Cookbook Acupuncture A Clinical Acupuncture Training Handbook

Cookbook Acupuncture A Clinical Acupuncture Training Handbook Designed for Practitioners of Acupuncture Anatomical Acupuncture Chiropractic Acupunctur...
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Cookbook Acupuncture A Clinical Acupuncture Training Handbook Designed for Practitioners of Acupuncture Anatomical Acupuncture Chiropractic Acupuncture Medical Acupuncture

& Acupuncture-Informed Trigger Point Dry Needling™

Jim Ventresca, Doctor of Oriental Medicine Principal, AcuPractice Seminars

Edited by Claudia Welch Note: The information in this book is true and complete to the best of my knowledge. This book is intended as an informative guide for those wishing to know more about health issues and acupuncture theories. This book is not meant to be used, nor should it be used, to diagnose or treat any medical condition. It is in no way intended to replace, countermand or conflict with the advice given to you by your physician or healthcare provider. The ultimate1 decision concerning care should be made between you and your doctor, or between any patient and her doctor. Information in this book is general and is offered with no guarantees on the part of the author or publisher. The author and publisher disclaim all liability in connection with the use of this book.

ISBN: AcuPractice Press

Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

Author’s Note:!..............................................................10 Preface!..........................................................................10 Acknowledgments!.......................................................12 Introduction!..................................................................13 2nd Edition Notes!........................................................15 Terminology & Literary Conventions!.........................15 7.

Reference Material!.......................................................17 The Basics: Chinese Medical theory 101 20 Yin & Yang!....................................................................21 The Eight Principles!....................................................22 The Vital Substances!...................................................25 Pulse & Tongue Diagnosis!.........................................30 Meridians & Organs!.....................................................32 The Five Elements!.......................................................37

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Causes of Disease!.......................................................41 The Organs 42 The Lungs!.....................................................................43 The Spleen!....................................................................44 The Stomach!.................................................................45 The Heart!.......................................................................46

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The Kidneys!.................................................................47 The Urinary Bladder!.....................................................48 The Pericardium!...........................................................48 The San Jiao!.................................................................49 The Liver!.......................................................................49 9.

The Gall Bladder!..........................................................51 Acupuncture Techniques Demystified 52 Clean Needle Technique!..............................................53 Risks to Acupuncture Providers! 55 Acupuncture Patient Side Effects!55

Contraindications and Cautions!................................56 Office Setup/Patient Flow!............................................57 Acupuncture Distal Techniques!.................................58 Getting The Qi!..............................................................58 Acupuncture!.................................................................59 Electro-Acupuncture (EA)!...........................................61 Laser Acupuncture!.....................................................66 Moxa!..............................................................................66 TDP Lamp!.....................................................................69 10.

Gua Sha & Cupping!.....................................................70 Points & Meridians: The Raw Ingredients 74 Meridian Overview!.......................................................74

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The 8 Extraordinary Meridians!...................................76 Dr. Jim’s Tai Ji Treatment!78

Points Overview!...........................................................79 Body Measurements and General Point Location!

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Classic Point Categories Table!...................................80 Controlling Points!81 Hua Tuo Jia Ji Points! 82 Yuan Source Points! 82 Five Element Points! 84 Tonification and Sedation Points!85 Horary Points! 85 Xi Cleft Points! 85 Five Shu (Transport) Points! 86 Luo Points!87 Meeting or Influential Points! 87 The Back Shu (Associated) Points! The Front Mu (Alarm) Points! 89 Trigger Points aka Ah Shi Points!90

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The Main Meridians & Their Major Points

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Du Meridian “Governing Vessel”!................................91 Ren Meridian “Conception Vessel”!............................94 Lung Meridian!..............................................................98 Large Intestine Meridian!............................................100 Stomach Meridian!......................................................104 Spleen Meridian!..........................................................108 Heart Meridian!............................................................111 Small Intestine Meridian!............................................113 Urinary Bladder Meridian!...........................................117 Kidney Meridian!..........................................................123 Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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Pericardium Meridian!.................................................126 San Jiao Meridian!.......................................................128 Gall Bladder Meridian!................................................131 Liver Meridian!.............................................................135 12.

Extraordinary Points!..................................................140 Auricular Acupuncture: Microsystems & Extraordinary Meridians 142 Hand Acupuncture!.....................................................143 Selected Upper Body Hand Points! Other Hand Points! 143

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Auricular Acupuncture!..............................................145 Ear Anatomy! 146 Major Auricular Points! 146 Specific Auricular Treatments! 148 Acupuncture Treatment of Chemical Dependency !

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Scalp Acupuncture!.....................................................150 Scalp Contraindications and Cautions! 151 ScalpTechnique! 151 Scalp Points! 154 Head & Neck Points! 154 Neck & Shoulder Points! 154 Shoulder Arm & Hand Points! 154 Thorax Points! 155 Low Back Points! 155

Chinese Scalp Lines!..................................................156 Based on Cortical Homunculus! 156 Finding the Lines: Lines of Measurement! 156 Continence Line (AKA: Leg & Foot Motor & Sensory)! 158 Motor Function Line! 160 Sensory Perception Line! 160 Tremor Control Line! 161 Vision Line!161

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Vertigo and Balance Line!161

The 8 Extraordinary Meridians In More Detail!.........163 Treatment Protocol for the Extraordinary Vessels!

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General Uses for the Extraordinary Meridians!........167 Dai Mai (Belt Vessel)!..................................................167 Chong Mai (Penetrating Vessel)!................................168 Ren Mai (Conception Vessel CV)!............................168 Du Mai (Governing Vessel GV)!.................................168 Secondary Extraordinary Vessels!............................169 Yin Qiao & Yang Qiao (Heel Vessels)! 169 Yin Wei & Yang Wei (Linking Vessels)! 169 Psychological Issues & Extraordinary Meridians!170

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The Main Course: Treatment of Pain

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Diagnosing The Pain!..................................................173 Immobilization!............................................................173 Ice & Heat!....................................................................174 Treatment Results!......................................................174 Palpation!.....................................................................175 Local Treatment!..........................................................175 Moving Stagnation!.....................................................176 Treating Pain: Local, Adjacent, & Distal Points!......177 Sinew (Tendino-Muscular) Meridians!.......................179 Zonal Treatment for Treating Pain by Area!..............179

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Microsystems!.............................................................181 The Main Local Points for Treating Pain!..................183 The Recipes: Treating Specific Painful Conditions!184 Headaches! 185 Facial Pain! 185 Neck Pain & Stiffness! 186 Wrist & Hand Pain!186 Arm & Shoulder Pain! 187 Upper and Mid Back Pain!187 Low Back & Hip Pain and Sciatica! Knee Pain!190 Foot & Ankle Pain!190 Abdominal Pain! 191

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Review: National Board Exam & Program

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Introduction!................................................................191 General Theory!...........................................................192 Yin Yang! 192 Eight Principles! 192 Five Elements! 193 Chronotherapy (The Horary Cycle)!

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The Essential Substances :!.......................................194 Qi! 194 Jing! 195 Blood! 195 Fluids: Jin Ye!

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The Causes of Disease or Pathogenic Factors!.......197 Organs!.........................................................................197 Lungs! 197 Spleen! 198 Heart AKA: The Emperor!198 Liver! 199 Kidney ! 200 Pericardium! 200 San Jiao! 201 7

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Extraordinary (Curious) Organs! 201

Tongue and Pulse Diagnosis!....................................201 Clean Needle Technique!............................................202 Acupuncture Techniques!..........................................203 Acupuncture Points and Meridians!..........................204 Auricular Acupuncture and Other Microsystems!...210 15.

Name That Disharmony / Diagnosis Review!...........211 Internal Medicine 212 Introduction!................................................................212 Theoretical Principles Review! 212 Meridian Review! 213 Organs Review! 213 Extraordinary Meridians! 213 Extraordinary / Curious Organs! 214

Respiratory System and Conditions!........................214 Upper Respiratory Conditions! 214 Lower Respiratory Conditions! 215 Allergies! 216 COPD: Asthma, Chronic Bronchitis, Emphysema, etc.! 216 Immune System Weakness! 217 Smoking Cessation! 217

Gastro-Intestinal System & Conditions!...................217 Oral Cavity (mouth, tongue, teeth, lips)! 217 Pharynx and Esophageal!217 Stomach! 218 Intestinal / Colorectal! 219

Genito-Urinary System & Conditions!.......................220 Kidney Disease / Failure! 220 Low Sex Drive, Impotence, Frigidity ! Urinary Tract Infections! 221 Urinary Retention! 221

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Male GU Conditions! 221 Female GU Conditions! 222

WOMEN’S HEALTH!....................................................223 Introduction! 223 Review Major Relevant Points:! 223 Organs, Meridians, and Substances! 223 Essential Etiology !226 Essential Diagnosis! 228 Treatment of the Most Common Disharmonies! 230 Treatment of Internal Organs! 230 Specific Disorders!233 Disorders after childbirth:!239 Infertility! 240 Breast lumps! 240 Abdominal Masses! 240 Polycystic ovary disease! 240 Menopause! 240

Women’s Health: Name That Disharmony!...............241

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Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

Author’s Note: This printing of this book is part of a process. I don't know when it will be what I hope it will become, but it’s getting there. It started out as a set of lecture notes that have been continuously updated since I began teaching Chinese Medical Theory at Southwest Acupuncture College in 1994. This time I thought I’d give it a full rewrite, and make it into a regular book. So, you can think of it as a book/course outline, that is that is being transformed into an educational narrative. I’d say I’m about 50% there, give or take. So, even though some of the recipes and instructions are still in outline form, I think you’ll find it a clinically useful, and maybe even fairly readable book. Jim Ventresca, Prince Edward Island July, 2015

Preface A cookbook is a good thing. It’s a quick reference guide to help you create good results in the kitchen. This acupuncture cookbook can help you get good results in the clinic. “Cookbook Acupuncture” is a term I’ve heard since I began to study acupuncture in 1982. It is has been given a bad rap as an inferior approach to treatment. I disagree. In my experience, almost every practitioner I know and teacher I’ve studied with,uses recipes, although they usually call them point prescriptions. Of course, most of them justify their recipes with theories, but the recipes persist, and they get handed down and around from one person to another. Here’s how it goes: “How do you treat stubborn low back pain?” “Well, I always like to try such and such or if that doesn’t work, I’ll try this and that,”etc.

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So why not just call it what it is, and get the information out to as many practitioners as possible? Of course, differential diagnosis is important. Holistic treatment dictates that one address both the root causes and the branches of disorders. I assume that, as a healthcare provider, you already have at your disposal one or more means of treating the root causes of your patients’ disorders. We could fill a small library with books on how to treat the roots. This book is designed to help you manage the branches. That said, we will look into the basic theories underlying TCM diagnosis and treatment, with sufficient depth that the avid student will find sufficient detail to benefit her patients. Comprehensive cookbooks go into great detail on all the theories and techniques associated with the recipes in the book. This isn’t one of those types of cookbooks. It’s more like a card file of recipes from your grandmother. Your grandmother would have assumed you already know the basics, yet she might still have written in a few a reminders such as, how to mix the pancake batter: “Mix only until the dry ingredients are moistened.” Because I assume you either have prior training, or are currently getting some, and have access to acupuncture charts, books, apps, and notes to fill in any gaps, this acupuncture cookbook only touches on the theories and techniques, as gentler reminders. I’ve been cooking since I was a boy. Yet still, I find it helpful to keep a cookbook or two in my kitchen, and open them from time to time, for a quick reminder of how to make something I haven’t cooked for a while, to learn how to make a dish I haven’t tried before, or inspiration for something new. I hope you find that Cookbook Acupuncture serves a similar purpose in your clinic.

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Acknowledgments Since I began practicing and studying acupuncture and Oriental medicine many years ago, I’ve had many wonderful teachers and colleagues from many different acupuncture traditions. The techniques in this book are drawn from all of them. It would be difficult—if not impossible, to trace the origin of each of these techniques, but I am ever grateful for and to all the folks who helped me along the way. Most especially I would like to thank Dr. James Tin Yao So who inspired the first few generations of acupuncturists in the US, and started the New England School of Acupuncture; Don Halfkenny who taught me how to be practical, fair and reasonable in dispensing acupuncture healthcare; Kiko Matsumoto for teaching me how to reason within the boundaries of acupuncture; Jeffery Yuen for teaching me how to understand the underpinnings of this medicine; My classmate and old friend Jean Loius (Lalou) Begue for showing me the value of paying attention to the details; Skya Abbate and Anthony Abbate for giving me the opportunity to discover how best to teach this medicine; my brother Dr. Chuck Ventresca for his example of complete integrity as a physician and his mastery of the science and art of healing; and Dr. Claudia Welch, a skilled healer, deep thinker, talented author, wonderful editor, my inspiration, best friend, partner, and wife.

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Introduction State rules and regulations, or individual practitioners, may make clear distinctions between the terms, “acupuncture,” “dry needling,” “meridian therapy,” or “trigger-point needling,” but it’s all the same to me, and probably to your patients too. Each of these methods of healing involve placing acupuncture needles into patients to relieve pain, be it neuromuscular or organ related, physical, or emotional. They all require some knowledge and experience to get good results. Whether you are a licensed acupuncturist, a doctor of: chiropractic, medicine, naturopathy, osteopathy, physical therapy, or Oriental medicine, this book assumes that you are a licensed healthcare practitioner, with acupuncture or dry needling in your scope of practice, and that you have taken or are currently taking at least basic acupuncture training. In other words, I assume that you already know how to insert a needle, which points are contraindicated in what conditions, how to find most of the important acupuncture points, and that you are qualified to practice. Hopefully you also know how to arrive at a basic TCM diagnosis like: Liver Qi Stagnation, Qi and Blood Stagnation, or Spleen Qi Deficiency. That said, like all of us, you may still need an acupuncture chart to find the point you’re looking for, and you may need a little reference material to hone your diagnosis on a particular patient. That’s all part of the experience that comes with time. Every time you use a point or make a diagnosis, and see good results, you’ll remember that point or diagnosis. The issue of who gets to practice acupuncture and how much training is necessary can be a hotly debated one. Individual state , 13

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and national laws and regulations allow various healthcare providers to practice acupuncture, or dry needling, or whatever you might call it, with certain minimum amounts of training. Because their laws allow them to employ these techniques, some health care providers naturally want to provide these therapies, They search out training programs that meet their minimum requirements. I believe everyone who practices acupuncture should have the best training that can fit into the number of hours required by law. I have put in a great deal of time debating acupuncture laws rules and regulations over the last 30 years, and I’m glad I had the opportunity to do so. Now however, I view my role exclusively as an educator, and as such I’ll leave the politics to others and concentrate on providing the best training possible to all acupuncture providers. The information in this book is not complete in and of itself. It’s meant to serve as an adjunct to classroom study, and as a clinical handbook, once you’ve completed some studies. If you are hoping to practice acupuncture with only the information contained in this book, you will find yourself severely under-informed. However if you are using it as intended, it should serve you well. This information is based on over 30 years of my personal experience treating patients and teaching acupuncture. It’s short, direct, and to the point. I really think it’s my best stuff. I hope you find it helpful.

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2nd Edition Notes This is the second edition of this book and is greatly expanded from my first attempt. The first edition of this book “The Acupuncture Cookbook” was aimed at assisting doctors who were already trained in acupuncture in honing their skills in treating pain. This edition: Cookbook Acupuncture is meant to double as companion set of notes to AcuPractice™ Seminars’ programs and courses in Acupuncture, and in Acupuncture-Informed Trigger Point Dry Needling™, as well as a clinical handbook for licensed practitioners.

Terminology & Literary Conventions Oriental Medicine includes all aspects of traditional medicine as is has been practiced throughout Asia (China, Japan, Korea, Taiwan, Vietnam, Tibet, and perhaps even India, etc.) for many centuries, and as it continues to be practiced around the world today. Traditional Chinese Medicine (TCM) is the version of Oriental medicine that is taught and practiced in mainland China today. This brand of Oriental medicine was created in the late 1940s and early 1950s as a way to consolidate 20 centuries of traditional medical information into a coherent system of that could be taught in a reasonable amount of time, to a vast number of practitioners. While it doesn’t include every aspect of Oriental medicine, it is quite effective and is likely the most commonly practiced from of Oriental medicine in the world today. Medical, Chiropractic, and Anatomical Acupuncture: These terms are generally applied to the type of acupuncture taught to

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physicians in focus programs of between 100 and 300 hours. These programs vary widely with regards to the depth of information on Oriental medical diagnosis and the treatment of internal medical disorders. As a result the term has come to refer to acupuncture treatment that is primarily focused on neurological and musculoskeletal pain syndromes. Trigger Point Dry Needling (TPDN) is a procedure that employs a single powerful needling technique, to treat neuromuscular and musculoskeletal pain syndromes. This needling technique is one acupuncture practitioners have been employing for centuries. The distinguishing factor is TPDN practitioner’s complete avoidance of any reference to acupuncture, coupled with a strict reliance on biomedicine & biomechanics for diagnostics and explaining mechanisms of action. It’s my belief that this strict avoidance of any acupuncture reference is more political than anything based on clinical effectiveness. Acupuncture-Informed Trigger Point Dry Needling™ is the practice of coupling the needling technique one would recognize as Trigger Point Dry Needling, together with some of the more powerful systemic and energetic acupoints and approaches to treatment to argument clinical results. It seems a shame that healthcare professionals who practice trigger point dry needling can not offer their patients the simple addition of major acupuncture point combinations and needling techniques that carry the very real likelihood of improved clinical results, for what may be purely political reasons. As the name implies, Acupuncture-Informed Trigger Point Dry Needling™ is my answer to this sad state of affairs. I have trained many healthcare providers in acupuncture over many years, and having kept in touch with a good number of them, I find that some of them end up practicing just this style of treatment. This is likely due to the fact that their practices are mostly geared toward treatment of painful neuromuscular and musculoskeletal disorders, and they’ve found this a most useful approach.

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Capitalization: Given that many technical Oriental medical terms are the same word as those used in western biomedicine, the accepted literary convention is to capitalize Oriental medical terms. For instance: “Blood” refers to the Oriental Medical term for the nutritive aspect of Qi, while “blood” refers to the red fluid found circulating in your blood vessels. Organ and Meridian Abbreviations: ! LU: Lung ! ! LI: Large Intestine ! SP: Spleen! ! ST: Stomach ! HT: Heart! ! SI: Small Intestine ! KD: Kidney ! ! UB: Urinary Bladder ! PC: Pericardium! SJ: San Jiao * ! LR:Liver! ! GB: Gall Bladder ! DU: (GV) Du Mai aka Governing Vessel ! ! REN: (CV) Ren Mai aka Conception Vessel ! ! ! !

