominal distension, diarrhea, dysmenorrheal, irregular menstruation, uterine bleeding, morbid leucorrhea, prolapse of the uterus, sterility, delayed labour, nocturnal emission, impotence, enuresis, dysuria, edema, hernia, pain in the external genitalia, muscular atrophy, motor impairment, paralysis and pain of the lower extremities, headache, dizziness and vertigo, insomia Abdominal distension, borborygmus, coldness, numbness and paralysis of the knee and leg

Perpendicular insert 0.2-0.3 cun;

4. The spleen meridian of foot-tai yin Cyclical flowing and distribution: the Spleen Meridian starts from the tip of the big toe. It runs along the medial aspect of the big toe between the red and white skin and ascends to the front of the medial malleolus and further up to the medial aspect of the leg. It follows the posterior aspect of the tibia and passes through the front of the Liver Meridian. Going on along the anterior medial aspect of the knee and then the thigh, it enters the abdomen, reaches the spleen, its pertaining organ, and connects with the stomach. Passing through the disphragm and running alongside the esophagus, it reaches the root of the tongue, and apreads over under the tongue. A branch goes upwards through the stomach and the diaphragm, then flows into the heart. Indications: Disorders of the spleen and stomach, gynecological diseases, genital problems and diseases involving the areas through which the meridian flows. Acupoints: Yinbai (SP 1); Dadu (SP 2); Taibai (SP 3); Gongsun (SP 4); Shangqiu (SP 5); Sanyinjiao (SP 6); Lougu (SP 7); Diji (SP 8); Yinlingquan (SP 9); Xuehai (SP 10); Jimen (SP 11); Chongmen (SP 12); Fushe (SP 13); Fujie (SP 14); Daheng (SP 15); Fuai (SP 16); Shidou (SP 17); Tianxi (SP 18); Xiongxiang (SP 19); Zhourong (SP 20); Dabao (SP 21);
Acupoint Yinbai (SP 1) Dadu (SP 2) Location Medial side of the great toe, 0.1 cun posterior to the corner of the nail Medial side of the great toe, distal and inferior to the first metatarsodigital joint, depression of the junction of the red and white skin Proximal and inferior to the 1st metatarsophalangeal joint, depression of the junction of Special points Jing-Well point Indications Abdominal distension, bloody stools, menorrhagia, uterine bleeding, mental disorders, dreamdisturbed sleep, convulsion Abdominal distension, gastric pain, constipation, febrile diseases with anhidrosis Note Subcutaneous 0.1 cun

Sanyinjiao (SP 6)

Xi-Cleft acupoint

Perpendicular insert 0.5-1 cun; Contraindicate d in pregnant women.

Lougu (SP 7)

Diji (SP 8) Yinlingqu an (SP 9)

6 cun from the tip of the medial malleolus, on the line connecting the tip of the medial malleolus and Yinlingquan, posterior to the medial border of the tibia 3 cun below Yinlingquan (SP 9), on the line connecting Yinlingquan and medial malleolus Lower border of the medial condyle of the tibia, depression posterior and inferior to the midial condyle of the tibia 2 cun above the mediosuperior border of the patella, on the bulge of the medial portion of m. quadriceps femoris 6 cun above Xuehai(SP 10), on the line drawn from Xuehai to Chongmen(SP 12)

Luoconnecting

Perpendicular 0.5-1.0 cun

Xi-Cleft

He-Sea

Xuehai (SP 10)

Ying-Spring

Perpendicular 0.1-0.3 cun

Jimen Perpendicular insert 0.3-0.5 cun (SP 11)

Taibai (SP 3)

Shu-Stream

Gastric pain, abdominal distension, constipation, dysentery, vomiting diarrhea, borborygmus,

Abdominal pain and distension, diarrhea, edema, dysuria, nocturnal emission, irregular menstruation, dysmenorrheal Abdominal pain and distension, diarrhea, dysentery, edema, jaundice, dysuria, enuresis, incontinence of urine, pain in the external genitalia dysmenorrheal, pain in the knee Irregular menstruation, dysmenorrhea, uterine bleeding, amenorrhea, urticaria, eczema, erysipelas, pain in the medial aspect of the thigh. Dysuria, enuresis, pain and swelling in the inguinal region, muscular atrophy, motor impairment, pain and paralysis of the lower extremities

Perpendicular 0.5-1.0 cun

Perpendicular 0.5-1.0 cun

Perpendicular 0.5-1.2 cun

Perpendicular 0.5-1.0 cun

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Chongme n (SP 12) Superior to the lateral end of the inguinal groove, lateral to the pulsating external iliac artery, at the level of the upper border of symphysis pubis, 3.5 cun lateral to Qugu(CV 2) 4 cun below the centre of the umbilicus, 0.7 cun superior to Chongmen, 4 cun lateral to the anterior midline 1.3 cun below Daheng(SP 15), 4 cun lateral to the anterior midline on the lateral side of m. rectus abdominis 4 cun lateral to the center of the umbilicus, lateral to m. rectus abdominis 3 cun above the centre of the umbilicus, and 4 cun lateral to the anterior midline Fifth intercostal space, 6 cun lateral to the anterior midline In the fourth intercostal space, 6 cun lateral to the anterior midline In the third intercostal space, 6 cun lateral to the anterior midline In the second intercostal space, 6 cun lateral to the anterior midline Lateral side of the chest and on the middle axillary line, in the 6th intercostal space Major LuoConnecting Abdominal pain, hernia, dysuria Avoid puncturing the artery, perpendicular 0.5-1.0 cun Perpendicular 0.5-1.0 cun

TCM REVIEW Acupoints: Jiquan (HT 1)Qing Ling (HT 2)Shao Hai (HT 3)Ling Dao (HT 4)Tong Li (HT 5)Yin Xi (HT 6)Shen Men (HT 7) Shao Fu (HT 8)Shao Chong (HT 9);
Acupoint Jiquan (HT 1) Location In the center of the axilla on the radial side of the axillary artery With the elbow flexed, 3 cun above HT 3 on the ulnar side of the biceps brachii in the medial groove. With the elbow flexed, between the ulnar end of the cubital crease and the medial epicondyle of the humerus. 1.5 cun above the wrist crease on the radial side of the flexor carpi ulnaris tendon, on the HT 3 - HT 7 line. 1 cun above the wrist crease on the radial side of the flexor carpi ulnaris tendon, on the HT 3 - HT 7 line 0.5 cun above the wrist crease on the radial side of the flexor carpi ulnaris tendon, on the HT 3 - HT 7 line. At the wrist crease, on the radial side of the flexor carpi ulnaris tendon, between the ulna and the pisiform bones. Special points Indications Pain in the costal and cardiac regions, scrofula, cold pain of the elbow and arm, dryness of the throat Pain in the cardiac and hypochondriac regions, shoulder and arm Note Perpendicularly 0.5-1 cun; avoid the axillary artery Perpendicularly 0.3-0.5 cun.

Fushe (SP 13) Fujie (SP 14) Daheng (SP 15) Fuai (SP 16) Shidou (SP 17) Tianxi (SP 18) Xiongxian g (SP 19) Zhourong (SP 20) Dabao (SP 21)

Lower abdominal pain, hernia

Pain around the umbilical region, abdominal distension, hernia, diarrhea, constipation Abdominal pain and distension, diarrhea, dysentery, constipation Abdominal pain, indigestion, constipation, dysentery Fullness and pain in the chest and hypochondriac region Fullness and pain in the chest and hypochondrium, cough, hiccup, mastitis, insufficient lactation Fullness and pain in the chest and hypochondriac region Fullness in the chest and hypochondriac region, cough, hiccup Pain in the chest and hypochondriac region, asthma, general aching and weakness

Perpendicular 0.5-1.0 cun

Qing Ling (HT 2) Shao Hai (HT 3) Ling Dao (HT 4) Tong Li (HT 5) Yin Xi (HT 6)

Perpendicular 0.7-1.2 cun Perpendicular 0.5-1.0 cun Obliquely 0.30.5 cun Obliquely 0.30.5 cun Obliquely 0.30.5 cun Obliquely 0.30.5 cun Obliquely 0.30.5 cun

He-Sea

Jing-River

Cardiac pain, spasmodic pain and numbness of the hand and arm, tremor of the hand, scrofula, pain in the axilla and hypochondriac region Cardiac pain, spasmodic pain of the elbow and arm, sudden loss of voice

Perpendicularly 0.5-1 cun.

Perpendicular insert 0.3-0.5 cun

Luo-Connecting

Xi-Cleft acupoint

Palpitation, dizziness, blurring of vision, sore throat, sudden loss of voice, aphasia with stiffness of the tongue, pain in the wrist and elbow Cardiac pain, hysteria, night sweating, hemoptysis, epistaxis, sudden loss of voice

Perpendicular insert 0.3-0.5 cun

Perpendicular insert 0.3-0.5 cun

Shen Men (HT 7)

Shu-Stream and Yuan-Primary

5. The heart meridian of hand-shaoyin Cyclical flowing and distribution: the Heart Meridian originates from the heart, spreads over the heart system. It goes down through the diaphragm to connect with the small intestine. The ascending portion of the meridian from the heart system runs along side the eaophagus to connect with the eye system. The straight portion of the meridian from the heart system goes upward to the lung, then it runs out from the axilla, it goes along the posterior border of the medial aspect of the upper arm behind the Lung Meridian and Pericardium Meridian, it runs downward the medial aspect ot the elblow and descends along the posterior border of the medial aspect of the forearm to the pisiform region proximal to the palm and enters the palm, it follows the medial aspect of the little finger to its tip. Indications: Disorders of the heart and chest and mental problems as well as diseases involving the regions covered by the meridian in cyclical flowing.

Shao Fu (HT 8) Shao Chong (HT 9)

When a loose fist is made where the tip of the little finger rests between the 4th and 5th metacarpal bones. 0.1 cun posterior to the corner of the nail on the radial side of the little finger.

Ying-Spring

Jing-Well

Cardiac pain, irritability, palpitation, hysteria, amnesia, insomnia, mania, epilepsy, dementia, pain in the hypochondriac region, feverish sensation in the palm, yellowish sclera Palpitation, pain in the chest, spasmodic pain of the litter, feverish sensation in the palm, enuresis, dysuria, pruritus of the external genitalia Palpitation, cardiac pain, pain in the chest and hypochondriac regions, mania, febrile diseases, loss of consciousness

Perpendicularly 0.3-0.5 cun

Perpendicularly 0.3-0.5 cun.

Puncture subcutaneously 0.1 cun, or prick bleeding.

6. The small intestine meridian of hand-taiyang

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TCM REVIEW Cyclical flowing and distribution: The Small Intestine Meridian starts from the ulnar side of the tip of the little finger. Following the ulnar side of the dorsum of the hand, it reaches the wrist. Then it goes out from the styloid process of the ulna, ascends along the posterior border of the lateral aspect of the forearm, passes between the olecranon of the ulna and the medial epicondyle of the humerus and runs along the posterior border of the lateral aspect of the upper arm to the shoulder joint. Circling around the scapular region, it meets the ruperior aspect of the shoulder, then turns downward to the supraclavicular fossa. It connects with the heart. From there, then it descends alon gthe exophagus, passes through the diaphragm, reaches the stomach and enters the small intestine, its pertaining organ. The branch from the supraclavicular fossa ascends along the neck to the cheek, reaches the outer canthus and enters the ear. The branch from the cheek runs upward to the infraobital region and further to the lateral side of the nose, then it reaches the inner canthus. Indications: Disorders of the organs on the face and throat, febrile disease and pathological changes of the lateral side of the upper limbs, scapula and neck. Acuponits: Shao Ze (SI 1); Qian Gu (SI 2); Hou Xi (SI 3); Wan Gu (SI 4); Yang Gu (SI 5); Yang Lao (SI 6); Zhi Zheng (SI 7); Xiao Hai (SI 8); Jian Zhen (SI 9); Nao Shu (SI 10); Tian Zong (SI 11); Bing Feng (SI 12); Qu Yuan (SI 13); Jian Wai Shu (SI 14); Jian Zhong Shu (SI 15); Tian Chuang (SI 16); Tian Rong (SI 17); Quan Liao (SI 18); Ting Gong (SI 19);
Acupoint Shao Ze (SI 1) Location 0.1 cun posterior to the corner of the nail on the ulnar side of the little finger When a loose fist is made, at the ulnar end of the crease, distal to the 5th metacarpophalangeal joint at the junction of the red & white skin. When a loose fist is made, at the ulnar end of the distal palmar crease proximal to the 5th metacarpal phalangeal joint at the junction of the red & white skin On the ulnar side of the palm in a depression between the base of the 5th metacarpal joint and the hamate bone. On the ulnar end of the Special points Jing-Well Indications Headache, febrile diseases, loss of consciousness, insufficient lactation, sore throat, redness of the eyes, cloudiness of the cornea Numbness of the fingers, febrile diseases, tinnitus, headache, reddish urine Note Subcutaneously 0.1 cun, or prick bleeding; (SI 5) transverse wrist crease in a depression between the styloid process of the ulna and the triquetral bone. Dorsal to the head of the ulna in the body cleft on the radial side of the styloid process, found with the palm facing the chest 5 cun proximal to the dorsal crease of the wrist on the SI 5 to SI 8 line. Between the olecranon process of the ulna and the medial epicondyle of the humerus, found with the elbow flexed. 1 cun above the posterior end of the axillary fold, posterior and inferior to the shoulder joint, found with the arm adducted. With the arm abducted, directly above SI 9 in a depression inferior to the scapular spine. On the scapula in a depression at the center of the infrascapular fossa, at the level of the 4th thoracic vertebra Directly above SI 11 in the center of the suprascapular fossa, found in a depression when the arm is lifted. At the medial extremity of the suprascapular fossa midway between SI 10 and the spinous process of T2. 3 cun lateral to the spinous process of T1 (GV 13). 2 cun lateral to the spinous process of C7 (GV 14)

TCM REVIEW
submandibular region, pain of the hand and wrist, febrile diseases Xi-Cleft Blurring of vision, pain in the shoulder, elbow and arm insert 0.3-0.5 cun

Yang Lao (SI 6)

Perpendicular insert 0.3-0.5 cun

Zhi Zheng (SI 7) Xiao Hai (SI 8)

Luo-Connecting

He-Sea

Neck rigidity, headache, dizziness, spasmodic pain in the elbow and fingers, febrile diseases, mania. Headache, swelling of the cheek, pain in the nape, shoulder, arm and elbow, epilepsy Pain in the scapular region, motor impairment of the hand and arm

Perpendicularly 0.5-0.8 cun

Perpendicularly 0.3-0.5 cun.

Jian Zhen (SI 9)

Perpendicularly 0.5-1 cun

Nao Shu (SI 10) Tian Zong (SI 11) Bing Feng (SI 12) Qu Yuan (SI 13)

Swelling of the shoulder, aching and weakness of the shoulder and arm Pain in the scapular region, pain in the lateroposterior aspect of the elbow and arm, asthma Pain in the scapular region, numbness and aching of the upper extremities, motor impairment of the shoulder and arm Pain and stiffness of the scapular region

Perpendicularly 0.5-1 cun

Perpendicularly obliquely 0.5-1 cun

Perpendicularly 0.5-0.7 cun

Qian Gu (SI 2)

Ying-Spring

Perpendicularly 0.3-0.5 cun

Perpendicularly 0.3-0.5 cun

Hou Xi (SI 3)

Shu-Stream, one of the eight confluent points

Wan Gu (SI 4)

Yuan-primary

Yang Gu

Jing-River

Pain and rigidity of the neck, tinnitus, deafness, sore throat, mania, malaria, acute lumbar sprain, night sweating, febrile diseases, contracture and numbness of the fingers, pain in the shoulder and elbow Febrile diseases with anhidrosis, headache, rigidity of the neck, contracture of the fingers, pain in the wrist, jaundice Swelling of the neck and

Perpendicularly 0.5-0.7 cun.

Jian Wai Shu (SI 14) Jian Zhong

Aching of the shoulder and back, pain and rigidity of the neck Cough, asthma, pain in the shoulder and back, hemoptysis

Obliquely 0.30.7 cun

Obliquely 0.30.6 cun

Perpendicular insert 0.3-0.5 cun

Shu Tian Chuang

Perpendicular

On the lateral side of the neck, posterior to the SCM and LI 18, level

Sore throat, sudden loss of voice, deafness, tinnitus, stiffness and pain of the neck

Perpendicularly 0.3-0.7

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TCM REVIEW
(SI 16) Tian Rong (SI 17) Quan Liao (SI 18) Ting Gong (SI 19) with the Adam's apple. Posterior to the angle of the mandible in a depression on the anterior border of the SCM Directly below the outer canthus of the eye in a depression on the lower border of the zygoma. Anterior to the tragus and posterior to the condyloid process of the mandible, in a depression formed when the mouth is opened Deafness, tinnitus, sore throat, swelling of the cheek, foreign body sensation in the throat, goiter Facial paralysis, twitching of eyelids, pain in the face, toothache, swelling of the cheek, yellowish sclera. Deafness, tinnitus, otorrhea, motor impairment of the mandibular joint, toothache Perpendicularly 0.5-0.7 cun

TCM REVIEW Shu (UB 27)Pang Guang Shu (UB 28)Zhong Lu Shu (UB 29)Bai Huan Shu (UB 30)Shang Liao (UB 31)Ci Liao (UB 32)Zhong Liao (UB 33)Xia Liao (UB 34)Hui Yang (UB 35)
Perpendicularly 0.5-0.8 cun

Cheng Fu (UB 36)Yin Men (UB 37)Fu Xi (UB 38)Wei Yang (UB 39)Wei Zhong (UB 40)Fu Fen (UB 41)Po Hu (UB 42)Gao Huang Shu (UB 43)Shen Tang (UB 44)Yi Xi (UB 45)Ge Guan (UB 46)Po Men (UB 47)Yang Gang (UB 48)Yi She (UB 49)Wei Cang (UB 50)Huang Men (UB 51)Zhi Shi (UB 52)Bao Huang (UB 53)Zhi Bian (UB 54)He Yang (UB 55)Cheng Jin (UB 56)Cheng Shan (UB 57)Fei Yang (UB 58)Fu Yang (UB 59) Kun Lun (UB 60)Pu Can (UB 61)Shen Mai (UB 62)Jin Men (UB 63)Jing Gu (UB 64)Shu Gu (UB 65)Zu Tong Gu (UB 66) Zhi Yin (UB 67)
Acupoint Jing Ming (UB 1) Zan Zu (UB 2) Location In a depression, 0.1 cun above the inner canthus of the eye. Special points Indications Redness, swelling and pain of the eye, itching of the canthus, lacrimation, night blindness, colour blindness, bluring of vision, myopia Headache, blurring and failing of vision, pain in the supraorbital region, lacrimation, redness, swelling and pain of the eye, twitching of eyelids, glaucoma Headache, giddiness, epilepsy, nasal obstruction Note Puncture slowly perpendicularly 0.3-0.7 cun. Moxibustion is forbidden Subcutaneously 0.3-0.5 cun, or prick bleeding

Perpendiculary 0.5-1 cun

7. The bladder meridian of foot-taiyang Cyclical flowing and distribution: The Bladder Meridian starts from the inner canthus and then ascends to the forehead, and joins the vertex. A branch arises from the vertex, runs to the temple. The straight portion of the meridian enters and communicates with the brain from the vertex. It comes out and bifurcates to descend along the posterior aspect of the neck. and then downward along the medial aspect of the scapula region and paralleled to the vertebral column. It reaches the lumber region where it enters the body cavity via the paravertebral muscle to connect with the kidney and join its pertaining organ, the urinary bladder. The branch of the lumbar region descends through the gluteal region and ends in the popliteal fossa. The branch from the posterior aspect of the neck runs straight downward along the medial border of the scapula, passes through the gluteal region and downward along the lateral aspect of the thigh, to meet the preceding branch descending from the lumbar region in the popliteal fossa, then descends through the gastrocnemius muscle to the posterior aspect of the external malleolus, then runs along the tuberosity of the external metatarsal bone, and reaches the lateral side of the tip of the little toe. Indications: Redness, swelling and pain of eyes, epiphora, blurred vision, dizziness, nearsightedness, night blindness and color blindness Acupoints: Jing Ming (UB 1)Zan Zu (UB 2)Mei Chong (UB 3)Qu Cha (UB 4)Wu Chu (UB 5)Cheng Guang (UB 6)Tong Tian (UB 7)Luo Que (UB 8)Yu Zhen (UB 9)Tian Zhu (UB 10)Da Zhu (UB 11)Feng Men (UB 12)Fei Shu (UB 13)Jue Yin Shu (UB 14)Xin Shu (UB 15)Du Shu (UB 16)Ge Shu (UB 17)Gan Shu (UB 18)Dan Shu (UB 19)Pi Shu (UB 20)Wei Shu (UB 21)San Jiao Shu (UB 22)Shen Shu (UB 23)Qi Hai Shu (UB 24)Da Chang Shu (UB 25)Guan Yuan Shu (UB 26)Xiao Chang Page 47 of 113

On the medial end of the eyebrow, directly above the inner canthus of the eye (on the supraorbital notch). 0.5 cun inside the anterior hairline, directly above UB 2, between GV 24 and UB 4. 1.5 cun lateral to GV 24, or 0.5 cun inside the AHL at the junction of the medial 1/3 and lateral 2/3's distance between GV 24 & ST 8. 0.5 cun behind UB 4 or 1 cun above the AHL and 1.5 cun lateral to the AML or 1.5 cun lateral to GV 23. 1.5 cun posterior to UB 5 or 2.5 cun above AHL and 1.5 cun lateral to the AML. 4 cun above the anterior

Mei Chong (UB 3) Qu Cha (UB 4)

Subcutaneously 0.3-0.5 cun

Headache, nasal obstruction, epistaxis, blurring and failing of vision

Subcutaneously 0.3-0.5 cun

Wu Chu (UB 5) Cheng Guang (UB 6) Tong Tian

Headache, blurring of vision, epilepsy, convulsion

Subcutaneously 0.3-0.5 cun

Headache, blurring of vision, nasal obstruction

Subcutaneously 0.3-0.5 cun

Headache, giddiness, nasal

Subcutaneously

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TCM REVIEW
(UB 7) Luo Que (UB 8) Yu Zhen (UB 9) hairline and 1.5 lateral to the midline 5.5 cun above the anterior hairline and 1.5 cun lateral to the midline 1.3 cun lateral to GV 17 or 2.5 cun above the posterior hairline and lateral to the midline in a depression level with GV 17 0.5 cun above the posterior hairline and 1.3 cun lateral to the midline on the lateral aspect of the trapezius muscle 1.5 cun lateral to GV 13 level with T1 obstruction, epistaxis, rhinorrhea Dizziness, blurring of vision, tinnitus, mania Headache and neck pain, dizziness, ophthalmalgia, nasal obstruction 0.3-0.5 cun Subcutaneously 0.3-0.5 cun Subcutaneously 0.3-0.5 cun Pi Shu (UB 20) 1.5 cun lateral to GV 6 level with T11 - SP Shu

TCM REVIEW
Back-shu point of the Spleen Epigastric pain, abdominal distension, jaundice, vomiting, diarrhea, dysentery, bloody stools, profuse menstruation, edema, anorexia, backache Pain in the chest and hypochondriac and epigastric regions, anorexia, abdominal dissension, borborygmus, diarrhea, nausea, vomit Borborygmus, abdominal distension, indigestion, vomiting, diarrhea, dysentery, edema, pain and stiffness of the lower back Nocturnal emission, impotence, enuresis, irregular menstruation, leucorrhea, low back pain, weakness of the knee, blurring of vision, dizziness, tinnitus, deafness, edema, asthma, diarrhea Low back pain, irregular menstruation, dysmenorrheal, asthma Low back pain, borborygmus, abdominal distension, diarrhea, constipation, muscular atrophy, pain, numbness and motor impairment of the lower extremities, sciatica Low back pain, abdominal distension, diarrhea, enuresis, sciatica, frequent urination Lower abdominal pain and distension, dysentery, nocturnal emission, hematuria, enuresis, morbid leucorrhea, lower back pain, sciatica Retention of urine, enuresis, frequent urinaton, diarrhea, constipation, stiffness and pain of the lower back Dysentery, hernia, stiffness and pain of the lower back Obliquely 0.50.7 cun