* San Jiao (SJ) is also known as: ! TE Triple Energizer ! TW Triple Warmer ! TH Triple Heater ! TB Triple Burner

Reference Material Clearly, the clinical application of acupuncture is difficult to convey in a book, so please forgive my self promotion. AcuPractice™ Seminars is the program I, my brother Dr. Charles Ventresca, and the rest of our Faculty have developed and offer, for training healthcare professionals in acupuncture. Most of our students are chiropractors, medical doctors, osteopaths, naturopaths, physical therapists and a few nurses here and there. If you need a training course, would like some additional training, or if you have a colleague who would like to study, please consider AcuPractice™ Seminars. We offer quality acupuncture education programs, that prepare healthcare providers to practice acupuncture safely and effectively. 17

Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

We offer National Board Review classes, Classes on AcuPoints & Meridians, Needle Techniques, MicroSystems, Internal Medicine, Women’s Health, and the Treatment of Pain. For dates, locations fees, hours, and the rest of the usual information, please visit us online: AcuPracticeSeminars.com If you haven’t read The Web That Has No Weaver by Dr. Ted Kaptchuck, I highly recommend you get a copy and read it. It will provide you with most of the information you need to understand the basic theories of acupuncture and Oriental medicine. Even if you’re not going to use all the information in the book, you should at least make sure you are familiar with it, if only to be able to speak knowledgeably on the subject. You might want have a good set of Acupuncture Charts. I recommend the kind that hang on your wall, so you have quick reference, and so your patients will become more interested in acupuncture. However you choose to reference them, you should have some way to easily locate points when you want them. The industry standard reference book for acupuncture points is A Manual of Acupuncture by Peter Deadman & Mazin Al-Khafji with Kevin Baker. It’s a great textbook and contains most all you could want to know about acupuncture points. A Manual of Acupuncture App, is a wonderful resource for learning and reviewing points and meridians. This app even has a video of how to locate and needle every acupoint. This app gets my highest recommendation. At the time of this printing, there is no app for Android devices, however, even if you need to purchase an Apple device to use it, it’s worth the trouble and expense. In addition to a resource for acupuncture points, a good set of Trigger Point Charts or one of the many good Trigger Point Apps, is really worth having. When you are treating pain, you will want to be able to quickly locate and treat the related trigger points. Of course you can simply palpate for the trigger points, but why reinvent the Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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wheel every day? Most common trigger points have already been discovered. The charts are worth having, and will get you in the ballpark for the most common trigger points. This is especially true for acupuncturists and others who haven’t had direct training in trigger points. If a Chinese doctor from the 17th century had taken the time to catalog all the Ah Shi (locally reactive) points, that were useful for treating pain, along with their referral pathways, those points would be taught in every acupuncture school. As it turns out, they were named and the cataloguing began in the mid to late 20th century, by Dr. Janet Travell, and she called them Trigger Points. I believe any acupuncture practitioner would be well-served by spending a little time learning how to find and work with them. In order to get a clear perspective on how Oriental medicine views and balances health through lifestyle and diet I highly recommend Balance Your Hormones, Balance Your Life: Achieving Optimal Health and Wellness through Ayurveda, Chinese Medicine and Western Science by Dr. Claudia Welch. This book is geared toward women’s health, but is clinically applicable to all patients, men and women. I highly recommend it to all healthcare practitioners, and to patients as well. Especially women. I also want to mention Close to The Bone, by David Legg, a very good book to find many of the “nuts and bolts” of treating painful musculoskeletal conditions.

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1. The Basics: Chinese Medical theory 101 This section briefly introduces many clinically useful theories that form the basis of acupuncture and Oriental medicine. These theories can be successfully employed to enhance the practice of acupuncture with only a little effort spent in understanding them. These concepts are extremely important when treating internal disorders. They are less critical for neurological and musculoskeletal disorders, but can still be quite useful for crafting more effective acupuncture treatments for these maladies. The Five Branches of Oriental Medicine Acupuncture & Moxibustion includes all application of Physical Stimulus to AcuPoints: Needles, Heat, Pressure, Cold Laser Light, Milliamp Electrical Stimulation, etc. Herbal Medicine includes the ingestion or topical application of natural, minimally-processed, medicinal substances. Exercise: Tai Chi & Qi Gong cultivate and manipulate one’s vital energies (Qi). Diet & Lifestyle: Michael Pollen’s advice on food is probably the best and most direct I’ve come across, and it blends well with the Oriental medical approach: “Eat Real Food (i.e. foods your great grandmother would recognize as food), Not Too Much, Mostly Plants.” Couple that with sufficient physical exercise, rest, and repose, and you’re well on your way to a healthy lifestyle. Massage & Manipulation: There is long history of both of these modalities in the Orient.

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Yin & Yang Yin and Yang are among the most basic ideas underlying traditional Chinese philosophy and medicine. Volumes have been written on this subject, and it is a rich and interesting topic to discuss, with many implications that can be interpreted in all aspects of our existence. Yin and Yang encompass any opposite and complementary pairings that exist. Night and day, hot and cold, up and down, male and female, left and right, are but a few of the myriad of possible pairs we find in our universe. Here we will only concern ourselves with the aspects of Yin and Yang that directly apply to the practice of Oriental medicine. There are three sets of opposites that describe Yin and Yang in most clinical applications. Respectively, they are “Substance and Function,” “Internal and External,” and “Cooling and Warming.” Yin represents the substance and substances of the body, the internal areas of the body, and the energies that cool and moisten the body, and provide for rest. Yang represents all functional aspects of the body, the body’s external aspects, and the energies that warm and activate the body. The information contained in the following tables is helpful in understanding some of the the clinical significance of Yin & Yang. FUNCTIONS OF YANG

FUNCTIONS OF YIN

Provides Function

Provides Substance

Warming

Cooling

Moves, Activates, Circulates

Provides Rest the Ability to Rest

Protects / Provides Defense

Provides the Ability to Recover from Disease

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Transforms

Maintains Structure

Holds Up and In Place: Blood, Fluids, & Organs

Nourishes & Moistens: Blood, Fluids, & Organs

DISORDERS WHICH ARE YANG IN NATURE ASSOCIATED WITH Excess Yang or Deficient Yin

DISORDERS WHICH ARE YIN IN NATURE ASSOCIATED WITH Excess Yin or Deficient Yang

Acute / Rapid Onset

Chronic / Slow Onset

Excess Activity / Insomnia

Rest / Fatigue / Sleepiness

Stretch Out To Sleep Heat Signs: Red Efflorescences Rapid Pulse Thirst: Likes Cold Drinks

Curls Up In Sleep Cold Signs: Pale Efflorescences Slow, / Not-Rapid Pulse No Thirst: Sips Warm Drinks

Loud Voice - Extrovert

Soft / Weak Voice - Introvert

YANG BODY AREAS

YIN BODY AREAS

CONTRASTED WITH YIN AREAS

CONTRASTED WITH YANG AREAS

Superior

Inferior

Posterior

Anterior

Lateral

Medial

External

Internal

The Eight Principles These are four sets of Yin/Yang pairs that help us begin to understand the nature of disorders, and form an Oriental medical Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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diagnosis. This diagnostic framework is usually combined with diagnostic information about the Organs, Meridians and Substances to arrive at a complete diagnosis. These four pairs of opposites are: Yin & Yang, Internal & External, Hot & Cold, Excess & Deficient. Yin & Yang: Determination of whether a symptom or diagnosis is more Yin or More Yang can be based on the material presented in the preceding section on Yin & Yang. Internal & External refer to either the location of the disorder or it’s etiology. For instance: A skin disorder is usually considered external. An emotional disorder or one pertaining to an Organ is generally considered internal. In addition, these designations can combine. For instance, a skin disorder which results from an emotional trigger such as stress, has an external location and and internal etiology, so would be considered both internal and external. Excess and Deficiency manifest in many ways. Some examples are found in the tables on Hot & Cold, below. A few notable guidelines: • Pain, Tension & Tightness are generally associated with Excess • Weakness, Numbness and Tingling are generally associated with Deficiency. • Somatic Accumulations, such as excess weight, tumors, cysts, and Stagnant Blood are excesses. • Organ disharmonies such as Spleen Qi weakness, are often related to deficiencies. • Again, these designations can also combine, as in the case of excess accumulation of adipose tissue arising out of a deficiency of the Spleen’s ability to fully digest the food and fluids one consumes. Hot & Cold: Many disorders present with symptoms that indicate heat or cold. The tables below illustrate many of the most common clinical presentations.

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DESCRIPTION OF CONDITION

Yin Excess

AKA

TREATMENT PRINCIPLE

True Cold

Sedate Yin

Invasion of Cold

Warm Cold

True Heat

Sedate Yang

Excess Heat / Full Heat

Cool Heat

YANG EXCESS Yin Deficiency

False Heat

Tonify Yin

Heat from Deficiency

Nourish Yin

Yang Deficiency

False Cold

Tonify Yang

Cold from Deficiency

Rekindle Yang

Excess, Full, or True Heat

Deficient Yin

Usually Seen in URI: aka OPI Heat

aka False Heat

Thirst Red Face / Red eyes Full Sweat / Fever Painful SoreThroat Strong Cough Yellow Expectorant Dark, Scanty, Urine (Burning if severe) Constipation w/ discomfort or Hot Diarrhea Pulse: Rapid & Full Tongue: Red Body / Yellow Coat

Dry Mouth, Skin, Hair, etc. Malor Flush Night Sweats / Hot Flashes Chronic Dry & Itchy Throat Chronic Dry Weak Cough Dark Scanty Urine Dry Stool Pulse: Rapid, Weak & Thin Tongue: Red / No Coat (Peeled)

Excess, Full, or True Cold Often Seen in URI: aka OPI Cold

Deficient Yang aka False Cold

Clear Copious Urine

SAME

Preference for Warm Liquids

SAME

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Pale Face

SAME

Chills

Cold Body, Hands, & Feet

Cramping Pain Better with Heat No Pain Associated Cold Diarrhea Tongue: Thick White Coat

Loose Stools / Undigested Food Tongue: Pale Puffy / Wet Coat

Pulse: Excessive / Full

Pulse: Weak & Slow

The Vital Substances Qi (pronounced “chi”) is energy. One could write an entire book about the details and intricacies of Qi, in fact many people have, but not me, at least not today. The idea of Qi reaches well beyond it’s implications for Oriental medical theories, but we will limit our discussion to this application. Let us suffice it to say that Qi is the energy that flows throughout an individual, and activates all life’s processes, the Vital Force that keeps us alive and thriving. Qi is a Yang phenomena, and as such has Yang attributes. The main functions of Qi are the following: • To Move, Transport and Activate: Any movement, be it muscular, circulatory, respiratory, cellular, or otherwise depends on Qi. If the Qi becomes deficient or stagnant, movement is impaired and disharmonies result. • To Warm: This function includes one’s ability to feel warm and comfortable as well as mediating the body’s “fires”. For instance, the “digestive fire” of the Spleen powers all our digestive processes. • To Protect: The Wei Qi is expressed in our ability to fight off pathogenic influences like colds and flus. It is the shield that is our immune system.

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To Hold in Place: Organs, Fluids and Blood all need to be held in place. When they are not held in place edema, prolapsed organs, easy bruising, varicosities, hemorrhoids, dysfunctional uterine bleeding, and other disorders result.

Disharmonies of Qi: There are Two Main categories of Qi Disharmonies. Since Qi is mainly responsible for making things happen (i.e. activation) and for moving things, QI can either be Deficient or Stagnant. • QI Deficiency (Qi Xu) results from malnutrition, overwork, insufficient rest & repose, chronic and acute illnesses, and often as a result of old age. Qi Xu can manifest in the entire body, the spirit, or a particular Organ. As we will see, many other disharmonies are built upon the following Qi Deficient symptoms: • Fatigue • Weakness • Malaise • Pale Face • Pale & Swollen Tongue • Weak Pulse • Organ Disfunction • Mainly: Spleen, Lungs, Kidneys & Heart • Qi Stagnation (Qi Yu) results from trauma, Outside Pernicious Influences (OPI), emotional upset, and inappropriate diet. The main symptoms include pain and emotions: • Pain: • Dull, Achy, and Unfixed • Intermittent or traveling • Feels better with massage • Intercostal neuralgia • Emotions: • Feeling stuck emotionally • Emotional outbursts • Uneven expression of emotions • Other Signs: • Slightly Purple tongue Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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• •

Wiry Pulse Plum Pit Throat aka “Feeling all choked up”

Two other disharmonies of Qi are Qi Collapse, and Rebellious Qi. When Qi becomes especially deficient it may collapse. There are two presentations of Collapsed Qi: • Spleen Qi Collapse = Prolapse. i.e. anus, uterus, bladder, stomach… • Heart Qi Collapse = heart attack (MI) Rebellious Qi is Qi moving in the opposite direction from it’s normal orientation. while all organs can suffer from rebelious Qi two are most common • Rebellious Stomach Qi = Heartburn, nausea, vomiting, acid reflux… • Rebellious Lung Qi = cough, sneezing, COPD, hiccough… Blood (Xue). Blood is the nutritive aspect of the body’s Qi. Blood is a Yin phenomena, and as such has Yin attributes. The main functions of Blood are: • To Nourish: When Blood is deficient, the lack of nourishment can be observed as fatigue, lack of muscle tone, and a pale and lusterless complexion. • To Moisten: The lack of moistening can be seen in symptoms such as dry skin, dry hair and eyes and vaginal dryness. In addition, the Tendons need to be moistened. When the Tendons dry out, tics, twitches and tremors are commonly seen. • To Provide the Ability to Rest: Blood Deficiency often results in difficulty falling asleep. • To Recover & Restore our strength after illness. The Main Relationships of Blood: ! Heart: Moves It Through Body ! Liver: Stores and Releases (includes Menstrual Blood) ! Spleen: Produces Blood & Holds It In the Vessels

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Disharmonies Of Blood: Blood, like Qi can become Deficient, or Stagnant, but can also become overheated, know as Hot Blood. Deficient Blood (Xue Xu) similar to Qi Xu arises from malnutrition, chronic Illness, congenital disease, old age, exhaustion from overwork, and also from a physical loss of blood. Also like Qi Xu, Xue Xu can manifest in the entire body, the spirit or a particular Organ. The signs & symptoms of Blood Xu are very Similar to Qi Xu, but with the addition of Lack of Both Nourishment and Moisture. Fatigue, Malaise Pale Lusterless Face Weak Thin Pulse Pale & Thin Tongue Organ Dysfunction Dry Skin Dry Brittle Hair Twitches And Spasms (Due To Drying Out Of Tendons) Scanty/Light/Shortened/Infrequent Menses Dizziness Difficulty Falling Asleep (Yin Substance) Dry Eyes (Liver) Palpitations (Heart) Stuck Blood (Xue Yu) Arises from trauma, or as a result of Qi stagnation. Like Qi Yu, one of the main symptoms of Xue Yu is pain. The Pain associated with Blood Stagnation is: • Sharp and Stabbing • Fixed in Time & Space • Feels worse with massage • Associated with • Tumors Or Cysts (Non-Moving) • Swollen Organs • Hematoma • Clots Hot Blood is a condition associated with heat entering the Blood either from the outside or from internal causes. Heat in the Blood often causes bleeding or redness of the skin, as seen in red dry skin, pimples, rashes, or hemorrhage of fresh red blood such as hemorrhoids, uterine bleeding, or blood in the urine. Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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Jin-Ye: All physiological fluids of the body, with the exception of Blood. • The Jin are the clear, watery, more Yang fluids such as tears and sweat. • The Ye are the more Yin and thick fluids such as the internal moisture and synovial fluids. • San Jiao, Kidneys, Spleen and Lungs: Produce and manage the fluids. Jing is the Constitutional Energy that we inherit from our parents. • Each of us is conceived and born with a potential, that manifests in our own unique physical, mental, and emotional makeup. How we take advantage of this potential varies from individual to individual. • As we age we “use up” this constitutional energy. As our Jing is depleted over a normal lifetime the process of aging progresses. • We conserve our Jing by living a healthy and balanced lifestyle. • When the Jing is Deficient or depleted too quickly, signs of early aging occur. These include: • Poor Development In Children • Poor Concentration / Memory • Reproductive Disorders • Loose Teeth • Brittle Bones • Gray-Thinning Hair • Senility Shen is an individual’s consciousness, and as such, it dictates one’s subjective experience of all aspects of life, joy and sorrow, pleasure and pain. When one’s Shen is disturbed, mental and emotional imbalances can be experienced. These imbalances can range from mild anxiety or depression, to a complete psychotic break. Treating the Shen is often part of the treatment plan when treating patients for painful conditions, as well as those who are 29

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suffering from psycho-spiritual disharmonies. Calming the Shen relaxes the patient and allows for a more free flow of Qi and Blood. If the Shen is not at peace, it can result in further imbalances that lead to increased tension, which leads to further stagnation, which increases pain, which furthers the loss of peace-of-mind, and snowballs into more physical and psychological suffering. Disharmonies of Shen show up as: • Emotional Problems, Psychological And Emotional Shock, Disturbances Of Psychological/Mental Nature • Eyes That Lack Luster • Muddled Personality Forgetful And Slow • General Spiritual Disorder (Psychosis)

Pulse & Tongue Diagnosis Palpation of the radial pulse and observation of the tongue have been in use as diagnostic indicators for many centuries in traditional Asian medicine. Mastering these techniques and acquiring the ability to diagnose a condition simply by feeling a pulse and looking at a tongue require many years of study and practice. However, learning the basics of these diagnostic techniques is simple, and can be learned in a single session. In addition by using only the most basic parameters of tongue and pulse diagnostics, a doctor can glean much useful diagnostic information with only a little practice. The following table illustrates the most common and easy to detect pulse and tongue combinations that are often found in practice and can offer significant diagnostic direction. Condition Normal

Tongue Normal Red Thin White Coat

Pulse Moderate Strength Slightly Slippery 60-80 BPM

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Condition

Tongue

Pulse

Qi Deficiency

Pale & Puffy Thin White Coat

Weak

Yang Deficiency

Pale & Puffy Wet Coat

Weak & Slow

Blood Deficiency Pale Thin & Dry Thin White Coat

Weak & Thin

Yin Deficiency

Red & Thin & Dry No / Peeled Coat

Weak & Thin & Rapid

True Excess Heat

Red & Dry Thick Yellow Coat

Full & Rapid

Dampness

Greasy Coat

Slippery

Qi Stagnation

Slightly Purple

Slightly Wiry

Blood Stagnation Dark Purple (Maybe Spots)

Definitely Wiry

OPI Heat

Red Tip Red Edges

Rapid & Floating

OPI Cold

Normal

Floating

Long-Standing SP Scalloped Edges Xu

Weak in Middle Position

LR Qi Stagnation Slightly Purple

Full & Wiry

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Meridians & Organs The Meridians and Organs of acupuncture have considerable areas of overlap. • Each of the Zang and Fu Organs has a corresponding set of meridians. • The 6 Zang or Solid Organs and Meridians are classified as Yin. • The 6 Fu or Hollow Organs are classified as Yang. Each Zang Organ is Paired with a Fu Organ, making up 12 Yin - Yang pairs. Yin Meridians and Organs, for the most part, address metabolic dysfunction and Internal Disharmonies, often referred to as Yin Disorders. In addition, many of the functions associated with the Yang Organs are orchestrated by, and treated through, the Yin Organs. For instance, the digestive functions western medicine associates with the large intestine, small intestine, gall bladder, liver, and pancreas, are all subsumed under the functioning of the Spleen. The points on these meridians become important for their effects in treating specific aspects of internal Organ function. Yang Meridians are generally used to address the Yang disorders, those that manifest more on the surface or exterior of the body, such as musculoskeletal pain, tension, and tightness. Since the Yang meridians tend to treat pain along their respective pathways these pathways become, in some ways, more important than the functions of their individual points. There are a few exceptions to the above rules and we will explore them as they arise. The Organs and Meridians pair up in a two main ways. • The primary pairing of Yin and Yang, is known as the Husband-Wife relationship. • A second grouping of Yin-Yin and Yang-Yang relationships is the Six-Division Pairing.

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• The Husband-Wife / Yang-Yin Pairs are grouped according to the Five Elements, which are further explained in the next chapter. Yin

Yang

Wife

Husband

Element

Lung

Lg. Intestine

Metal

Spleen

Stomach

Earth

Heart

Sm. Intestine

Fire

Kidney

Urinary Bladder

Water

Pericardium

San Jiao

Fire

Liver

Gall Bladder

Wood

The Six-Division / Yang-Yang and Yin-Yin Pairs. Note: The Yang/Yang pairs play a significant role in the treatment of musculoskeletal, neuromuscular and painful conditions.

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Divisions

Yang-Yang Pairs

Grater Yang / Tai Yang

Small Intestine & Urinary Bladder

Lesser Yang / Xiao Yang

San Jiao & Gall Bladder

Effulgent Yang / Yang Ming

Large & Intestine Stomach

Divisions

Yin- Yin Pairs

Grater Yin / Tai Yin

Lung & Spleen

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Divisions

Yang-Yang Pairs

Lesser Yin / Xiao Yin

Heart & Kidney

Yielding Yin / Jue Yin

Pericardium & Liver

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The Great Loop Chart below, illustrates the flow of Qi among the Organs and Meridians within the context of both the Husband-Wife and Six- Division pairs.

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The Horary Cycle in the table below, illustrates how the flow of Qi throughout an individuals meridians and Organs coincide with one’s diurnal 24 hour cycle.