Wei Shu (UB 21) San Jiao Headache, nasal obstruction, sore throat, neck rigidity, pain in the shoulder and back Perpendicularly 0.5-0.8 cun Shu (UB 22) Shen Shu Influential point of bone Headache, pain in the neck and back, pain and soreness in the scapular region, cough ,fever, neck rigidity Common cold, cough, fever and headache, neck rigidity, backache Cough, asthma, chest pain, spitting of blood, afternoon fever, night sweating Cough, cardiac pain, palpitation, stuffy chest, vomiting Cardiac pain, panic, loss of memory, palpitation, cough, spitting of blood, nocturnal emission, night sweating, mania, epilepsy Hot a/or toxic skin conditions (esp. on the back): acne, boils, etc. Vomiting, hiccup, belching, difficulty in swallowing asthma, cough, spitting of blood, afternoon fever, night sweating, measles Jaundice, pain in the hypochondriac region, redness of the eye, blurring of vision, night blindness, mental disorders, epilepsy, backache, spitting of blood, epistaxis Jaundice, bitter taste of the mouth, pain in the chest and hypochondriac region, pulmonary tuberculosis, afternoon fever Obliquely 0.50.7 cun (UB 23)

1.5 cun lateral to midline level with T12 - ST Shu

Back-shu point of the stomach

Obliquely 0.50.8 cun

1.5 cun lateral to GV 5 level with L1 - TH Shu

Back-shu point of triple energizer

Perpendicularly 0.5-1 cun

Tian Zhu (UB 10) Da Zhu (UB 11) Feng Men (UB 12) Fei Shu (UB 13) Jue Yin Shu (UB 14) Xin Shu (UB 15) Du Shu (UB 16) Ge Shu (UB 17)

1.5 cun lateral to GV 4 level with L2 - KD Shu

Back-shu point of the Kidney

Perpendicularly 1-1.2 cun

1.5 cun lateral to midline level with T2 - Wind Shu 1.5 cun lateral to GV 12 level with T3 - LU Shu 1.5 cun lateral to midline level with T4 - PC Shu Back-Shu point of the Lung Back-shu point of the Pericardium

Obliquely 0.50.7 cun Obliquely 0.50.7 cun Obliquely 0.50.7 cun

Qi Hai Shu (UB 24) Da Chang Shu (UB 25)

1.5 cun lateral to midline level with L3 - Qi Shu

Sea of Qi Back-shu Point

Perpendicularly 0.8-1.2 cun

1.5 cun lateral to GV 3 level with L4 - LI Shu

Back-shu point of the large intestine

Perpendiculary 0.8-1.2 cun

1.5 cun lateral to GV 11 level with T5 - HT Shu

Back-shu point of the Heart

Obliquely 0.50.7 cun

Guan Yuan Shu (UB 26) Xiao Chang Shu (UB 27) Pang Guang Shu (UB 28) Zhong Lu Shu (UB 29) Bai Huan Shu (UB 30)

1.5 cun lateral to midline level with L5 - Yuan Shu

Storage of Yuan Qi Back-shu Point

Perpendiculary 0.8-1.2 cun

1.5 cun lateral to GV 10 level with T6 - GV Shu 1.5 cun lateral to GV 9 level with T7 Diaphragm Shu

Bach-shu point of Du meridian Influential point of Blood

Obliquely 0.50.7 cun Obliquely 0.50.7 cun

1.5 cun lateral to midline level with 1st PSF - SI Shu

Back-shu point of the small intestine

Perpendicularly 0.8-1.2 cun

Gan Shu (UB 18)

1.5 cun lateral to GV 8 level with T9 - LV Shu

Back-shu point of the Liver

Obliquely 0.50.7 cun

1.5 cun lateral to midline level with 2nd PSF - UB Shu

Urinary Bladder Back-shu Point

Perpendicularly 0.8-1.2 cun

1.5 cun lateral to midline level with 3rd PSF

Center of the Back Muscles Back-shu Point

Perpendicularly 0.8-1.2 cun

Dan Shu (UB 19)

1.5 cun lateral to GV 7 level with T10 - GB Shu

Back-shu point of the Gallbladder

Obliquely 0.50.8 cun

1.5 cun lateral to midline level with 4th PSF Baihuan Shu

Enuresis, pain due to hernia, morbid leucorrhea, irregular menstruation, cold sensation and pain of the lower back,

Perpendicularly 0.8-1.2 cun

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TCM REVIEW
dysuria, constipation, tenesmus, prolapse of the rectum Lower back pain, dysuria, constipation, irregular menstruation, morbid leucorrhea, prolapse of the uterus Lower back pain, hernia, irregular menstruation, leucorrhea, dysmenorrheal, nocturnal emission, impotence, enuresis, dysuria, muscular atrophy, pain, numbness and motor impairment of the lower extremities Low back pain, constipation, diarrhea, dysuria, irregular menstruation, morbid leucorrhea Low back pain, lower abdominal pain, dysuria, constipation, morbid leucorrhea Dysentery, bloody stools, diarrhea, hemorrhoids, impotence, morbid leucorrhea Pain in the lower back and gluteal region, constipation, muscular atrophy, pain, numbness and motor impairment of the lower extremities Pain in the lower back and thigh, muscular atrophy, pain, numbness and motor impairment of the lower extremities, hemiplegia Numbness of the gluteal and femoral regions, contracture of the tendons in the popliteal fossa Stiffness and pain of the lower pain, distension and fullness of the lower abdomen, edema, dysuria, cramp of the leg and foot Low back pain, motor impairment of the hip joint, contracture of the tendons in the popliteal fossa, muscular atrophy, pain, numbness and motor impairment of the lower

TCM REVIEW
extremities, hemiplegia, abdominal pain, vomit, diarrhea, erysipelas Stiffness and pain of the shoulder, back and neck, numbness of the elbow and arm Pulmonary tuberculosis, hemoptysis, cough, asthma, neck rigidity, pain in the shoulder and back Pulmonary tuberculosis, cough, asthma, spitting of blood, night sweating, poor memory, noctural emission Asthma, cardiac pain, palpitation, stuffy chest, cough, stiffness and pain of the back Cough, asthma, pain of the shoulder and back Dysphagia, hiccup, vomiting, belching, pain and stiffness of the back Pain in the chest and hypochondriac region, back pain, vomiting, diarrhea Borborygmus, abdominal pain, diarrhea, pain in the hypochondriac region, jaundice Abdominal distension, borborygmus, vomiting, diarrhea, difficulty in swallowing Abdominal distension, pain in the epigastric region and back, infantile indigestion Abdominal pain, constipation, abdominal mass Nocturnal emission, impotence, enuresis, frequency of urination, dysuria, irregular menstruation, pain in the back and knee, edema Borborygmus, abdominal distension, pain in the lower back, anuria bleeding

Shang Liao (UB 31) Ci Liao (UB 32)

On the sacrum at the midpoint of the PSIS and the midline level with the 1st PSF(posterior sacral foramen) On the sacrum medial and inferior to the PSIS level with the 2nd PSF

Perpendicularly 0.8-1.2 cun

Fu Fen (UB 41) Po Hu (UB 42) Gao Huang Shu (UB 43) Shen Tang

Perpendicularly 0.8-1.2 cun

3 cun lateral to the midline level with T2 on the spinal border of the scapula 3 cun lateral to GV 12 level with T3 on the spinal border of the scapula - LU 3 cun lateral to midline level with T4 - PC

Perpendiculary 0.3-0.5 cun

Obliquely 0.30.5 cun

Perpendicularly 0.3-0.5 cun

Zhong Liao (UB 33) Xia Liao (UB 34) Hui Yang (UB 35) Cheng Fu (UB 36)

On the sacrum medial and inferior to the PSIS(posterior superior iliac spine) level with the 3rd PSF On the sacrum lateral to GV 2 level with the 4th PSF 0.5 cun lateral to either side of the tip of the coccyx On the posterior side of the thigh at the midpoint of the inferior gluteal crease

Perpendicularly 0.8-1.2 cun

(UB 44) Yi Xi

3 cun lateral to GV 11 level with T5 HT

Obliquely 0.30.5 cun

Perpendicularly 0.8-1.2 cun

(UB 45) Ge Guan (UB 46) Po Men (UB 47) Yang Gang (UB 48) Yi She

3 cun lateral to GV 10 level with T6 3 cun lateral to GV 9 level with T7 Diaphragm 3 cun lateral to GV 8 level with T9 - LV 3 cun lateral to GV 7 level with T10 GB

Obliquely downward 0.30.5 cun Obliquely 0.30.5 cun Obliquely 0.30.5 cun Obliquely 0.30.5 cun

Perpendicularly 0.5-1 cun Perpendicularly 1.0-1.5 cun

Yin Men (UB 37) Fu Xi (UB 38) Wei Yang (UB 39) Wei Zhong (UB 40)

6 cun below UB 36 on the line joining UB 36 to UB 40

Perpendicularly 1.0-1.2 cun

(UB 49) Wei Cang

3 cun lateral to GV 6 level with T11 SP

Obliquely 0.30.5 cun

1 cun above UB 39 on the medial side of the biceps femoris tendon, found with the knee slightly bent Lateral to UB 40 on the medial border of the biceps femoris tendon

Perpendiculary 0.5-1.0 cun

(UB 50) Huang Men (UB 51) Zhi Shi (UB 52)

3 cun lateral to midline level with T12 - ST 3 cun lateral to GV 5 level with L1 TH 3 cun lateral to GV 4 level with L2 KD

Obliquely 0.30.5 cun Obliquely 0.30.5 cun Perpendicularly 0.5-1.0 cun

Low He-Sea point of Triple Energizer

Perpendicularly 0.5-1.0 cun

Midpoint of the transverse crease of the popliteal fossa between the biceps femoris and semitendinosus tendons

He-Sea point

Perpendicularly 0.5-1.0 cun, or prick the popliteal vein with three-edged needle to cause

Bao Huang (UB 53)

3 cun lateral to the medial sacral crest level with the 2nd PSF UB

Perpendicularly 0.8-1.2 cun

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Zhi Bian (UB 54) 3 cun lateral the midline level with the 4th PSF Pain in the lumbosacral region, muscular atrophy, motor impairment of the lower extremities, dysuria, swelling around external genitalia, hemorrhoids, constipation Low back pain, pain and paralysis of the lower extremities Perpendicularly 1.5-2.0 cun (UB 64) Shu Gu (UB 65) Perpendicularly 0.7-1.0 cun Zu Tong Gu (UB 66) Zhi Yin Spasm of the gastrocnemius, hemorrhoids, acute lower back pain Perpendicularly 0.8-1.2 cun (UB 67) the junction of the red and white skin Posterior to the 5th metatarsophalangeal joint at the junction of the red and white skin Anterior to the 5th metatarsophalangeal joint

TCM REVIEW
epilepsy Shu-stream point Mania, headache, neck rigidity, blurring of vision, blurring of vision, backache, pain in the lower extremities Headache, neck rigidity, blurring of vision, epistaxis, mania Headache, nasal obstruction, epistaxis, ophthalmalgia, malposition of fetus, difficulty labour, detention of after birth, feverish sensation in the sole Perpendicularly 0.3-0.5 cun

He Yang (UB 55)

Cheng Jin (UB 56)

Cheng Shan (UB 57) Fei Yang (UB 58) Fu Yang (UB 59) Kun Lun (UB 60) Pu Can (UB 61)

2 cun directly below UB 40 between the medial and lateral heads of the gastrocnemius muscle on line joining UB 40 and UB 57 5 cun below UB 40 midway between UB 55 and UB 57 in the center of the belly of the gastrocnemius muscle on line joining UB 40 and UB 57 8 cun below UB 40 in a depression below the gastrocnemius muscle , found when the leg is stretched or heel is lifted 7 cun above UB 60 on the posterior border of the fibula about 1 cun lateral and inferior to UB 57 3 cun directly above UB 60

Ying-spring point

Perpendicularly 0.2-0.3 cun

0.1 cun posterior to the corner of the nail on the lateral side of the small toe

Jing-well point

Superficially 0.1 cun

Low back pain, spasm of the gastrocnemius, hemorrhoids, constipation, beriberi

Perpendicularly 0.8-1.2 cun

Luo-connecting point

Xi-cleft point of the Yang Heel vessel

In a depression between the tip of the external malleolus and the achilles tendon Posterior and inferior to the external malleolus lateral to the calcaneum at the junction of the red and white skin, directly below UB 60 In a depression directly below the external malleolus On the lateral side of the foot directly below the anterior border of the external malleolus on the lower border of the cuboid bone Below the tuberosity of the 5th metatarsal bone at

Jing-river point

Headache, blurring of vision, nasal obstruction, epistaxis, back pain, hemorrhoids, weakness of the leg Heavy sensation of the head, headache, low back pain, redness and swelling of the external malleolus, paralysis of the lower extremities Headache, blurring of vision, neck rigidity, epistaxis, pain in the shoulder, back and arm, swelling and pain of the heel, difficult labour, epilepsy Muscular atrophy and weakness of the lower extremities, pain in the heel

Perpendicularly 0.7-1.0 cun

Perpendicularly 0.5-1.0 cun

8. The kidney meridian of foot-shaoyin Cyclical flowing and distribution: The Kidney Meridian starts from the inferior aspect of the small toe and runs obliquely towards the sole. It comes out from Rangu(KI2), runs behind the medial malleolus and enters the heel. Then it ascends along the medial side of the leg to the medial side of the popliteal fossa and goes further upward along the posterior medial aspect of the thigh towards the vertebral column, where it enters the kidney, its pertaining organ, and connects with the bladder. The straight portion of meridian re-emerges from the kidney. Ascending and passing through the liver and diaphragm, it enters the lung, runs along the throat and terminates at the root of the tongue. A branch springs from the lung, joins the heart, and runs into the chest. Indications: Gynecological diseases, genital diseases, kidney, lung and throat disorders as well as diseases involving the regions through which the meridian passes Acupoints: Yong quan (KI 1) Ran Gu (KI 2) Tai xi (KI 3) Da zhong (KI 4) Shui quan (KI 5) Zhao hai (KI 6) Fu liu (KI 7) Jiao xin (KI 8) Zhu bin (KI 9) Yin Gu (KI 10) Heng gu (KI 11) Da He (KI 12) Qi xue (KI 13) Si man (KI 14) Zhong zhu (KI 15) Huang shu (KI 16) Shang qu (KI 17) Shi guan (KI 18) Yin du (KI 19) Fu tong gu (KI 20) You men (KI 21) Bu lang (KI 22) Shen feng (KI 23) Ling xu (KI 24) Shen cang (KI 25) Yu zhong (KI 26) Shu fu (KI 27)
Acupoint Yong quan (KI 1) Location On sole, in depression with foot in plantar flexion, at the junction of the anterior 1/3 and posterior 2/3 of line connecting base of the 2nd and 3rd toes with the heel. Anterior and Inferior to Special points Jing-Well Indications Headache, blurring of vision, dizziness, sore throat, dryness of the tongue, loss of voice, dysuria, infantile, convulsion, feverish sensation in the sole, loss of consciousness Note Perpendicularly 0.3-0.5 cun

Perpendicularly 0.5-1.0 cun

Perpendicularly 0.3-0.5 cun

Shen Mai (UB 62) Jin Men (UB 63)

Confluent point

Epilepsy, mania, headache, dizziness, insomnia, backache, aching of the leg Mania, epilepsy, infantile convulsion, backache, pain the external malleolus, motor impairment and pain of the lower extremities Headache, neck rigidity, pain in the lower back and thigh,

Perpendicularly 0.3-0.5 cun Perpendicularly 0.3-0.5 cun

Xi-cleft point

Jing Gu

Yuan-primary point

Perpendicularly 0.3-0.5 cun

Ran Gu

Ying-Spring

Pruritus vulvae, proplapse of

Perpendicularly

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(KI 2) the medial malleolus in a depression on the lower border of the tuberosity of the navicular bone. uterus, irregular menstruation, nocturnal emission, hemoptysis, thirst, diarrhea, swelling and pain of the dorsum of foot, acute infantile omphalitis Sore throat, toothache, deafness, tinnitus, dizziness, spitting of blood, asthma, thirst, irregular menstruation, insomnia, nocturnal emission, impotence, frequency of micturition, pain in the lower back Spitting of blood, asthma, stiffness and pain of the lower back, dysuria, constipation, pain in the heel, dementia Amenorrhea, irregular menstruation, dysmenorrheal, prolapse of uterus, dysuria, blurring of vision Irregular menstruation, morbid leucorrhea, prolapse of uterus, pruritus vulvae, frequency of micturtion, retention of urine, constipation, epilepsy, insomnia, sore throat, asthma Edema, abdominal distension, diarrhea, borborygmus, muscular atrophy of the leg, night sweating, spontaneous sweating, febrile diseases without sweating Irregular menstruation, dysmenorrheal, uterine bleeding, proplapse of uterus, diarrhea, constipation, pain and swelling of testis Mental disorders, pain in the foot and lower leg, hernia 0.3-0.5 cun 11) cun below CV8, 0.5 cun lateral to CV2. (CV8 is at the center of the umbilicus) 4 cun below CV8, 0.5 cun lateral to CV3

TCM REVIEW
nocturnal emission, impotence, pain of genitalia

Da He Perpendicularly 0.3-0.5 cun (KI 12) Qi xue (KI 13) Si man (KI 14) Perpendicularly 0.3-0.5 cun Zhong zhu Perpendicularly 0.3-0.5 cun (KI 15) Huang shu (KI 16) Shang qu (KI 17) Shi guan (KI 18) Perpendicularly 0.5-0.7 cun Yin du (KI 19) Fu tong gu (KI 20) You men (KI 21) Perpendicularly 0.5-0.7 cun Bu lang (KI 22) Shen feng (KI 23) Ling xu (KI 24) Shen cang

Tai xi (KI 3)

In depression midway between the tip of the medial malleolus and the attachment of the achilles tendon, level with the tip of the medial malleolus

Shu-stream and yuan-primary point

3 cun below CV8, 0.5 cun lateral to CV4 2 cun below CV8, 0.5 cun lateral to CV5

Da zhong (KI 4) Shui quan (KI 5) Zhao hai (KI 6)

Posterior and inferior to the medial malleolus in a depression anterior to the medial attachment of the achilles tendon. 1 cun directly below KI3 in a depression anterior and superior to the medial tuberosity of the calcaneus. In a depression 1 cun below the tip of the medial malleolus

Luo-connecting point

1 cun below CV8, 0.5 cun lateral to CV7 0.5 cun lateral to CV8 at the umbilicus 2 cun above CV8, 0.5 cun lateral to CV10 3 cun above CV8, 0.5 cun lateral to CV11 4 cun above CV8, 0.5 cun lateral to CV12 5 cun above CV8, 0.5 cun lateral to CV13 6 cun above CV8, 0.5 cun lateral to CV14. Avoid liver when needling

Nocturnal emission, impotence, morbid leucorrhea, pain in the external genitalia, prolapse of uterus Irregular menstruation, dysmenorrheal, dysuria, abdominal pain, diarrhea Abdominal pain and distension, diarrhea, nocturnal emission, irregular menstruation, dysmenorrheal, postpartum abdominal pain Irregular menstruation, abdominal pain, constipation Abdominal pain and distension, vomit, constipation, diarrhea Abdominal pain, diarrhea, constipation Vomit, abdominal pain, constipation, postpartum abdominal pain, sterility Borborygmus, abdominal pain, epigastric pain constipation, vomit Abdominal pain and distension, vomit, indigestion Abdominal pain and distension, indigestion, vomit, diarrhea, nausea, morning sickness

Perpendicularly 0.5-1.0 cun

Perpendicularly 0.5-1.0 cun Perpendicularly 0.5-1.0 cun

Perpendicularly 0.5-1.0 cun Perpendicularly 0.5-1.0 cun Perpendicularly 0.5-1.0 cun Perpendicularly 0.5-1.0 cun Perpendicularly 0.5-1.0 cun Perpendicularly 0.5-1.0 cun Perpendicularly 0.3-0.7 cun. Avoid injuring the liver, deep insertion is not advisable Obliquely 0.30.5 cun

Xi-cleft point

The eight confluent point, communicates with Yin-qiao(heel) meridan Jing-river point

Perpendicularly 0.3-0.5 cun

Fu liu (KI 7)

2 cun above KI3 on the anterior border of the achilles tendon

Jiao xin (KI 8) Zhu bin (KI 9) Yin Gu (KI 10)

0.5 cun anterior to KI7, 2 cun above KI3, posterior to the medial border of the tibia 5 cun above KI3 on the line drawn from KI3 to KI10 at the lower border of the gastrocnemius muscle at the medial side of the popliteal fossa when the knee is flexed, between the tendons of semitendinosus and semimembranosus muscles level with BL54 At the superior border of the symphysis pubis, 5

xi-cleft point of the Yin heel vessel

Perpendicularly 0.5-0.7 cun

xi-cleft point of the Yin link vessel

He-sea point

Impotence, hernia, uterine bleeding, dysuria, pain in the knee and popliteal fossa, mental disorders

Perpendicularly 0.8-1.0 cun

Heng gu (KI

Fullness and pain of the lower abdomen, dysuria enuresis,

Perpendicularly 0.5-1.0 cun

In 5th intercostal space 2 cun lateral to CV16. Avoid heart when needling In 4th intercostal space 2 cun lateral to CV17. Avoid heart when needling In 3rd intercostal space 2 cun lateral to CV18. Avoid heart when needling In 2nd intercostal space 2

Cough, astham, distension and fullness in the chest and hypochondriac region vomit, anorexia Cough, asthma, fullness in the chest and hypochondriac region, mastitis Cough, asthma, fullness in the chest and hypochondriac region, mastitis Cough, asthma, chest pain

Obliquely 0.30.5 cun

Obliquely 0.30.5 cun

Obliquely 0.3-

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(KI 25) Yu zhong (KI 26) Shu fu (KI 27) cun lateral to CV19. Avoid heart when needling In 1st intercostal space 2 cun lateral to CV20 0.5 cun (PC 5) crease of the wrist PC 7, between palmaris longus and flexor carpi radialis tendons, on the line connecting PC3 and PC7 2 cun above the transverse crease of the wrist PC7, between palmaris longus and flexor carpi radialis tendons, on the line connecting PC3 and PC7

TCM REVIEW
stomachache, vomit, febrile diseases, irritability, malaria, mental disorders, epilepsy, swelling of the axilla, contracture of the elbow and arm Cardiac pain, palpitation, stuffy chest, pain in the hypochondriac region, stomachache, nausea, vomit, hiccup, mental disorders epilepsy, insomnia, febrile diseases, irritability, malaria, contracture and pain of the elbow and arm Cardiac pain, palpitation, stomachache, vomit, mental disorders, epilepsy, stuffy chest, pain in the hypochondriac region, convulsion, insomnia, irritability, foul breath Cardiac pain, mental disorder, epilepsy, gastritis, foul breath, fungus infection of the hand and foot, vomit, nausea 0.5-1.0 cun

In depression on lower border of clavicle, 2 cun lateral to the midline.