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The Five Elements Wood, Fire, Earth, Metal and Water - Like Yin and Yang, Five Element Theory is another way of classifying phenomena. The Five Elements permeate traditional Chinese thought, and can be applied to almost everything. The Five Elements comprise a diagnostic framework that blends nicely with Yin & Yang, the Organs and the Substances. However, in practice most TCM diagnosis discuss the Organs, Substances and Disharmonies or Pathogens without referring to the Five Elements. Still, they are useful for constitutional typing, diagnosis and prognosis. “Five Element Acupuncture” is a rich and effective sub-genre of acupuncture, which for he most part, will remain outside the scope of this book. Each of these elements; The Elements, Wood, Fire, Earth, Metal & Water is related to a particular pair of Organs and Meridians, color, sound, odor, emotion, taste, body tissue, body type, climate, and other characteristics. There exist many relationships between these elements as illustrated below.

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Fire Heart

Wood Liver

Gall Bladder

Earth Spleen

Stomach

Water

Metal

Kidneys

Lungs

Lg Intestine

The Interrelationships of the Five Elements Notes: 1. The Solid Line Arrows which make up the Circle, represent the Creative (Sheng)Cycle also known as the Parent-Child Cycle 2. The Dotted Line Arrows which make up the Star represent the Control (Ko)Cycle, aka the Grandparent-Grandchild Cycle 3. The Fire Element also includes the Pericardium (Yin) and San Jiao aka Triple Warmer (Yang) Organs. • Within each element are Yin and Yang aspects, sometimes referred to as the husband-wife relationship: • Yin organs representing wives and Yang representing husbands. • Aberrations of the Sheng, Creative, Parent/Child, or Generating Cycle • overproduction: hyper function generating Excess (Excess) • underproduction: hypo function creating Deficiency(Deficiency) • over-taxed, in which case the child drains the parent (Deficiency producing exhaustion) (analog to underproduction) • Aberrations of the Ko, Control, Grandparent, or Over-Acting Cycle

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• too much control, over-bearing, invasive and destructive (Excess producing Deficiency) • insufficient restraint, too weak to be effective (Deficiency generating Excess) • Reversed Ko cycle in which the child (normally restrained) rebels and insults the grandparent (Excess creates Deficiency)

The interrelationships of these Elements and their related attributes can create, and affect disharmonies between one another in many in varied ways. The table below lists many of the attributes of each of these Elements and can assist in predicting the results of some of these interactions. Because this is a complex system, and is not one we will be utilizing in this book to any significant degree, I leave it to be discussed and further explained in the classroom. That said, the table below is helpful in understanding the breadth of the Five Elements, and deserves consideration.

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Table of Five Element Attributes CATEGORY

WOOD

FIRE

EARTH

METAL

WATER

ZANG: Solid Yin Organ FU: Hollow Yang Organ SEASON

Liver

Heart

PC

Spleen

Lungs

Kidney

Gall Bladder

SI

SJ

Stomach

Lg. Intestine

Bladder

Spring

Summer

Late Summer

Fall

Winter

CYCLE

Birth

Growth

Maturity

Harvest

Rest / Storage

CLIMATE

Wind

Heat

Damp

Dry

Cold

ORIFICE

Eyes

Tongue

Mouth

Nose

Ears

SENSE

Vision

Speech

Taste

Smell

Hearing

BODY TISSUE

Blood Blood Vessels Complexion

Flesh Muscles Lips

Skin

RESIDUES

Tendons Sinews Nails

Body Hair

Teeth Bone Marrow Head Hair

TONGUE

Sides

Tip

Center

Behind Tip

Root

COLOR

Green

Red

Yellow

White

Blue/Black

Raspy Weeping Decorous Architect Create Order Po - Physical Vitality Strength Sustainability Grief/Sadness Nasal Mucus Spicy & Pungent

Resonant Groaning Wise Treasurer Store Essence Zhi -Will Commitment Survival Determination Fear Internal Moisture Salty & Musty

SOUND

Shouting Laughing Singing Sighing OFFICE Benevolent Righteous Faithful General Sovereign Farmer DUTY Plan Rule Nourish Hun - Soul Shen - Spirit Yi -Thoughts SPIRITS Persona Consciousness Memory EMOTION Decisiveness Joy Harmonizing Control Balanced Deep Thought Anger Psychosis Obsessive BODY FLUID Tears Sweat Saliva TASTE ODOR Sour & Sharp Bitter & Burnt

Sweet & Fragrant

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Causes of Disease External causes of disease are mainly what we call colds and flus, and are designated as Wind, Cold, Heat, Dryness, and Dampness, depending on their associated signs and symptoms. These pathogens are commonly used to represent the different manifestations of upper respiratory infections (URIs). They are often referred to as Outside Pernicious Influences (OPIs) Wind is usually the earliest stage of a URI. Cold is recognized by the presence of chills and body ache. Heat is characterized by red face, and tongue, and sore throat. Dampness produces excess mucous, and Dryness produces a dry cough. These pathogens also often combine in various ways. In addition to upper respiratory infections, these external pathogens manifest in other disorders as well. A few examples follow: Cold can manifest as pain in the joints as in arthritis, bursitis, or other aches and pains which are worse in cold weather. Cold can also enter the lower part of the body (Lower Warmer) and cause cramping menstrual pain. Heat can enter the skin causing burning sores like boils, and carbuncles. Wind has similar effects to the wind we experience in nature, causing tremors and sudden unpredicted movements, or in extreme cases even paralysis. Dampness too is similar to what we find in nature. Like dampness in a basement, it’s hard to resolve. Pain and feelings of heaviness which linger and may be accompanied by swelling, tend to indicate Dampness. Dampness can collect as excessive mucous seen in the Lungs, or stools or as joint swelling. Overweight and other somatic accumulations are also signs of Dampness accumulating. The Internal Causes of Disease are the Emotions. When any emotion is experienced inappropriately, it will effect the functioning of the Organs it is associated with. Whether one experiences or expresses an emotion too strongly, or insufficiently (repressing it) it will have consequences. Anger affects the Liver, Grief affects the 41

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Lungs, Joy affects the Heart, Worry and Over Thinking affect the Spleen, and Fear affects the Kidneys. Miscellaneous causes of disease are the many and various influences we encounter in our lives. Examples include, getting hit by a bus, bitten by a snake and contacting environmental toxins. In most western countries today the most common of the Miscellaneous causes of disease are likely: Inappropriate Diet, Inappropriate Exercise, Overwork, and Insufficient Rest and Repose.

The Organs When we use the term “Organ” or the names of the Organs, in TCM, we do not infer the identical meaning as we understand them in current biological medicine in the West. We use these terms to address a complex system of interrelationships that, while they include the organs as we understand them, they also include emotions, thoughts, and other physical systems in the body, or body/mind/spirit. In this way the ancients in China could understand and work with all the aspects of an individual within the context of just a handful of systems. While modern biology cannot fully explain this approach, there are countless generations of experience to attest to its efficacy. Each Organ has a specific job to perform. I will discuss the main jobs of each Organ, and the typical symptoms associated with their primary dysfunctions. There are, of course, many other associations for each Organ, but I’ll only address those associations that have clear clinical application, and are regularly encountered in daily practice. I am focusing on the functions of the Yin Organs, since they are the ones that perform most of the jobs that I address in this book. For the most part the Yang organs

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support the Yin Organs in their operation. The only Yang Organ I’ll address here is the Stomach. I have focused this edition of this book on the treatment of painful conditions. However, I did want to include at least a little direction on internal medicine. Perhaps in the next edition, I will give more detailed “recipes” for internal disorders. For now, I hope you and your patients find this, admittedly limited, set of directions helpful.

The Lungs The Lungs are responsible for respiration, energy (QI) production, and protection from outside influences, similar to our concept of the immune system. When the Lungs are functioning well, the individual is vital and strong. When they are in disharmony, we see respiratory problems like COPD, shortness of breath, and a tendency towards upper respiratory infections. When the Lungs are in disharmony, the following are some common possible symptoms: All types of respiratory disorders All sinus disorders Many Skin Disorders Common Colds and Flus Fatigue Treating The Lungs Tonify the Lungs: Lu 9, Lu 1, UB 13 Colds and Flus: LI 4, LU 7, LI 20, Cough LU 5 Sore Throat or other Heat in the Lungs: LU 10

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The Large Intestine is the Yang/Fu organ associated with the Lungs. Occasionally the Large Intestine is involved in treatment of digestive disturbances, however the Spleen is generally treated in most of these situations. However as a Fu Organ, the Large Intestine Meridian is important in diagnosing and treating surface conditions such as musculoskeletal and neurological pain.

The Spleen The Spleen is responsible for managing all aspects of D i g e s t i o n a n d A s s i m i l a t i o n , Tr a n s f o r m a t i o n a n d Transportation. This is mainly seen as managing the transformation of food and fluids into energy, blood, body fluids and tissues. When the Spleen is not functioning well, food and fluids are not fully processed, one’s energy level drops, and digestive problems become apparent. These unprocessed products then accumulate in the individual as excess weight and phlegm and mucous. The Spleen is in charge of Transportation and Transformation (T&T). It is associated with: ! T&T of Qi, Blood & Jin Ye ! Holding Blood Fluids & Organs in Place ! Manifests In The Lips ! Dislikes Dampness & Cold ! Rules The Flesh & Muscles When the Spleen is in disharmony, the following are some common possible symptoms: ! Fatigue ! All problems with the Lower Digestive Processes! ! ! Bloating, Gas, Loose Stools, Tired After Eating ! Overweight Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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! Underweight ! Muscle weakness/atrophy ! Weakness of the flesh / flaccidity ! Prolapses ! Excessive or Insufficient Menstrual bleeding ! Excessive Bruising ! Blood in Stools ! Mucous in Stools ! Hemorrhoids ! Treating The Spleen Since the Spleen mainly suffers from deficiencies of Qi, Yang, and Blood, it tends to respond best to Diet and Herbal Treatment. However, acupuncture can often be very helpful and is certainly worth a good try, especially if you can add some moxa for tonification. Also Tonifying the Kidneys is often helpful when treating the Spleen. Keep in mind that tonifying the Spleen can take some months. When treating the Spleen, you will generally want to tonify all the points: ST 36, SP 6, Ren 6, Ren 8 (moxa only), UB 20 Adjust Diet: Cut out or reduce highly processed, cold and damp foods

The Stomach The Stomach is responsible for the early digestive processes. While the Spleen is responsible for all digestive processes, once the food has left the Stomach, problems with the Stomach itself are usually addressed directly. Heartburn, hiatial hernias, and stomach ulcers are all symptoms of Stomach disharmonies. Also as a Fu Organ, the Stomach Meridian is important in diagnosing and treating surface conditions such as musculoskeletal and neurological pain.

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When the Stomach is in disharmony, the following are some common possible symptoms: ! Stomach Pain / Distention ! Nausea ! Vomiting ! Belching ! Acid Regurgitation , Heartburn, Ulcers ! Bad Breath ! Increased/decreased appetite Treating The Stomach The Main points for treating the Stomach are the same for most conditions: ! ST 36, SP 6, Ren 12, UB 21 ! If there’s Heat: add ST 44 and perhaps ST 45

The Heart The Heart is the Organ that stores our “Shen.” The Shen is our spirit, or that aspect of awareness which is reflected in our eyes; our sense of “self” our perception of the world around us, and how we fit in. In a word, consciousness. Disharmonies of the Heart can manifest as any disturbance of the consciousness, from mild anxiety or depression to severe psychological disorders. All these disorders fall under the term of “Shen Disturbance.” When the Heart is in disharmony, the following are some common possible symptoms: All disorders effecting the Mind: Spirit, Consciousness, Memory, & Thinking Most Sleep disorders Most Heart disorders can be effectively treated by treating the Pericardium.

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The Small Intestine is the Yang/Fu organ associated with the Heart. It is seldom a cause of disease in and of itself. However as a Fu Organ, it’s Meridian is important in diagnosing and treating surface conditions such as musculoskeletal and neurological pain.

The Kidneys The Kidneys are responsible for the balance of Yin and Yang in the body. They regulate our constitutional energies, and manage reproductive, urogenital, and sexual functions. Urinary, prostate, premature aging, and lowered libido are a few of the disharmonies we associate with the Kidneys. The Kidneys are “housed” in the lower back, and so are responsible for the strength of our low back. This is useful in treating chronic low back and sciatic disorders. When the Kidneys are in disharmony, the following are some common possible symptoms: Low back pain & weakness Pain & weakness of the Legs, Knees, & Ankles Impotence and Infertility Incontinence Polyuria Loss of hearing / Tinnitus Lower body Edema Problems of growth and development Signs of premature aging Sciatica Low sex drive Fearfulness & Lack of Will Fatigue Treating The Kidneys

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Like the Spleen, Treating the Kidneys most always involves tonification. Like the Stomach most Kidney treatments involve the same points: ! KD 3, KD 16, UB 23, DU 4 ! If there’s Heat (from Yin Deficiency) add KD 2 and KD 7

The Urinary Bladder is the Yang/Fu organ associated with the Kidneys. As such it supports the Kidneys and can often be treated as an adjunct to treating the Kidneys. Only ins cases of Bladder infections do we usually address the Bladder itself. Otherwise we address Urinary Bladder problems via the Kidneys. However as a Fu Organ, the Bladder Meridian is important in diagnosing and treating surface conditions such as musculoskeletal and neurological pain.

The Pericardium The Pericardium is responsible for Setting the Order of the Heart. In other words, we treat the pericardium for all the organic functioning of the heart: Treat the pericardium for tachycardia, bradycardia, irregular heartbeat, chest pain, palpitations, etc. The Pericardium also treats the psychological aspects (Shen) of the Heart. Treating The Heart and Pericardium Most all aspects of the Spirit can be treated with the Tai Ji Treatment discussed earlier in the book (PC6, SJ 5, LR 3, GB 41) Fast, Slow or Irregular Heartbeat PC 5, Ht 7 HT 8 will reset the order of the heart PC 8 for dream disturbed sleep

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The San Jiao (aka Triple Warmer, Triple Heater, Triple Energizer, Triple Burner) plays an important role in explaining many concepts that are central to the theories of Chinese medicine. “San Jiao” translates as “Three Burning Spaces.” Also, as a Fu Organ, it’s Meridian is important in diagnosing and treating surface conditions such as musculoskeletal and neurological pain. The Three Jiaos or Burning Spaces are: • Upper Jiao (Upper Burner): LU & HT, Responsible for Respiration & Circulation • Middle Jiao (Middle Burner): SP & ST, Responsible for Digestion & Assimilation • Lower Jiao (Lower Burner): KD, UB & Reproductive Organs, Responsible for Elimination & Reproduction The Three Jiaos are collectively responsible for Water Metabolism, Classically Described As A System Of Sluices Or Waterways • Lungs Descends & Disseminate Fluids • Spleen Transforms Fluids and Transports them to Upper Warmer • Kidneys Power Fluid Metabolism

The Liver The Liver is responsible for the smooth and easy flow of energy and emotions in an individual. This includes assisting all processes, physical, mental and emotional in flowing smoothly and regularly. Muscle contraction, menstrual cycles, and managing the smooth flow of the emotions--especially anger, are just a few examples of this function. The Liver is like known as The “Free & Easy Wanderer,” the General, the City Planner, and the Traffic Cop.

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It doesn't perform all the tasks in the body, but it facilitates the free flow of Qi in order for all the other organs to accomplish their jobs. The Liver is associated with: Smooth and Easy Flow of Qi & Emotions Tendons & Muscles (Tension) Sea of Blood (Stores) Controls the Eyes Houses the Hun (Self) Planning Dislikes Wind, Heat, & Stagnation When the Liver is in disharmony, the following are some common possible symptoms: ! Stress Related Disorders, Anger / Irritability ! Excessive muscular tension, esp. Neck and Shoulders !Contractures, spasms / uncoordinated movements ! ! ! ! Tics, Twitches & Tremors ! Throat clearing/ feeling of plum pit in the throat ! Gynecological problems ! ! PMS w/ breast pain & distention ! ! Painful Menses w/ clots & sharp stabbing pain ! Meridian related Sx. ! ! Inguinal pain and Hernias ! ! Acute inflammatory problems, Herpes, Conjunctivitis ! Erratic mood swings / Moodiness / Irritability ! ! Quick to Anger /Volatile-violent outbursts ! ! Frustration ! ! Compulsive energy ! Eye problems: ! ! Tearing, blurry vision, night blindness, ! ! Floaters, photophobia & light sensitivity Treating The Liver The Liver is most prone to stagnation. Since it’s main job is to move Qi, any disharmony of the Liver will result in some degree of Liver Qi Stagnation. The Liver can also be affected by Xue Xu and Yin Xu.

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Acupuncture is quite good for moving Liver Qi Stagnation, but the patient will have to make some lifestyle changes to keep the condition from returning. Some type of stress reduction technique needs to be employed by the patient. Usually people need to understand that rest, relaxation, and repose are as important as, or more important than, achieving their external goals. I know it's a tall order, but how else can you get folks to let go of vain strivings that are affecting their health? Patients should consider doing some gentle form of yoga, or tai chi or Qi gong. The gentle stretching of the tendons is a wonderful way to relax the Liver, and it usually helps with the stress too. (GENTLE stretching, not strenuous, hot, & sweaty types of yoga). One other thing is removing coffee from the diet. Coffee (not caffeine) has a particular affinity for the Liver, and I believe it contributes greatly to Liver Qi stagnation. ! To sum up: ! ! Acupuncture once a week to move LR Qi. ! ! LR 3, GB 41, PC 6, SJ 5 ! ! Gentle Yoga ! ! Quit Coffee ! ! 1-3 months produces excellent results in most cases

The Gall Bladder is the Yang/Fu organ associated with the Liver. As such it supports the Liver and can often be treated as an adjunct to treating the Liver. It is seldom a cause of disease in and of itself. However as a Fu Organ, the Gall Bladder Meridian is important in diagnosing and treating surface conditions such as musculoskeletal and neurological pain.

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2. Acupuncture Techniques Demystified In China the term used for Acupuncture is “ZhenJiu” which means Acupuncture/Moxibustion. It’s as if those two words were not meant to be separated. I believe this is for the reason that there are strengths and weaknesses to all the modalities of Chinese medicine and they complement one another. Let me briefly name and describe the main interventions usually considered in Chinese medicine, and point out their strong points. Acupuncture is the physical stimulation of acupoints, on the surface of the body, with some external stimulator. The most common stimulator is an acupuncture needle. However point can be stimulated by many various means such as finger pressure, heat, electricity, laser light, magnets, as well as cupping, and guasha, which we will address below. It is my opinion that while there are arguments for each method of stimulating acupuncture points, needles work best in most cases. No one really likes getting needled, and so we can surmise that if needles weren’t superior for stimulating points, we’d probably use something a bit more comfortable. The strong point of acupuncture treatment is it’s ability to move stagnation. Since all painful conditions are a result of stagnation of one sort or another, acupuncture is particularly effective at treating painful conditions and an assortment of other conditions that are associated with stagnation or excess. Moxibustion is the application of heat to acupoints, specifically by heating or burning an herb called “moxa” Moxa is a bastardization of the words “mo kusha”, Japanese for “burning herb.” The actual herb is artemisia vulgaris. This herb has significant properties that make it particularly effective for this purpose. Like acupuncture, moxa is effective in moving stagnation. Moxa is also effective for building deficiencies, especially deficiencies of Qi and Yang. In addition moxa is quite warming, and so treats Cold conditions. Herbal Medicine is where Chinese medicine shines with most deficient internal conditions, and conditions where stagnations are Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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internal and chronic. While acupuncture and moxibustion can be helpful, many metabolic conditions can be treated more effectively when herbal medicine is added into the mix. Physical Manipulation has a long history in the Chinese medical tradition. Tuina, a type of massage which is surprisingly similar in many ways to chiropractic, has been practiced for centuries, with good effect on structural correction. Energetic Manipulation consists mainly of exercises such as Tai-Ji and Qi-Gong, which are used to both cultivate and manipulate Qi, for improved health. These exercises have proved to be particularly helpful in promoting balance, physically, mentally, and emotionally. Before moving on to the techniques let’s consider hygiene and safety.