Cough, asthma, accumulation of phlegm, fullness in the chest and hypochondriac region Cough, asthma, chest pain

Obliquely 0.30.5 cun Nei guan Obliquely 0.30.5 cun (PC 6)

9. The pericardium meridian of hand-jue yin Cyclical flowing and distribution: The Pericardium Meridian starts from the chest, and enters its pertaining organ, the pericardium. It descends through the diaphragm to connect successively with the upper, middle and lower energizer. A branch arising from the chest runs inside the chest, comes out from the costal region below the axilla and ascends to the axilla. Following the medial aspect of the upper arm, it runs between the Lung Meridian and Heart Meridian to the cublital fossa, further downward to the forearm between the tendons of m.palmaris longus and m.flexor carpi radiadis, enters the palm, then passes along the middle finger right down to its tip. Another branch arising from the palm runs along the ring finger to its tip. Indications: disorders of the heart, chest, stomach and mind as well as diseases involving the regions covered by the cyclical flowing of the meridian. Acupoints: Tian chi (PC 1) Tian quan (PC 2) Qu ze (PC 3) Xi men (PC 4) Jian shi (PC 5) Nei guan (PC 6) Da ling (PC 7) Lao gong (PC 8) Zhong chong (PC 9)
Acupoint Tian chi (PC 1) Tian quan (PC 2) Qu ze (PC 3) Location 5 cun lateral to the anterior midline or 1 cun lateral to the nipple in the fourth intercostal space. Deep needle not advised 2 cun below the anterior axillary fold between the 2 heads of the biceps brachii On the transverse cubital crease, at the ulnar side of the biceps brachii tendon Special points Indications Suffocating sensation in the chest, pain in the hypochondriac region, swelling and pain of the axillary region Cardiac pain, distension of the hypochondriac region, cough, pain in the chest, back and the medial aspect of the arm Cardiac pain, palpitation, febrile diseases, irritability, stomachache, vomit, pain in the elbow and arm, tremor of the hand and arm Cardiac pain, palpitation, epistaxis, hematemesis, haemoptysis chest pain, furuncle, epilepsy Note Obliquely 0.20.4 cun

Luo-connect point, the eight confluent point; one of the eight convergent acupoints associating with yin link vessel.

Perpendicularly 0.5-0.8 cun

Da ling (PC 7)

In the middle of the transverse crease of the wrist between palmaris longus and flexor carpi radialis tendons

Shu-stream and yuan-primary point

Perpendicularly 0.3-0.5 cun

Lao gong (PC 8)

Zhong chong (PC 9)

On the transverse crease of the palm just below where the tip of the middle finger rest when a fist is made. Between the 2nd and 3rd metacarpal bones In the center of the tip of the middle finger. For graphing measurement, 0.1 cun posterior lateral to the corner of the nail

Ying-spring point

Perpendicularly 0.3-0.5 cun

Jing-well point

Cardiac pain, palpitation, loss of consciousness, aphasia with stiffness and swelling of the tongue, febrile diseases, heat stroke, convulsion, feverish sensation in the palm

Superficially 0.1 cun or prick with a three-edged needle to cause bleeding

Perpendicularly 0.5-0.7 cun

He-sea point

Perpendicularly 0.5-0.7 cun

Xi men (PC 4)

Jian shi

5 cun above the transverse crease of the wrist PC7, between the palmaris longus and flexor carpi radialis tendons, on the line connecting PC3 and PC7 3 cun above the transverse

Xi-cleft point

Perpendicularly 0.5-1.0 cun

10. Triple energizer meridian of hand-shaoyang Cyclical flowing and distribution: The Triple Energizer Meridian originates from the tip of the ring finger, runs upward between the 4th and 5th metacarpal bones along the dorsal aspect of the wrist to the lateral aspect of the forearm between the radius and ulna then ascends through the olecranon and goes along the lateral aspect of the upper arm, reaches the shoulder region, across and passes behind the Gallbladder Meridian winding over to supraclavicular fossa, and spreads in the chest to connect with the pericardium. It then descends through diaphragm and joins its pertaining organ, the upper, middle and lower energizer. A branch starts from the chest (Tanzhong)(CV17) runs upward and comes out from the wupraclavicular fossa, then ascends to the neck, runs along the posterior border of the ear and further to the corner of the anterior hairline. Then it runs downward to the neck and terminates in the infraorbital region. The branch arises from the retroauricular region and enters the ear, comes out at the front of ear, crosses the previous branch at the cheek and reaches the outer canthus.

Jing-river point

Cardiac pain, palpitation,

Perpendicularly

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TCM REVIEW Indications: disorders of the side of the head, ears, eyes and throat as well as diseases involving the regions through which the meridian runs. Acupoints: Guan chong (TE 1) Ye men (TE 2) Zhong zhu (TE 3) Yang chi (TE 4) Wai guan (TE 5) Zhi gou (TE 6) Hui zong (TE 7) San yang luo (TE 8) Si du (TE 9) Tian jin (TE 10) Qing leng yuan (TE 11) Xiao luo (TE 12) Nao hui (TE 13) Jian liao (TE 14) Tian liao (TE 15) Tian you (TE 16) Yi feng (TE 17) Qi mai (TE 18) Lu xi (TE 19) Jiao sun (TE 20) Er men (TE 21) Er he liao (TE 22) Si zhu kong (TE 23)
Acupoint Guan chong (TE 1) Ye men (TE 2) Zhong zhu (TE 3) Location 0.1 cun posterior to the corner of the nail on the ulnar side of the fourth digit 0.5 cun proximal to the margin of the web between the fourth and fifth digit With fist clenched, on the dorsum of the hand between the fourth and fifth metacarpal bones in a depression proximal to the fourth metacarpophalangeal joint On the transverse crease of the dorsum of the wrist between the tendons of muscles extensor digitorum and extensor digiti minimi On the dorsum of the forearm, 2 cun above TW4 between the radious and the ulna Special points Jing-well point Indications Headache, redness of the eyes, sore throat, stiffness of the tongue, febrile diseases, irritability Headache, redness of the eyes, sudden deafness, sore throat, malaria, pain in the arm Note Superficially 0.1 cun, or prick with a threeedged needle to cause bleeding Obliquely 0.30.5 cun towards the interspace of the metacarpal bones Perpendicularly 0.3-0.5 cun San yang luo (TE 8) Si du (TE 9) Tian jin (TE 10) Qing leng yuan (TE 11) Xiao luo (TE 12) Nao hui (TE 13) Jian liao (TE 14) Tian liao Perpendicularly 0.3-0.5 cun (TE 15) Tian you (TE 16) On the dorsum of the forearm 4 cun above TW4 between the radius and the ulna On the dorsum of the forearm, 5 cun below the olecranon between the radius and the ulna 1 cun superior to the olecranon in a depression formed with the elbow flexed With the elbow flexed, 1 cun above TW10

TCM REVIEW
Deafness, sudden hoarseness of voice, pain in the chest and hypochondriac region, pain in the hand and arm, toothache Deafness, toothache, migraine, sudden hoarseness of voice, pain in the forearm He-sea point Migraine, pain in the neck, shoulder and arm, epilepsy, scrofula, goiter Motor impairment and pain of the shoulder and arm, migraine Headache, neck rigidity, motor impairment and pain of the arm Goiter, pain in the shoulder and arm Perpendicularly 0.5-1.0 cun

Perpendicularly 0.3-0.5 cun

Perpendicularly 0.3-0.5 cun

Ying-spring point

Shu-stream point

Headache, redness of the eyes, deafness, tinnitus, sore throat, febrile diseases, tinnitus, sore throat, febrile diseases, pain in the elbow and arm, motor impairment of fingers Pain in the arm, shoulder and wrist, malaria, deafness, thirst

5 cun superior to the olecranon on a line midway between TW10 and TW14 3 cun below TW14 on the posterior border of the deltoid muscle, on the line joining the olecranon and TW14 In the depression posterior and inferior to the acromion process, about 1 cun posterior to LI15 Midway between GB21 and SI13 on the superior angle of the scapula Posterior and inferior to the mastoid process, on the posterior border of the SCM(sternocleido mastoid muscle) and level with BL10. Posterior to the lobule of the ear in a depression between the mandible and the mastoid process In the center of the mastoid process at the junction of the middle and lower third of the curve formed by TW17 and TW20, posterior to the helix Posterior to the ear at the junction of the upper and middle third of the curve formed by TW17 and TW20, posterior to the

Perpendicularly 0.5-0.7 cun

Perpendicularly 0.5-0.8 cun

Pain and motor impairment of the shoulder and upper arm

Perpendicularly 0.5-0.7 cun

Pain in the shoulder and elbow, stiffness of the neck Headache, neck rigidity, facial swelling, blurring of vision, sudden deafness

Perpendicularly 0.3-0.5 cun Perpendicularly 0.3-0.5 cun

Yang chi (TE 4)

Yuan-primary point

Wai guan (TE 5)

Luo-connecting point, the eight confluent point, communicates with yang-wei(link) meridian Jing-river point

Zhi gou (TE 6)

On the dorsum of the forearm, 3 cun above the TW4 between the radius and the ulna

Hui zong (TE 7)

One finger width lateral to TW6 on the radial side of the ulna

xi-cleft point

Febrile diseases, headache, pain in the cheek, strained neck, deafness, tinnitus, pain in the hypochondriac region, motor impairment of the elbow and arm, pain of the fingers, hand tremor Tinnitus, deafness, pain in the hypochondriac region, vomit, constipation, febrile diseases, aching and heavy sensation of the shoulder and back, sudden hoarseness of voice Deafness, pain in the ear, epilepsy, pain of the arm

Perpendicularly 0.5-1.0 cun

Yi feng (TE 17) Qi mai

Perpendicularly 0.8-1.2 cun

(TE 18)

Tinnitus, deafness, otorrhea, facial paralysis, toothache, swelling of the cheek, scrofula, trismus Headache, tinnitus, deafness, infantile convulsion

Perpendicularly 0.5-1.0 cun

Subcutaneously 0.3-0.5 cun or prick with a three-edged needle to cause bleeding Obliquely 0.30.5 cun

Lu xi Perpendicularly 0.5-1.0 cun (TE 19)

Headache, tinnitus, deafness, pain in the ear, infantile convulsion.

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helix Directly above the ear apex just above the hairline With the mouth open, in the depression anterior to the supratragic notch and posterior to the mandibular condyloid process Anterior and superior to TW21, level with the root of the auricle on the posterior border of the hairline of the temple where the superficial temporal artery passes. Avoid artery when needling In the depression at the lateral end of the eyebrow

TCM REVIEW Indications: Disorder of the lateral side of the head, eyes, ears and throat as well as mental problems, febrile disease and other diseases involving the areas through which the meridian passes Acupoints: Tong zi liao (GB 1)Ting hui (GB 2)Shang guan (GB 3) Han yan (GB 4)Xuan lu (GB 5)Xuan li (GB 6)Qu bin (GB 7) Shuai gu (GB 8)Tian chong (GB 9)Fu bai (GB 10)Tou qiao yin (GB 11)Wan gu (GB 12)Ben shen (GB 13)Yang bai (GB 14)Tou

Jiao sun (TE 20) Er men (TE 21)

Tinnitus, redness, pain and swelling of the eye, swelling of gum, toothache, parotitis Tinnitus, deafness, otorrhea, toothache, stiffness of the lip

Subcutaneously 0.3-0.5 cun Perpendicularly 0.3-0.5 cun

Er he liao (TE 22)

Migraine, tinnitus, lockjaw

Obliquely 0.10.3 cun. Avoid puncturing the artery

lin qi (GB 15)Mu chuang (GB 16)Zheng ying (GB 17)Cheng ling (GB 18)Nao kong (GB 19)Feng chi (GB 20)Jian jing (GB 21) Yuan ye (GB 22)Zhe jin (GB 23)Ri yue (GB 24)Jing men (GB 25)Dai mai (GB 26)Wu shu (GB 27)Wei dao (GB 28)Ju liao (GB 29)Huan tiao (GB 30)Feng shi (GB 31)Zhong du (GB 32)Xi

Si zhu kong (TE 23)

Headache, redness and pain of the eye, blurring of vision, twitching of the eyelid, toothache, facial paralysis

Subcutaneously 0.3-0.5 cun

yang guan (GB 33)Yang ling quan (GB 34)Yang jiao (GB 35) Wai qiu (GB 36)Guang ming (GB 37)Yang fu (GB 38)Xuan zhong (GB 39)Qiu xu (GB 40)Zu lin qi (GB 41)Di wu hui (GB 42) Xia xi (GB 43)Zu qiao yin (GB 44)
Acupoint Tong zi liao (GB 1) Ting hui (GB 2) Shang guan (GB 3) Han yan (GB 4) Xuan lu (GB 5) Xuan li (GB 6) Qu bin Location 0.5 cun lateral to the outer canthus of the eye in a depression on the lateral side of the orbit. Anterior to the intertragic notch at the posterior border of the condyloid process of the mandible with the mouth open Anterior to the ear, in the depression directly above ST7 on the upper border of the zygomatic arch Within the hairline at the junction of the upper 1/4 and lower 3/4 distance between ST8 and GB7 Within the hairline midway between ST8 and GB7 Within the hairline at the junction of the lower 1/4 and upper 3/4 distance between ST8 and GB7 Within the hariline, Special points Indications Headache, redness, and pain of the eyes, failing of vision, lacrimation, deviation of the eye and mouth Deafness, tinnitus, toothache, motor impairment of the temporomandibular joint, mumps, deviation of the eye and mouth Headache, deafness, tinnitus, diplacusis, deviation of the eye and mouth, toothache Migraine, vertigo, tinnitus, pain in the outer canthus, toothache, convulsion, epilepsy Migraine, pain in the outer canthus, facial swelling Migraine, pain in the outer canthus, tinnitus, frequent sneezing Headache, swelling of the Note Subcutaneously 0.3-0.5 cun

11. The gallbladder meridian of foot-shao yang Cyclical flowing and distribution: The Gallbladder Meridian starts from the outer canthus, ascends to the corner of the forehead, then curves downward to the retroauricual region and rounds along the side of the neck in front of the Triple Energizer Meridian to the shoulder, then turns back, transverses and passes behind the Triple Energizer Meridian, down to the supraclavicular fossa. The branch arises from the rectroauricular region and enters into the ear. It comes out and passes the preauricular region to the posterior aspect of the outer canthus. The branch arising from the outer canthus runs downward to Daying(ST5) and meets the Triple Energizer Meridian in the infraorbital region, then passes through Jiache(TE6) , descends to the neck and enters the supraclavicular fossa, then further descends into the chest, passes through the diaphragm to connect with the liver and enters its pertaining organ, the gallbladder. Then it runs inside the hypochondriac region, comes out from the lateral side of the lower abdomen, from there, runs superficially along the region of the pubic hair and goes transversely into the hip region. The branch from the supraclavicular fossa runs downward to the axilla, along the lateral side of the chest and through the floating rib to the hip region. Then it descends along the lateral aspect of the thigh to the lateral side of the knee and goes further downward along the anterior aspect of the fibula, reaches the anterior aspect of the external malleolus. It then follows the dorsum of the foot to the lateral side of the tip of the 4th toe. The branch from the dorsum of the foot runs between the first and second metatarsal bone to the distal portion of the great toe and passes through the nail and terminates at its hairy region.

Perpendicularly 0.5-0.7 cun

Perpendicularly 0.3-0.5 cun

Subcutaneously 0.3-0.5 cun

Subcutaneously 0.3-0.5 cun Subcutaneously 0.3-0.5 cun

Subcutaneously

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(GB 7) Shuai gu (GB 8) Tian chong (GB 9) Fu bai (GB 10) anterior and superior to the auricle, about 1 cun anterior to TW20 Superior to the apex of the auricle, 1.5 cun within the hairline 0.5 cun posterior to GB8, 2 cun within the hairline directly above the posterior border of the auricle Posterior and superior to the mastoid process at the junction of the middle 1/3 and upper 1/3 of the curve between GB9 and GB12 Posterior and superior to the mastoid process at the junction of the middle 1/3 and lower 1/3 of the curve between GB9 and GB12 In the depression posterior and inferior to the mastoid process 0.5 cun within the hairline on the forehead, 3 cun lateral to GV4. Midway between ST8 and BL4 On the forehead directly above the pupil, 1 cun above the midpoint of the eyebrow Directly above GB14, within the hairline, midway between GV24 and ST8 1.5 cun posterior to GB15, 2 cun above the hairline and 2.25 cun lateral to GV22 1.5 cun posterior to GB16, 3.5 cun above the hairline and 2.25 cun lateral to GV21 1.5 cun posterior to GB17, 5 cun above the hairline and 2.25 cun lateral to GV20 At the upper border of the external occipital protuberance, 2.5 cun lateral and level to GV 17. directly above GB20 cheek, trismus, pain in the temporal region, infantile convulsion Migraine, vertigo, vomiting, infantile convulsion Headache, epilepsy, swelling and pain of the gums, convulsion 0.3-0.5 cun Feng chi (GB 20) In the depression created between the origins of the Sternocleidomastoid and Trapezius muscles, at the junction of the occipital and nuchal regions. Lateral and level with GV16 Midway between the spinous process of C7 (GV14) and the acromion process at the highest point of the trapezius muscle With the arm raised, 3 cun below the axilla on the midline in the 4th intercostal space, below HT1 1 cun anterior to GB 22 in the 4th intercostal space, level with the nipple Directly below the nipple in the 7th intercostal space, inferior to LV14 On the lateral side of the abdomen, at the lower border of the free end of the 12th rib Directly below LV 13 at the free end of the 11th rib level with the umbilicus (CV8) On the lateral side of the abdomen, anterior to the ASIS, 3 cun below the level of umbilicus, lateral to CV4 Anterior and inferior to the ASIS, 0.5 cun anterior and inferior to GB27 In a depression at the midpoint between the ASIS and the greater trocanter of the femur. At the junction of the lateral 1/3 and medial 2/3 of the distance between the greater trocanter and the hiatus of the sacrum (GV2) 7 cun above the transverse popliteal crease on the

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Headache, vertigo, insomnia, pain and stiffness of the neck, blurred vision, glaucoma, red and painful eyes, tinnitus, convulsion, epilepsy, infantile convulsion, febrile diseases, common cold, nasal obstruction, rhinorrhea Pain and rigidity of the neck, pain in the shoulder and back, motor impairment of the arm, insufficient lactation, mastitis, scrofula, apoplexy, difficult labour Fullness of the chest, swelling of the axillary region, pain in the hypochondriac region, pain and motor impairment of the arm Fullness of the chest, pain in the hypochondriac region, asthma Pain in the hypochondriac region, vomit acid regurgitation, hiccup, jaundice, mastitis Abdominal distention, borborgmus, diarrhea, pain in the lumbar and hypochondriac region Irregular menstruation, amenorrhea, leucorrhea, abdominal pain, hernia, pain in the lumbar and hypochondriac region Leucorrhea, lower abdominal pain, lumbar pain, hernia, constipation Puncture 0.5-0.8 cun towards the tip of the nose

Subcutaneously 0.3-0.5 cun Subcutaneously 0.3-0.5 cun

Jian jing (GB 21)

Subcutaneously 0.3-0.5 cun

Headache, tinnitus, deafness

Subcutaneously 0.3-0.5 cun Yuan ye (GB 22) Zhe jin Obliquely 0.30.5 cun (GB 23) Ri yue (GB 24) Subcutaneously 0.3-0.5 cun Jing men (GB 25) Dai mai (GB 26) Wu shu (GB 27) Subcutaneously 0.3-0.5 cun

Obliquely 0.30.5 cun

Tou qiao yin (GB 11) Wan gu (GB 12) Ben shen (GB 13) Yang bai (GB 14) Tou lin qi (GB 15) Mu chuang (GB 16) Zheng ying (GB 17) Cheng ling (GB 18) Nao kong (GB 19)

Pain of the head and neck, tinnitus, deafness, pain in the ears

Subcutaneously 0.3-0.5 cun

Obliquely 0.30.5 cun Obliquely 0.30.5 cun

Headache, insomnia, swelling of the check, retroauricular pain, deviation of the eye and mouth, toothache Headache, insomnia, vertigo, epilepsy

Front-mu point of the gallbladder

Front-mu point of the kidney

Perpendicularly 0.3-0.5 cun

Headache in the frontal region, pain of the orbital ridge, eye pain, vertigo, twitching of the eyelids, prosis to the eyelids, lacrimation Headache, vertigo, lacrimation, pain in the outer canthus, rhinorrhea, nasal obstruction Headache, vertigo, red and painful eyes, nasal obstruction

Subcutaneously 0.3-0.5 cun

Perpendicularly 0.5-0.8 cun

Subcutaneously 0.3-0.5 cun

Perpendicularly 0.5-1.0 cun

Wei dao (GB 28) Ju liao (GB 29)

Leucorrhea, lower abdominal pain, hernia, prolapse of uterus Pain and numbness in the thigh and lumbar region, paralysis, muscular atrophy of the lower limbs Pain of the lumbar region and thigh, muscular atrophy of the lower limbs, hemiplegia

Perpendicularly 0.5-1.0 cun Perpendicularly 0.5-1.0 cun

Migraine, vertigo

Subcutaneously 0.3-0.5 cun

Headache, vertigo, epistaxis, rhinorrhea

Subcutaneously 0.3-0.5 cun

Huan tiao (GB 30)

Perpendicularly 1.5-2.5 cun

Headache, stiffness of the neck, vertigo, painful eyes, tinnitus, epilepsy

Subcutaneously 0.3-0.5 cun

Feng shi

Pain and soreness in the thigh and lumbar region, paralysis

Perpendicularly 0.7-1.2 cun

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(GB 31) lateral midline of thigh, where the tip of the middle finger touches when the patient is standing and hands are at their sides At the lateral side of the thigh 5 cun above the transverse popliteal crease between vastus lateralis and biceps femoris muscles, 2 cun below GB31 On the lateral side of the thigh 3 cun above the transverse popliteal crease in a depression superior and posterior to the lateral condle of the femur, between the femur and the tendon of biceps femoris In a depression anterior and inferior to the head of the fibula of the lower limbs, beriberi, general pruritus Qiu xu (GB 40) Pain and soreness of the thigh and knee, numbness and weakness of the lower limbs, hemiplegia Perpendicularly 0.7-1.0 cun Zu lin qi (GB 41) Swelling and pain of the knee, contracture of the tendons in popliteal fossa, numbness of the leg Perpendicularly 0.5-1.0 cun peroneous longus and brevis muscles Anterior and inferior to the lateral malleous in a depression on the lateral side of the extensor digitorum longus tendon

TCM REVIEW
limbs, spastic pain of the leg, beriberi Pain in the neck, swelling in the axillary region, pain in the hypochondriac region, vomit acid regurgitation, muscular atrophy of the lower limbs, pain and swelling of the external malleolus, malaria Headache, vertigo, pain o fthe outer canthus, scrofula, pain in the hypochondriac region, distending pain of the breast, irregular menstruation, pain and swelling of the dorsum of foot, spastic pain of the foot and toe Pain of the canthus, tinnitus, distending pain of the breast, swelling and pain of the dorsum of foot

Yuan-primary point

Perpendicularly 0.5-0.8cun

Zhong du (GB 32)

On the dorsum of the foot, in the depression between the fourth and fifth metatarsal bones

Shu-stream point, the eight confluent point

Perpendicularly 0.3-0.5cun

Xi yang guan (GB 33)

Di wu hui (GB 42) He-sea point, influential point of tendon Hemiplegia, weakness, numbness and pain of the lower extremities, swelling and pain of the knee, beriberi, hypochondriac pain, bitter taste in the mouth, vomit, jaundice, infantile convulsion Fullness of the chest and hypochondriac region, muscular atrophy and paralysis of the leg Pain in the neck, chest, thigh and hypochondriac region, rabies Pain in the knee, muscular atrophy, motor impairment and pain of the lower extremities, blurring of vision, ophthalmalgia, night blindness, distending pain of the breast Migraine pain of the outer canthus, pain in the axillary region, scrofula, lumbar pain, pain in the chest, hypochondriac region and lateral aspect of the lower extremities, malaria Apoplexy, hemiplegia, pain of the neck, abdominal distension, pain in the hypochondriac region, muscular atrophy of the lower Perpendicularly 0.8-1.2 cun Xia xi (GB 43) Perpendicularly 0.5-0.8cun Zu qiao Perpendicularly 0.5-0.8cun yin (GB 44)

Yang ling quan (GB 34)

Yang jiao (GB 35) Wai qiu (GB 36) Guang ming (GB 37)

7 cun above the tip of the lateral malleous on the posterior border of the fibula 7 cun above the tip of the lateral malleous on the anterior border of the fibula 5 cun above the tip of the lateral malleous on the anterior border of the fibula

xi-cleft point of the yang link vessel

Posterior to the 4th metatarsophalangeal joint between the fourth and fifth metatarsal bones, on the medial side of the tendon of extensor digiti minimi On the dorsum of the foot between the fourth and fifth metatarsals 0.5 cun proximal to the margin of the web at the junction of the red and white skin 0.1 cun posterior to the corner of the nail on the lateral side of the fourth toe

Perpendicularly 0.3-0.5cun

Ying-spring point

Jing-well point

Xi-cleft point

Headache, dizziness and vertigo, pain of the outer canthus, tinnitus, deafness, swelling of the cheek, pain in the hypochondriac region, distending pain of the breast, febrile disease Migraine, deafness, tinnitus, ophthalmalgia, dreamdisturbed sleep, febrile diseases

Perpendicularly 0.3-0.5cun

Superficially about 0.1 cun

Luo-connecting point

Perpendicularly 0.7-1.0cun

Yang fu (GB 38)

4 cun above and slightly anterior to the tip of the lateral malleous on the anterior border of the fibula

Jing-river point

Perpendicularly 0.5-0.7cun

Xuan zhong (GB 39)

3 cun above the tip of the lateral malleous in a depression between the posterior border of the fibula and the tendons of

Influential point of the marrow

Perpendicularly 0.3-0.5cun

12. The liver meridian of foot-jueyin Cyclical flowing and distribution: The Liver Meridian starts from the dorsal hair of the great toe, runs upward along the dorsum of the foot through the point, 1 cun in front of the medial malleolus, ascends to the area 8 cun above the medial malleolus when it runs across and behind the Spleen Meridian. Then it runs further upward to the medial side of the knee, and along the medial side of the thigh to the pubic hair region where it curves around the external genitalia and goes up to the lower abdomen. It then runs upward and curves around the stomach to enter the liver, its pertaining organ, and connects with the gallbladder. It ascends, passing through the diaphragm and branching out in the costal and hypochondriac regions. Then it ascends along the posterior aspect of the throat to the nasopharynx and connects with the eye. Running upward, it comes out from the forehead and meets the Governor Vessel at the vertex. The branch arising from the eye runs downward into the cheek and curves around the inner surface of the lips. The branch arising from the liver passes through the diaphragm, runs upward into the lung.

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TCM REVIEW Indications: Liver disease, gynecological disease, genitalia disorder and other diseases involving the areas through which the meridian flows. Acupoints: Da du (LR 1)Xing jian (LR 2)Tai chong (LR 3)Zhong feng (LR 4)Li gou (LR 5)Zhong du (LR 6)Xi guan (LR 7)Qu quan (LR 8)Yin bao (LR 9)Zu wu li (LR 10)Yin lian (LR 11) Ji mai (LR 12)Zhang men (LR 13)Qi men (LR 14)
Acupoint Da du (LR 1) Xing jian (LR 2) Location On the lateral side of the great toe, 0.1 cun from the corner of the nail. On dorsum of the foot between the 1st and 2nd toes, proximal to the margin of the web at the junction of the red and white skin Special points Jing-well point Indications Hernia, enuresis, uternine bleedin, prolapse of the uterus, epilepsy Pain in the hypochondrium, abdominal distension, headache, dizziness and vertigo, congestion, swelling and pain of the eye, deviation of the mouth, hernia, painful urination, retention of urine, irregular menstruation, epilepsy, insomnia, convulsion Headache, dizziness and vertigo, insomnia, congestion, swelling and pain of the eye, depression, infantile convulsion, deviation of the mouth, pain in the hypochondriac region, uterine bleeding, hernia, enuresis, retention of the urine, epilepsy, pain in the anterior aspect of the medial malleolus Hernia, pain in the external genitalia, nocturnal emission, retention of urine, distending pain in the hypochondrium Note Subcutaneously 0.1-0.2 cun Obliquely 0.30.5 cun the depression of the medial border of the tibia When the knee is flexed, the point is found above the medial end of the transverse popliteal crease, posterior to the medial epicondyle of the tibia in a depression on the anterior border of the insertions of the semimembraneous and semitendoneous muscles 4 cun above the medial epicondyle of the femur, between vastus medialis and sartorius muscles 3 cun below ST30 at the proximal end of the thigh on the lateral border of adductor longus muscle 2 cun below ST30, 2 cun from the midline at the proximal end of the thigh and on the lateral border of adductor longus muscle 2.5 cun lateral and inferior to the superior border of the pubic symphysis. In the inguinal groove lateral and inferior to ST30 On the lateral side of the abdomen below the free end of the 11th rib Directly below the nipple, 4 cun lateral to the midline in the 6th intercostal groove

TCM REVIEW

(LR 8)

He-sea point

Prolapse of uterus, lower abdominal pain, retention of urine, nocturnal emission, pain in the external genitalia, pruritus vulvae, pain in the medial aspect of the knee and thigh

Perpendicularly 0.5-0.8 cun

Yin bao (LR 9) Zu wu li (LR 10) Yin lian (LR 11) Ji mai (LR 12)

Ying-spring point

Pain in the lumbosacral region, lower abdominal pain, enuresis, retention of urine, irregular menstruation Lower abdominal distention and fullness, retention of urine

Perpendicularly 0.5-0.7 cun

Perpendicularly 0.5-1.0 cun

Irregular menstruation, leucorrhea, lower abdominal pain, pain in the thigh and leg

Perpendicularly 0.5-1.0 cun

Tai chong (LR 3)

On dorsum of the foot in a depression distal to the junction of the 1st and 2nd metatarsal bones

Shu-stream and yuan-primary point

Perpendicularly 0.3-0.5 cun

Lower abdominal pain, hernia, pain in the external genitalia

Perpendicularly 0.5-1.0 cun

Zhang Perpendicularly 0.3-0.5 cun men (LR 13) Qi men (LR 14) Subcutaneously 0.3-0.5 cun

Zhong feng (LR 4)

Li gou (LR 5)

1 cun anterior to the medial malleolus, midway between SP5 and ST41, in a depression on the medial side of the tendon of tibialis anterior 5 cun above the tip of the medial malleolus on the medial side of the tibia

Jing-river point

Front-mu point of the spleen, influential point of zang organs Front-mu point of the liver

Abdominal distention, borborygmus, pain in the hypochondriac region, vomit, diarrhea, indigestion Hypochondriac pain, abdominal distention, hiccup, acid regurgitation, mastitis, depression, febrile diseases

Perpendicularly 0.5-0.8 cun

Obliquely 0.30.5 cun

Luo-connecting point

Zhong du (LR 6) Xi guan (LR 7)

7 cun above the tip of the medial malleolus and posterior to the medial tibia 1 cun posterior to SP9, posterior and inferior to the medial condyle of the tibia in the upper portion of the medial head of the gastrocnemius muscle. In

xi-cleft point

Retention of urine, enuresis, hernia, irregular menstruation, leucorrhea, pruritus valvae, weakness and atrophy of the leg Abdominal pain, hypochondriac pain, diarrhea, hernia, uterine bleeding, prolonged lochia Pain of the knee

Subcutaneously 0.5-0.8 cun

13. The governor vessel Cyclical flowing and distribution: It arises from the lower abdomen and comes out from the perineum. It runs posteriorly along the interior side of the spinal column to Fengfu(GV16) at the nape where it enters the brain. It further ascends to the vertex and goes down along the forehead to the nasal column. Indications: mental problems, febrile disease, disorders of the lumbosacral region, back and head as well as diseases of the related viscera. Acupoints: Chang qiang (GV 1) Yao shu (GV 2) Yao yang guan (GV 3) Ming men (GV 4) Xuan shu (GV 5) Ji zhong (GV 6) Zhong shu (GV 7) Jin suo (GV 8) Zhi yang (GV 9) Ling tai (GV 10) Shen dao

Perpendicularly 0.5-1.0 cun

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TCM REVIEW (GV 11) Shen zhu (GV 12) Tao dao (GV 13) Da zhui (GV 14) |Ya men (GV 15) Feng fu (GV 16) Nao hu (GV 17) Qiang jian (GV 18) Hou ding (GV 19) Bai hui (GV 20) Qian ding (GV 21) Xin hui (GV 22) Shang xing (GV 23) Shen ting (GV 24) Su liao (GV 25) Shui gou (GV 26) Dui duan (GV 27) Yin jiao (GV 28)
(GV 11) Shen zhu (GV 12) Tao dao (GV 13) Da zhui Note Perpendicularly 0.5-1.0 cun (GV 14) Ya men Obliquely upward 0.5-1.0 cun (GV 15) process of T5

TCM REVIEW
palpitation, pain and stiffness of the back, cough, cardiac pain Cough, asthma, epilepsy, pain and stiffness of the back, furuncles Stiffness of the back, headache, malaria, febrile diseases Neck pain and rigidity, malaria, febrile diseases, epilepsy, afternoon fever, cough, asthma, common cold, back stiffness Mental disorders, epilepsy, deafness and mute, sudden hoarseness of voice, apoplexy, stiffness of the tongue and aphasia, occipital headache, neck rigidity Headache, neck rigidity, blurring of vision, epistaxis, sore throat, post-apoplexy aphasia, hemiplegia, mental disorders 0.5-1.0 cun

Below the spinous process of T3 Below the spinous process of T1 Below the spinous process of C7

Obliquely upward 0.5-1.0 cun Obliquely upward 0.5-1.0 cun Obliquely upward 0.5-1.0 cun

Acupoint Chang qiang (GV 1) Yao shu (GV 2) Yao yang guan (GV 3)

Location Midway between the tip of the coccyx bone and the anus with patient lying prone In the sacral hiatus of the sacrum

Special points Luo-connecting point

Below the spinous process of L4

Ming men (GV 4) Xuan shu (GV 5) Ji zhong (GV 6) Zhong shu (GV 7) Jin suo (GV 8) Zhi yang (GV 9) Ling tai (GV 10) Shen dao

Below the spinous process of L2

Below the spinous process of L1 Below the spinous process of T11 Below the spinous process of T10 Below the spinous process of T9 Below the spinous process of T7 Below the spinous process of T6 Below the spinous

Indications Diarrhea, bloody stools, hemorrhoids, prolapse of the rectum, constipation, pain in the lower back, epilepsy Irregular menstruation, pain and stiffness of the lower back, hemorrhoids, muscular atrophy of the lower extremities, epilepsy Irregular menstruation, nocturnal emission, impotence, pain in the lumbosacral region, muscular atrophy, motor impairment, numbness and pain of the lower extremities Stiffness of the back, lumbago, impotence, nocturnal emission, irregular menstruation, diarrhea, indigestion, leucorrhea Pain and stiffness of the lower back, diarrhea, indigestion Pain in the epigastric region, diarrhea, jaundice, epilepsy, stiffness and pain of the back Pain in the epigastric region, low back pain, stiffness of the back Epilepsy, stiffness of the back, gastric pain Jaundice, cough, asthma, stiffness of the back, pain in the chest and back Cough, asthma, furuncles, back pain, neck rigidity Poor memory, anxiety,

0.5 cun above the midpoint of the posterior hairline in a depression below the spinous process of C1 1 cun directly above the midpoint of the posterior hairline directly below the external occipital protruberance. In the depression between the trapezius muscles of both sides Midway between GV16 and GV18, 1.5 cun above GV16 Midway between GV16 and GV20, 1.5 cun above GV17 5.5 cun above the midpoint of the posterior hairline. Midway between GV18 and GV20, 1.5 cun above GV18 7 cun above the midpoint of the posterior hairline, 5 cun above midpoint of anterior hairline, miway on a line connecting the apex of both ears 1.5 cun anterior to GV20. Midway between GV20 and GV22. 2 cun posterior to the anterior hairline, 3 cun anterior to GV20

Perpendicularly 0.5-0.8 cun

Perpendicularly 0.5-1.0 cun

Feng fu (GV 16)

Perpendicularly 0.5-1.0 cun

Nao hu (GV 17) Qiang jian (GV 18) Hou ding (GV 19) Bai hui

Epilepsy, dizziness, pain and stiffness of the neck

Perpendicularly 0.5-0.8 cun Deep puncture is not advisable. Medullary bulb is in the deep layer, special attention should be paid in acupuncture Subcutaneously 0.3-0.5 cun

Perpendicularly 0.5-1.0 cun Perpendicularly 0.5-1.0 cun Perpendicularly 0.5-1.0 cun Perpendicularly 0.5-1.0 cun Obliquely upward 0.5-1.0 cun Obliquely upward 0.5-1.0 cun Obliquely upward

Headache, neck rigidity, blurring of vision, mania Headache, vertigo, mania, epilepsy

Subcutaneously 0.3-0.5 cun Subcutaneously 0.3-0.5 cun

(GV 20)

Headache, vertigo, tinnitus, nasal obstruction, aphasia by apoplexy coma, mental disorders, proplapse of the rectum and the uterus Epilepsy, dizziness, blurring of vision, vertical headache, rhinorrhea Headache, blurring of vision, rhinorrhea, infantile convulsion

Subcutaneously 0.3-0.5 cun

Qian ding (GV 21) Xin hui (GV

Subcutaneously 0.3-0.5 cun Subcutaneously 0.3-0.5 cun. This point is prohibited

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22) Shang xing (GV 23) 1 cun posterior to the anterior hairline, 0.5 cun posterior to GV24 Headache, ophthalmalgia, epistaxis, rhinorrhea, mental disorders in infants with metopism. Subcutaneously 0.3-0.5 cun or prick to cause bleeding. This point is prohibited in infants with metopism Subcutaneously 0.3-0.5 cun, or prick ot cause bleeding Perpendicularly 0.2-0.3 cun, or prick to cause bleeding Obliquely upward 0.3-0.5 cun Obliquely upward 0.2-0.3 cun Guan Obliquely upward 0.1-0.2 cun, or prick to cause bleeding yuan (CV 4) on the midline, 3 cun inferior to the umbilicus (CV 1) the anus and the scrotum in males. Between the anus and the posterior labial commissure in females On top of the notch in the center of the superior border of the pubic symphysis

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hemorrhoids, nocturnal emission, enuresis, irregular menstruation, mental disorders 0.5-1.0 cun

Qu gu (CV 2)

Shen ting (GV 24) Su liao (GV 25) Shui gou (GV 26) Dui duan (GV 27) Yin jiao (GV 28)

0.5 cun above the midpoint of the anterior hairline. On tip of nose

Epilepsy, anxiety, palpitation, insomnia, headache, vetigo, rhinorrhea Loss o fconscriousness, nasal obstruction, epistaxis, rhinorhea, rosacea Also known as Renzhong Mental disorders, epilepsy, hysteria, infantile convulsion, coma, apoplexy-faint, Mental disorders, lip twitching, tip stiffness, pain and swelling of the gums Mental disorders, pain and swelling of the gums, rhinorrhea

Retention and dribbling of urine, enuresis, nocturnal emission, impotence, morbid leucorrhea, irregular menstruation, dysmenorrheal, hernia

Zhong ji (CV 3)

1 cun above CV2, on the midline, 4 cun inferior to the umbilicus

Front-mu point of the bladder

At junction of the upper and middle third of philtrum At junction of upper lip and philtrum At junction of gum and frenulum of upper lip

Front-mu point of the small intestine

14. The Conception vessel Cyclical flowing and distribution: The Course of the Vessel: It starts from the inside of the lower abdomen and comes out from the perineum. It goes anteriorly to the pubic region and ascends along the interior side of the abdomen, passes through Guanyuan(CV4) and reaches the throat. Ascending further, it curves around the lips, passes through the cheek and enters the infraorbital region Chengqi(ST1). Indications: local disorders of the abdomen, chest, neck and head and diseases of the related viscera. A few of the acupoints on the conception vessel are effective in strengthening the body. Acupoints: Hui yin (CV 1) Qu gu (CV 2) Zhong ji (CV 3) Guan yuan (CV 4) Shi men (CV 5) Qi hai (CV 6) Yin jiao (CV 7) Shen que (CV 8) Shui fen (CV 9) Xia wan (CV 10) Jian li (CV 11) Zhong wan (CV 12) Shang wan (CV 13) Ju que (CV 14) Jiu wei (CV 15) Zhong ting (CV 16) Tan zhong (CV 17) Yu tang (CV 18) Zi gong (CV 19) Hua gai (CV 20) Xuan ji (CV 21) Tian tu (CV 22) Lian quan (CV 23) Cheng jiang (CV 24)
Acupoint Hui yin Location On the midline between Special points Indications Vaginitis, retention of urine Note Perpendicularly

Shi men (CV 5) Qi hai (CV 6)

On the midline, 2 cun inferior to the umbilicus

Front-mu point of triple energizer

On the midline, 1.5 cun inferior to the umbilicus

Yin jiao (CV 7)

On the midline, 1 cun inferior to the umbilicus

Enuresis, nocturnal emission, impotence, hernia, uterine bleeding , irregular menstruation, dysmenorrheal, morbid leucorrhea, frequency of urination, retention of urine, pain in the lower abdomen, prolapse of the uterus, vaginitis Enuresis, nocturnal emission, frequency of urination, retention of urine, hernia, irregular menstruation, morbid leucorrhea, dysmenorrheal, uternine bleeding, postpartum hemorrhage, lower abdominal pain, indigestion, diarrhea, prolapse of the rectum, flaccid type of apoplexy Abdominal pain, diarrhea, edema, hernia, anuria, enuresis, amenorrhea, morbid leucorrhea, uterine bleeding, postpartum hemorrhage Abdominal pain, enuresis, nocturnal emission, impotence, hernia, edema, diarrhea, dysentery, uternine bleeding, irregular menstruation, dysmenorrheal, amenorrhea, morbid leucorrhea, postpartum hemorrhage, constipation, flaccid type of apoplexy, asthma Abdominal distention, edema, hernia, irregular menstruation, uterine bleeding, morbid leucorrhea, pruritus vulvae, postpartum hemorrheage, abdominal pain around the umbilicus

Perpendicularly 0.5-1.0 cun. Great care should be taken to puncture the points from Qu gu(CV 2) to Shang wan(CV 13) of this meridian in pregnant women. Perpendicularly 0.5-1.0 cun.

Perpendicularly 0.8-1.2 cun. This is one of the important points for tonification.

Perpendicularly 0.5-1.0 cun.

Perpendicularly 0.8-1.2 cun.

Perpendicularly 0.8-1.2 cun

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Shen que (CV 8) Shui fen (CV 9) Xia wan (CV 10) Jian li (CV 11) Zhong wan (CV 12) In the center of the umbilicus Abdominal pain, borborygmus, flaccid type of apoplexy, prolapse of the rectum, unchecked diarrhea Abdominal pain, borborygmus, edema, retention of the urine, diarrhea Epigastric pain, abdominal pain, borborygmus, indigestion, vomit, diarrhea Stomachache, vomit, abdominal distention, borborygmus, edema, anorexia Stomachache, abdominal distention, borborygmus, nausea, vomit, acid regurgitation, diarrhea, dysentery, jaundice, indigestion, insomnia Stomachache, abdominal distention, nausea, vomit, epilepsy, insomnia Pain in the cardiac region and the chest, nausea, acid regurgitation, difficulty in swallowing, vomit, mental disorders, epilepsy, palpitation Pain in the cardiac region and the chest, nausea, mental disorders, epilepsy Distension and fullness in the chest and intercostal region, hiccup, nausea, anorexia Front-mu point of the pericardium, influential point of Qi Asthma, pain in the chest, fullness in the chest, palpitation, insufficient lactation, hiccup, difficulty in swallowing Pain in the chest, cough, asthma, vomit Pain in the chest, asthma, cough Pain and fullness in the chest and intercostal region, asthma, cough Pain in the chest, cough, asthma Puncture is prohibited Tian tu (CV 22) 0.5 cun superior to the suprasternal notch, in the center of the depression

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Asthma, cough, sore throat, dry throat, hiccup, sudden hoarseness of the voice, difficulty in swallowing , goiter First puncture perpendicularly 0.2 cun and then insert the needle tip downward along the posterior aspect of the strernum 0.5-1.0 cun Obliquely 0.5-1.0 cun toward the tongue root

On the midline, 1 cun superior to the umbilicus On the midline, 2 cun superior to the umbilicus. On the midline, 3 cun superior to the umbilicus On the midline, 4 cun superior to the umbilicus Front-mu point of the stomach, influential point of the fu organs

Perpendicularly 0.5-1.0 cun Perpendicularly 0.5-1.2 cun Perpendicularly 0.5-1.2 cun Perpendicularly 0.5-1.2 cun

Lian quan (CV 23)

On the midline, in the depression superior to the hyoid bone

Cheng jiang (CV 24)

In the depression in the center of the mentolabial groove, below the middle of the lower lip

Swelling and pain of the subglossal region, salivation with glossoplegia, aphasia with stiffness of tongue by apoplexy, sudden hoarseness of the voice, difficulty in swallowing Facial puffiness, swelling of the gums, toothache, salivation, mental disorders, deviation of the eyes and mouth

Obliquely upward 0.2-0.3 cun

Shang wan (CV 13) Ju que (CV 14)

On the midline, 5 cun superior to the umbilicus On the midline, 6 cun superior to the umbilicus Front-mu point of the heart

Perpendicularly 0.5-1.2 cun Perpendicularly 0.3-0.8 cun

15. The extra points

Acupoint Tai yang Location In the depression about one finger breadth posterior to the midpoint between the lateral end of the eyebow and the outer canthus Midway between the medial ends of the two eyebrows 1 cun below the midpoint of the lower jaw, in the depression between the hyoid bone and the lower border of the jaw Fold the auricle, the point is at the apex of the auricle At the midpoint of the eyebrow, directly above the pupil Indications Headache, eye diseases, deviation of the eyes and mouth Note Perpendicularly 0.30.5 cun

Yin tang Obliquely downward 0.4-0.6 cun Subcutaneously 0.3-0.5 cun Er jian Subcutaneously 0.3-0.5 cun

Jiu wei (CV 15) Zhong ting (CV 16) Tan zhong (CV 17) Yu tang (CV 18) Zi gong (CV 19) Hua gai (CV 20) Xuan ji (CV 21)

On the midline, 7 cun superior to the umbilicus and inferior to the xiphoid process On the midline level with the 5th intercostal space at the sternocostal angle On the midline level with the 4th intercostal space midway between the nipples. On the midline level with the 3rd intercostal space On the midline level with the 2nd intercostal space On the midline level with the 1st intercostal space On the manubrium midline, 1 cun below CV22

Luo-connecting point

Shang lian quan

Headache, head heaviness, epistaxis, rhinorrhea, infantile convulsion, frontal headache, insomnia Alalia, salivation with stiff tongue, sore throat, difficulty in swallowing, loss of voice Redness, swelling and pain of the eyes, febrile disease, nebula Pain in the supraorbital region, twitching of the eyelids, ptosis, cloudiness of the cornea, redness, swelling and pain of the eyes Headache, vertigo, insomnia, poor memory, epilepsy Eye diseases

Subcutaneously 0.30.5 cun Obliquely 0.8-1.2 cun toward the tongue root Perpendicularly 0.10.2 cun or prick to cause bleeding Subcutaneously 0.30.5 cun