Clean Needle Technique 1. ALWAYS: a) Wash Hands Between Patients (1) # 1 for Infection Control (2) Soap & Running Water 10 Seconds Minimum b) Establish a Clean Field c) Sanitize Hands Prior to Inserting Needles if Hands Have Been Slightly Contaminated (1) Alcohol Based Hand Disinfectants are Acceptable for Hand Washing d) Isolate Used Needles Immediately e) Use Universal Precautions: Prevention of Exposure and Prevention of Disease if Exposure Occurs. (1) Gloves, Gowns, Masks, Goggles etc. when needed f) Use Sterile and/or Clean Equipment and Work Areas as directed (1) Needles & other Instruments that Penetrate the Skin or Touch the Mucous Membrane, must be sterile (2) Always use Sterile Needles

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(a) Use Single-Use Disposable Needles (b) Avoid Contamination when removing needles from packaging (c) Never reuse or reinsert a needle (d) Never use a needle that’s been contaminated. i.e dropped, miss-inserted g) Disinfection / Antisepsis/ 70% Isopropyl Alcohol (1) Use on Clean Skin to reduce pathogens and inanimate objects on the skin 2. Clean Technique a) Using Sterilization, Disinfection, Antisepsis, Washing, etc. b) Clean Field (1) The area prepared to contain acupuncture equipment & supplies (2) Clean Tray or Paper Towel Work Surface (3) Sealed/Open Needles (4) Alcohol Swabs (5) Dry Cotton Balls (6) Gloves (7) Clean Instruments (8) Gua Sha Tool (9) Cups (10) Forceps (11) Ear Probe c) Off the clean field (1) Waste container (a) Plastic Lined Paper Bag (2) Biohazard Container (3) Other Non-Clean Items: (a) Pens (b) Discarded Insertion tubes and wrappers 3. Cups and Guasha Tools a) If no bleeding occurs: Cups May be Cleaned with Soap and Water b) If Bleeding occurs: Cups Must be Cleaned and Sterilized

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(1) Bleach Solution Sterilization for Non-Porous Items (a) 1:10 solution Bleach: Water (b) Soak for 1 hour 4. Biohazard Containers a) ONLY Needles go in in Biohazard Containers (1) NO tubes, packaging, cotton balls, prep pads, etc. (2) Cotton balls tinged with blood are disposed in double bagged waste (3) Cotton balls are placed in BioHazard container ONLY IF ACTUALLY SOAKED WITH BLOOD b) Check State regulations for Disposal, Storage and Transportation of biohazard containers.

Risks to Acupuncture Providers 1. Needle Stick a) Use Caution to Avoid b) CDC Recommends (1) Consult a Physician Immediately (2) Test Source for HBV, HCV, HIV within 2 hours if possible (3) Begin Treatment ASAP, if required 2. Blood Exposure a) Glove Carefully 3. Train Staff Carefully in a) Recognition of Contaminated Needles b) Office Procedures Regarding Needles c) Handling Contaminated Needles d) Needle Sticks Acupuncture Patient Side Effects 1. High Risk Patients 2. Use Universal Precautions 3. Needle Sickness / Fainting a) Vasovagal Response b) Remove Needles, Have Patient Lie Down c) Perhaps a few sips of water 4. Pain / Bruising / Swelling at Needle Site 55

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5. 6. 7. 8.

Stuck Needle Forgotten Needle Neuritis Moxa Burns a) Use Caution b) Assess Patient's Heat Tolerance (1) Neural injury, diabetes, paralysis, etc. c) Treat w/ Western Medical Techniques (1) Sterile dressing (2) Appropriate referral 9. Abscess 10. Allergic Dermatitis 11. Broken Needle a) Leave some shaft visible 12. Auricular Chondritis 13. 30 sec - 5 minutes direct pressure 14. Organ Puncture a) Veins/Arteries b) Pneumothorax c) Eyes d) Enlarged (1) Heart (2) Liver (3) Spleen (4) Kidney e) Spinal Cord (1) Exercise Caution With DU 15 & DU16 15. Seizures

Contraindications and Cautions 16. Always use Caution when treating Patients who are or may be a) Pregnant b) Elderly c) Diabetic d) Very Tired e) Very Hungry f) Under the influence of any Mind Altering/Pain Relieving Medications Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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g) Numb in an area to be treated 17. Points Contraindicated in Pregnancy a) LI 4 b) SP 6 c) GB 21 d) UB 60 e) Points on the Abdomen f) Points on the Lower Back 18. GB 21 Contraindicated for patients with Heart Conditions 19. Electro-Acupuncture Contraindicated for patients with a) Pacemakers and other electrical implants b) History of Seizure Disorders c) Strongly Recommended not to apply electro-acupuncture across the heart (i.e. Chest to Back/ Left to Right/ Arm to Arm) Before jumping into treatment techniques lets consider some information on setting up your office to accommodate acupuncture treatment.

Office Setup/Patient Flow 20. Patient Scheduling a) Order of Treatment Modality 21. Assistant(s) 22. Gowns / Gym Shorts 23. Treatment Tables a) Bolsters b) Table Extenders c) Boards & Blocks 24. Stool/Chair 25. Treatment Cart a) Clean Field b) Treatment Supplies 26. Biohazard container 27. TDP/Heat Lamp 28. (Space) Blankets 29. Timers 30. Call Buttons 57

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31. Forms a) Find Forms Online: www.AcuPracticeSeminars.com (Resources Page) b) Intake c) Informed Consent d) Moxibustion Instruction/Consent e) Cupping / Guasha Information Letter 32. Patient Education Handouts Let’s look now at Acupuncture, Moxa, and other Basic Treatment Techniques. Effective acupuncture treatment consists of point selection, location and needle technique. This chapter offers an explanation of how to apply some of the different acupuncture techniques to effectively treat many common disorders.

Acupuncture Distal Techniques You can often affect local pain with just distal techniques, but local treatment is usually necessary as well. In the section on treating specific conditions I will cover many useful distal treatment points and techniques.

Getting The Qi When you’re is performing acupuncture it is important to “Get the Qi.” But what does that mean? According to the prevalent teachings in China today, it means that the patient must feel a deep, aching, distending, electrical or traveling sensation. This doesn’t mean pain. The Qi sensation should be clear and strong to the patient, but not painful. When the patient reports the feelings associated with “getting the qi,” the practitioner can stop stimulation of the point and rest assured that she has contacted the Qi. A painful acupuncture treatment is seldom necessary. Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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There are, however plenty of other traditions of acupuncture where the practitioner does not depend on the patient’s report of feeling the Qi to ascertain that the Qi has been contacted. In fact, it could be easily argued that it is more important that the practitioner feel the Qi than the patient, since the practitioner is presumably more familiar with the feeling of Qi than the patient, and the practitioner knows better what to look for. But, how does the practitioner know what to feel, to be sure that she has contacted the Qi? After 30 year of practice, I am pretty sure that I can feel the contact with the Qi, most of the time. Unfortunately, I can’t describe it in sufficient detail, in this book, to make it clear. I can however, sometimes demonstrate it to students, when we can be together. It is a skill that can be learned but cannot be easily taught. I’m sure you will find that this skill develops, as you gain more experience. Therefore, I suggest that, until and unless you know for sure, that you have developed this skill, you should ask the patient for feedback as to when you’ve contacted the Qi.

Acupuncture 33. There are three basic types of needles: a) Standard Acupuncture Needles (1) Designed to be inserted for between a few seconds up to perhaps an hour. Usually for 20 minutes. (2) Needle Selection Considerations (a) Ease of application and Insertion (b) Degree of Painlessness (c) Degree of Stimulation i) Rotate / thrust etc. (d) Personal Preference (e) Electrical Conductivity (f) Ability to feel and transmit Qi (3) Variables 59

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(a) Thickness (b) Length (c) Handle i) Metal / Plastic (4) AcuPractice Recommendation (a) Seirin Brand Needles i) Lhasa OMS 1-800-722-8775 www.lhasamedical.com (b) 30mm # 3 = 36 gauge Chinese / 0.20mm i) General Utility Needle (10 to 1) ii) Blue Handle (c) 40mm # 5 = 32 gauge Chinese / 0.25mm i) Stronger Stimulation ii) Deeper Points (d) 60mm # 8 = 28 gauge Chinese / 0.30mm i) Strongest Stimulation ii) Deepest points iii) Chinese Scalp Acupuncture b) Bleeding Needles are used to extract a few drops of blood from specific acupoints. Traditionally there were a few different types of “triangular needles.” Today we use lancets, usually with an auto-lancet device. c) Retained Needles are small needles that are inserted and left in place for times ranging between a few hours and a few days (1) APS semi-permanent needles (a) Stainless Steel, Gold, and Titanium (2) Interdermal needles: 6mm #1

B. There are three basic Needling Techniques which are used to achieve the effects of Tonification, Sedation, and Harmonization. While there :are many techniques employed by practitioners to achieve these results, we will look at the basic approach to each of them, which entails the amount and degree of stimulation applied.

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1. Harmonizing or Even Technique is used when balance is desired, such as in the case of needling PC 6 to calm the Shen. a) Moderate Stimulus b) Moderate Thrusting c) Moderate Rotation 2. Tonification, used when deficiencies are treated, such as needling ST 36 for digestive weakness. a) Mild Stimulus b) Mild Thrusting c) Minimal Rotation 3. Sedation is mainly used for treating stagnation. As such it’s usually employed for painful and excess conditions, such as releasing trigger points. a) Strong Stimulus b) Strong Thrusting c) Great rotation C. Needling Depths & Angles 1. Angle of Insertion a) Usually Perpendicular to the Skin b) Exceptions will be noted 2. Needling Depths a) Avoid Organs and Blood Vessels b) Consider the Underlying Structure c) Usually into the middle of the muscle under the point d) Usually between ¼ and ¾ inch deep

D. Electro-Acupuncture (EA) 1. Introduction a) First used in the 1950s 2. How does it Work? a) Electrical signals travel to the Brain or Spinal Cord and encourage the production of Hormones and Neurotransmitters. 3. Often Used For a) Acute & Chronic Pain (55%-85% success rate) b) Traumatic Injury c) Paralysis

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d) Surgical Anesthesia 4. Two Types of Electro -Acupuncture a) Microamps aka Microcurrent (1) Much Less stimulation (2) Function on a cellular level (3) Microcurrent is not covered in this book. b) Milliamps (1) Standard Electro Acupuncture (2) The following material covers Millamp Electro-Acupuncture c) Machines (1) Quality Considerations (2) Expense (3) Precise Frequency and Intensity Adjustments (4) Number of Channels d) AcupuncturePoint Detection / Elect. Stim. e) Quality of Biphasic Wave f) Recommended Machines (1) Pointer Excel II (a) Non-Invasive Millamp Stimulation (b) Acupuncture Point Detection (c) Relatively Inexpensive (d) Works well (2) E-Stim II (a) Milliamp & Microamp (b) 2 Channels (c) Inexpensive (d) Works Well (3) ITO IC 1107 (a) Milliamp Only (b) 3 Channels (c) Moderately Priced (d) Works Very Well (4) Pantheon (a) Milliamp and Microamp (b) 4 Channels (c) Higher Price (d) Works Very Well Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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g) User Interface (1) On/Off Switch (2) Intensity Controls (a) Click Off Before Turning Unit On (b) Reliability May be Dependent on Battery (c) Some Machines are Very Sensitive (d) Always turn up SLOWLY (e) Turn Intensity to Zero Before Switching any other controls (3) Usually 3- 4 Channels (Output Jacks) (4) (+) (-) Switches (5) Intensity Multiplier (6) Frequency Multiplier (7) Frequency Modulation Controls (8) Visual freq. Indicator Light (a) Continuous (b) Constant Hz (c) each pulse follows the preceding one i) ////////////////////// (d) Discontinuous i) Irregularly Irregular ii) Constant Hz / Random Time Slots iii) //////-------//////////--------//////----------------/// (e) Dense - Disperse i) Varying Set c/s / Random Time Slots ii) / / / / ////////// / / / / / / //////////// / / / ////// (9) Acupuncture Point Detection (a) Pros & Cons 5. EA Principles a) Neural messages are sent to Brain or Spinal Cord and Neurochemicals or Hormones are released b) Spinal Cord Stimulation (1) Local AA effect, only (2) Stimulates Spinal Chord Reflex Arc Only (3) Enkephalin & dynorphin (4) NO Circulating Beta Endorphin production c) Midbrain / Hypothalamus / Pituitary Stimulation (1) Systemic effect 63

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(2) Similar to Da Qi Needle Stimulation (3) Including Acupuncture Anesthesia (AA) at a distance (4) enkephalin, serotonin, & norepinephrine (5) Increased Hormonal Stimulation (6) Circulating Beta-Endorphin released into Blood & CSF d) Pulse (1) Pulse Width (a) 0.1-1.0 ms - microseconds (2) Pulse Strength (a) 2.5-5.0 mA - milliamps (3) Biphasic Pulse (a) Imperfectly Matched Biphasic Pulses lead to the area where the Black (-) clip is placed, experiencing more stimulation(pain) e) Intensity (1) Low Intensity (a) At threshold of M. contraction (b) Observable M.(or needle) movement (c) May be useful for tonification (2) High Intensity (a) 5-10 times the threshold for M. contraction (b) Intense M. Contractions (3) Gradually increase every 5 min. for 30 min. until intense M. contractions are observed if necessary f) Frequency (1) Low Frequency (a) Individual M. Contractions (b) 1-4 Hz (c) Midbrain / Hypothalamus / Pituitary Stimulation (2) High Frequency (a) Tetanic M. Contraction (b) 50 Hz or Greater (c) Spinal Cord Stimulation Only 6. EA Treatments a) Needles Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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b) choose a heavy gauge (# 5-8) (1) Finer needle = greater resistance c) Pair in areas of EQUAL sensitivity (1) face to face (2) Skin Nerves (3) hand to arm (4) Deep M. Nerves d) High Frequency / Low Intensity (1) No Cumulative Effect (2) Spinal Cord Only (3) Intensive Local Anesthesia (4) Short onset e) Low Frequency / High Intensity (1) Longer lasting Cumulative Effect (2) Midbrain & Hypothalamus-Pituitary (3) Systemic Effect 7. EA Contraindications a) Note: Amer. Assoc. for Medical Instrumentation recommends levels below 250 mA @ 1.0 ms across the heart (arm to arm). This is 50 - 100 times higher than EA. devices generally deliver (2.5 -5.0 mA @ 1.0 ms) b) No EA. W/ Pacemakers (Nat. Exam) c) FDA bans EA on Head d) No EA stim over Neck e) STRONG EA stim in spastic Muscles f) No EA Crossing the Heart g) In Pregnancy (1) No EA Around Fetus (2) No EA on Strong Moving Points (3) No EA Below Bl23 h) Do not shine laser through pupils when treating around eyes i) No laser to fontanels of infants (1) 8. Patients may experience the same side-effects as with needles, such as needle sickness, dizziness, fainting,

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nausea, tiredness, headache, change in the site or degree of pain

E. Laser Acupuncture 1. Low Level Laser Therapy / LLLT 2. Recommended Laser for Acupuncture Treatment a) Class III Lasers b) Wavelength (1) Prime determinant of tissue penetration. c) Areas of thick skin or muscle may require higher doses for penetration than finer skin areas e.g. ear. d) Lasers which penetrate less deeply / suitable for acupuncture point stimulation and biostimulation. e) 630 - 680nm (nanometers) visible, coherent, bright red f) 1.5mW - 5 mW (1) up to 10 mW are available g) A minimum of 1mw and 10-12seconds are required to produce any sort of reaction h) HeNe (Helium Neon) gas or Diode i) Should shine @ 65 feet in a well lit room, 300 feet in a dark room 3. Use the same rules of point selection as needle acupuncture a) Energetics (1) Moving (2) Perhaps Warming b) Trigger points/snap signs release c) To promote healing d) Wounds: ulcers, burns, pressure sores e) Skin infections such as herpes zoster f) Enhancing effect on healing wherever inflammation is present

F. Moxa 1. Actions a) Warms (1) Body (2) Meridians Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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2.

3. 4.

5.

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(3) Limbs (4) Uterus b) Expels Cold & Damp c) Revives Dying Yang d) Invigorates/Moves Qi & Blood e) Regulates Qi & Blood f) Opens The 12 Primary Channels g) Repairs Traumatized Tissue Indications a) Pain b) Cold c) Deficient Yang d) Stagnation (1) Qi (2) Blood (3) Phlegm Procedure a) Treat Upper Body before Lower Body b) Head & Body before Extremities Cautions & Contraindications a) Not on Upper Body W/ Heat b) Pregnancy (1) Not Direct (2) Not Near Fetus (3) Not on Moving Points c) No Direct (1) Cv14, 15 (2) Ht (3) Face - Hands (4) Scar (5) Bl1 (6) St1 (7) St9 Methods of Use a) Always Explain Procedure To Pt. b) Make sure the Patient Is In Control of the amount of heat she can tolerate. c) ‚”Hot” is the Operative Term

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6. Indirect Moxa a) Tonifys Spleen & Kidney Qi & Yang b) Warm Uterus c) Strengthen Digestion d) Most Painful Conditions especially those associated with Cold. e) Seirin MoxSafe Smokeless Moxa System (1) AcuPractice Seminars Recommended system for using indirect moxa f) Pole / Roll (1) Straight vs. With Other Herbs (2) Bird Pecking / Warming Technique (3) Touch Pt. With Finger (4) Do Not Move the pole around (5) Hold 0.5 To 4 Inches Away (6) To Disperse hold pole close: 0.5 “- 1.0” away form the skin (7) To Tonify hold pole at least 2.2 inches away (a) The Object of the technique is to increase blood circulation to the area, NOT to scorch the skin. (b) This Takes Time (c) 8-10 minutes minimum per point g) Tiger Warmer (1) Milder odor than regular moxa Pole (2) Two Sizes Small and Large (Lion Warmer) h) Belly Bowl (1) Well suited for Digestive and GYN disorders i) Loose Moxa (1) Moxa Instrument (2) Moxa on Ginger (3) Moxa on Salt (a) Special For CV8 7. Direct Moxa a) AcuPractice Recommendation: Purchase Pre-rolled Direct Moxa (small size) 8. Treat Moxa Burn a) Blister Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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b) Use Standard Western Medical Treatment for Burns c) Cover W/ Sterile Dressing d) If the burn is severe or becomes infected, seek specialized Western medical attention. e) Antibiotic ointment, if any

G. TDP Lamp 1. Interesting Read on Wikipedia 2. Western Theory a) USFDA Class II:Class of devices approved by the FDA for temporary relief from pain and arthritis b) Far Infrared (below visible light) Heating Device c) Increase Microcirculation d) Loosens Fascia e) Accelerate Natural Healing Processes 3. Oriental Theory a) Therapeutic substitute for moxibustion b) Reported to be the only mechanical device that can add Qi to the body 4. Application a) Bare skin exposure with the lamp positioned 12-18¬†inches from the body b) 15 - 30 minutes c) Replaceable Mineral Plate (1) Proprietary formula of 33 trace elements (2) Estimated life of 1000 - 1500 hours. (3) When the mineral plate looks ash grey, it is time to replace it. 5. Dr. Jim’s Experience a) Everyone should have and use TDP Lamps, but they are not exactly moxa b) Replaces Moxibustion for: (1) Warming (2) Moving QI & Blood (3) Repairing Traumatized Tissue (4) Can Tonify Somewhat, when used together with Spray Moxa