Yu yao

Subcutaneously 0.3-0.5 cun Subcutaneously 0.3-0.5 cun Subcutaneously 0.3-0.5 cun Subcutaneously 0.3-0.5 cun

Si shen cong Qiu hou

A group of 4 points, at the vertex, 1 cun repectively posterior, anterior and lateral to Baihui (GV 20) At the junction of the lateral and the medial of the infraorbital margin

Subcutaneously 0.51.0 cun Push the eyeball upward gently, then puncture perpendicularly 0.51.2 cun along the orbital margin slowly without movements of lifting, thrusting, twisting and rotating Obliquely 0.5-1.0 cun

Jia cheng jiang

1 cun lateral to Cheng jiang(CV 24)

Pain in the face, deviation of the eyes and mouth, spasm of facial muslcle

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Jinjing, yu ye Bi tong Qian zheng Yi ming An mian Ding chuan Hua tuo jia ji On the veins on both sides of the frenulum of the tongue, Jin jin is on the left, Yu ye, on the right At the highest point of the nasolabial groove 0.5-1.0 cun anterior to the auricular lobe 1 cun posterior to Yi feng Midpoint between Yi feng(TE 17) and Fengchi(GB 20) 0.5 cun lateral to Dazhui(GV 14) A group of 34 points on both sides of the spinal column, 0.5 cun lateral to the lower boder of eacn spinous process from the first thoracic vertebra to the fifth lumbar vertebra Swelling of the tongue, vomit, aphasia with stiffness of tongue Rhinitis, nasal obstruction, nasal boils Deviation of the eyes and mouth, ulceration on tongue and mouth Eye diseases, tinnitus, insomnia Insomnia, vertigo, headache, palpitation, mental disorders Asthma, cough, neck rigidity, pain in the shoulder and back, rubella T1-T3: Diseases in the upper limbs; T1-T8: Diseases in the chest region; T6-L5: Diseases in the abdominal region; L1-L5: Diseases in the lower limbs Prick to cause bleeding Ba xie Subcutaneously upward 0.3-0.5 cun Obliquely 0.5-1.0 cun Luo zhen Perpendicularly 0.50.8 cun Perpendicularly 0.50.8 cun Perpendicularly 0.50.8 cun Perpendicularly 0.51.0 cun in the cervical and chest region, puncture perpendicularly 1.01.5 cun in the lumbar region Perpendicularly 0.30.5 cun Obliquely 0.5-0.7 cun

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interphalangeal joint of the middle finger at dorsum aspect On the dorsum of the hand, at the junction of the white and red skin of the hand webs, eight in all, making a loose fist to locate the points On the dorsum of the hand, between the second and third metacarpal bones, about 0.5 cun posterior to metacarpophalangeal joint On the dorsum of the hand, midway between the transverse wrist crease and metacarpophalangeal joint, between the second and third metacarpal bones, and between the fourth and fifth metacarpal bones, four points in all on both hands On the dorsal crease of the wrist in the depression on the radial side of the tendon of common extensor muscle of fingers between Yang xi(LI 5) and Yang chi(TE 4) On the metacarpal aspect of the forearm, 4 cun above the transverse wrist crease, on the both sides of the tendon of m. flexor carpi radias, two points on one hand On the lateral aspect of the forearm, midway between the transverse wrist crease and elbow crease, between the radius and the ulna On the tip of the ulnar olecranon when elbow is flexed Midway between Huan tiao(GB 30) and Yao shu(GV 2) 1 cun above Xue hai(SP 10) A paire of points in the two depressions, medial and lateral to the patellar ligament, locating the point with the knee flexed. These two points are also termed medial and lateral Xiyan respectively. Lateral Xi yan overlaps with Du bi(ST 35) The tender spot about 2 cun below Zu san li(ST 36) In the depression of the midpoint of the superior patellar border The tender spot 1-2 cun directly below Yang ling quan(GB 34) applied with three moxa cones Obliquely 0.3-0.5 cun, or prick to cause bleeding Perpendicularly 0.50.8 cun

Excessive heat, finger numbness, spasm and contracture of the fingers, redness and swelling of the dorsum of the hand Sore neck, pain in the shoulder and arm

Yao tong xue

Acute lumbar sprain

Obliquely 0.5-1.0 cun toward the center of metacarpus from both sides

Zhong quan

Stuffy chest, gastric pain, spitting of blood

Perpendicularly 0.30.5 cun

Bai lao Wei wan xia shu Shi qi zhui Yao qi Pi gen

2 cun above Dazhui(GV 14), 1 cun lateral to the midline 1.5 cun lateral to the lower border of the spinious process of the eighth thoracic vertebra Below the spinous process of the fifth lumbar vertebra 2 cun directly above the tip of the coccyx 3.5 cun lateral to the lower border of the spinous process of the first lumbar vertebra About 3.5-4 cun lateral to the lower border of the spinous process of the fourth lumbar vertebra. The point is in the depression appearing in prone position 3 cun lateral to Zhong ji(CV3) Midway between the end of the anterior axillary fold and Jian yu(LI 15)

Scrofula, cough, asthma, whooping cough, neck rigidity Diabetes, vomit, abdominal pain, pain in the chest and hypochondriac region Lumbar pain, thigh pain, paralysis of the lower extremities, irregular menstruation, dysmenorrheal Epilepsy, headache, insomnia, constipation Hepatosplenomegaly, lumbar pain

Er bai

Hemorrhoids, prolapse of the rectum

Perpendicularly 0.51.0 cun

Perpendicularly 0.81.2 cun Subcutaneously upward 1.0-2.0 cun Perpendicularly 0.50.8 cun Perpendicularly 0.81.2 cun

Bi zhong

Paralysis,spasm, and contracture of the upper extremities, pain of the forearm Scrofula

Perpendicularly 1.01.2 cun

Zhou jian

Yao yan

Lumbar pain, frequency of urine, irregular menstruation

Huan zhong Bai chong wo Xi yan

Lumbar pain, thigh pain Rubella, eczema, gastrointestinal parasitic diseases Knee pain, weakness of the lower extremities

Zi gong xue Jian qian(also known as Jian nei ling) Shi xuan

Prolapse of the uterus, irregular menstruation Pain in the shoulder and arm, paralysis of the upper extremities

Perpendicularly 0.81.2 cun Perpendicularly 0.81.2 cun Lan wei xue He ding Dan nang xue

Moxibustion is applied with seven to fourteen moxa cones Perpendicularly 1.52.0 cun Perpendicularly 1.01.2 cun Perpendicularly 0.51.0 cun

On the tips of the ten fingers about 0.1 cun distal to the nails

Si feng

On the palmar surface in the midpoint of the transverse creases of the proximal interphalangeal joints of the index, middle, ring and little fingers O the midpoint of the proximal

Apoplexy, coma, epilepsy, high fever, acute tonsillitis, infantile convulsion, numbness of the finger tips Malnutrition and indigestion syndrome in children, whooping cough

0.1-0.2 cun superficially, or prick to cause bleeding Prick to cause bleeding, or squeeze out a small amount of yellowish viscous fluid locally Moxibustion is

Ba feng

Zhong kui

Nausea, vomit, hiccup

On the dorsum of foot, in the depressions on the webs between toes,

Acute and chronic appendicitis, indigestion, paralysis of the lower extremities Knee pain, weakness of the foot and leg, paralysis Acute and chronic cholecystitis, cholelithiasis, biliary ascariasis, muscular atrophy and numbness of the the lower extremities Beriberi, toe pain, redness and swelling of the dorsum of the foot

Perpendicularly 1.01.2 cun Perpendicularly 0.30.5 cun Perpendicularly 0.81.2 cun

Obliquely 0.5-0.8 cun

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proximal to the margins of the webs, at the junction of the red and white skin, eight points in all

TCM REVIEW 2. The length and gauge refer to the dimension of the needle body. 3. Needles from gauges 26-32 in diameter and 1-3 cun in length are most frequently used in clinic. 4. Clean Needle Technique (CNT): 1). The need for CNT : The immune response to pathogens (Autogenous infections; Cross-infections); Hepatitis [Hepatitis A, B, C, D, E(HAV, HBV, HCV, HDV, HEV)]; 2). Basic principles of CNT: a. Always wash hands between patients b. Always use sterile needles c. Always establish a clean field d. Always wash hands just prior to inserting needles if hands have been contaminated e. Always immediately isolate used needles. 3). Several terms: sterilization; contamination; aseptic techniques; antiseptic; disinfection; disinfectants; clean technique; clean field; 4). Recommendations for practitioners: yearly physical; clothing; hand care; personal health; testing for TB, HBV, HCV and HIV; 5) Recommendations for equipment: Acupuncture needles; needle guide tubes; needle trays; seven-star or plum-blossom needles; cupping devices; 6). Applying CNT in an acupuncture treatment a. General guidelines: Establishing a clean work area; positioning the patient; handwashing; preparing the site for insertion of a needle; palpating the point; using sterile needles; using guide tubes; using gloves; inserting needle to correct depth; dealing with blood to blood contact; managing used instruments; bleeding during cupping; cleaning a spill of blood or body fluid; disposing of biohazardous waste; b. Working in public health setting: handwashing; choice of instruments; positioning the patient; removing needles; managing patient accidents; 7). CNT outside the office: preparing and using a travel kit 8). Choosing the appropriate sterilization method and equipment: autoclave; dry heat sterilization; classification and types of chemical disinfectants; 9). Successful sterilization: a. Choosing the appropriate method and equipment b. Preparing and labeling instruments for sterilization c. Loading the sterilizer d. Monitoring that sterilization has occurred e. Ensuring proper function of the equipment f. Knowing what methods of sterilization are unacceptable 10). The double sterilization procedure: preliminary sterilization; final sterilization; 11). Unacceptable procedures for sterilization: boiling water; alcohol; pressure cookers 12). Acceptable sterilization modes: autoclave (30min at 250degrees F, 15 pounds pressure with rapid decompression at the end of the cycle); dry heat (2h at 338 degree F.); chemical sporicidal sterilant; 13). Risk reduction: office enviorment; informed consent; maintaining accurate patient records; daily appointment schedules; patient confidentiality; 14). Employers of health care workers are encouraged to take OSHA training.

Chapter 5 Acupuncture Techniques

1. A filiform needle may be divided into five parts: handle; tail; tip; body; root

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TCM REVIEW 15). What to do for: Accidents, needlesticks; pain or trauma on or after insertion; fainting; stuck needle; broken needle; accidental injury to organs; high-risk patients; 16). Safety issues when using special techniques: electrical stimulation; moxibustion; bleeding techniques; 5. The fundamental manipulation techniques: lifting, thrusting, twirling and rotaing. 6. Arrival of qi: feeling of numbness, heaviness and distension around the point, or transmission upward and downward along the meridians; 7. The basic reinforcing and reducing methods: a. Reinforcing: Insert slowly, withdraw rapidly; lift gently and slowly, thrust rapidly and heavily; rotate gently and slowly b. Reducing: Insert rapidly, withdraw slowly; insert thrust gently and slowly, lift rapidly and heavily; rotate rapidly 8. Comprehensive reinforcing and reducing methods a. Setting the mountain on fire-----deficiency cold b. Penetrating-heaven coolness-----excess syndrome and heat syndrome 9. Functions of moxibustion: a. To warm meridians and expel cold b. To induce the smooth flow of qi and blood c. To strength yang from collapse d. To prevent diseases and keep healthy 10. Contraindications for moxibustion: excess syndrome and heat syndrome; scarring moxibustion should not be applied to the face and head, and the area in the vicinity of the large blood vessels; the abdominal region and lumbosacral region of the pregnant women; 11. General introduction to acupuncture treatment a. Regulation of Yin and Yang b. Strengthing the body resistance and eliminating the pathogenic factors c. Distinguishing the primary from the secondary d. Treatment of diseases according to climatic and seasonal conditions, geographical locations and the individual conditions 12. Therapeutic method: reinforcing; reducing; warming; cleaing; asceding; descending; 13. Principles for point selection: selection of nearby points; selection of distant points; 14. Application of specific points a. Specific points on the four extremities: the five-shu points; b. The combination of mother and son points for Reinforcing and reducing: LU 9 and LU 5 c. The lower He-sea points of the six fu organs: d. The combination of the yuan (primary) points and the luo-(connecting) points: LU 9 and LI 6; LI 4 and LU 7 e. The eight confluent points of the eight extra meridians f. Specific points on the head and trunk: back shu points; the front-mu points; g. The eight influential points of the eight tissures 15. Special needling cautions & contraindications Caution during pregnancy: Ren-2; Ren-3; Ren-4; Ren-11; Sp-2; Sp-6; GB-21; UB-60; UB-67; LI-4; ST-25

TCM REVIEW Contraindicated-No needling or use with caution with direction: Ren-5(may cause infertility in female); Ren-8(may be fatal); Ren-15(may shorten life); Du-11(may damage heart); Du-24; PC-1(may cause pneumothorax); ST-17; HT-2; LU-2(may cause inability to raise arm); LIV-12; GB-3(may cause deafness); GB-18; GB-21(deep needle forbidden in heart cases); KI-11; UB-56; SJ-7; SJ-8; E-zhongkui; No head points on infants; No points on lower abdomen and lower back 3 months after pregnancy; No Moxa: PC-1; PC-9(forbidden moxa on females) Caution-over pulses and major vessels: PC-3; LU-7; LU-8; LU-9; ST-30; ST-42; ST11; LIV-3; LIV-12; UB-1; UB-2; LI-4; LI-5; LI-13; SJ-23 Combination of Yuan-Luo In the clinic, we name it zhu ke yuan-luo that means we treat disease according to the order of affected meridians. The primary affected meridian is named zhu or host; We take yuan point from host affected channel. The secondary affected meridian is named ke or guest. We select the luo point from guest channel. For example, if the lung channel is first affected by exogenetic factors, we take the yuan point (LU 9) of lung channel; while we take the luo point of Large Intestine (LI 6) channel. Zang channel-----yuan point; Fu channel-----luo point; Fu channel--------yuan point ; Zang channelluo point ;

Yuan Points of 12 channels

12 LU Channel Yuan Point LU 9 (Tai yuan) ST 42 HT 7 LI 4 SP 3 (Chong (Shen (He gu) (Tai bai) yang) men) SI 4 (Wan gu) UB 64 KI 3 (Jing (Tai xi) gu) PC 3 (Da ling) LV 3 SJ 4 GB 40 (Yang (Qiu xu) (Tai chi) chong LI ST SP HT SI UB KI PC SJ GB LV

15 Luo Points
Channel LU HT PC SI LI SJ UB GB ST SP KI LV Ren Du Large Luo of Spleen

Luo Point

ST LU 7 HT 5 PC 6 SI 7 LI 6 SJ 5 UB 58 GB 37 SP 4 KI 4 LV 5 Ren Du 1 SP 21 40 (Lie (Tong (Nei (Zhi (Pian (Wai (Fei (Guang (Gong (Da (Li 15 (Jiu (Chang (Da (Feng que) li) guan) zheng) Li) guan) yang) ming) sun) zhong) gou) wei) qiang) bao) long)

Combination of Yuan and Luo

Zang LU LI ST SP HT SI UB KI PC SJ GB Liv

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Fu Yuan LU 9 point Luo LI 6 point

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Lower He Sea Points of the 6 Fu (Yang) Organs

LI 4 LU 7

ST 42 SP 3 SP 4

HT 7

SI 4 HT 5

UB 64 KI 3 KI 4

PC 3

SJ 4 PC 6

GB 40 LV 3 LV 5 GB 37

Large Intestine Triple Heater

ST 37(shang ju xu)

-Yang Ming-Shao Yang-Tai Yang-

Stomach

ST 36(zu san li)

ST 40 SI 7

UB 58 SJ 5

UB 39(wei yang)

Gall Bladder Urinary Bladder

GB 34(yang ling quan)

General speaking, Xi cleft point treat acute disease in the corresponding channel and related Zang Fu; Xi cleft points in Yin channel usually treat blood syndrome; i.e LU 6(Kong zui) usually treats emptysis in the clinic; Xi cleft points in Yang channel usually treat acute pain; i.e ST 34(Lang qiu) usually treats Stomachache Xi cleft not only helps treat disease, but also helps diagnosis in the clinic. Pressing Xi cleft point help diagnosis and see if which channel is affected. 16 Xi cleft points: 12 channel Xi cleft plus Yin qiao, Yin wei, Yang qiao, Yang wei;
Xi-Cleft Points Urinary Bladder Kidney Yin Qiao Vessel Yang Qiao Vessel Yin Wei Vessel Yang Wei Vessel

Small Intestine

ST 39(xia ju xu)

UB 40(wei zhong)

8 Influential points Zang influential point (LV-13, zhang men): Spleen, Live disorder; Fu influential point (Ren-12, zhong wan): Stomach, SI, LI disorder; Qi influential point (Ren-17, tan zhong): Qi Ji disorder Blood influential point (UB-17, ge shu): Blood disorder, i.e. invigorate blood, stop bleeding Sinews influential point (GB-34, yang ling quan): lower limb tendon disorder, i.e. wei Bi, paralysis, etc. Marrow influential point (GB-39, xuan zhong): brain and mental problem; Bones influential point (UB-11, da zhu): tonify and strengthen bones Vessels influential point (LU-9 tai yuan): Lung and heart disorder

Lung Large Intestine Stomach

LU 6(kong zui)

UB 63(jin men)

KD 8(jiao xin)

8 Extra Mridian Points

Ren Yin Qiao Du Yang Qiao Dai Yang Wei Chong Yin Wei Master Lu-7 (lie que) K-6 (zhao hai) SI-3 (hou xi) UB-62 (shen mai) GB-41(zu lin qi) SJ-5 (wai guan) SP-4 (gong sun) PC-6 (nei guan) Indications Abdomen, chest, lungs, throat, face

LI 7(wen liu)

KD 5(shui quan)

UB 59(fu yang)

ST 34(liang qiu)

Pericardium

PC 4(xi men)

KD 9(zhu bin) GB 35(yang jiao)

Back of legs, back, spine, neck, head, eyes, brain

Spleen Heart Small Intestine

SP 8(di ji) HT 6(yin xi) SI 6(yang lao)

Triple Heater Gall Bladder Liver

TH 7(hui zong) GB 36(wai qiu) LV 6(zhong du)

Outer aspect of leg, sides of body, shoulders, side of neck

Inner aspect of leg, abdomen, chest, heart, stomach

Five shu points: Jing-Well: First aid; Mental illness, stiffing chest, fullness under the heart; Ying-spring: Heat syndrome (clear heat); Febrile complexion, hot sensations Shu-stream: Stop pain; Bi, wind, damp, heaviness, joint pain Jing-river: exterial syndrome; asthma, cough, hot/cold sensations, change of voice He-sea: Fu organs disorder; stomach, intestines, rebellious Qi, diarrhea
Lower He sea points treat 6 Fu diseases.

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Five Shu Points
Jing-well Ying-spring Shu-stream Jing-river He-Sea (Wood) LU 11 PC 9 HT 9 SP 1 LV 1 KD 1 (Fire) LU 10 PC 8 HT 8 SP 2 LV 2 KD 2 (Earth) LU 9 PC 7 HT 7 SP 3 LV 3 KD 3 (Metal) LU 8 PC 5 HT 4 SP 5 LV 4 KD 7 (Water) LU 5 PC 3 HT 3 SP 9 LV 8 KD 10

TCM REVIEW Lumbosacral joints: Yaoyangguan(DU-3),Ciliao(BL-32); Hip joints: Huantiao(GB-30), Fenshi(GB-31); Knee joints: Xiyan(EX-LE5), Yanglingquan(GB-34); Ankle joints: Jiexi(ST-41), Kunlun(BL-60). Hypertension Select points : (1) Quchi(LI-11) ,Taichong(LR-3) (2)Fengchi(GB-20), Zusanli(ST-36) Hemiplegia Select points: Jianyu(LI-15),Quchi (LI-11),Waiguan(SJ-5),Hegu (LI-4),Jianjing(GB-21) for upper extremities; Lower extremities: Huantiao(GB-30) ,Yanglingquan(GB-34), Jianjing(GB-21), Fengling(ST-40), Tiaokou(ST38), Ciliao(cupping); Sequel(dysphasia): Lianquan(RN-23), Tiantu(RN-22), Neiguan(PC-6), Jianliao(SJ-14). Bronchitis Select points: Tiantu(RN-22), Danzhong(RN-17), Dingchuan(EX-B-1); fever plus Dazhui(DU-14), throat pain plus Hegu(LI-4), chestpain plus Neiguan(PC-6). Bronchial asthma Select points: Tiantu(RN-22), Danzhong(RN-17), Feishu(BL-13), not onset time , treating often f the Hegu(LI-4),Zusanli(ST-36). Prostatitis Select points: Guanyuan (RN-4), Zhongji(RN-3), Shenshu(BL-23). Epilepsy Select pints: Seizure stage: Shuigou(also known as renzhong,DU-26)for intense stimulation with the induction pole or non-induction pole. Remission stage: Fengchi(GB-20),Fenglong(ST-40). trigeminal neuralgia select points: Yangbai(GB-14),Taiyang(EX-HN-1), or Yifeng(SJ-17); Sibai(ST-2),Yifeng;(3)Xiaguan(ST-7),Yifeng(SJ-17). NB: This disease must be differentiated from the secondary trigeminal neuralgia. Sciatica Select points: Huantiao(GB-30), Yanglingquan(GB-34), Xiajuxu(ST-39), Ciliao(BL-32). Facial paralysis Select points: Sibai(ST-2), Chengjiang(RN-24), Dicang(ST-4), Jiache(ST-6), Yangbai(GB-14) etc. Facial spasm

Yin Meridians LU PC HT SP LV KD Yang Meridians LI TH SI ST GB UB

Jing-well Ying-spring Shu-stream Jing-river He-Sea (Metal) LI 1 TH 1 SI 1 ST 45 GB 44 UB 67 (Water) LI 2 TH 2 SI 2 ST 44 GB 43 UB 66 (Wood) LI 3 TH 3 SI 3 ST 43 GB 41 UB 65 (Fire) LI 5 TH 6 SI 5 ST 41 GB 38 UB 60 (Earth) LI 11 TH 10 SI 8 ST 36 GB 34 UB 40

Headache Select points: Migraine (one-side headache): Taiyang(E-HN5), Fengchi(GB-20) Forehead: Touwei (ST-8), Taiyang (EX-HN 5) Occipital region: Fengchi(GB-20), Dazhui(DU-14), Yintang(Ex-HN3) Whole potions: Yintang (EX-HN3),Fengchi(GB-20) Stomachache Select points: Zusanli(ST-36), Zhongwan(RN-12), Qimen(LR-14,right), Weishu(BL21,Cupping), Liangqiu(ST-34). Low back spin (Lunar pain) Select points: Shenshu(BL-23), Weizhong(BL-40), Painful spot(i.e. Ahshi point), or cupping at the painful spot. Scapulohumeral periarthritis Select points: Naoshu(SI-10), Jianjing(GB-21), Shaohai(HT-3), Quchi(LI-11), Ahshi spots(painful spot), Jianzhen(SI-9), Jianqian(I, e. Jianneiling). Arthritis Select points:Temporomandibular joint: Xiaguan(ST-7), Hegu(LI-4); Interspinal vertebrae joints: Correspond with Jiaji points; Shoulder joints: Jianyu(LI-15), Jianliao(SJ-14); Elbow joints: Quchi(LI-11),Shaohai(HT-3); Wrist, metacarpophalangeak, digital joints; (PC-7)Waiguan(SJ-5);

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TCM REVIEW Select points : Sibai (ST-2), Sizhukong (ST-23), Yangbai (GB-14). Sprain Select points:Neck position: Houxi(SI-3),Fengchi(GB-20) Shoulder elbow, wrist: Quchi(LI-11),Weiquan(SJ-5) Lumbar position: Painful spots Hip position: Xuanzhong(GB-34),Huantiao(GB-30) Knee position: Yang lingquan(GB-34),Zusanli(ST-36) Ankle position: Kunlun(BL-60),Xuanzhong(GB-39). Upper respiratory tracts infections Select points: Fengchi(GB-20),Hegu(LI-4). Acupoints according to symptoms and signs: Nasal obstruction ,plus Yingxiang(LI-20) Continued headache ,plus Taiyang(EX-LE-9) High fever ,plus Dazhui(DU-14) Chronic rhinitis Select points : Yintang (EX-HN-3), Hegu (LI-4), Yingxiang (LI-20). Chronic nasal sinusitis Select points: Yingxiang(LI-20),Cuanzu(BL-2),Sibai(LI-20) Headache, plus Taiyang(EX-HM-5),Fengchi(GB-20). Sore throat Select points: Yuji(LU-10),Hegu(LI-4). Toothache Select points: Hegu(LI-4),Taichong(LR-3) Upper toothache ,plus Jiache(ST-6). Lower toothache ,plus Xiaguan(ST-7) Neurasthenia Select points: Shenmen(HT-7),Sanyinjiao(SP-6). Insomnia Select points : Shenmen (HT-7), Sanyinjiao (SP-6), Fengchi (GB-20), Neiguan (PC-6).

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Impotence Select points : Guanyuan (RN-4), Zhongji (RN-3), Shenshu (BL-23), Sanyinjiao (SP-6). Dizziness and vertigo(Meniere's syndrome) Select points: Fengchi(GB-20),Neiguan(PC-6) Points according to symptoms and signs:Vomiting seriously, plus Zusanli(ST-36) Tinnitus ,plus Yifeng(SJ-17). Deafness and tinnitus Select points: Yifeng(SJ-17),Tinghui(GB-2). Menoxenia(abnormal menstruation) Select points: Sanyinjiao(SP-6),Zigong(EX-CA-1). Dysmenorrhea Select points : Sanyinjiao (SP-6), Guanyuan (RN-4), Zhongji (RN-S), Zigong (EX-CAA). Diarrhea, Distension Select points: Zusanli(ST-36), Tianshu(ST-25), Quchi(LI-11), Pishu(BL-20,cupping) Constipation Select points: Zhigou(SJ-6),Tianshu(ST-25),Zusanli(ST-36) Nocturnal Enuresis Selection points : Guanyuan (RN-4), Zhongji (RN-3), Sanyinjiao (SP-6) Contraindicated in debilitated patients, plus Zusanli(ST-36),Shenshu(BL-23) Heatstroke(or sunstroke) Select points:Mild ,Qishi(LI-11),Dazhui(DU-14); Serious, plus Shuigou(DU-26,also known as Renzhong) Stiffneck Select points: Jianjing(GB-21),Wailaogong(EX-UE-8) Ahshi points(painful spots) Hemorrhoids Select points: Changqiang (DU-1), Chengshan(BL-57), Quchi(LI-11), Ciliao(BL-32) Neurodermatitis Select points: Quchi (LI-11), Xuehai (SP-10), San yinjiao (SP-6) Mastoplasia(mammies) Select points: Rugen(ST-18)

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TCM REVIEW Myopia Select points: Chengqi(ST-1),Cuanzhu(BL-2),Taiyang(EX-HN-5) Diabetes mellitus Select points: (1)Feishu(BL-13),Yishu(new EX.) (2)Lianquan(RN-23),Lieque(LU-7),Yuji(LU-10) Diabetes involving the middle warm, take food more and hungry, weight loose and constipation. Select points: (1)Weishu(BL-21),Neiting(ST-44) (2)Zusanli(ST-36),Yishu(new EX.) Diabetes involving the lower warmer: Select points: (1)Shenshu(BL-23,cupping),Yishu(cupping) (2)Sanyinjiao(SP-6),Guanyuan(RN-4,cupping), Zhongji(RN-3,cupping) Cervical spondylosis Select points: Fengchi(GB-20),Yamen(DU-15),Dazhui(DU-14) Hyperplasia of cervical vertebra Select points:Yamen(DU-15),Dazhui(DU-14),Jiangjing(GB-21),Quchi(LI-11),Hegu(LI4). Cholecystitis Select poins: Dannang(EX-LE-6), Qimen(LR-14,right), Zhangmen(LR-13,right) Appeddicitis Select points:Zigong(EX-CA-A),Lanwei(EX-LE-7) Chronic appeddicitis: Select points: (1)Zigong (right,EX-CA1,cupping), Zhangmen(LR-13,right), Quchi(LI-11) (2)Zusanli(ST-36),Neiting(ST-44) Epistaxis select points: Neiting(SY-44), Sanyinjiao(SP-6), Quchi(LI-11), Taichong(LR-3) Varicose veins Select points: Yinlingquan(LR-11),Sanyinjiao(SP-6) Painful heels Select points: Taixi(KI-3), Kunlun(BL-60), Gongsun(SP-4), Yongquan(KI-1).

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Chapter 6 TCM Diagnosis

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1. Diagnosis of TCM is a study involving the examination of the body based on the theories of traditional Chinese medicine. 2. Diagnostic Methods include: Observation; Listening/Smelling; Inquiring; Palpation Inspection 1. Inspection of patients whole body 1.1 Inspection of Vitality/Spirit(shen) a. Strong vitality/spiritedness b. Lack of Vitality/Spiritlessness c. Pseudo-Vitality/False Spiritedness 1.2 Inspection of Complexion ---- Normal Complexion Zhu(host) complexion Ke(Guest) complexion ----- Diseased Complexion a. White: Weakness, Qi and Blood Deficiency, Yang Deficiency b. Yellow: Jaundice, Heat c. Red: Heat/ Yin Deficiency d. Green/Blue/Purple: Cold, pain, blood stasis, convulsion e. Black: Deficiency, cold, blood stasis, fluid retention 1.3 Inspection of Form and Bearing: Thin or fat, strong or weak, and their movement 2. Inspection of patients body in parts 2.1 Head and hair a. Head: yang, related to kidney b. Hair: manifestation of blood and kidney: color, loss of hair, hair loss in patch 2.2 Eyes: spirit, color, form and movement a. Eyes and internal organs b. The spirit of the eyes c. Color of eyes d. The form and movement of the eyes 2.3 Ears: kidney and shaoyang meridian 2.4 Nose 2.5 Lips, teeth, pharynx 2.6 Skin: color, macules& pacules, eczema 3. Inspection of secretions and excreta 3.1 Phlegm 3.2 Nasal mucus and tears 3.3 Vomitus 3.4 Stool and urine 4. Inspection of the superficial venules of an infants index finger (Infants finger examination) Three passes: wind pass/Qi pass/Life pass Methods of inspection of the superficial venules Clinical significances 5. Inspection of the tongue

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TCM REVIEW Corresponding areas of the internal organs on the tongue ----- Clinical significance of the Tongue inspection ----- Methods of Tongue inspection 5.1 Light and order 5.2 The bearing of the tongue on exertion 5.3 Stained tongue fur Contents of Tongue inspection The normal tongue: Light-red tongue with thin white moderate moist coating, the tongue body is soft, flexible and light red I. Inspection of Tongue Body a. Inspection of Tongue color Pale tongue: Deficiency (Qi and blood deficiency), cold (deficiency cold or excess cold) Red tongue: Heat (excess heat and deficiency heat) Crimson tongue/deep red tongue: Heat (excess heat or deficiency heat), blood stasis Purple tongue: Heat (excess heat or deficiency heat), cold (excess or deficiency cold), phlegm and dampness, blood stasis Blue tongue: Cold, blood stasis b. Inspection of Tongue shape Rough tongue: excess syndrome, heat syndrome Tender tongue: deficiency syndrome, cold syndrome Enlarged tongue: yang deficiency, water retention due to Qi deficiency, phlegm and rheumor, dampness and heat Swollen tongue: heat toxin, heat in the heart and spleen, poison or alcohol poison Thin tongue: Qi and blood deficiency, yin deficiency Fissured tongue: deficiency (blood or yin deficiency), some health people Teeth-marks tongue (often combining with enlarged tongue): deficiency (Qi deficiency and spleen deficiency result in water and dampness retention), cold and dampness retard spleen Prickly tongue: excess heat (in ying-blood, liver and gall bladder, heart, intestine and stomach) Slippery/watery tongue: water and dampness (or associated with qi or yang deficiency) b. Inspection of Tongue movement Stiffness: wind, heat, phlegm and turbid Flaccidity/Limpness: deficiency (Qi and blood deficiency, yin-deficiency in the kidney and liver, yin-fluid exhaustion due to heat) Trembling: wind (due to qi or blood deficiency, heat) Deviation: wind-stroke Contraction/Shortening: yin-impairment due to excess heat, collapse of yang-qi, phlegm obstruction Worrying/Protrusion and wagging: heat in the heart and spleen, infectious toxin attacking the heart, premature of fright wind on child or congenital deficiency c. Inspection of Tongue coating (the nature of tongue fur) 1). The color of Tongue coating White coating: exterior syndrome, cold or dampness

TCM REVIEW White coating also can be seen on heat syndrome Yellow coating: Heat syndrome Grey coating: cold and dampness, phlegm and water, yin-fluid exhaustion due to heat, or hyperactivity of fire due to yin-deficiency Black coating: extremely heat, deficiency cold 2). The quality/nature of Tongue coating Thickness: ---Thin coating: normal or exterior syndrome ----Thick coating: interior pathogen, such as dampness, phlegm or food stagnation in the stomach and intestine Moistness: showing the condition of body fluid ------Moistened coating: no impairment on fluid. If it is watery or slippery it shows dampness or deficiency cold due to yang-deficiency ------Dry or scorched coating: yin-fluid impairment due to heat and dryness, yin or blood deficiency, yang-qi deficiency Greasy: Cold and dampness pathogen, retention of phlegm, food stagnation, or dampness pathogen Curdy: Food stagnation, or phlegm and turbid; also can be seen on internal carbuncles or aphthous stomatitis due to dampness; ------ Festered curdy fur: pulmonary, stomach, and liver abscess ------Rotten-curdy fur: syndrome of damp-warm, acute febrile disease caused by virulent heat pathogens, dysentery with bloody stool, and syphilis Peeling: (map-like coating, mirror-like coating): Qi and yin deficiency of stomach Auscultation & olfaction (listening & smelling) 1. Auscultation: Voice; speech; breathing; cough; hiccough 2. Olfaction: Breath and body smell; Excreta odors Inquiry ----- General identification ----- Environmental and living condition ------Occupation and working condition ------Medical history and medications (type, dose, term of use) ------ Family history ------ Personal history (eating, drinking, emotional state, use of alcohol, tobacco, caffeine, and drugs; exercises and physical activity, allergies) -------Chief and secondary complaints Song of ten inquiries (By Dr. Zhang jiebin): 1. Chills and fever (with or without fever or chills, its extent, style and duration; its concomitant symptoms) 1). Aversion to cold with fever 2). Chills 3). Fever a. High fever b. Tidal fever: due to yin deficiency; due to dampness-heat syndrome; yangming tidal fever. 4). Alternative attack of chills and fever

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TCM REVIEW 2. Sweating (location, frequency, time of occurrence, extent) 1). Sweating related to exterior syndromes 2). Spontaneous sweating 3). Night sweating 4). Profuse sweating 5). Shivering sweating 6). Location-limited sweating: Hyperhydrosis of the head; Hemihydrosis; Polyhydrosis of hands and feet 3. Pain (location, character, duration, triggering factor, concomitant symptoms) 1). Location of pain: Headache; chest pain; hypochondriac pain; stomachache; abdominal pain; lower back pain; pain on four limbs 2). Character of pain: distending pain; sharp pain; colic pain; burning pain; cold pain; dull pain; dragging pain 4. Sensation of dizziness, tinnitus, palpations, chest constriction: Dizziness; Tinnitus; Palpations; Chest constriction 5. Stool and urine 1). Defecation (frequency, form, color, smooth or not, form, with or without blood) Constipation; Diarrhea 2). Urination (frequency, form, color, smooth or not, with or without blood) 6. Diet and taste 1). Thirst and fluid intake: thirst or not, hot drink or cold drink 2). Food intake and digestion (dietary patterns and preferences) 3). Taste in the mouth 7. Sleep (how much, deep or not, with or without dreams) 1). Insomnia 2). Somnlence 8. Edema (yang edema, yin edema) Hematemesis; Hemafecia; Hematuria; 9. About gynecological matters 1). Menstruation a. Menstrual cycle: proceded cycle; delayed cycle; irregular cycle; b. Dysmenorrhea c. Ammenorrhea d. Metrorrhagia and metrostaxis (beng lou) 2). Leukorrhea: white; yellow; red 3). Birth control methods and obstetric history 10. About children: fetus stage; vaccination; milk and diet Pulse & Palpation 1. Pulse examination Pulse group based on the 6 principle pulses; The normal pulse is marked by gastric qi, spirit and root 1.1 Floating pulse= pulse on skin------Indicates external syndrome; Scatter pulse (san mai)= floating + big + forceless + no root-----Indicates depletion of yuan qi, visceral essence at the verge to exhaust and external floating of deficient yang.

TCM REVIEW Hollow/scallion-stalk pulse (kou mai)= floating+ empty interiorly= hole in a grass-----Indicates loss of blood and impairment of yin. Leathering pulse (ge mai)= floating + extreme forceful (taut)-------Indicates loss of blood and essence. Soggy/soft pulse (ru mai)= slightly floating + soft+ thin----Indicates insufficiency of qi and blood, and dampness syndrome Surging/flooding pulse (hong mai)= floating + huge with force like tide------Indicates exuberant internal heat. Big pulse (da mai)= big in size+ forceful------Indicates internal heat. 1.2 Deep pulse= pulse close to bone--------Indicates internal syndrome Hidden pulse (fu mai)= deepest pulse on the bone + indistinct-------Indicates excess evil inside Prison pulse/confined pulse (lao mai)= deep+ wiry + long----Indicates internal yin cold Weak pulse (ruo mai)= deep+ soft+ thin------Indicates deficiency of both qi and blood 1.3 Slow pulse (chi mai)= 3 beats per breathing--------Indicates cold syndrome. Moderate/Leisurely pulse (huan mai)= 4 beats per breathing (slightly faster than slow pulse)-------Indicates damp disease and weakness of the stomach and spleen Rough/choppy pulse (se mai)= Slow (feels slow, actually not obvious slow) and unsmooth, hesitate to march forward------Indicates qi stagnation and blood stasis. Knotted/bound pulse (jie mai)= slow + irregular break------Indicates excess yin, qi stagnation, retention of phlegm and blood stasis Regular interrupted pulse (dai mai)= slow+ regular break------Indicates declination of visceral qi and yuan qi. 1.4 Rapid pulse (shuo mai)= 6 beats per breathing-----Indicates heat syndrome. Swift/racing pulse (ji mai)= fastest pulse, 7 beats per breathing (over 120 beats per minute)-----Indicates loss of control of hyperactive yang, declination of kidney and yuan qi. Skipping Pulse (cu mai)= rapid+ irregular breaks------Indicates yang heat or deficient visceral qi and insufficiency of blood Agitated/Stirred/Throbbed Pulse (Dong mai)= on guan portion, slippery+ short+ rapid-------Indicates pain syndrome and fright syndrome Tight pulse (jin mai)= bigger than wiry, like twisting rope under the skin----Indicates cold syndrome, pain syndrome and retention of food. 1.5 Replete pulse (shi mai)= forceful on cun, guan and chi portion (General name for all of the pulses with force)------Indicates excess syndrome Long pulse (chang mai)= longer than cun, guan and chi three portion------Indicates yang syndrome, heat syndrome and excess syndrome. Slippery pulse (hua mai)= shape in a round pearl rolling under finger----Indicates phlegm, retention of food and heat syndrome. Wiry/Taut pulse/String-like (xuan mai)= straight+ long+ taut like Guitars string---Indicates disorders of the liver and gallbladder, pain syndrome and retention of phlegm and fluid. Tight pulse (jin mai)= bigger than wiry, like twisting rope under the skin----Indicates cold syndrome, pain syndrome and retention of food

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TCM REVIEW 1.6 Deplete pulse (xu mai)= forceless on cun, guan and chi three portion (General name for all of the pulses with less force)----Indicates deficient syndrome. Weak pulse(ruo mai)= deep+ thin+ soft----Indicates deficiency of qi and blood. Scatter pulse (san mai)=floating+ forceless+ no root---- Indicates depletion of yuan qi, visceral essence at the verge to exhaust and external floating of deficient yang. Minute/faint pulse (wei mai)= extreme thin+ extreme soft+ indistinct----Indicates extreme deficiency of qi and blood as well as yang qi. Thin/thready pulse (xi mai)= thin like a fine thread + distinct------Indicates deficiency of both qi and blood, various overstrain and diseases due to dampness. Short pulse (duan mai)= only on cun or guan, one or two portions-----Indicates declination of visceral qi and deficiency of yuan qi. 2. General palpation 2.1 Palpation of the skin a. Detecting cold and heat b. Detecting moistness & dryness c. Examining for edema and swelling: lung, spleen, kidney disorders 2.2 Palpation of the limbs Surveying for Warmth or Coolness: Generally speaking, cold hands and feet belong to cold syndromes that is caused by yang deficiency and yin excess. Hot hands and feet pertain to heat syndromes and reflect yin deficiency or yang excess. 2.3 Palpation of the chest The softness or hardness, the coolness or warmth of the chest and abdomen and whether there is pain, distention, swelling & mass are the main aspects. The visceral state & evil nature may be found out by doing so. 2.4 Palpating the breast: lump or not 2.5 Palpation of Hypochondrium a. Distention and pain: Liver qi stagnation; Liver fire b. Lump: Blood stasis; Blood cancer 2.5 Palpation of abdomen a. Location of disorder: b. Palpation of stomach region: distention and pain c. Stuffiness: Stuffiness refers to the feeling of distending and something clogged up in stomach. Although there is distending sensation in stomach, there is no change in shape. d. Palpation of "big abdomen": The big abdomen is the house of the spleen. So, abnormality in this region is closely related to diseases of the spleen. 1) If the abdomen is soft, the pain decreases when it is pressed, the visceral qi is deficient. 2) The hard, full,and painful abdomen, giving a sense of resistance, its pain increasing when pressed, reflects excessive evil in the abdomen.

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Chapter 7 Syndrome Differentiation

Syndrome Differentiation: Eight Principles Differentiation: Exterior and Interior Syndromes; Cold and Heat syndromes; Deficiency and Excess Syndromes; Yin and Yang Syndrome; Differentiation of Pathogens: 6 external pathogens differentiation; Differentiation of Seven abnormal Emotions; Differentiation of Food injury(physical overstrain; sexual overstrain) Differentiation of Qi, Blood, Body fluid disorders: Differentiation of Qi disorder; Differentiation of blood disorder; Concurrence of Qi & Blood disorders; Differentiation of body fluid disorder; Differentiation of Zang-Fu organs Disorders: Differentiation of Heart and Small Intestine Disorders; Differentiation of Lung and large intestine disorders; Differentiation of Spleen and stomach disorders; Differentiation of Liver and Gallbladder disorders; Differentiation of Kidney and Urinary Bladder disorders; Differentiation of Comprehensive disorders of Zang-Fu organs; Differentiation of meridian and collateral disorders: Differentiation for the 12 regular meridians disorders; Differentiation for the 8 extra meridians disorders; Differentiation for the 15 collaterals disorders; Differentiation for the 12 divergent meridians disorders; Differentiation of six channels: 6 channels differentiation(yangming, shaoyang, taiyang, taiyin, yueyin, shaoyin syndrome); 4 stage differentiation (wei-level, qi-level, ying-level; blood-level syndrome) 1. Eight principles differentiation: 1). Differentiation of Exterior and Interior syndromes a. Exterior Syndrome: Concept: Refers to the symptoms appearing at the primary stage of exogenous diseases caused by invasion of six pathogenic factors into the body through skin, mouth and nose, marked by sudden onset, short duration and shallow location. Clinical manifestations: fever, aversion to cold (or wind), thin and white fur and floating pulse, accompanied by stuffy and running nose, sore-throat and cough. b. Interior Syndrome: Concept: Refers to the symptoms in disorders with deep location (such as disorders of viscera, qi and blood and bone marrow), usually seen at the middle and advanced stages of exogenous disease and the whole course of diseases due to internal impairment. Clinical manifestations: Different due to different causes and location. c. Half external and half internal syndrome Concept: Refers to the symptoms appearing in exogenous disease at the stage marked by confliction of healthy qi and pathogenic factors between the exterior and interior phases, and is usually caused by transmission of pathogenic factors from the exterior to the interior but still lingering between the exterior and interior phases. Clinical manifestations: Alternation of cold and fever, oppression and distress over the chest and hypochondrium, dysphoria, susceptibility to belching, silence, anorexia, bitter taste in the mouth, dry throat, dizziness and taut pulse, etc. ( See shaoyang syndrome)

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TCM REVIEW 2). Syndrome differentiation of cold and heat a. Cold syndrome Concept: Refers to symptoms caused by deficient yang or excess yin due to invasion of cold pathogenic factors or various other factors. Clinical manifestations: aversion to cold or preference for warmth, cold limbs and huddling up in sleeping, pale or light colored complexion, moist mouth without thirst, thin sputum, saliva and snivel, clear and profuse urine, loose stool, light colored tongue with whitish moist and slippery fur, slow or tense pulse. b. Heat syndrome Concept: Refers to symptoms due to attack by yang heat or various other factors or yin deficiency. This syndrome is usually caused by invasion of exogenous yang heat, or by interior transmission of heat transforming from pathogenic cold, or by transformation of heat from improper diet, or by internal generation of asthenic fire resulting from excessive coitus. Clinical manifestations: aversion to heat with preference for cold, flushed complexion or flushed cheeks, thirst with preference for cold drinks, restlessness and insomnia, yellowish and sticky sputum and snivel, vomiting blood and epistaxis, scanty brownish urine, dry feces, reddish tongue with scanty moist and fast pulse, etc. 3). Syndrome differentiation of asthenia (deficiency) and sthenia (excess) a. Deficiency syndrome Concept: Refers to symptoms marked by deficiency of health qi and nonpredomination of pathogenic factors. The cause of deficient syndrome is either congenital or postnatal, especially the postnatal one. Clinical manifestations: Vary with deficient qi, blood, essence and body fluid. Common symptoms include fatigue, shortness of breath, no desire to speak, aversion to cold and cold limbs, spontaneous sweating, clear and profuse urine, loose stool, emaciation, feverish sensation over the five centers, tidal fever, flushed cheeks, night sweating , pale or sallow complexion, dizziness, palpitation and insomnia, dry mouth and throat, thirst with desire to drink, dry skin, scanty urine and dry feces, tender tongue with thin fur or little fur and weak pulse, etc. b. Excess syndrome Concept: Refers to symptoms of predominant pathogenic factors and non-deficient healthy qi. The cause includes: invasion of exogenous pathogenic factors into the body; dysfunction of the viscera. Clinical manifestations: Vary with different factors. Common symptoms include fever, restlessness, even coma with delirium, chest oppression, hoarse breath, exuberance of phlegm and drool, unpalpable pain of abdomen, retention of dry feces, or dysentery with blood and pus, tenesmus, inhibited urination, or painful stringuria, tough gonge, thick or greasy fur and excess pulse. 4). Syndrome differentiation of yin and yang a. Yin syndrome Concept: Internal syndrome, cold syndrome and deficient syndrome are of yin category. However, yin syndrome usually refers to deficient cold syndrome Clinical manifestations: dull complexion, dispiritedness, fatigue, cold limbs, low voice, shortness of breath, bland taste in the mouth without thirst, clear and profuse