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H. Gua Sha & Cupping 1. Definitions: a) Gua Sha: Scraping of the skin with a Blunt Instrument to release congestion in the exterior b) Cupping: Stationary or Moving Suction Cups applied to the skin to help bring stagnation to the surface, and release it. 2. Gua Sha a) Scraping of the skin with a blunt instrument b) Similar to Graston Technique c) Often Causes Some Bruising d) Actions (1) Stubborn Pain or Congestion with Sha‚Äù (2) Especially for upper and mid-back pain e) ”Sha” or Evidence of significant bruising from Guasha (1) evidence of stagnation plus (2) blanching upon palpation f) Traditional Indications (1) Reduce fever (2) Cough and dyspnea (3) Muscle and tendon injuries (4) Benefits circulation (5) Headache (6) Sunstrokes (7) Stiffness (8) Pain (9) Immobility (10) Digestive disorders (11) Urinary disorders (12) Gynecological disorders (13) To assist with reactions to food poisoning g) Procedure (1) Lubricate (2) Instrument (3) Gua Sha Instrument (4) Porcelain Spoon (5) Smooth Coin

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(6) Apply Gua Sha till Sha Appears (7) Follow with Indirect Moxa (8) to inhibit cold entering h) Recommendations for Post- Gua Sha Patient Behavior (1) Immediately Post Tx.: Indirect Moxa/ TDP Lamp over entire area treated (2) Keep area Warm and Covered for 12 -24 hr. (3) 48 - 72 hr. Avoid Excessive consumption of (a) Flour Products/Baked Goods (b) Greasy/Fried Foods (c) Excessive Dairy (esp. cold) (d) A little alcohol may be helpful in some cases 3. Cupping a) Stationary or Moving Suction Cups Applied to the Surface of the Skin b) AcuPractice Seminars Recommendation: Silicone Cups c) Often Causes Some Bruising d) Indications (1) Lungs (2) Upper & Mid-back Pain, Tension & Tightness (3) Low Back - Sciatica e) Procedure (1) Lubricate Skin (2) Apply Cups f) Stationary Cups g) Leave in place for @ 20 minutes h) Moving Cups (1) Pressure on Trailing Edge (2) Follow Natural Qi Flow (3) Think of it as a Cup Massage‚ or Cupping Gua Sha i) Recommendations for Post- Cupping Patient Behavior (1) Same as for Gua Sha II. 71

Needle Technique Demo / Practice Session Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

A. Ideally all participants in hands-on classes should practice needling at least each of the following points. B. Hands & Feet 1. LI 4, LR 3 2. SJ 5, GB 41 3. PC 6, SP 4 4. LU 7, KD 6 5. SI 3, UB 62 C. Back: 1. Du 4 2. UB 23 3. Hua Tou Jia Ji Points D. Leg & Arm 1. St 36 2. Sp 6 3. KD 3 4. LI 14 5. LI 15 E. Hip & Waist 1. GB 26 2. GB 30 F. Head 1. Du 20 2. Tai Yang 3. Yin Tang 4. St 6 5. GB 14 G. Abdomen / Lower Warmer 1. St 30 2. Ren 2 3. KD 16 4. Ren 12

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3. 4. Points & Meridians: The Raw Ingredients Many of the most popular acupuncture points have multiple uses. Many of these points can be added to almost any treatment, for varied conditions. You will see these ubiquitous points show up in many different point prescriptions. Again, like in a cookbook, if you are in the baking section, you will see flour, sugar, salt, butter, etc. show up time and time again, but in different proportions and used in different ways to get various results. Similarly, you will see many of the same points again and again when treating similar problems like pain, or disorders of the head & neck, or digestive disorders. There are many good and exhaustive resources on the acupuncture points, and it is not my aim to repeat that information here. (i.e. the Manual of Acupuncture App.) To keep emphasis on the most clinically useful material, I focus on the pathways of the Yang acupuncture meridians, and describe the locations and use for the points I find most useful, and which I commonly use. I also discuss these points and point combinations in the treatment many disorders. Therefore, the lists of points by meridian are not complete nor is this an oversight or misprint. I have included only the points from each category that I have found to be particularly useful. I expect you will supplement this material with information from other sources, and from your own experience.

Meridian Overview 12 Primary Meridians: (AKA 14 Main Meridians) There are 12 Main Meridians which compose the Central Supporting Structure of the Meridian System. Most all the other meridians are in someway associated with these channels, and usually follow these pathways. Each of these meridians is associated with an Organ, and each Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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meridian is found bilaterally. For instance: The Large Intestine Meridian is found on both arms, beginning at the tip of the index finger and ending in the nasolabial groove. There is also a circadian flow of Qi through these meridians that follows the 6 Divisions, and the Horary Cycle. Each of the 12 Main Meridians has it’s own Acupuncture Points located along its pathway. In addition, 2 of the 8 Extraordinary Meridians also have their own acupuncture points. There are therefore, 14 Meridians with discreet acupuncture points. All the other meridians share points from these 14. It might be good to again be reminded here that Yin meridians and their points are used mainly in relation to the Organs, and so treat more internal disorders. The Yang meridians, on the other hand, are used for more surface disorders, and will be employed principally in the treatment of pain syndromes, or other symptoms that appear along the path of the meridian itself. 12 Sinew Meridians (AKA Tendino-Muscular Meridians) circulate on the periphery of the body, and do not penetrate to the Zang/Fu or Organs. Therefore they are primarily used to treat acute and chronic musculoskeletal and neurological syndromes that include pain, tension, tightness, and various forms of paralysis and paresthesias. These meridians are associated with, and take their names from the twelve primary channels. They originate at the extremities (Jing-Well Points) and broadly follow the course of their associated primary channels. However, they are wider, and tend to follow the lines of major muscles and muscle groups, tendons & ligaments, expanding the influence of the primary meridians when treating muscles, tendons, and joints.

12 Divergent Meridians connect with and follow the course of their associated primary channels paired channels. Divergent meridians run deeper than Primary Meridians, and govern the inside of the 75

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body. they are distributed on the Chest, Abdomen and Head, and extend the areas of influence of main meridians to these areas.Fo instance: The Divergent Channel of the Liver Meridian, extends the liver Meridian’s influence to the Head, despite the fact that the primary meridian only reaches from the foot to the chest. 12 Skin Regions / Channels Follow the pathways of and are related to the Main Meridians, and they help to explain Dx & Tx via the skin. 15 Luo Connecting Channels are made up of one small branching channel for each of the 12 primary channels, one each for the Ren & Du, and one for the Great Luo of the Spleen, They spread Qi from the Luo-connecting point of their own channel to connect with their paired channel. For instance Large Intestine 6 (luo pt) connects to Lung 7 (luo pt.) After joining with their paired channel they usually continue to follow their own pathways.

The 8 Extraordinary Meridians I believe that these are the most powerful points on the human body. These points are the ones that affect some of the deepest and most primal energies of the body. If one looks at the actions and effects of these points and then couples them with the energetics of the Extraordinary Meridians they are truly “Extraordinary Points.” I choose from them first in almost all of my treatments, whether I am treating pain or internal disorders. Also, I often simply choose from these “Extraordinary Points” for their actions, energetic and/or effects. I will address the uses of the Extraordinary Meridians more extensively in a later chapters.

Master Point Coupled Point

Extraordinary Meridian

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SI3

BL62

Du Mai

Lu7

Ki6

Ren Mai

GB41

TW5

Dai Mai

Sp4

P6

Chong Mai

BL62

SI3

Yang Chiao Mai

Ki6

Lu7

Yin Chiao Mai

TW5

GB41

Yang Wei Mai

P6

Sp4

Yin Wei Mai

Master Point

Action / Energetic / Effect

SI3

Any Back Pain, Posterior Shoulder Pain

Lu7 GB41

Circulates Fluids and Qi in the Head and Neck Soothe the Liver and Gall Bladder

Sp4

Discomfort in the Waist, Hips, Intestines & Pelvic Region Digestive Disorders

BL62

Lower Abdominal Discomfort Most Back Pain

Ki6

Strengthens the Kidneys

SJ5

Calms the Spirit (Shen)

P6

Expels Pathogens Abdominal Discomfort Calms the Spirit

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Dr. Jim’s Tai Ji Treatment This isn’t really a point category, but these four points are so powerful when used together, that I consider them a category in and of themselves. A “Tai Ji” or “Great Ultimate” Treatment is one that accomplishes many objectives, in many different patients, and is used often to balance a patient, before or in lieu of, focusing on individual complaints. This particular Tai Ji Treatment is my favorite method for Harmonizing the Liver and Heart, which can be a very powerful method for calming the Shen/Mind/Spirit and freeing up many physical energies in the body. It uses three Extraordinary Meridian Master Points together with Liver 3. I use it regularly on patients to harmonize the Qi prior to beginning a more individualized treatment. I discovered this treatment quite by accident. I originally learned it (I thought) from my teacher, Kiko Matsumoto, and found myself using it more and more frequently on many different patients. The results were so profound that some 5 or 6 years later I ran into Kiko and mentioned how useful this treatment was. I was surprised when Kiko informed me that I had gotten it wrong. I had “heard” LR 3, when she said “SP 4.” After getting over my embarrassment, I realized how glad I was that I had mis-heard. I know that over the years, a lot of my patients, and patients of my students have benefited from my “mistake.” Needle-on-the-LEFT

Needle-on-the-RIGHT

P6

LR3

GB41

SJ5

To enhance the calming effect of this treatment, I often add Yin Tang, and the Auricular points: Liver, Heart and Shen Men.

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Points Overview Acupuncture Points are often located in hollows or natural depressions on the surface of the body. With some practice one can easily palpate for most of the common acupuncture points. Needling Depths: For most points needles are inserted between 0.25-1.0 inch (cun), in many cases needling into the middle of the muscle that is located below the point. Exceptions will be noted. Of course, one must always keep the anatomy in the area of the point in mind, to avoid needling into blood vessels, organs, and other sensitive structures. Needle Directions: Needles are usually inserted perpendicular to the skin, Exceptions will be noted Points are usually described as having both “indications” (individual symptoms treated: i.e. headaches) and “actions” (energetic uses: i.e. clears heat)

Body Measurements and General Point Location ! The “Cun” is known as the personal inch. Based on the width of the patient’s thumb, it is the standard measurement for locating points. For instance: PC 6 is located two cun proximal to the wrist crease between the the tendons of palmaris longus and flexor carpi radialis. Two cun equals 2 times the width of the patient’s thumb. General Comments On AcuPoints Every practitioner of acupuncture has his or her own favorite points, and knows that there are some points that he/she has found that work best. Of course my point choice is based on my experience. When I look at the categories of points, I find that the actions that are associated with them are more applicable to some points,

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within the category, than other points. So the following lists of points have been edited by my personal experience. This is by no means meant to discount the experience of other practitioners and teachers. There are many acupuncture practitioners who I know, love, and respect, who use different points and techniques from those I generally choose and teach. I can only teach what I know, works. You’ll have to get information on other effective points and techniques from other teachers. Eventually you’ll discover what points and techniques work best for you and your patients. Let me say just a few words about Points Below the Knees and Elbows. I like them. The most powerful points on the body are usually found from the knees and the elbows down. I don’t mean to indicate that the other body points are not powerful, they are, but I always seem to get better results with the arm and leg points. Now, please remember that I often use other points, like Front Mu and Back Shu points as well as Scalp and Ear points, but I often use them secondarily to the Points Below the Knees and Elbows. Before we examine the meridians and their main points, let’s look at some of the categories of points and how they may be used.

Classic Point Categories Table This table contains most of the classic point categories, and is what one might use to study for a national exam in acupuncture. Each of these categories have specific uses. YIN

Xi Luo Back Front Ying Shu Jing He Sea Yuan Shu Mu Spring Stream River Water Source Cleft UB Wood Fire Earth Metal

Jing

Meridian Well

LU SP

11 1

10 2

9 3

8 5

5 9

9 3

6 8

7 4

13 LU 1 20 LR 13

HT

9

8

7

4

3

7

6

5

15 Ren 14

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KD

1

2

3

7

10

3

5

4

23 GB 25

PC

9

8

7

5

3

7

4

6

14 Ren 17

LR

1

2

3

4

8

3

6

5

18 LR 14

YANG Jing Meridian Well

Xi Luo Back Front Ying Shu Jing He Sea Yuan Shu Mu Spring Stream River Earth Source Cleft UB Metal Water Wood Fire

LI

1

2

3

5

11

4

7

6

25 ST 25

ST

45

44

43

41

36

42

34

40

21 Ren 12

SI

1

2

3

5

8

4

6

7

27 Ren 4

UB (BL)

67

66

65

60

40

64

63

58

28 Ren 3

SJ (TW)

1

2

3

6

10

4

7

5

22 Ren 5

GB

44

43

41

38

34

40

36

37

19 GB 24

One might reasonably assume that all the points in each of the above listed categories are effective as categorized. However, in my experience, that’s not always the case. The rest of this chapter contains commentaries on what I’ve found to be the more effective acupuncture points, drawn from the above categories together with other clinically important categories, including the Extraordinary Meridian Points, the Controlling Points and a few others.

Controlling Points Again, while this not a classic category, these are points and combinations that are useful additions to any point prescription associated with the area in question. You may not find all of these listed in other books, but they all work well. 81

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LI 4 & LR 3: Pain Anywhere in the Body LI 4 & LU 7: Most any condition of the Head, Neck, Face, & Mouth ST 36: Controls Digestion & Tonifys Qi P 6: Controls the Chest to Navel Area & Calms Restlessness UB 40: Low Back Pain SJ 5: Controls the Hand SJ 3: Controls the Ear LR 3: Commands & Moves Liver QI & Blood, Relaxes Tendons GB 26: Commands the Hips & Lower Warmer

Hua Tuo Jia Ji Points A series of points 0.5 - .75 cun lateral each interspinous space), these points can influence any problem associated with the nerves exiting at the level of the spine where the point is located. Think about dermatomes as well as internal influences. These points are extremely effective at releasing the paraspinal muscles.

Yuan Source Points The Source points of the Yin Meridians can always be added to a point prescription to affect the Organ being treated. I’m not sure the Yang Meridian Source points work all that well, but the Yin ones surely do. I believe that these points are probably the best points for affecting the basic Yin and Yang energies of the Organ, especially of the Yin Organs. When it comes to tonifying Qi, Xue, Yin or Yang, I’ve found the Yuan Source Points to be more powerful than the Back Shu Points or Du Points, with the possible exceptions of UB 23 & Du4 Ht 7: A very good point for tonifying Heart Yin, however I often use PC 6 in it’s place. I like Ht 7 for difficulty sleeping from Ht Yin Xu (Deficiency) and Heart Xue Xu. PC 7: While this is a good point, I generally use PC 6 in it’s place, and PC 8 for dream disturbed sleep.

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Lu 9: tonifies the Qi of the Lungs. The Lungs are the “Master of Qi.” Without their proper functioning the Qi cannot be utilized. Sp 3, Liv 3, and Kid 3: I use these points to tonify their respective Organs. In fact, I often use them together as an alternative to SP 6

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Five Element Points When considering points from the Five Element classification I find that the Fire points and the Water points are just about the only ones I regularly choose from for their Element correlation. There are of course a number of effective ways to use the Five Element points to construct effective treatments based on the Sheng (Creative) and Ko (Controlling) Cycles, but as I said earlier, that topic is beyond the scope of this book. I use both the Fire and Water points to cool heat in their respective meridians or organs. When needling the Fire points I almost always obtain a strong stimulus to disperse heat. Fire Points LR 2: is quite effective for reducing heat in both the Liver and the Gall Bladder. I use LR 2 as one of the principal points when treating oral and/or genital herpes, as well as shingles (herpes zoster) or any other LR/GB meridian heat. Red burning eyes, and Headaches with associated heat, also respond well to treatment with LR 2. I locate this point just proximal to the margin of the web between the big toe and the second toe. Needle it at a 45o angle in the direction of LR 3. KD 2: is effective in treating burning urination and other manifestations heat in the lower warmer. It is also very effective in treating heat along the Kidney and Urinary Bladder meridians. Because of the close communication between the Kidneys and the Lungs in water metabolism, KD 2 can also be effective in treating hot skin conditions. I often combine it with LR 2. LU 10: This seems to me to be a quintessential Fire point. For all hot Lung and skin conditions, this is the point of choice. I often couple it with LU 11. I locate this point in an unconventional way, and find that it is a very effective location. This point is located in the center of the belly of the thenar eminence. The point is needled toward the

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metacarpal bone of the thumb. You will find that needling this point in this way will result in a strong stimulus, and good heat reduction. Water Points LU 5: is good for treating heat in the lungs, especially when the heat is accompanied by cough. KD 10: I use this point for treating heat from KD Yin Xu.

Tonification and Sedation Points These are a subcategory of the Five element Points. While I don't use them much in practice, some practitioners find them helpful. They are commonly used for treatments based on electronic meridian testing , and so I will address the basic idea. Based on the five Element Production cycle (Wood> Fire> Earth> Metal> Water) The Tonification Point of an Organ is its Mother Point, or point that immediately precedes it’s Horary Point. For Instance: The Heart is within the Fire Element, Wood comes immediately before Fire, so the Wood Point (HT 9) is the Tonification Point. The Sedation Point of an Organ is its Child Point, or point that immediately follows it’s Horary Point. For Instance: The Heart is within the Fire Element, Earth comes immediately after Fire, so the Earth Point (HT 7) is the Sedation Point.

Horary Points The Horary Points are also a subcategory of the Five Elements points. They are the points that are associated with the Associated Element of each Organ. For instance: The Heart is associated with the Fire Element. Therefore the Fire Point on the Heart Meridian (HT 8) is the Horary Point for the Heart.

Xi Cleft Points Xi Cleft Points are traditionally used to treat pain along the pathway of their respective meridians. For instance: Large Intestine 7 is the Xi Cleft Point for the Large Intestine and therefore should treat pain 85

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along the pathway of the Large Intestine Meridian. I haven’t found them particularly useful in clinic, however many practitioner seemingly have.

Five Shu (Transport) Points I love the imagery created by the Five Shu Points: The Qi lies deep but is assessable, like water in a well, at the Jing-Well. (@ finger and toe tips) At the Ying-Spring the Qi bubbles to the surface. The Qi gathers and begins to flow at the Shu-Stream. Force gathers and the Qi flows with vitality through the Jing-River. The Qi is flowing and moving as well as integrating as it forms the He Sea. (@ knees and elbows) The Jing Well Points are at the tips of the fingers and toes, where the QI of each meridian is highly individuated. As we move though the Ying Spring, Shu Stream, and Jing River points, we proceed proximally up the limb arriving at the knees and elbows and the He Sea points, where the Qi is more internal and less individuated. That said, I find that the Jing-Well points are the main ones I choose for their Shu-point effects. But I use them all the time. When treating pain, I find that expressing a few drops of blood from the Jing-Well point of the effected meridian can be one of the most effective parts of the initial treatment.

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Luo Points The distribution of the effects of the Luo Points covers a multitude of areas over the body. With the exception of SP 21, I really only use P 6 and LR 5 for these purposes, as explained above. Sp 21 is the Great Luo, and will help to restore a healthy sense of comfort, symmetry and balance in the body. For instance it might help to restore proper proprioception, in an individual with post-stroke syndrome.

Meeting or Influential Points The Qi Meets at CV 17: I use this point to move the Qi of the Chest and Upper Warmer. Always needle this point from superior to inferior at an oblique angle. Strong stimulation of this point is forbidden. I always needle it with a gentle stimulation, but I like to get the Qi to move slightly down toward the belly. The Hollow Organs Meet at CV 12: This is a very good point to harmonize digestion and assimilation. The Pulse Meets at Lu 9: Again, the Lungs are the Master of Qi. If the pulse is weak, consider the Lungs, and LU 9 is especially good for generating Qi, which in turn generates the pulse. The Nerves and/or Tendons Meet at GB 34: It is a good point for treating tightness and tension in the muscles and tendons. It is especially useful for tension and tightness along the course of the Gall Bladder meridian and in the mid-to-upper back and neck. I locate and needle this point deeper, and in a slightly different direction, than most sources suggest. Begin at the junction of the heads of the tibia and the fibula. Palpate below the junction into the deep depression that is about 1.5 Cun distal to the junction. This is the insertion point. Using a needle that is long enough, insert at about a 30o – 45o angle so that the needle contacts the point, which lies under the junction of the heads of the femur and the tibia. 87

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The Bones Meet at BL 11: Include it in treatments of broken bones, osteoporosis and osteoarthritis and other bone disorders.

The Back Shu (Associated) Points While I don’t use many of the Back Shu Points, those I use, I use regularly. They are sometimes the points I use when choosing points to treat the root of a dermatome. However, just as often as not, I will choose one of the Hua To Jia Ji Points rather than the Back Shu Points. The Hua To Jia Ji Points are found on line with the Back Shu points, but only 0.5cun from the inter-spinus space. Many practitioners use these in place of the Back Shu points because they can be needled perpendicular to the skin and much deeper than Back Shu Points, and they release the paraspinal muscles very well. UB 11 the Back Shu Point of the Bones: As mentioned above, this point is very good for helping with bone-knitting after a break, or any other bone disorders. UB 13 the Back Shu Point of the Lung: This point is very good for pain and congestion in the lungs. I have found cupping at UB 13 to be helpful in quelling asthma attacks and relieving shortness of breath. UB 18 the Back Shu Point of the Liver: A good point for moving Liver Qi Stagnation. I mainly use it when there is tension, tightness and pain in the mid and upper back. UB 23 the Back Shu Point of the Kidney: Very good point for low back pain due to Kidney Qi, Yin or Yang Xu (deficiency). It is especially effective when used with Du 4 and combined with Moxa. UB 29 the Back Shu Point of the Sacrum: Another good point I commonly use for lower back pain.

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The Front Mu (Alarm) Points The Front Mu Points are points that are particularly well suited for treating the internal Organs. Like Back Shu Points, I don’t use many of them, but the ones I use, I use often. Ren 12 the Front Mu Point of the Stomach is very useful when treating Stomach disharmonies and pain. Ren 17, the front Mu of the Pericardium, & Liver 14, the front Mu of the Liver, are both good points to treat when there is constriction, pain or discomfort in the chest or ribcage. I always combine them with Pericardium 6. Stomach 25 the front Mu of the Large Intestine is useful when there is discomfort in the abdomen with constipation, diarrhea, or any gripping pain in the abdomen. Combine this point with Stomach 36, Pericardium 6, and Urinary Bladder 25. Ren 3 the front Mu of the Bladder can be quite helpful in treating burning urination, frequent or difficult urination. Combine this point with Kidney 2 or 3, and Stomach 29 or 30.

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Trigger Points aka Ah Shi Points Last but certainly not least are the points that are most commonly used in the treatment of pain. I’m convinced that Ah Shi points (locally tender) and Trigger Points are the same phenomena. In the same manner that I’m using “acupuncture” to refer to all needling, I’ll just use the term “Trigger Point” in this text to refer to all points found by palpation, including Ah Shi Points. As far back as the classics, these points were discussed and their use described. However, I will offer one piece of advice. Whenever possible, find a point that is a recognized acupuncture point or Trigger Point. This is not hard; careful palpation moving slowly out from the painful, tight, and or tender areas, along muscle and/or meridian pathways will usually reveal Trigger Points that have been previously recognized. If you spend a bit of time pursuing these points you will be rewarded with better results then just needling the first tender point you find.

The Main Meridians & Their Major Points I’m only listing the most common points I use. above, there are a lot more good and useful points.

As mentioned

The first two meridians I will consider are, the Du Meridian, and the Ren Meridian. Technically they belong to the Eight Extraordinary Meridians, and are not main meridians. However, while they have special significance, they also function like main meridians, in that the Ren and Du have their own points. The other 6 Extraordinary Meridians share points from other meridians. Once again you may notice that the points on Yang Meridians tend to treat pain along the pathway of the meridian, and those on the Yin Meridians tend to treat more internal disorders.

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Du Meridian “Governing Vessel” The pathway of the Du Meridian runs from the perineum, up through the middle of the spine, over the head, and ends at the upper lip. All points are on the posterior midline of the body. It is the most Yang meridian on the body. Since Yang Meridians are often used to treat disorders along the pathway of the meridian, the Du is important, for treating any and all disorders of the back and specifically the spine.

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Point Location Main Uses Du 1: Midway between the tip of Hemorrhoids; Rectal or Other the coccyx and the anus Prolapse; Rectal Bleeding Du 2: On the hiatus of the sacrum Sacral and Coccyx Pain Du 4: With the patient in the Controlling Point for Lower prone position, it’s in the Back and KD; All Lower Back deepest hollow in the low Problems, Especially Weakness; back. Below the spinous process of the 2nd lumbar Kidney Deficiency vertebrae Du 14: Below the spinous process Controlling Point for Neck & of the 7th cervical vertebrae Upper Back; Pain, Heat & Fevers in the Upper Body; Releases Exterior; Tonifies Wei Qi Du 20: On the midline of the head, Any Excess Disorders of the approximately on the Head; Any Prolapse In The midpoint of the line Body; Connects with Brain; connecting the apexes of Clears the Mind; Headache the two auricles Du 25: At the tip of the nose Nasal/Sinus Congestion

Ren Meridian “Conception Vessel” The pathway of the Ren Meridian runs from the perineum, up the midline of the front of the body, ending just under the lower lip. All its points are on the anterior midline of the body. It is also the most Yin meridian on the body. Since Yin Meridians are often used to treat internal disorders, the Ren is important, for treating many internal disorders and especially those associated with reproductive function

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Point Location Main Uses Ren 2 On the midpoint of the upper Controlling Point for All GYN border of the symphysis and Urogenital Disorders pubis Ren 4 On the midline of the Tonify the Kidneys; All GYN abdomen, 3 Cun below the & Urinary Disorders; Tonifies umbilicus Jing, Yang, Yin, & Qi Ren 6 On the midline of the Tonify the Spleen; Relieves abdomen, 1.5 Cun below Stagnation in Abdomen the umbilicus Ren 8 In the center of the Strengthen Digestion; umbilicus Diarrhea; Yang Collapse (No Needle - Moxa Only) Ren 12 On the midline of the Harmonize the Stomach; All abdomen, 4 Cun above the Abdominal Problems umbilicus Ren 17 On the anterior midline, at Descends the Qi of the level with the 4th intercostal Chest space Ren 22 In the center of the Throat and Swallowing suprasternal fossa Problems

Lung Meridian The pathway of the Lung Meridian runs from the second intercostal space, 2/3 the distance from the middle of the sternum to the acromion process, down the anterior surface of the arm and ending at the proximal radial corner of the nail of the thumb. Since Yin Meridians are often used to treat internal disorders, the Lung Meridian is important, for treating many internal disorders associated with the Lungs. These include all respiratory disorders and symptoms associated with colds and flus

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Point

Location

Main Uses

LU 1 Lateral and superior to the Mu / Alarm Point of The Lungs: sternum at the lateral side All Lung Disorders of the 1st intercostal space, 6 Cun lateral to the midline LU 5 On the cubital crease, on the radial side of tendon of m. biceps brachii, with the elbow slightly flexed. LU 7 Superior to the styloid process of the radius, 1.5 Cun above the transverse crease of the wrist

Strong, Productive Cough; Any Heat and/or Fullness in Lungs

Master Point of the Ren Mai; Controlling Point For Neck & Throat; Circulates the Qi of The Lungs. Luo Point; Use with LI 4 for Headaches and OPIs LU 9 At the radial end of the Source Point; Tonifies the transverse crease of the Lungs; All Deficient Lung wrist, in the depression on Problems the lateral side of the radial artery. LU 11 On the thumb, 0.1 Cun Jing Well Point: Clears Heat proximal to the radial From The Lungs (Sore Throat, corner of the nail. Tonsillitis, Etc); Moxa Opposite Side For Nosebleeds

Large Intestine Meridian The pathway of the Large Intestine Meridian runs from the proximal radial corner of the index finger along the arm on the lateral border of the radial bone to the top of the shoulder, crossing the SCM on the neck to the lower border of the ala nsai, on the opposite side. Since Yang Meridians are often used to treat disorders along the pathway of the meridian, the Large Intestine is important, for treating any and all disorders of arm, neck and head. Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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Point

Location

LI 1

On the radial side of the index Jing Well Point: acute finger, about 0.1 Cun proximal pain on the meridian; to the corner of the nail Clears Heat from the Head and throat; (sore throat, tonsillitis, red burning eyes, etc) On the dorsum of the hand, Controlling point for between the 1st and 2nd Head and Face: Main metacarpal bones, point for pain and other approximately in the middle of excesses in the head the 2nd metacarpal bone on neck and arm. OPIs; the radial side. CONTRAINDICATED IN PREGNANCY On the radial side of the wrist. Good local point for pain When the thumb is tilted in the thumb and area upward, it is in the depression between the tendons of muscle extensor pollicis longus and brevis.

LI 4

LI 5

LI 11-12

LI 14

Two points, best palpated for. When the elbow is flexed, these points are in and around the area between the depression at the lateral end of the transverse cubital crease and a spot superior to the lateral epicondyle of the humerus.

Main Uses

Fever; elbow pain

Just superior to the lower end Deltoid and shoulder pain of the deltoid muscle.

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Point

Location

Main Uses

LI 15-

Anterior and inferior to the acromion, on the upper portion of the deltoid muscle.

LI 16

When the arm is in full Major points for shoulder abduction, in the upper aspect joint pain of the shoulder, in the depression between the acromial extremity of the clavicle and scapular spine.

LI 17-18 Two points best palpated for. Good local points for On the lateral side of the neck, throat and neck problems about level with the tip of the Adam's Apple, on the SCM. LI 20

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In the nasolabial groove, at the any nose problem, level of the midpoint of the including nasal or sinus lateral border of the ala nasi. congestion; often used with LI 4 and LU 7

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Stomach Meridian The Stomach meridian runs from the middle of the lower border of the eye socket down to the outer corner of the mouth, back to the mandible up to the corner of the hairline. It proceeds inferior along the mid-clavicular line over the ribcage, moves closer to the midline, and down to the upper border of the pubic bone. It travels down the leg along a trajectory just lateral to the crest of the tibia, ending at the proximal medial corner of the nail of second toe. Since Yang Meridians are often used to treat disorders along the pathway of the meridian, the Stomach meridian is important, for treating any and all disorders of and eye, head, teeth, and leg

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Point ST 3

Location Directly below the center of the eye, at the level of the lower border of the ala nasi.

Sinus conditions; knee pain

Lateral to the corner of the mouth, directly below ST 3.

Facial paralysis; trigeminal neuralgia; herpes; mouth ulcers; gum problems; tooth pain

ST 4

ST 5

ST 6

Main Uses

Anterior to the angle of the mandible, on the anterior border lower jaw toothache of the masseter muscle. One finger-breadth anterior and superior to the lower angle of the lower jaw toothache, mandible where the masseter Bruxism attaches, at the prominence of the muscle when the teeth are clenched.

ST 7

At the lower border of the zygomatic arch, in the depression TMJ; upper jaw anterior to the condyloid process toothache of the mandible - located with mouth slightly slack.

ST 8

.5 Cun within the anterior hairline Frontal and band-like at the corner of the forehead, 4.5 headaches Cun lateral to GV 24. 2 Cun lateral to the center of the any intestinal problems; front mu of umbilicus. LI; 3 Cun below the umbilicus, 2 Cun All GYN problems; lateral to CV 4 damp heat in lower 4 Cun below the umbilicus, 2 Cun warmeThese ar; genital herpes; leucorrhoea. lateral to CV 3 Cold and/or blood stagnation in lower warmer

ST 25

ST 28 ST 29

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All GYN problems; damp heat in lower warmeThese ar; genital herpes; leucorrhoea. Point Location Main Uses Cold and/or blood ST 30 5 Cun below the umbilicus, 2 Cun stagnation in lower warmer lateral to CV 2. ST 31

ST 34

ST 35 ST 36

ST 40

ST 41

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At the crossing point of the line drawn down from the ASIS and the line level with the lower border of the pubic symphysis, in the depression on the lateral side of sartorius, when the thigh is flexed. When the knee is flexed, point is 2 Cun above the laterosuperior border of the patella. When the knee is flexed, the point is at the lower border of the patella, in the depression lateral to the patellar ligament. 3 Cun below ST 35, one finger breadth lateral to the anterior crest of the tibia

Strengthens and moves the thigh and entire leg

xi cleft; acute breast discomfort; knee pain/weakness knee joint problems Controlling point for Digestion: All digestive problems; builds qi and blood; regulates digestion

8 Cun superior to the external Helps resolve phlegm malleolus two fingers breadth lateral to the anterior crest of the anywhere in the body tibia. On the dorsum of the foot, at the midpoint of the transverse crease of the ankle, in the depression Pain/ weakness and between the tendons of muscle stiffness in the foot and extensor digitorum longus and ankle. hallucis longus, approximately at the level of the tip of the external malleolus.

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Point

Location

Main Uses

ST 44

Proximal to the web margin between the 2nd and 3rd toes.

ST 45

Jing Well Point: acute On the lateral side of the 2nd toe, pain on the meridian; .1 Cun proximal to the corner of Clear heat from head, the nail. face, mouth and gums

Clear heat from head, face, mouth and gums

Spleen Meridian The pathway of the Spleen Meridian runs from the proximal medial corner of the nail of the great toe along the medial edge of the foot, up the leg following the posterior border of the tibia. At the waist it runs parallel to the midline, along the mid-clavicular line until it departs to end at the mid-axillary line midway, between the axilla and the free end of the 11th rib. Since Yin Meridians are often used to treat internal disorders, the Spleen Meridian is important for treating many internal disorders associated with the Spleen. These include all digestive disorders and symptoms associated with fatigue, and dampness

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Point SP 1

SP 3

SP 4

Location

On the medial side of the Jing Well Point: Moxa for great toe, 0.1 Cun proximal bleeding from deficiencies to the corner of the nail. Proximal and inferior to the head of the first metatarsal Source Point: Tonifies SP bone, at the junction of the red and white skin. In the depression distal and Master point of the Chong inferior to the base of the Mai, All menstrual disorders; first metatarsal bone, at the All gastric disorders; masses junction of the red and white in the abdomen skin.

SP 6 3 Cun above the tip of the medial malleolus, on the posterior border of the medial aspect of the tibia. SP 9

SP 21

Main Uses

On the lower border of the condyle of the tibia, in the depression on the medial border of the tibia. On the mid-axillary line, midway between the axilla and the free end of the 11th rib.

strengthens SP, KD, yin, qi and blood; All GYN; moves the lower abdomen; calms the mind; all reproductive issues CONTRAINDICATED IN PREGNANCY All damp disorders; A mildly diuretic point Great Luo of the Spleen Helps restore a healthy sense of comfort, symmetry and balance in the body

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Heart Meridian The pathway of the Heart Meridian runs from the middle of the axilla, down the medial surface of the arm and ending at the proximal radial corner of the nail of the pinky finger. Since Yin Meridians are often used to treat internal disorders, the Heart Meridian is important for treating disorders associated with the

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Heart. These include all mental / emotional disorders and symptoms associated with sleep.

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Point

Location

Main Uses

HT 1 When the arm is abducted, the point is in the center of Seldom used. Deep needling the axilla, on the medial can access m. subscapularis side of the axillary artery. HT 7 At the ulnar end of the Source Point: Most commonly transverse crease of the used HT point all heart wrist, in the depression on disorders. Nourishes the HT, the radial side of the tendon Calms the Shen; relieves of muscle flexor carpi insomnia ulnaris. HT 8 When the palm faces upward, the point is tachycardia; heat in the Heart; between the 4th and 5th metacarpal bones. When a dream disturbed sleep, night terrors fist is made, the point is where the tip of the little finger rests. HT 9 On the radial side of the Jing Well Point: extreme heat little finger, .1 Cun proximal in the Heart; loss of to the corner of the nail. consciousness; tachycardia

Small Intestine Meridian The pathway of the Small Intestine Meridian runs from the proximal ulnar corner of the pinky finger, along the arm on the lateral border of the ulnar bone, to the back of the shoulder, through the scapula, up to the back of the neck past the ear, and ending lateral to the eye. Since Yang Meridians are often used to treat disorders along the pathway of the meridian, the Small Intestine is important for treating any and all disorders along its pathway, especially around the scapula and neck.

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Point SI 1

Location

Main Uses

On the ulnar side of the little Jing Well Point: acute pain on finger, about .1 Cun proximal the meridian; mastitis; to the corner of the nail. insufficient lactation

SI 3

When a loose fist is made, the point is on the ulnar side Controlling point for Spine: of the hand, proximal to the Master Point of the DU Mai: stiff neck; all back pain; 5th MP joint, at the end of the transverse crease at the stroke, MS, Turette’s and junction of the red and white other wind disorders and skin. SI 6 When the palm faces the chest, the point is in the xi cleft; pain in the meridian; bony cleft on the radial side stiff neck; Shoulder pain of the styloid process of the ulna. SI 8 When the elbow is flexed, the point is located in the local point for elbow depression between the pain/stiffness olecranon of the ulna and the medial epicondyle of the humerus. SI 9 Posterior and inferior to the shoulder joint. 1 Cun above the posterior end of the local points for shoulder pain axillary fold. and Range of Motion SI 10 Directly above SI 9, in the depression inferior to the scapular spine. SI 11 In the infrascapular fossa, at the junction of the upper and Most important local point for middle third of the distance the upper back, and scapular between the lower border of area the scapular spine and the inferior angle of the scapula. 115

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Point

Location

SI 17 Posterior to the angle of the mandible, in the depression on the anterior border of the SCM. SI 19 Anterior to the tragus and posterior to the condyloid process of the mandible, in the depression formed when the mouth is open.

Main Uses local point for jaw, neck, and ear

benefits the hearing; jaw problems

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Urinary Bladder Meridian The Urinary Bladder Meridian runs from the medial inner canthus over the head just lateral to the midline, down the side of the neck where it separates into two pathways, running parallel to the midline of the back. One pathway is located at the distance of the medial border of the scapula, and the other is halfway between the medial border of the scapula and the midline. At the sacrum the meridian moves out to the buttocks and down to the center of popliteal crease, and the back of the calf, to the ankle where it runs just under the lateral maleoleous ending at the lateral proximal corner of the little toe. Since Yang Meridians are often used to treat disorders along the pathway of the meridian, the Urinary Bladder is important, for treating any and all disorders of back, and legs. This meridian contains the “Back Shu Points.”

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Point Location Main Uses UB 1 0.1 Cun superior and slightly medial to the Main Point for All eye problems inner canthus UB 2 on the medial end of the Alternate point for all eye eyebrow, or on the problems supraorbital notch UB 10 1.3 Cun lateral to GV 15, in the depression on the All neck pain, weakness and lateral aspect of the stiffness trapezius muscle UB 11 1.5 Cun lateral to GV 13, at the level of the lower Back Shu Point of the Bones: All border of the spinous bone problems; arthritis process of T1 UB 12 1.5 Cun lateral to the GV meridian, at the level of OPIs; headache; cough; the lower border of the stimulates wei qi spinous process of T2 UB 13 1.5 Cun lateral to GV 12, Back Shu Point of the LU: all lung at the level of the lower problems; builds wei qi; chronic or border of the spinous acute process of T3 UB 15 1.5 Cun lateral to GV 11, at the level of the lower Back Shu Point of the HT: all border of the spinous heart problems process of T5 UB 17

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Back Shu Point of the Blood: All 1.5 Cun lateral to GV 9, blood problems; tonifies blood; at the level of the lower skin problems from heat in blood; border of the spinous Back Shu Point of the Diaphragm: process of T7 Hiccough; Hiatial Hernia

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Point Location UB 18 1.5 Cun lateral to GV 8, at the level of the lower border of the spinous process of T9

Main Uses Back Shu Point of the LR: benefits all aspects of the liver; smooths, harmonizes, and tonifies liver

UB 19 1.5 Cun lateral to GV 7, at the level of the lower Back Shu Point of the GB: all GB border of the spinous problems process of T10 UB 20 1.5 Cun lateral to GV 6, Back Shu Point of the SP: all SP at the level of the lower problems; benefits all aspects of border of the spinous spleen process of T11 UB 21 1.5 Cun lateral to the GV meridian , at the level of Back Shu Point of the ST: the lower border of the benefits all aspects of the ST spinous process of T12 UB 22 1.5 Cun lateral to the GV 5, at the level of the Back Shu Point of the SJ: lower border of the regulates and transforms fluids; spinous process of L1. UB 23 1.5 Cun lateral to GV 4, Back Shu Point of the KD: all KD at the level of the lower pathologies; regulates all aspects border of the spinous of the KD process of the L2. UB 25 1.5 Cun lateral to GV 3, Back Shu Point of the LI: low at the level of the lower back pain; colon problems; border of the spinous constipation, diarrhea, etc. process of L4.