TCM REVIEW urine, loose stool, pale and tender tongue, sunken and thin pulse, or sunken, slow and weak pulse, etc. b. Yang syndrome Concept: External syndrome, heat syndrome and excess syndrome are of yang category. However, usually yang syndrome refers to excess heat syndrome. Clinical manifestations: flushed complexion, fever with preference for cold, restlessness, high voice, hoarse breath, dyspnea with sputum rale, dry mouth with thirst and desire to drink, scanty brownish urine, retention of dry feces, deep reddish tongue with yellow and dry fur, powerful of full or slippery pulse, etc. c. Yin deficiency syndrome and yang deficiency syndrome Yin deficiency syndrome: refers to deficient heat symptoms due to failure of yin to control yang resulting from deficiency of yin fluid. Clinical manifestations: Emaciation, dry mouth and throat, dizziness, palpitation, insomnia, scanty tongue fur, thin pulse, or even feverish sensation over the five centers, tidal fever, flushed cheeks, night sweating, deep reddish tongue with scanty fur and thin and fast pulse. Yang deficiency syndrome: refers to excess cold symptoms due to failure of insufficient yangqi to control yin. Clinical manifestations: pale complexion, dispiritedness, fatigue, shortness of breath, no desire to speak, aversion to cold with cold limbs, spontaneous sweating, moist mouth thirst, or thirst with preference for hot drinks, clear and profuse urine, loose stool, or scanty urine with edema, pale, bulgy and tender tongue, whitish slippery fur as well as slow, sunken and weak pulse, etc. d. Yin depletion syndrome and yang depletion syndrome Yin depletion syndrome: refers to the critical conditions of severe exhaustion of yin fluid. Clinical manifestations: apart from the serious symptoms seen in the primary disease, there appear some other symptoms, including pyretic, salty and sticky sweating, fever over the body, warm limbs with aversion to heat, dry skin, flushed complexion, thirst with preference for cold drinks, restlessness, or even coma, scanty urine, reddish and dry tongue as well as thin, fast, swift and weak pulse, etc. Yang depletion syndrome: refers to critical symptoms due to declination of yangqi. Clinical manifestations: Apart from severe symptoms in primary disease, there are still some other manifestations, such as profuse cold sweating, pale complexion, cold skin, cold limbs, bland taste in the mouth without thirst and preference for hot drinks, weak breath, dispiritedness, or even unconsciousness, coma, pale and moist tongue as well as indistinct pulse. 5) Relationship among the eight principal syndromes a. Relationship between external and internal syndromes i. Simultaneous external and internal disorder ii. External and internal transmission b. Relationship between cold and heat syndrome i. Mixture of cold and heat: Upper heat and lower cold syndrome; Upper cold and lower heat syndrome; External heat and internal cold syndrome; External cold and internal heat syndrome

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TCM REVIEW ii. Inter-transformation of cold and heat: Transformation of heat syndrome into cold syndrome; The transformation of cold syndrome into heat syndrome. iii. False and true manifestations of cold and heat: True cold and false heat syndrome; the heat and false cold syndrome; c. Relationship between deficiency and excess syndrome i. Mixture of deficiency and excess: Excess syndrome complicated by deficiency; Deficiency syndrome complicated by excess; Equality of deficiency and excess; ii. Transformation of deficiency and excess: iii. False and true manifestations of deficiency and excess: True excess and false deficiency syndrome; True deficiency and false excess syndrome d. Relationship between different pairs of principles i. External cold syndrome ii. External heat syndrome iii. External excess syndrome iv. External deficient syndrome v. Internal excess cold syndrome vi. Internal deficient cold syndrome vii. Internal excess heat syndrome viii. Internal deficient heat syndrome

TCM REVIEW Clinical manifestations: Cough and asthmatic breath in upward reversion of pulmonary qi; hiccup, belching, nausea and vomiting in upward reversion of gastric qi; headache, dizziness, even coma and hematemesis in upward reversion of liver qi. 2). Syndrome differentiation of blood disease a. Blood deficient syndrome Concept: refers to deficient syndrome caused by failure of insufficient blood to nourish viscera, meridians and tissues. Clinical manifestations: Pale or sallow complexion, pale eyelids, lips and nails, dizziness, palpitation, insomnia, numbness of hands and feet, scanty, pale and delayed menstruation, or even amenorrhea, pale tongue, and thin and weak pulse. b. Blood stasis syndrome Concept: refers to syndrome caused by retention of blood stasis in the body. Clinical manifestations: Stabbing and cutting pain with fixed location which is unpalpable and worsened at night; local lumps which appear cyanotic in the superficies and hard and unmovable in the abdomen; repeated bleeding with purplish colour or with clot or with asphalt-like stool; amenorrhea or metrorrhagia in women; blackish complexion, cyanotic lips and nails, subcutaneous purplish petechiae, or squamous skin, or visible abdominal veins, or silk-like red stripes on the skin; cyanotic tongue or with cyanotic petechiae and points, thin and astringent pulse. c. Blood cold syndrome Concept: refers to syndrome caused by cold retention and qi stagnation in local meridians and vessels. Clinical manifestations: Local cold pain which alleviates with warmth and aggravates with cold, cyanotic and cold skin over the affected part, delayed menstruation, purplish menorrhea with clot, dysmenorrheal, purplish tongue with white fur, and sunken, slow and astringent pulse. d. Blood heat syndrome Concept: refers to syndrome caused by exuberance of fire and heat in the viscera that invades blood phase. Clinical manifestations: Hemoptysis, or hematemesis, bleeding, hematuria, hematochezia, advanced profuse menstruation, even metrorrhagia, dysphoria, thirst, deep reddish tongue and fast pulse. e. Syndrome differentiation of simultaneous disorder of qi and blood i. Deficiency of qi and blood ii. Qi deficiency and hemorrhagia syndrome iii. Depletion of qi with bleeding syndrome iv. Qi deficiency and blood stasis syndrome v. Qi stagnation and blood stasis syndrome

2. Syndrome differentiation of qi, blood and body fluid 1). Syndrome differentiation of qi disorders a. Qi deficient syndrome Concept: refers to insufficiency of primordial qi and deficient symptoms of
hypofunction of the viscera and tissues. Clinical manifestations: Lack of qi, no desire to speak, low voice, shortness of breath, dispiritedness, lassitude, dizziness, spontaneous sweating, aggravation of all the symptoms after movement, pale and tender tongue, as well as weak pulse.

b. Qi sinking syndrome Concept: refers to symptoms of deficiency marked by prolapse of the viscera due to
inability of qi to lift and sinking of lucid yang. Clinical manifestations: Prolapsing distension of epigastrium and abdomen, or prolapse of rectum due to chronic diarrhea, prolapse of uterus, dizziness, lassitude, pale tongue with whitish thin fur and weak pulse, etc. c. Qi stagnation syndrome Concept: refers to symptoms caused by qi stagnation in a certain region or a certain viscera in the human body. Clinical manifestations: Distending oppression, pain (distension is more serious than pain) or migratory pain and attacking pain are felt over the chest, hypochondrium, epigastrium and abdomen. The pain may be attenuated or worsened with the changes of emotions. d. Qi reversion syndrome: Concept: refers to symptoms of disorder of qi to ascend and descend, or excessive ascent.

3) Syndrome differentiation of fluid disorder a. Insufficiency of body fluid Concept: refers to syndrome due to deficiency of body fluid which fails to nourish and
moisten viscera, tissues and organs.

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TCM REVIEW

TCM REVIEW

Clinical manifestations: dry mouth and throat, dry or fissured lips, sunken orbit, dry skin, thirst with desire for water, scanty urine, retention of dry feces, dry tongue with scanty saliva and thin and astringent pulse. b. Phlegm syndrome Concept: refers to syndrome due to local retention of phlegm or migration of phlegm. Clinical manifestations: Cough with sticky sputum, chest oppression, or dizziness,
or epigastric mass, anorexia, nausea, vomiting, or coma with sputum rale, or mental derangement with mania, dementia and epilepsy or numbness of limbs, hemiplegia, or scrofula, goiter, breast nodules, phlegm nodules, greasy fur and slippery pulse.

Clinical manifestations: palpitation, shortness of breath, spiritual lassitude, aggravation after movement, pale complexion, orspontaneous sweating, pale tongue and weak pulse. Such syndrome can be seen in cardiac insufficiency (compensatory period) due to coronary atherosclerotic cardiopathy, viral myocarditis, chronic rheumatic heart disease, hypotension, primary myocardiopathy, chronic pulmonary heart disease, and mitral valve prolapse syndrome as well as patients with cardiac neurosis b. Heart yang deficient syndrome Concept: refers to deficient cold syndrome marked by palpitation, aversion to cold and
cold limbs due to deficiency of heart yang to warm and propel. Clinical manifestations: Palpitation, chest oppression or pain, shortness of breath, spontaneous sweating, aversion to cold and cold limbs, pale complexion or cyanotic complexion and lips, pale and bulgy tongue or purplish tongue, whitish slippery tongue fur, weak pulse, or knotted pulse, or slow regular intermittent pulse. This syndrome is usually seen in coronary atherosclerotic cardiopathy, infectious endocarditis, viral myocarditis, chronic heart disease, hypotension, primary myocardiopathy, chronic pulmonary heart disease, mitral valve prolapse syndrome and cardiac insufficiency (compensatory period) due to cardiac neurosis.

c. Fluid-retention syndrom Concept: refers to syndrome caused by retention of fluid in the viscera and tissues. Clinical manifestations: Epigastric and abdominal fullness and distension,
borborygmus, vomiting of clear fluid; or cough and asthma, profuse thin sputum, chest oppression and palpitation, even inability to lie flat on bed; or thoracic and hypochondriac fullness, distending pain, aggravation of pain after cough, spitting or rotating the body; or dizziness, dysuria, dropsy and aching heaviness of the limbs; whitish slippery fur and taut pulse.

d. Edema Concept: refers to dropsy of eyelid, face, four limbs, chest and abdomen or even the
whole body due to accumulation of fluid in the muscles resulting from disturbance of the lung, spleen and kidney in distributing and excreting fluid. i. Yang edema: Excess in nature, is marked by swelling above the waist and short duration due to exogenous pathogenic wind or spreading of fluid and dampness. Clinical manifestations: dropsy of face and eyelids, eventually involving the whole body with rapid development, smooth and bright skin, scanty urine, accompanied by fever, aversion to wind and cold, aching pain of limbs, sore-throat, thin fur and floating pulse; ii. Yin edema: marked by deficiency of spleen and kidney qi, severe edema of the part below the waist and long duration, usually caused by deficiency of the health qi due to prolonged illness, internal impairment due to overstrain and consumption of spleen and kidney yang. Clinical manifestations: repeated relapse of edema, severity below the waist, depression under pressure, epigastric and abdominal distension and oppression, poor appetite and loose stool, dispiritedness, fatigue of limbs, cold body and limbs, preference for warmth, or aching cold sensation of loins and knees, scanty urine, dull or pale complexion, pale and bulgy tongue with white and slippery fur as well as sunken, slow and weak pulse.

c. Sudden loss of heart yang syndrome Concept: is a critical condition due to extreme exhaustion of heart yang and sudden loss
of yang qi. This syndrome is the further development of heart yang deficient. Clinical manifestations: Apart from the symptoms of heart yang deficient, there appear some other symptoms, such as sudden profuse cold sweating , cold limbs, weak health, pale complexion, or sharp heart pain, cyanotic lips, indistinct pulse, even or unconsciousness and coma, usually seen in cardiogenic shock due to various diseases. The syndrome is usually seen in cardiogenic shock due to various diseases.

d. Heart blood deficient syndrome Concept: caused by deficient of heart blood and lack of proper moisture and
nourishment of the heart.

Clinical manifestations: Palpitation, dizziness, insomnia, dreaminess, amnesia, pale

complexion or sallow complexion, pale lips and tongue as well as thin and weak pulse, seen in various hemorrhagia, disturbance of blood production and anemia due to various chronic and consumptive diseases. The syndrome is usually seen in various hemorrhagia, disturbance of blood production and anemia due to various chronic and consumptive diseases.

e. Heart yin deficient syndrome Concept: refers to the syndrome caused by depletion of heart yin and internal
disturbance of deficient heat.

3. Syndrome differentiation of viscera 1) Syndrome differentiation of heart disease a. Deficiency of Heart qi Concept: refers to asthenia symptoms of palpitation and shortness of breath resulting
from insufficiency of heart qi to propel.

Clinical manifestations: dysphoria, palpitation, insomnia, dreaminess, afternoon tidal fever, feverish sensation over five centers, flushed cheeks, night sweating, reddish tongue with scanty saliva, thin and fast pulse. The syndrome is usually seen in viral myocarditis, chronic rheumatic heart disease, mitral valve prolapse syndrome, pericarditis, arrhythmia, cardiac neurosis and rehabilitative stage of various infectious diseases. f. Heart vessels obstruction syndrome

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TCM REVIEW complexion, spontaneous sweating, aversion to wind, susceptibility to invasion of exogenous pathogenic factors and weak pulse. Usually seen in b. Lung yin deficient syndrome Concept: refers to syndrome of asthenic internal heat due to insufficiency of lung yin and failure of depuration. Clinical manifestations: dry cough with scanty sputum, or scanty and sticky sputum difficult to expectorate, or sputum mixed with blood, hoarseness, dry mouth and throat, emaciation, feverish sensation over five centers, afternoon tidal fever, flushed cheeks and night sweating, reddish tongue with scanty fluid as well as thin and fast pulse. c. Syndrome of wind cold encumbering lung Concept: refers to the syndrome of failure of pulmonary qi to disperse due to wind cold attacking the lung. Clinical manifestations: cough, thin expectoration, stuffy nose with clear snivel and throat itching, accompanied by aversion to cold and fever, or body pain without sweating , whitish thin tongue fur as well as floating and tense pulse. d. Wind heat invading lung syndrome Concept: refers to the syndrome of the lung failing to disperse resulting from wind heat attacking the lung. Clinical manifestations: cough, yellowish thick sputum, stuffy nose with turbid snivel, fever, slight aversion to wind and cold, slight thirst, or sore-throat, reddish tongue tip, thin and yellowish tongue fur, floating and fast pulse. e. Syndrome of dryness attacking lung Concept: refers to the syndrome of consumption of fluid in the lung system due to invasion of pathogenic dryness into the lung. Clinical manifestations: dry cough with scanty sputum, or sticky sputum difficult to expectorate, even chest pain, sputum mingled with blood, or epistaxis, hematemesis, dryness of mouth, lips, nose and throat, dry feces with scanty urine, thin and dry tongue with scanty saliva, or accompanied by fever, slight aversion to wind cold, no sweating or scanty sweating, floating and fast pulse or floating and tense pulse. f. Syndrome of accumulation of pathogenic heat in lung Concept: refers to the syndrome due to loss of depuration of the lung resulting from exuberant pathogenic heat in the lung. Clinical manifestations: fever, cough, asthmatic breath, even flapping nose with hot breath, red swelling and pain of throat, chest pain, yellowish sticky sputum, or rusty sputum, or foul sputum mingled with blood, thirst, scanty urine, constipation, red tongue with yellow fur and fast pulse. g. Syndrome of phlegmatic dampness retention in lung Concept: refers to the syndrome due to failure of the lung to disperse and descend resulting from retention of phlegmatic dampness in the lung. Clinical manifestations: cough with profuse whitish sputum easy to expectorate or with clear, thin and fronty sputum, even asthmatic breath with sputum rale, pale tongue with whitish greasy fur and slippery pulse. h. Syndrome of confliction of wind and fluid in lung Concept: refers to the syndrome due to invasion of pathogenic wind which prevents the lung from dispersing, descending and regulating water passage as well as causes extravasation of fluid and dampness in the skin

Concept: refers to symptoms of palpitation, chest oppression and heart pain due to
obstruction of the heart vessels by blood stasis, phlegm, yin cold and qi stagnation. Clinical manifestations: palpitation, chest oppression and pain, pain involving the shoulder, back and inner part of arm and occasional occurrence; or stabbing chest pain, dull tongue or tongue with purplish petechiae, thin and astringent pulse or knotted pulse and slow regular intermittent pulse; or chest oppression and pain, obesity and profuse sputum, heaviness of body and lassitude, whitish greasy tongue fur, sunken and slippery pulse or sunken and astringent pulse; or aggravation of pain with cold, alleviation with warmth, cold body and limbs, pale tongue with white fur, sunken and slow pulse or sunken and tense pulse, or pain and distension, hypochondriac distension, sighing, light reddish tongue and taut pulse. The syndrome is usually seen in coronary atherosclerotic cardiopathy, angina pectoris, myocardiac infarction and primary cardiac myopathy, etc.

g. Exuberance of heart fire syndrome Concept: refers to excess heat syndrome due to internal exuberance of heart fire. Clinical manifestations: dysphoria, insomnia, flushed complexion, thirst, fever,
constipation, yellow urine, deep reddish tongue tip, yellow fur and fast pulse; or ulceration and pain of tongue, or hematemesis, hemorrhagia, or even mania, delirium and unconsciousness, hemorrhagia, or even mania, delirium and unconsciousness. Usually seen in hypertension, thyroidism, endocarditis, periodontitis, infection of urinary system and craniocerebral infection, etc.

h. Mind confusion by phlegm Concept: refers to symptoms of unconsciousness due to phlegm confusing heart spirit. Clinical manifestations: mental confusion, even unconsciousness, or mental
depression, dull facial expressions, dementia, murmuring, abnormal behaviour; or sudden coma, unconsciousness, drooling, sputum rale in the throat; dull complexion, chest oppression, nausea, whitish greasy fur, slippery pulse. Usually seen in craniocerebral infection and depressive schizophrenia, etc.

i. Disturbance of the heart by phlegmatic fire Concept: refers to the syndrome of mental derangement due to fire, heat and
phlegmatic turbid substance disturbing the heart spirit.

Clinical manifestation: fever, restlessness, or coma with delirium, flushed

complexion, thirst, hoarse breath, constipation,yellow urine, or sputum rale in the throat, chest oppression, dysphoria, insomnia, or even mania, fighting against people, breaking objects, ravings, emotional disorder, reddish tongue, yellow and greasy fur as well as slippery and fast pulse. Usually seen in craniocerebral infection and manic schizophrenia, etc.

2) Syndrome differentiation of lung disease

a. Pulmonary qi deficient syndrome Concept: refers to asthenia syndrome due to insufficiency of pulmonary qi and hypofunction of the lung in governing qi and weakness of weiqi to protect the superficies. Clinical manifestations: weak cough, shortness of breath with aggravation after movement, cough with thin sputum, low and timid voice, spiritual lassitude, pale

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TCM REVIEW Clinical manifestations: primary dropsy of the eyelids and face, eventual edema of the whole body with rapid development, thin and bright skin, scanty urine, accompanied by aversion to cold, fever, no sweating, whitish thin tongue fur, floating and tense pulse; or accompanied by swelling and pain of throat, reddish tongue as well as floating and fast pulse.

TCM REVIEW f. Syndrome of damp heat encumbering the spleen Concept: refers to the syndrome caused by dysfunction of the spleen and stomach due to retention of damp heat in the middle energizer. Clinical manifestations: fullness and oppression in the epigastrium and abdomen, anorexia, vomiting, nausea, thirst with oligodipsia, loose stool, unsmooth defecation, scanty and yellow urine, heaviness of limbs, dull fever, failure to relieve fever after sweating, or yellow coloration of the skin and eyes, or pruritus of the skin, reddish tongue, yellowish and greasy tongue coating as well as soft pulse.

3) Syndrome differentiation of spleen disease

a. Syndrome of deficiency of splenic qi Concept: refers to the syndrome due to asthenia of splenic qi and failure of transportation and transformation. Clinical manifestations: poor appetite, abdominal distension, especially after meal, loose stool, or dry feces followed by loose stool, lack of qi, no desire to speak, lassitude of limbs, sallow complexion, emaciation, or dropsy, pale tongue with whitish fur, slow and weak pulse. b. Syndrome of deficiency of splenic yang Concept: refers to the syndrome due to asthenia of splenic yang and internal exuberance of yin cold. Clinical manifestations: poor appetite, abdominal distension, lingering abdominal cold pain, preference for warmth and palpation, aversion to cold, cold sensation of four limbs, light whitish complexion, bland taste in the mouth without thirst, loose stool, or stool with indigested food, heaviness of limbs, or dropsy of limbs, dysuria, profuse and thin leukorrhagia, pale, bulgy and tender tongue, or tongue with tooth prints, whitish slippery fur, sunken, slow and weak pulse. c. Syndrome of sinking of splenic qi Concept: refers to the syndrome due to asthenia of splenic qi and failure of splenic qi to rise. Clinical manifestations: prolapsing sensation and distension of epigastrium and abdomen, especially after meal, frequent desire for defecation, prolapsing sensation of anus, or chronic diarrhea, or even prolapse of rectum, or prolapse of uterus, or tubid urine, accompanied by lack of qi, fatigue, lassitude of limbs, low voice or no desire to speak, dizziness, pale tongue with whitish fur and weak pulse. d. Syndrome of failure of the spleen to govern blood Concept: refers to the syndrome of bleeding due to failure of the spleen to control blood caused by asthenia of the spleen. Clinical manifestations: hematemesis, or hematochezia, or hematuria, or hematohidrosis, or epistaxis, or heypermenorrhea and profuse uterine bleeding, accompanied by poor appetite, abdominal distension, loose stool, sallow complexion or lusterless complexion, dispiritedness, lassitude, lack of qi, no desire to speak, pale tongue, thin and weak pulse. e. Syndrome of cold and dampness encumbering the spleen Concept: refers to the syndrome due to internal exuberance of cold and dampness and stagnancy of gastrosplenic yang. Clinical manifestations: abdominal fullness and oppression, poor appetite, nausea and vomiting, abdominal pain and loose stool, bland taste in the mouth and no thirst, heavy sensation of the head and body, or dropsy of the limbs, scanty urine, or yellow and dull coloration of the body and eyes, or leukorrhagia, bulgy tongue, whitish greasy or whitish slippery fur, slow and weak or sunken and thin pulse.

4) Syndrome differentiation of liver disease

a. Deficient syndrome of liver blood Concept: refer to syndrome caused by malnutrition of the liver and related tissues and organs due to insufficiency of liver blood. Clinical manifestations: vertigo, dizziness, pale complexion, dry and irritating sensation in the eyes, blurred vision or night blindness, dry and lusterless nails or numbness of limbs, inflexibility of joints, tremor of hands and feet, or scanty and light-color menstruation, or even amenorrhea, whitish tongue and thin pulse. b. Syndrome of liver yin deficiency Concept: the syndrome resulting from failure of yin to control yang due to consumption of liver yin. Clinical manifestations: dull scorching pain in the hypochondria, dizziness, dry and irritating sensation in the eyes, hypopsia, feverish sensation over the cheeks, tidal fever and night sweating, feverish sensation over the five centers, reddish cheeks in the afternoon, dry mouth and throat, or tremor of the hands and feet, reddish tongue with scanty fluids as well as taut, thin and rapid pulse. c. Syndrome of liver qi stagnation Concept: refers to the syndrome due to failure of the liver to disperse and stagnation of qi. Clinical manifestations: emotional depression, migratory pain in the chest, hypochondria or lower abdomen, chest oppression, frequent sign, thin and white tongue fur as well as taut pulse; or sensation of foreign body in the throat, or goiter and scrofula, or lump in the hypochondria; distending pain of breast, dysmenorrheal, irregular menstruation and even amenorrhea in women. d. Syndrome of liver fire hyperactivity Concept: refers to the syndrome due to exuberant fire in the liver meridian and upward adverse rising of fire. Clinical manifestations: dizziness, distending headache, flushed face and red eyes, bitter taste and dryness of mouth, irritability and susceptibility to rage, tinnitus and deafness, insomnia or nightmare, or scorching pain in the hypochondria, or hematemesis and epistaxis, constipation, scanty and yellow urine, red tongue, yellow fur and taut and rapid pulse. f. Syndrome of liver yang hyperactivity Concept: refers to the syndrome marked by upper excess and lower deficiency due to consumption of liver and kidney yin, failure of yin to control yang and hyperactivity of liver yang.