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Point Location Main Uses UB 27 1.5 Cun lateral to the GV meridian, at the level of Back Shu Point of the SI: used the lower border of the with CV 3 for damp heat in urine; sacroiliac joint problems 1st posterior sacral foramen. UB 28 1.5 Cun lateral to the GV meridian, at the level of Back Shu Point of the UB: all UB the 2nd posterior sacral Problems foramen. UB 31 In the 1st posterior sacral foramen. UB 32 In the 2nd posterior sacral foramen. UB 33 In the 3rd posterior sacral foramen. UB 34 In the 4th posterior sacral foramen UB 35 On either side of the tip of the coccyx, .5 Cun lateral to the GV meridian. UB 40 Midpoint of the transverse crease of the popliteal fossa, between the tendons of muscle biceps femoris and muscle semitendinosis.

These are the 8 Liao Points: Used for all genito-urinary, GYN, low back & leg problems

Coccygeal pain

Controlling point for the low back: All Low back pain; clears heat Note: An Outdated Numbering System lables this point “UB 54”

UB 57 Directly below the belly of muscle gastrocnemius, on a line Upper back pain/tension; used with UB 67 for spasms of the calf; joining BL 40 and tendo-calcaneus, about 8 Cun below BL 40. 121

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Point Location Main Uses UB 60 In the depression occipital headache; neck pain; between the external distal point for sciatica; for labor malleolus and tendo pain; "aspirin point" calcaneus. UB 62 In the depression directly Master Point of the Yang Qiao below the external Mai: Lateral musculoskeletal malleolus. problems UB 67 On the lateral side of the Jing Well Point: acute pain on the meridian; turning a breech fetus; small toe, .1 Cun proximal to the corner of used with UB 57 for spasms of the calf; back pain; tight the nail hamstrings

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Kidney Meridian The pathway of the Kidney Meridian runs from the center of the ball of the foot, along the medial edge of the foot, under the medial maleolus, up the medial aspect of the leg posterior to the tibia. At the waist it runs parallel--and just lateral to--the midline, ending at the top of the sternum. The Kidney Meridian is important for treating many internal disorders. These include all growth development and aging, reproductive and urinary disorders, and symptoms associated with fatigue and general weakness.

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Location Main Uses KD 1 On the sole, in the depression emergency point; loss when the foot is in plantar flexion, of consciousness; approximately at the junction of the brings heat down fro the anterior third and posterior 2/3. upper body KD 2 Anterior and inferior to the medial malleolus, in the depression of the Heat/Fire in the throat lower border of the tuberosity of the and lower warmer; UTIs navicular bone. KD 3 In the depression between the Source Point; All KD medial malleolus and tendo disorders; weakness in calcaneus, at the level of the tip of the knees; low back; the medial malleolus. lowered libido, E.D. KD 6 In the depression of the lower master point of yin qiao; border of the medial malleolus, or 1 Tonifies KD yin Cun below the medial malleolus. KD 7 2 Cun directly above KD 3, on the Tonifies KD Yin and anterior border of tendo calcaneus. Vaporizes fluids KD 0.5 Cun lateral to Ren and level 11-21 with the Ren points. KD 11 lateral to Ren 2 on the superior border of the reinforce the Ren points symphysis pubis. KD 21 under the sternum KD .5 Cun lateral to the umbilicus, level Strengthens the KD 16 with CV 8. Point

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Pericardium Meridian The pathway of the Pericardium Meridian runs from the chest, down the medial surface of the arm, and ends at the tip of the middle finger. Since Yin Meridians are often used to treat internal disorders, and the Pericardium is closely related to the Heart Meridian, it is most commonly used to treat disorders associated with the Heart. These include all mental / emotional disorders and symptoms associated with sleep, as well as organic heart disorders.

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Point Location Main Uses PC 4 5 Cun above the transverse crease of the wrist, on the line connecting PC 3 and PC xi cleft point; chest pain; pain in the meridian 7, between the tendons of palmaris longus and flexor carpi radialis PC 5 3 Cun above the transverse crease of the wrist between calms the spirit; regulates the tendons of palmaris Heart rhythm longus and flexor carpi radialis PC 6 2 Cun above the transverse Master Point of the Yin Wei crease of the wrist between Mai: Controlling point for the the tendons of palmaris Chest and Abdomen; calms longus and flexor carpi the spirit radialis PC 7 In the middle of the transverse crease of the Source Point: calms the wrist, between the tendons of spirit; regulates Heart rhythm muscle palmaris longus and flexor carpi radialis. PC 8 On the transverse crease of the palm, between the 2nd tachycardia; heat in the and 3rd metacarpal bones. Heart; dream disturbed When the fist is clenched, sleep the point is just below the tip of the middle finger. PC 9

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Jing Well Point: extreme In the center of the tip of the heat in the Heart; loss of middle finger. consciousness; tachycardia; night terrors

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San Jiao Meridian The pathway of the San Jiao is similar to that of the Small Intestine, but more radial on the forearm. It runs from the proximal ulnar corner of the ring finger along the arm on the lateral border of the ulnar bone to the back of the shoulder, along the top posterior aspect of the trapezius, up to the back of the neck, around the ear, and ends just anterior to the tragus of the ear. Since Yang Meridians are often used to treat disorders along the pathway of the meridian, the San Jiao is important for treating any and all disorders along its pathway, especially around the shoulder, and ear. Point Location Main Uses SJ 1

On the lateral side of the ring finger, about 0.1 Cun Jing Well Point; acute pain on proximal to the corner of the the meridian nail.

SJ 3 On the dorsum of the hand between the 4th and 5th metacarpal bones, in the Controlling Point for the Ear depression proximal to the metacarpophalangeal joint. SJ 4 On the transverse crease of the dorsum of the wrist, in the depression lateral to the Good local point for the wrist tendon of muscle extensor digitorum communis. SJ 5

2 Cun above TW 4, Master Point of the Yang Wei between the radius and the Mai: local point ulna.

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Point SJ 10

Location When the elbow is flexed, the point is in the depression about 1 Cun superior to the olecranon.

Point Location

Main Uses

Good Local Point for the elbow

Main Uses

SJ 14 Posterior and inferior to the acromion, in the depression about 1 Cun posterior to LI Shoulder joint pain and ROM 15 when the arm is abducted. SJ 15 About 1 Cun posterior to GB 21. Midway between Tightness, tension and pain in GB 21 and SI 13, on the the neck and shoulders superior angle of the scapula. SJ 17 Posterior and superior to the angle of the mandible. Posterior to the lobule of All Ear disorders the ear, in the depression between the mandible and the mastoid process. SJ 21 In the depression anterior to the supratragic notch and slightly superior to the condyloid process of the All Ear and Jaw disorders mandible. The point is located with the mouth slack. SJ 23 At the lateral end of the eyebrow

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All disorders involving the side of the head/face; lateral headaches, eye pain, ear pain

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Gall Bladder Meridian The pathway of the Gall Bladder Meridian runs from the Lateral outer canthus, back and forth across the sides of the head, down the side of the neck, where it follows the top of the trapezius, down to the side of the ribcage, throughout the flanks, to the hip, and down along the most lateral aspect of the leg, to the ankle, where it runs under the lateral maleoleous and ends at the lateral proximal corner of the fourth toe. Since Yang Meridians are often used to treat disorders along the pathway of the meridian, the Gall Bladder is important for treating any and all disorders of sides of the head, trunk, hip, and legs

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Point

Location

Main Uses

GB 1 0.5 Cun lateral to the outer Secondary point for eye canthus, in the depression on the problems lateral side of the orbit. GB 2 Anterior to the intertragic notch, at the posterior border of the Good local point for ear condyloid process of the and jaw mandible. The point is located with the mouth open. GB 8 Superior to the apex of the auricle, 1.5 Cun within the hairline. GB On the forehead, 1 Cun directly 14 above the midpoint of the eyebrow. GB 20

Lateral Headaches; post stroke speech disorders; enters the brain

GB 21

Primary point for neck and shoulder tension, pain and tightness. (CONTRAINDICATED IF PATIENT IS PREGNANT, OR HAS A HEART CONDITION)

All eye problems; frontal and temporal HA

All Wind: internal LV wind and external OPI wind; opens the orifices of the In the depression between the head: All disorders upper portion of the SCM and the effecting the eyes, ears, trapezius, just below the occiput. and nose; All Headaches, especially occipital

Midway between GV 14 and the acromion, at the highest point of the shoulder.

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Point

Location

Main Uses

GB 25

On the lateral side of the Front mu of KD; pain in abdomen, on the lower border of lumbar region the free end of the 12th rib.

GB 26

Directly below the free end of the 11th rib, where the LV 13 is Main Point on the Dai located, at the level of the Mai; All GYN Disorders umbilicus.

GB 28

Anterior and inferior to the ASIS, Secondary Point on the 0.5 Cun anterior and inferior to Dai Mai; All GYN GB 27. Disorders

GB 29

In the depression of the midpoint between the ASIS and the great trochanter. 0.

Main Points for Sciatica, hip; lumbar to thigh, leg pain and paralysis

GB 30

At the junction of the lateral 1/3 and medial 2/3 of the distance between the greater trochanter and the hiatus of the sacrum.

GB 31

On the midline of the lateral Main Points for Sciatica, aspect of the thigh, 7 Cun above lumbar to thigh, leg pain and the transverse political crease. paralysis

GB 34

relaxes the tendons; In the depression anterior and in good point for knee, inferior to the head of the fibula. sciatica and leg pain; pain anywhere in the body; shoulder pain

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Point GB 40

GB 41

GB 44

Location

Main Uses

Anterior and inferior to the lateral malleolus, in the depression on Ankle Pain the lateral side of the tendon of m. extensor digitorum longus. In the depression distal to the junction of the 4th and 5th Master Point of the Dai metatarsal bones, on the lateral Mai: All GYN and LV side of the tendon of m. extensor disorders digiti minimi of the foot. On the lateral side of the 4th toe, Jing Well Point; acute about .1 Cun proximal to the pain on the meridian corner of the nail.

Liver Meridian The pathway of the Liver Meridian runs from the proximal lateral corner of the nail of the great toe, along the medial edge of the foot, up the leg, posterior to the border of the tibia, between the Spleen and Kidney meridians. At the waist it runs parallel to the midline until it departs to the free end of the 11th rib, ending at the sixth intercostal space on the mid-clavicular line. Since Yin Meridians are often used to treat internal disorders, the Liver Meridian is important for treating many internal disorders associated with the Liver. These include many emotional disorders and symptoms associated with stagnation and wind.

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Point

Location

Main Uses

LR 1 On the lateral side of the great toe, 0.1 Cun proximal to the corner of the nail. LR 2

LR 3

LR 13

LR 14

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Jing Well Point: restores consciousness; Inguinal pain; groin pulls; moves Qi in the lower warmer; genitourinary issues; stops bleeding On the dorsum of the LV fire and heat in the head; Heat foot, between the 1st in the Lower Warmer; Burning and 2nd toes, proximal urination; red burning eyes; LV to the margin of the yang rising HA; Herpes I & II; web. Shingles; LV wind On the dorsum of the foot, in the depression Source Point: Primary point to distal to the junction of benefit all aspects of LV. Move LR QI, Quell LR Wind, etc. the 1st and 2nd metatarsal bones. On the lateral side of the abdomen, below the Front MU Point of the SP: Liver invading Spleen free end of the 11th floating rib. Directly below the Pain and tightness/fullness in the nipple, in the 6th chest, ribs and breast intercostal space.

Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

Point

Helpful Location Translations

Bi Tong

Nose Opening

Jian Nie Ling

Shoulder Out Midway between the end of the anterior axillary Front fold and LI 15 Draw a line following path of lateral end of Eye Pain / eyebrow down to Great Yang intersection of line from Discomfort outer canthus of eye, at Headaches intersection, in depression.

Tai Yang

Xi Yan

Yao Tong Xue

At the highest point of the nasolabial groove.

Main Uses Stuffy-Runn y Nose

Calf's Nose

A pair of points in the two depressions, medial and lateral to the patellar ligament, locating the Knee Pain point with the knee flexed. Lateral Xiyan overlaps with S 35.

Back Pain Point

On the dorsum of the hand, midway between the transverse wrist crease and metacarpophalangeal Acute Back joint, between the Pain/Sprain second and third metacarpal bones, and between the fourth and fifth metacarpal bones, 4 points in all on both hands.

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Point Yin Tang

An Mian Point

Helpful Location Translations Midway between the medial ends of the two eyebrows. Peaceful Sleep Helpful Translations

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Clams the Mind/Shen

Midpoint between Yifeng Calms the (SJ 17) and Fengchi (GB Shen for 20) Insomnia Location

A group of 34 points along both sides of the spinal column, 0.5 Cun Hua Tou Jia lateral to the lower Ji border of each spinous process from the first thoracic vertebra to the fifth lumbar vertebra. On dorsum of hand, between 2nd & 3rd Falling From metacarpal bones, 0.5 Luo Zhen Pillow Cun posterior to metacarpophalangeal joint Shi Qi Below the spinous 17th Vertebrae Zhuxia process of the 5th (Josen) lumbar vertebrae Ding Chuan Stop Asthma

Main Uses

Main Uses Any disorders associated with the level of the spine

Neck Pain

Low Back Pain

Stop / 0.5 Cun lateral to Dazhui Reduce (Du 14). Asthma Attack

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Point

Ba Feng

Ba Xie

Dan Nang Xue He Ding Shi Mian Point

Si Shen Cong

Helpful Location Main Uses Translations On the dorsum of the foot, in the depressions Foot/ Toe on the webs between 8 Winds Pain toes, proximal to the margins of the webs, eight points in all. On the dorsum of the hand, at the junction of the white and red skin of Hand / 8 Ghosts the hand webs, eight in Finger Pain all, making a loose fist to locate the points. The tender spot 1-2 Cun Gall stones GB Point below G 34. In the depression of the Knee pain/ Crane Top midpoint of the superior dysfunction patellar border. In the center of the heel Heel & Knee Lost Sleep on the bottom of the foot Pain Helpful Location Main Uses Translations Four Spirits Cleverness

Yu Yao Zi Gong Xue

Uterus Point

A group of 4 points, at the vertex, 1 Cun Clears the respectively posterior, Mind anterior and lateral to Du 20 At the midpoint of the Headache, eyebrow. Eye Pain 3 Cun lateral to Ren 3

All GYN

Extraordinary Points

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5. Auricular Acupuncture: Microsystems & Extraordinary Meridians Microsystems in general, are helpful in treating all painful conditions, as well as many internal disorders. Auricular or Ear Acupuncture is commonly used by acupuncture practitioners in a majority of treatments. Ear points are easily accessible and can be added to most treatments to augment the primary points. Ear points are effective for both internal and external disorders. I find Hand and Scalp Acupuncture to be it especially good for acute pain in the upper or Yang regions of the body. Point location and treatment technique are both very important with microsystems. As there are many points in small areas with microsystems, one must find points precisely. Once located, and needled, active or passive movement or functioning of the injured area should be employed during treatment if possible. Look for immediate positive change during and after treatment. When microsystem points are located and treated appropriately, they often will yield immediate results. Microsystems can be used exclusively for treatment, but are usually combined with primary acupuncture points. There is contralateral ipsilateral

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Hand Acupuncture usually use opposite side move affected joint if possible Needling and Location TechniqueLocate at the epiphysis of the bone and needle in at a 45 degree angle to the point in the direction of the finger tips.

Selected Upper Body Hand Points • Shoulder • Radial side of the metacarpophalangeal joint of the index finger • Shoulder pain • Nape & Neck • Ulnar side of the metacarpophalangeal joint of the index finger • Stiff neck • Migraine • Ulnar side of the first interphalangeal joint of the ring finger • Migraine • Chest pain • Headache • Ulnar side of the metacarpophalangeal interphalangeal joint of the thumb • H/A • dizziness

Other Hand Points • • • •

Low Back (Loin & Leg) Sciatic Nerve Ankle Polyhydrosis point • Not lustrated. About ½ way between PC 7 & PC 8. • Works well for excessive sweating, (especially if it is linked to the Shen)

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Auricular Acupuncture General Introduction Techniques Find point exactly Active or passive movement For Yang disorders, palpate the Yang side of the ear for sensitivity and needle/seed it in addition to the Yin side Usual Modalities Needles Seeds Press-balls Magnets

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Ear Anatomy Major Auricular Points Shen Men Heart Liver Kidney Sympathetic N. Stomach Mouth Thirst Hunger Nicotine Shoulder-Arm-Hand Back Hip-Leg-Foot-Toe Sciatica Uterus Toothache Aspirin

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Insomnia

Specific Auricular Treatments •



Pain Protocols • When treating pain, ear points corresponding to the region of pain, can be added to the treatment. • Points should be carefully palpated for. The Detox Protocol (Shen Men, Liver, Kidney, Heart, Sympathetic N.) is useful in treating an number of disorders in addition to substance addictions. • Anxiety/ ADHD / PTSD (use as is) • Quit Smoking (add Nicotine Pt.) • Weight Loss ( Add Hunger & Thirst Pts.)

Acupuncture Treatment of Chemical Dependency A. Acupuncture is Not Complete in and of Itself for Detox. It must be part of an integrated whole system, to achieve these results. 1. Individual counseling 2. Group support 3. Case management 4. Urine screening 5. Other conventional treatment approaches. B. Get the patient to return C. Remember the primary diagnosis. 1. Chemical Dependency is Primary 2. It will kill faster than anything else D. Withdrawal General Sx 1. Severe Flu-Like Sx. 2. fever 3. chills 4. insomnia 5. cramping 6. headaches 7. agitation 8. violent outbursts 9. nausea

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E.

F.

G.

H.