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TCM REVIEW Clinical manifestations: distending headache, dizziness, tinnitus, flushed cheeks and red eyes, irritability and susceptibility to rage, insomnia and dreaminess, aching pain and weakness of loins and knees, top-heaviness, reddish tongue with scanty fluid, taut pulse or taut and thin pulse. g. Syndrome of endogenous liver wind Concept: the syndrome marked by dizziness, convulsion and tremor. i. Syndrome of liver yang transforming into wind Concept: refers to wind syndrome due to consumption of liver and kidney yin and hyperactivity of liver yang. Clinical manifestations: dizziness, shaking head, headache, neck stiffness, tremor of limbs, stuttering, numbness of hands and feet, abnormal gait, red tongue with white or greasy fur, powerful pulse, even sudden coma, facial distortion, hemiplegia, aphasia and sputum rale in the throat. ii. Syndrome of extreme heat generating wind Concept: refers to the syndrome due to exuberant pathogenic heat scorching tendons and vessels. Clinical manifestations: continuous high fever, restlessness, spasm of hands and feet, stiff necks, upward staring of eyes, even episthotonos, lackjaw, unconsciousness, deep reddish tongue, yellowish dry fur and taut and rapid pulse. iii. Syndrome of endogenous wind due to yin deficiency Concept: refers to the syndrome due to consumption of yin fluid and malnutrition of tendons and vessels. Clinical manifestations: tremor or flaccidity of hands and feet, dizziness and tinnitus, tidal fever in the afternoon or in the evening, feverish sensation over the five centers or bone-steaming fever, flushed cheeks, emaciation, dry mouth and throat, red tongue with scanty fluid and thin and rapid pulse. iv. Syndrome of blood deficient generating wind Concept: refers to the syndrome due to consumption of blood and malnutrition of tendors and vessels. Clinical manifestations: tremor of hands and feet, fascicular twitching, numbness of limbs, dizziness, tinnitus, pale complexion, light colored nails, whitish tongue and thin and weak pulse. h. Syndrome of cold stagnation in the liver meridian Concept: refers to the syndrome due to cold pain in the distributing region of liver meridian caused by stagnation of pathogenic cold in the liver vessels. Clinical manifestations: lower abdominal cold pain, staging distension and pain of the pudendum, or contraction and pain of scrotum, aggravation with cold and alleviation with warmth, or cold pain in the vertex, cold limbs and body, light colored tongue with whitish and moist fur, sinking and tense pulse or taut and tense pulse. 5) Syndrome differentiation of kidney disease Kidney disease mainly reflects morbid changes in the physiological functions of the kidney proper and its functions, such as storing essence, management of growth and reproduction, governing water and bones, producing marrow and blood, controlling the reception of qi as well as nourishing and warming viscera. a. Syndrome of kidney yang deficiency

TCM REVIEW Concept: refers to the deficiency cold symptoms due to failure to qi to transform resulting from decline of kidney yang and its failure in nourishing the body. Clinical manifestations: aching and cold sensation in the loins and knees, cold limbs and body, dispiritedness and lassitude, impotence, immature ejaculation, cold sperm, infertility due to cold in the uterus, sexual hypoesthesia, or loose stool, early morning diarrhea, or frequent micturition, clear and profuse urine, profuse noctural urine, bright whitish or blackish complexion and light colored tongue with white fur as well as sinking, deep and weak pulse. b. Syndrome of edema due to kidney deficiency Concept: refers to the symptoms of edema due to kidney yang deficiency and its failure in transforming qi. Clinical manifestations: anasarca (especially the region below the waist) rebounding after pressure with fingers, oliguria, aching cold in the loins and knees, aversion to cold and cold limbs, abdominal distension and fullness, or palpitation and shortness of breath, or cough, dyspnea and sputum rale, light-colored and bulgy tongue, whitish slippery tongue fur, sinking, slow and weak pulse. c. Syndrome of kidney yin deficiency Concept: refers to the symptoms of endogenous deficient heat due to consumption of kidney yin and insufficiency of nourishment Clinical manifestations: aching and weakness of the loins and knees, dizziness and tinnitus, insomnia and amnesia, seminal emission, scanty menstruation or amenorrhea, or metrorrhagia and metrostaxis, flushed cheeks in the afternoon, bone-steaming tidal fever, night sweating, dry mouth and throat, emaciation, yellowish and scanty urine, reddish tongue with scanty fur and thin and rapid pulse. d. Syndrome of kidney essence insufficiency Concept: refers to the symptoms of retard growth, decline in reproduction and senilism due to consumption of kidney essence. Clinical manifestations: infantile retardation of growth and closure of fontanel, flaccidity of skeleton, retardation of body growth, slowness in action and feeblemindedness; senilism in adults, aching and weakness of loins and knees, dizziness, tinnitus and deafness, loss of hair and looseness of teeth, flaccidity of feet, amnesia and dull facial expression; sterility due to oligospermia in man, infertility due to amenorrhea in woman and sexual hypoesthesia. f. Syndrome of kidney qi weakness Concept: refers to the symptoms due to deficiency of kidney qi and its failure in storage and consolidation. Clinical manifestations: aching and weakness of loins and knees, dizziness and tinnitus, frequent clear urine, or dripping urination, or enuresis, or frequent clear urine, or dripping urination, or enuresis, or frequent noctural urination, or incontinence of urine in man, seminal emission, immature ejaculation, dripping menstruation, or thin and profuse leukorrhagia, or excessive movement of fetus and susceptibility to abortion, light-colored tongue with whitish fur and weak pulse. g. Syndrome of kidney failing to receive qi Concept: refers to the symptoms of dyspnea and shortness of breath due to deficiency of the kidney qi and its failure to receive qi and direct it to its source.

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TCM REVIEW Clinical manifestations: dyspnea and shortness of breath, more exhalation and less inhalation, aggravation of dyspnea after movement, low and weak voice, spontaneous sweating, lassitude, aching and weakness of loins and knees, light-color tongue and weak pulse; or aggravation of dyspena, profuse cold sweating, cold limbs and cyanotic complexion, floating and large pulse; or shortness of breath and dyspnea, flushed cheeks and dysphoria, vexation, dry mouth and throat, reddish tongue with scanty fluid as well as thin and rapid pulse.

TCM REVIEW a. Syndrome of gallbladder stagnation and phlegm disturbance Concept: refers to the symptoms of gallbladder failing to disperse due to internal disturbance of phlegm-heat. Clinical manifestations: timidity and susceptibility to fright, palpitation and restlessness, insomnia and dreaminess, dysphoria, difficulty in making decision, thoracic and hypochondriac oppressin and distension, frequent sigh, dizziness and vertigo, bitter taste in the mouth, vomiting, reddish tongue, yello-wish and greasy fur as well as taut and slippery pulse.

8) Syndrome differentiation of small intestinal disease 6) Syndrome differentiation of stomach disease

a. Syndrome of stomach cold Concept: refers to internal cold syndrome marked by epigastric and abdominal cold pain due to pathogenic cold attacking on the stomach, or due to weakness of the stomach yang and endogenous yin cold. Clinical manifestations: cold pain in the epigastrium which is worsened with cold and alleviated with warmth; or sharp pain which is unpressable or lingering or prefers pressure; nausea and vomiting, relief of pain after vomiting, bland taste in the mouth without thirst, whitish or bluish complexion; or epigastric and abdominal distending pain, gurgling of water in the stomach and regurgitation of clear fluid; or accompanied by dispiritedness and lassitude, cold limbs and preference for warmth and loose stool; lightcolored tongue with whitish slippery fur, sinking, tense or slow pulse. b. Syndrome of stomach heat Concept: refers to symptoms of excessive heat due to superabundance of fire and heat in the stomach and failure of gastric qi to descend. Clinical manifestations: scorching pain in the stomach, gastric discomfort with acid regurgitation, or vomiting right after eating, or preference for cold drinks, or polyorexia, or halitosis, or swelling, pain and ulceration of gum, dental bleeding, constipation, scanty yellowish urine, reddish tongue with yellow fur and slippery and rapid pulse. c. Syndrome of food retention in the stomach Concept: refers to the symptoms of gastric and abdominal fullness and pain, vomiting, diarrhea, acid regurgitation and halitosis due to retention of food in the stomach. Clinical manifestations: unpalpable gastric and abdominal fullness and pain, eructation with fetid odor, anorexia, or vomiting of fetid food, alleviation of abdominal distension and pain after vomiting, or borborygmus with abdominal pain, unsmooth defecation, foul stool like decayed eggs, thin and greasy tongue fur, slippery pulse or sinking and excessive pulse. d. Syndrome of deficient stomach yin Concept: refers to the symptoms due to insufficiency of gastric yin, loss of proper moistening and descending of the stomach as well as internal disturbance of deficient heat. Clinical manifestations: scorching and dull pain in the epigastrium, hunger without desire to take food, or epigastric fullness and discomfort, or dry vomiting and hiccup, dry mouth and throat, dry feces, scanty urine, reddish tongue with scanty fluid and thin and rapid pulse. a. Excess heat Syndrome of small intestine Concept: refers to the symptoms due to exuberance of heat in the small intestine. Clinical manifestations: dysphoria and thirst, ulcer in the mouth and on the tongue, scanty and brownish urine, inhibited urination, scorching pain in urination, hematuria, reddish tongue, yellowish tongue fur and rapid pulse.

9) Syndrome differentiation of large intestine disease

a. Syndrome of large intestine fluid consumption Concept: refers to the symptoms of retention of dry feces and difficulty in defecation due to consumption of large intestinal fluid and inhibited transportation. Clinical manifestations: dry feces and difficulty in defecation, defecation once in several days, dry mouth and throat, or dizziness and halitosis, reddish tongue with scanty fluid, yellow and dry tongue fur, as well as thin and unsmooth pulse. b. Syndrome of large intestine damp-heat Concept: refers to the symptoms of diarrhea and dysentery due to invasion of damp heat into the intestinal tract and failure of the intestine to transport. Clinical manifestations: abdominal pain, yellowish and foul fulminant diarrhea, scorching sensation over the anus, or purulent and bloody dysentery, tenesmus, scanty and yellow urine, reddish tongue, yellow and greasy tongue fur as well as slippery and rapid pulse.

10) Syndrome differentiation of bladder disease

a. Syndrome of damp heat in the bladder Concept: refers to symptoms of morbid changes in urine due to retention of damp heat in the bladder and inhibited transformation of qi. Clinical manifestations: frequent and urgent urination, lower abdominal distending pain, scorching pain in urination, scanty and brownish urine, or hematuria, or sandy urine, accompanied by fever, lumbago, reddish tongue, yellowish greasy tongue fur and slippery and rapid pulse.

11) Syndrome differentiation of accompanying diseases of viscera

a. Deficient Syndrome of heart and lung qi Concept: refers to the symptoms of palpitation, cough and dyspnea due to simultaneous deficiency of heart and lung qi. Clinical manifestations: palpitation, shortness of breath, chest oppression, weakness in cough, vomiting of thin and clear sputum, dizziness and dispiritedness, timid and low voice, spontaneous sweating and lassitude, aggravation after movement, pale complexion,

7) Syndrome differentiation of gallbladder disease

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TCM REVIEW light-colored tongue with whitish fur, or light purplish tongue and lips, sinking and weak or knotted pulse and intermittent pulse. b. Deficient Syndrome of heart and spleen Concept: refers to the symptoms of malnutrition of the heart, dysfunction of the spleen and weakness of the heart, dysfunction of the spleen and weakness of the spleen in controlling blood. Clinical manifestations: sallow complexion, lassitude, palpitation, insomnia and dreaminess, dizziness and amnesia, poor appetite, abdominal distension and losse stool, hematemesis, hematochezia, or subcutaneous hemorrhage, or scanty and light-color menstruation and dripping menstruation, light-color and tender tongue as well as thin and weak pulse. These symptoms are usually seen in arrhythmia, cardiac neurosis, chronic gastritis, digestive ulcer, hemorrhage from upper digestive tract, malabsorption syndrome, iron-deficiency anemia, aplastic anemia, purpura, leucopenia and dysfunction uterine bleeding. c. Deficient Syndrome of heart and kidney yang Concept: refers to the symptoms of blood stagnation and retention of fluid due to decline of heart and kidney yangqi. Clinical manifestations: palpitation, cold body and limbs, dispiritedness and lassitude, edema of limbs, dysuria, cyanosis of lips and nails, light-color, dull and purplish tongue, whitish and slippery coating as well as sinking, thin and indistinct pulse. Such symptoms are usually seen in heart and kidney failure due to hypertension, infectious endocarditis, myocarditis, chronic pulmogenic heart disease, chronic nephritis, systemic lupus erythematosus, diabetes, hypothyroidism and epidemic hemorrhagic fever. d. Syndrome of disharmony between the heart and kidney Concept: refers to the symptoms of deficiency of heart and kidney yin and hyperactivity of heart and kidney yang due to imbalance between the heart and the kidney. Clinical manifestations: restlessness and insomnia, palpitation and dreaminess, dizziness and tinnitus, amnesia, aching and weakness of loins and knees, seminal emission, feverish sensation over the five centers, tidal fever and night sweating, dry mouth and throat, reddish tongue with scanty coating or without coating and thin and rapid pulse. Such symptoms are usually seen in neurasthenia, arrhythmia, cardiac neurosis, hypertension and hyperthyroidism. e. Syndrome of lung and spleen qi deficiency Concept: refers to the symptoms of deficiency due to deficiency of lung and spleen qi, failure of the lung to disperse and descend as well as failure of the lung to disperse and descend as well as failure of the lung to transform. Clinical manifestations: continuous cough, shortness of breath and dyspnea, profuse thin and clear sputum, poor appetite, abdominal distension and loose stool, low voice and no desire to speak, lack of energy, pale complexion, or edema of limbs, light-color tongue with whitish and slippery coating as well as thin and weak pulse. Such symptoms can be seen at the remission stage in chronic bronchial asthma and chronic obstructive pulmonary emphysema as well as in immunological hypofunction due to various factors. f. Syndrome of spleen and kidney yang deficiency Concept: refers to deficient cold symptoms marked by diarrhea or edema due to deficiency of spleen and kidney yang as well as failure of kidney yang to warm and transform.

TCM REVIEW Clinical manifestations: chronic diarrhea and dysentery, morning diarrhea with indigested or thin and cold stool, dropsy of face and body, abdominal distension, dysuria, cold pain in loins and knees or lower abdomen, bright-white complexion, cold limbs and body, light-color and bulgy tongue with whitish slippery coating as well as deep, slow and weak pulse. Such symptoms are usually seen in chronic enteritis, malabsorption syndrome, irritable intestinal syndrome, Crohns disease, chronic nephritis, purpuric nephritis and chronic failure of the kidney. g. Syndrome of kidney and liver yin deficiency Concept: refers to symptoms of interior disturbance of deficient-heat due to consumption of liver and kidney yin fluid and failure of yin to control yang. Clinical manifestations: dizziness, tinnitus and amnesia, dull pain in the hypochondria, aching and weakness of the loins and knees, insomnia and dreaminess, seminal emission, scanty menstruation or amenorrhea, or metrorrhagia and metrostaxis, dry mouth and throat, feverish sensation over the five centers, night sweating and flushed cheeks, reddish tongue with scanty coating, thin and rapid pulse. Such symptoms are usually seen in various consumptive diseases and at the rehabilitative stage of various infectious diseases. h. Syndrome of liver fire invading lung Concept: refers to the symptoms of the lung failing to depurate and clear due to invasion of adverse movement of fire in the liver meridian into the lung. Clinical manifestations: scorching pain in the chest and hypochondria, irritability and susceptibility to rage, dizziness and distension of head, flushed cheeks and red eyes, restless fever and bitter taste in the mouth, paroxysmal cough, yellowish thick and sticky sputum, or hemoptysis, dry feces, yellowish and reddish urine, reddish tongue, yellowish thin coating and taut and rapid pulse. Such symptoms are usually seen in bronchiectasis, pulmonary tuberculosis, endobronichial tuberculosis and lung cancer. i. Syndrome of imbalance between liver and spleen Concept: refers the symptoms of chest and hypochondriac distending pain, abdominal distension and loose stool due to failure of the liver to disperse and convery as well as dysfunction of the spleen. Clinical manifestations: distending pain and wandering pain in the chest and hypochondria, susceptibility to sigh, emotional depression irritability and susceptibility to rage, anorexia and abdominal dissension, loose stool and retention of feces or loose stool and unsmooth defecation, borborygmus and breaking wind, or abdominal pain with desire of diarrhea, alleviation of pain after diarrhea, whitish tongue coating, taut pulse or slow and weak pulse. Such symptoms are usually seen in chronic enteritis, irritable intestinal syndrome, allergic colitis, malabsorption syndrome and chronic hepatitis. j. Syndrome of incoordination between liver and stomach Concept: refers to the symptoms of epigastric and hypochondriac distension and pain due to stagnation of liver qi from normal descending. Clinical manifestations: hypochondriac and epigastric distending pain or wandering pain, hiccup, belching, acid regurgitation, anorexia, mental depression, irritabiligy and susceptibility to anger and sigh, whitish thin or yellowish thin tongue coating, taut pulse or taut and rapid pulse. Such symptoms are usually seen in acute gastritis, chronic gastritis, digestive ulcer, reflux esophagitis, cholecystitis and gallstones. k. Syndrome of damp-heat in liver and gallbladder

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TCM REVIEW Concept: refers to the symptoms of dysfunction in dispersion and conveyance due to accumulation of damp-heat in the liver and gallbladder. Clinical manifestations: hypochondriac scorching distending pain, or hypochondriac mass, anorexia and abdominal distension, bitter taste in the mouth, acid regurgitation and nausea, disorder of defecation, scanty and reddish urine, or alternate chills and fever, yellow coloration of the skin and eyes, or pudendal pruritus, or foul and yellowish leucorrhea, reddish tongue with yellowish and greasy coating, taut and rapid pulse or slippery and rapid pulse. Such symptoms are usually seen in various digestive system diseases as well as orchitis, scrotal eczema, pelvic inflammation and vaginitis.

TCM REVIEW Concept: refers to the syndrome with retention of dry feces in the intestines due to mixture of superabundance of pathogenic heat with waste materials in the intestines. Clinical manifestations: fever, afternoon tidal fever, continuous sweating over hands and feet, abdominal hardness and fullness with unpressable pain, constipation, restlessness, even delirium, yellowish dry tongue coating or brownish tongue coating, tongue with prickles, deep and powerful pulse.

3) Shaoyang syndrome
Concept : refers to the syndrome due to pathogenic factors attacking the gallbladder. Clinical manifestations: alternate chills and fever, chest and hypochondriac discomfort and fullness, no appetite, vexation and susceptibility to vomiting, bitter taste in the mouth and dry throat, dizziness and taut pulse.

4. Syndrome of six-meridians differentiation 1). Taiyang syndrome a. Taiyang meridian syndrome

i. Taiyang wind-attack syndrome Concept: a syndrome caused by invasion of pathogenic wind into the superficies and disorder of nutrient and defensive qi Clinical manifestations: fever, aversion to wind, sweating, stiffness and pain in the neck and head, whitish thin tongue coating and floating and slow pulse. ii. Taiyang cold-attack syndrome Concept: the disease caused by invasion of pathogenic cold into the superficies, obstruction of defensive qi and stagnation of nutrient qi. Clinical manifestations: aversion to cold, fever, no sweating, or dyspnea, stiffness and pain in the neck and head, body pain, whitish thin tongue coating and floating and tense pulse.

4) Taiyin syndrome
Concept : refers to the syndrome due to decline of spleen yang and internal superabundance of cold-dampness. Clinical manifestations: abdominal fullness and vomiting, poor appetite, diarrhea, frequent abdominal pain, preference for warmth and pressure, no thirst, light-color tongue with white coating and slow and weak pulse.

5) Shaoyin syndrome
a. Shaoyin cold-transformation syndrome Concept : refers to the syndrome due to deficiency of heart and kidney yang and pathogenic factors transforming into cold following the nature of yin. Clinical manifestations: aversion to cold and curled posture in sleep, dispiritedness and sleepiness, cold limbs, diarrhea with indigested food, no thirst or thirst with preference for hot drinks, clear and profuse urine, light-color tongue with white coating and deep and indistinct pulse. b. Shaoyin heat-transformation syndrome Concept : refers to the syndrome of deficienct-heat due to deficiency of heart and kidney yin, hyperactivity of heart and kidney yang as well as pathogenic factors transforming into heat from yang. Clinical manifestations: vexation and insomnia, dry mouth and throat, reddish tongue tip or deep-red tongue and thin and rapid pulse.

b. Taiyang fu syndrome
i. Taiyang water-accumulation syndrome Concept : A syndrome caused by hypofunction of the bladder in transforming qi and accumulation and retention of water due to failure to relieve taiyang meridian syndrome and transmission of pathogenic factors into the bladder. Clinical manifestations: fever, aversion to cold, dysuria, lower abdominal distension and fullness, thirst, vomiting after drinking water and floating pulse. ii. Taiyang blood-accumulation syndrome Concept: This syndrome is caused by internal transmission of pathogenic factors and its mixture with blood in the lower energizer due to failure to relieve taiyang meridian syndrome. Clinical manifestations: lower abdominal spasm, fullness or mass, normal urination, mania, deep and unsmooth pulse or deep and knotted pulse.

6) Jueyin syndrome
Concept : appears in the advanced stage of six meridians disorders due to cold-attack, marked by complex changes and mixture of cold and heat in pathogenesis. Clinical manifestations: thirst, qi rushing up into the heart, pain and feverish sensation in the heart, hunger without appetite, postcibal vomiting of ascaris, cold extremities and diarrhea.

2) Yangming syndrome a. Yangming meridian syndrome

Concept: refers to the syndrome with no retention of feces in the intestines due to hyperactivity of pathogenic heat. Clinical manifestations: high fever, no aversion to cold but aversion to heat, profuse sweating, polydipsia, flushed cheeks and dysphoria, reddish tongue with yellowish dry coating and full and large pulse.

5. Syndrome of defensive qi, qi, nutrient qi and blood differentiation

1). Defensive phase syndrome Concept: refers to the syndrome due to invasion of pathogenic factors into the lung, disorder of defensive qi and dysfunction of the lung. Clinical manifestations: fever, slight aversion to cold and wind, reddish tongue tip, whitish thin or slightly yellow tongue coating, floating and rapid pulse, usually accompanied by headache, cough, dry mouth, slight thirst and swelling pain of the throat. 2) Qi phase syndrome

b. Yangming fu syndrome
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TCM REVIEW Concept: refers to internal excess-heat syndrome due to febrile pathogenic factors penetrating inside and attacking the viscera, marked by superabundance of healthy qi and excess of pathogenic factors. Clinical manifestations: fever, aversion not to cold but to heat, vexation and thirst, sweating, reddish urine, reddish tongue, yellowish tongue coating and rapid pulse. 3) Nutrient phase syndrome Concept: refers to the syndrome due to internal transmission of pathogenic febrile factors, consumption of nutrient yin and disturbance of the mind. Clinical manifestations: severe fever in the night, mild thirst, vexation and insomnia, or even delirium, appearance of macules and eruption, deep-red tongue with scanty coating and thin and rapid pulse. 4) Blood phase syndrome Concept: caused by invasion of pathogenic febrile factors into yin blood and leading to disturbance of blood, generation of wind and consumption of yin. Clinical manifestations: worsened fever in the night, restlessness, or even delirium, mania, appearance of purplish or blackish macules and eruptions, or hematemesis, epistaxis, hematochezia, hematuria, deep-red tongue, and rapid pulse.

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