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10. depression 11. malaise / fatigue 12. anxiety 13. paranoia 14. TCM a) Def. QI b) Def. Yin c) Stuck Qi d) Empty. Fire Acute Medical Emergency from Withdrawal 1. Alcohol 2. Benzodiazepines 3. Barbiturates Effects of Acu Detox 1. Decrease in Recidivism Rate 2. High degree of outpatient compliance 3. Reduced a) Drug Cravings b) Pain c) Muscle cramping d) Stress e) Anxiety f) Sleeplessness Cost effectiveness 1. 1 acupuncture provider, 1 Counselor, 1 Case Worker, & 1 admin. Can handle @ 30 patients in a two hour time period. Start to finish. Treatment 1. NADA Protocol a) National Acupuncture Detox Association b) Ear Protocol (1) Shen Men (2) Liver (3) Heart (4) Kidney (5) Sympathetic N. c) Patient Prep Station (1) Cotton

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d) e)

f)

g)

(2) Alcohol (3) Sharps container (4) Tissue (5) Mirror (6) Patients clean own ears (7) Patients Remove own needles (8) Patients clean up blood Frequency of treatment DETOX Phase (1) Lasts until pt. has put together 14 days clean & sober (2) Weeks 0-2 of recovery (3) 1-2 Acupuncture. Tx. Daily (4) Group work (5) Case Management Recovery Phase (1) Four Weeks (2) Weeks 3-6 of recovery (3) Three Acupuncture TX /week (4) Group Work (5) Case Management (6) Individual Counseling Maintenance Phase (1) Weeks 7-10 of recovery (2) Acupuncture Tx. twice weekly (3) Group work (4) Case management (5) Individual Counseling (6) Re-Evaluation / Referral

Scalp Acupuncture A. Chinese Scalp Acupuncture is associated with Lines 1. Based On, Cortical Homunculus 2. Western Function 3. Sensory / Motor areas etc. 4. Chinese Scalp Lines: Generally Treat Contralateral Side

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B. YNSA: Yamamoto’s New Scalp Acupuncture 1. Treatment Based on Discreet Points 2. Based On Dr. Yamamoto’s Long Experience 3. YNSA Points: Generally Treat Ipsilateral Side C. All Points and Lines are palpated carefully to find the most reactive point for treatment D. Scalp Contraindications and Cautions 1. Contraindicated: Acute Stage Cerebral Hemorrhage: Wait at least 4 weeks 2. Caution During Pregnancy 3. Contraindicated: Children With Fontanel Not Closed 4. Caution: People who are Too Hungry or Nervous E. Used for: 1. All Painful Conditions 2. Especially effective in the upper body 3. Neurological Conditions 4. All Disorders Involving the Brain/CNS 5. Post Stroke 6. Cerebral Thrombosis / Embolism: Treat early 7. Post Stroke Prognosis a) 1-3 mos: Excellent b) 3-6 mos: Very Good c) 6-1 year: Good d) Up to 3 years: Hopeful e) After 3 years: Guarded 8. Phantom Limb Pain 9. Spinal Chord Injury 10. Post Traumatic Paralysis 11. Brain Damage 12. Multiple Sclerosis 13. Muscular Atrophy 14. Urinary Incontinence F. ScalpTechnique

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1. Points a) Palpate carefully for Discreet Point to Needle b) Needles: #2 or 3 X 30mm 2. Lines: a) Palpate carefully for Discreet Point to Needle b) If No Discreet Point is Reactive: Treat Entire Line c) Needles: #5 - # 8 X 30 - 60 mm d) Position Patient Sitting Up e) Transverse Needle Insertion / 15-250 3. Depth of insertion a) Five Layers of scalp (1) Cutaneous (a) Thick (b) Rich in blood circulation (c) Painful to needle (2) Subcutaneous (a) Firm (b) Dense (c) Short fibers (d) Major vessels and nerves (e) Painful to needle (3) Galea aponeurofic layer (a) Tough & tensile fibrous Tissue (b) Very painful to needle (4) Aerial tissue layer (a) Loose connective tissue (b) The Best Layer To Needle (5) Periosteum (a) Outer layer of Skull (b) Very painful to needle 4. Minimizing Pain a) Insert Quickly b) Needle Correct Layer c) Check for shallow enough angle 5. Stimulation a) No Thrusting: Rotation Only b) For Best Results: Stimulate for 1-2 min. Every 10-15 min. Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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6. Needling Direction a) Generally From Superior to Inferior b) Or Anterior to Posterior 7. Lay needles a) 20-60 min. b) Up to Twelve Hours 8. If Possible: have patient Walk or Talk, Utilize or Move the affected part/faculty during treatment 9. Remove Needles a) Always use Cotton b) Often bleeding 10. Interdermals, Electro Acupuncture, Moxa, and Massage Can All Be Used G. Finding the Hairline: 1. The Hairline can be found about 1cm superior to the most superior wrinkle on the forehead. 2. The Corner of the Hairline can be found @ 4-5 cm lateral to the midline, about the same distance lateral to the middle of the eye, as the middle of the eye is from the midline of the face.

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Scalp Points II.

Head & Neck Points A. A Series of Discreet Points, corresponding to the cervical vertebrae and occiput. B. The points are found on a 2 cm long Line, centered on the hairline, 1cm lateral to the midpoint of the hairline. C. Any Pain/Disorder of the Face, Head, and Neck D. Any Disorder associated with the Cervical Spine E. Neurological Disorders F. Post Surgical Complications G. Trigeminal Neuralgia H. Bell's Palsy I. Headache/Migraine J. Vertigo

III. Neck & Shoulder Points A. A Series of Discreet Points, Found on a 2 cm long Line, centered on the hairline, 2cm lateral to the midpoint of the hairline. B. Any Pain/Disorder of the Neck, Clavicle, Shoulder and Scapular Regions. C. Paralysis D. Post trauma E. Post operative F. Fractures G. Upper Body CRPS / RSD H. Complex Regional Pain Syndrome / Reflex Sympathetic Dystrophy Syndrome

IV. Shoulder Arm & Hand Points A. A Series of Discreet Points, which are found on a 2 cm long Line, beginning at the corner of the hairline, and extending diagonally toward the nose (Yin Tang). B. These points correspond to the shoulder, which is found near the top/lateral end of the line; the arm in the middle; and the hand, at the inferior/medial end. C. Any disorders of the Shoulder Joint, Scapular Region, Arm, Hand, Wrist & Fingers Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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D. E. F. G. H. I.

V.

Pain Paralysis Post trauma/operative Fractures Dislocations Carpal Tunnel Syndrome

Thorax Points A. A Series of Discreet Points, corresponding to T1-T12. B. The points are found on a line, which begins about 1cm lateral to the midline at the top border of the eyebrow. (This medial border corresponds to T-1) The line continues to the midpoint of the eyebrow at a 150 angle upward ending above the middle of the eyebrow. (The lateral end corresponds to T-12.) C. Any Disorder associated with the Thorax or Thoracic Spine D. Back Pain E. Rib Pain F. Angina G. Herpes Zoster H. Asthma / Bronchitis

VI. Low Back Points A. A Series of Discreet Points, corresponding to the Lower Back, Lumbar, and Belt Region. B. The Points are found about 1 cm above the Zygomatic Arch. Beginning at the anterior hairline, and progressing to the anchor of the helix, then proceeding superiorly for about centimeter. C. Primary Treatment points for Low Back Pain, Paralysis, and other disorders of the Lumbar Spine, Lower Body, and Lower Extremities

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Chinese Scalp Lines Based on Cortical Homunculus

Finding the Lines: Lines of Measurement I.

Draw Two Lines A. Anterior - Posterior Midline 1. From Glabella to the EOP (External Occipital Protuberance) 2. Find Mid-point of the line 3. Can be found by describing a plumb line from the top of the ears to the A-P Midline

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4. The Midpoint of the Anterior-Posterior Midline is a useful landmark for finding treatment lines. B. Eyebrow - Occipital Line 1. From center of eyebrow to EOP (Via the temple and across the ear) 2. The point at which this line crosses the anterior hairline is a useful landmark for finding treatment lines.

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Continence Line (AKA: Leg & Foot Motor & Sensory)

I.

Beginning at a point 0.5 Cun lateral to the midpoint of the anterior-posterior midline, Draw bilateral lines, parallel to midline, in the posterior direction, 2 Cun in length II. Needle From Anterior to Posterior III. Paralysis, Pain, Numbness of Lower Limb Opposite Side A. The Function is similar to the functions of the upper 1/5th of both motor and sensory area together. B. Urinary Incontinence 1. Most All Urinary Problems C. Prolapsed Urinary Bladder/ Uterus / Stomach D. Bowel Disorders 1. Bowel Incontinence Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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E. F. G. H. I.

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2. Allergic Colitis 3. Crohn's Disease 4. Hemorrhoids Post Traumatic Stress Syndrome ADHD (Attention Deficit Hyperactive Disorder) Multiple Sclerosis Male Reproduction 1. Impotence 2. Spermatorrhea Female Reproduction 1. Uterine Bleeding 2. Endometriosis 3. Prolapse Uterus

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J. Swollen Ankles

Motor Function Line I.

From Midpoint on Anterior - Posterior Midline go 0.25 Cun Posterior A. Draw Line from this point to the point where the Eyebrow Occipital Line crosses the anterior hairline @ the sideburn B. Motor Area is divided into 5 parts C. Superior 1/5th of motor Area 1. Treats paralysis of Lower Limbs and Trunk on Opposite Side D. Middle 2/5ths of motor Area 1. Treats paralysis of Upper on Opposite Side E. Inferior 2/5ths of Motor Area 1. Facial Paralysis on Opposite Side 2. Nerve Damage 3. Bell's Palsy 4. AKA Speech 1 area 5. Motor Aphasia

Sensory Perception Line I.

A Line Parallel to and 0.75 Cun Posterior to the motor area A. Sensory Area is divided into 5 parts B. Superior 1/5th of Sensory Area 1. Parastisia of Lower Limb and trunk on the opposite side 2. Phantom Pain of Lower Limb and trunk on the opposite side 3. Special Effects a) Occipital H/A b) Neck Pain / Stiffness C. Middle 2/5ths of Sensory Area 1. Parastisia of Upper Limb on Opposite Side 2. Phantom Pain of Upper Limb on the opposite side D. Inferior 2/5ths of Sensory Area 1. opposite Side 2. Migraine H/A

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3. Trigeminal Neuralgia 4. Toothache 5. TMJ

Tremor Control Line I.

A Line Parallel to and 0.75 Cun Anterior to the motor area A. From Midline to the inferior border of the hairline B. Divided into Three Parts C. Superior Third for Lower Limbs D. Middle Third for Upper Limbs E. Inferior Third Head & Neck F. For Treatment of: 1. Any Involuntary movement or tremor 2. Chorea 3. Parkinson's Disease

Vision Line From a point 0.75 Cun lateral to, and level with, the EOP (External Occipital Protuberance) draw a line parallel to the midline, and 2.0 Cun in length, Superior from the EOP ! Indications ! ! Cortical Vision Disturbances ! ! Glaucoma ! ! Cataract

Vertigo and Balance Line From a point 2.0 Cun lateral to, and level with, the EOP (External Occipital Protuberance) draw a line parallel to the midline, and 2.0 Cun in length, Inferior beginning at the level of the EOP ! Indications ! ! Balance ! ! Proprioception

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The 8 Extraordinary Meridians In More Detail Before we look at the Eight Extraordinary Meridians, lets consider the levels to which meridians penetrate the body. Primary Meridians Access & Connect The Wei (External /Protective) & Ying (Internal / Nourishing) Levels Divergent Meridians Connect The Wei & Yuan Levels, to translocate pathogens from the internal level to the external level to protect the Zang/Fu Sinew / TM Meridians Access The Wei Level and are used for pathologies that manifest on the surface and in the joints, as well as those that cross from meridian to meridian, transversely: i.e. LI & SJ. Luo Meridians Access The Ying Level and are the manifestation of internal pathogens. These meridians are created as needed, and may manifest as varicosities or phlegm nodules. They are best treated by releasing Xue through Plumb blossom & Lancet bleeding. The Eight Extraordinary Vessels/Meridians Access and Treat at the Yuan QI or Jing Level. At this level we are working with with issues that are deeply embedded in our lives. These are the 1st channels to develop in the embryo. Therefore, when working with the 8 Extraordinary Meridians we are reminding the body of what it was like when it was perfect. The First cell division‚creates the Du, Ren, & Chong The Second division creates the Dai The Third division creates the Yin Wei, Yang Wei, Yin Qiao & Yang Qiao

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They are the foundation of Yin & Yang, and the 7 & 8 year cycles

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Treatment Protocol for the Extraordinary Vessels Use this protocol for internal medicine, women’s health and psychological & emotional disorders. Other options exist for the treatment of pain Keep in mind that treating at the level of the Jing can take some time. It is not unusual to see results right away, and it is also not unusual for a course of treatment to take one to three months, at one treatment per week. Use the following needling order, and be sure to obtain the Qi deeply, for each point. 1. Needle Master Point / Opening Point • Right or Left - according to sex • Women / Right • Men / Left 2. Treat Coalescent Points on the Meridian, and other related points as needed 3. Needle Coupled Point /Closing Point 4. Remove Needles in reverse order: Last in-First out

General Uses for the Extraordinary Meridians Dai Mai (Belt Vessel) •



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Points • Master/Opening Point: GB 41 • Coupled/Closing Point: SJ 5 • Major Coalescent Points: GB 26 (27-28) Opens the Lower Warmer • All lower warmer stagnation • Adjusts the Menses • Guides and Supports the Uterus • Supports the Low Back • Radiatiing Low Back Pain Influences flow of LR Qi Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015



Harmonizes ascending and descending of Qi

Chong Mai (Penetrating Vessel) “Wide Trunk Road” • Points • Master/Opening Point: SP 4 • Coupled/Closing Point: PC 6 • Major Coalescent Points: ST 30, KI 11 to 21 • Sea of blood • Controls The Menses • Harmonizes ascending and descending of Blood

Ren Mai (Conception Vessel CV) •



Points • Master/Opening Point: LU 7 • Coupled/Closing Point: KD 6 • Major Coalescent Points: Ren 2 - Ren 15 Sea of Yin • Yin Deficiency with Yin Stagnation • Supports Yin: Jing and Fluids • Supports Yin (sex) Hormonal Balance • Relate to int. and ext/ genitalia

Du Mai (Governing Vessel GV) •



Points • Master/Opening Point: SI 3 • Coupled/Closing Point: UB 62 • Major Coalescent Points: Du 2 - Du 15 Governs the Yang • Supports the Spine • Enters the Brain • Supports the CNS • Supports Yang (Stress) Hormonal Balance

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Secondary Extraordinary Vessels Yin Qiao & Yang Qiao (Heel Vessels) •





Yin Qiao Points • Master/Opening Point: KD 3 • Coupled/Closing Point: LU 7 • Major Coalescent Point: KI 8 Yang Qiao Points • Master/Opening Point: UB 62 • Coupled/Closing Point: SI 3 • Major Coalescent Point: GB 20 Secondary for Excess patterns of Lower Jiao • Masses • Fibroids • Adhesions • Difficult delivery • External genitalia

Yin Wei & Yang Wei (Linking Vessels) • • • • • • • • • •

Yin Wei Points ! Master/Opening Point: PC 6 ! Coupled/Closing Point: SP 4 ! Major Coalescent Point: KI 9 Yang Wei Points ! Master/Opening Point: SJ 5 ! Coupled/Closing Point: GB 41 ! Major Coalescent Point: GB 21 Nourish Blood Calm mind /Shen

Zonal Approach to the treatment of pain using the Extraordinary Meridians. The pathways of the 8 Extraordinary Meridians and their associated channels, together construct the Anterior, Posterior, Medial, and Lateral Zones. Treating the opening and coupled points can influence the flow of Qi throughout these Zones, effectively treating

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many painful conditions. This Material is covered in detail in the Chapter on Treatment of Pain.

Psychological Issues & Extraordinary Meridians The language of Chinese Medicine is Psychosomatic. Although current translations of Chinese medical books often do not mention psychological disorders, translations can also be made in way that expresses the psycho-emotional aspects of the words. It is good to keep this in mind when considering points, and the Extraordinary Meridians. • Chronic Diarrhea or Purging = Not wanting to keep what you have • Angina = Heart Pain, Broken Heart • Nausea = Can’t stomach it, but can't let it go • Red Face = Anger, Frustration Also it is worth noting that depression is often related to Blood Deficiency. The body begins to accumulate fluid as a substitute for Blood, Then Dampness accumulates and transforms into phlegm, which prevents the free flow of the emotions, and leads to depression. Phlegm nodules also form which contribute to further stagnation resulting in disorders like fibromyalgia, chronic fatigue, and Qi Stagnation. The Extraordinary Meridians are particularly helpful in addressing some psycho-emotional issues. Below are some indications that may be helpful in pointing the direction for using them in such cases. Dai / Belt Mai • Major Issues which accumulate over time, which we can't stand, but can't get rid of • Unresolved Postnatal Issues,Trauma, Sentiments, Emotions, Guilt, Inadequacies • All these accumulations, concentrations, and conglomerations are deposited into the Dai/Belt Channel where they are stored. • When the Dai Mai gets saturated, it begins to leak out • This is like emptying the garbage, but we fill it up again & again • Physical Sx. Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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Infertility, Impotents, Reproductive disorders, Sagging feeling in the waist, Excessive vaginal discharge, Diarrhea, Constipation Psycho-Emotional sx. • Feeling Stuck, Indecisive, Lack of clarity, Lack of creativity, Inferiority

Chong / Penetrating Mai • Coming to terms with one's own nature, purpose, temperament & culture • The Chong Mai penetrates the center of the body, joining together the Kidney which stores Jing / Yuan Qi, the Spleen: which produces QI & Blood and the Heart which stores our consciousness Ren / Conception Mai • Sea of Yin • Yin Stasis, with Yin Deficiency • Yin forms the process by which we bond and form unions • Original Bonding / Mother Child Bonding • Nurturing • Security & Trust, Contentment, Feeling at Home • Completion, Craving completion • Competence, and control over internal and external environment Du / Governing Mai • Governs the Yang: Tai Yang, Xiao Yang, & Yang Ming • Yang allows for separation from the mother • Nurturing oneself • Ability to stand erect • Individuality • Moving into the World • Freedom of movement of head • Expression & temperance of desires / Taking risks • Survival Motivation

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Yin Wei / Yin Linking Mai • Treats traumas which may have occurred at a significant turing point in life, and which blocks full development • Devoting Qi & Blood to memories leaves less for the present moment • Contingency • Always Asking “What if…?” • Not accepting oneself Yang Wei Yang Linking Mai • Cast my net into the world • Forever searching for one's Role in Life • The process by which we move into a certain role in the world • Our choices and the process by which we don't choose • Commitment and lack of Commitment • Movement from Family Intimacy to Global commitments Yin & Yang Qiao Yin & Yang Heel Mais • Focusing on the present moment • Qiao = heel, stance, bridge, and motility • Yang Qiao = one's stance to the world • Yin Qiao = one's stance to oneself • Polar Opposites • Yin Qiao • Receiving of Qi • Introvert • Insomnia • Medial aspect of legs tight • “My Bad” • Yang Qiao • Giving of Qi • Extrovert • Hypersomnia • Lateral aspect of legs tight • “Everyone's and Idiot” The Chart of the 8 Extraordinary Meridian below, while not exhaustive, is included below for quick reference. Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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6. The Main Course: Treatment of Pain As mentioned above, there are three important facets to performing effective acupuncture treatment of pain: choosing the correct points, precise point location, the technique applied to the points.

Diagnosing The Pain First, don’t get too complicated. A complicated diagnosis can often distract from a successful treatment. Most pain for example, whether it is back pain, neck pain or leg pain; whether it is from a musculoskeletal injury, arthritis, bursitis, an inflammatory reaction, or as part of a sequela of stroke; will manifest as obstruction of the meridians due to either Qi (energy) Stagnation or Xue (blood) Stagnation. When treating the pain with acupuncture and related techniques, it is often of little consequence to the treatment, whether it is from Qi or Xue Stagnation. The main difference between these two syndromes lies more in the prognosis rather than treatment approach. The treatment, with acupuncture and associated techniques, is usually the same. However, in general, a more aggressive approach is used for Xue stagnation than is used for Qi stagnation. This differentiation also carries more significance when choosing topical or internal application of herbs. The complications of Cold, Heat, Dampness, and Wind can also often influence the treatment, but this is secondary to moving the stagnation.

Immobilization A commonly overlooked point in the treatment of injuries is immobilization. When there is a soft tissue injury, such as a strain or sprain, it is important to immobilize the area as much as possible

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until the discomfort has been relieved. When injured, the body’s response is to produce pain and swelling. This mechanism serves to protect the area and allows for natural healing to occur. In our society, we want to minimize down time and get back to work (or play) as soon as possible. So we reduce swelling, take pain relievers, or acupuncture and herbal wraps, and get right “back on our feet.” This approach may fit some societal needs, but it may not the best approach for one’s physical needs. Injuries take time to heal, and they require rest too. Many cases of chronic pain syndromes originally began with Qi and Xue stagnation, which stem from improper treatment of soft tissue injuries i.e. using the injured part too soon. I usually recommend that soft tissue injuries are well splinted, or wrapped, and that patients avoid using the affected part as much as possible, until most or all of the pain is gone. This leads to less trouble with Cold, Dampness, Stagnation, and the like, getting trapped in the meridians and causing future problems.

Ice & Heat The problem of cold getting trapped brings up the question of the application of heat or cold to an injury. In acupuncture theory it is well established that cold can penetrate an injured joint and stagnate, causing additional pain and possibly long term problems. Therefore, I avoid ice or cold unless it’s absolutely necessary. Either way, I strongly recommend using heat (moxa or TDP lamp) on injuries as soon as it is feasible, to move stagnation.

Treatment Results The question that may surface when considering the treatment might be, “Do I need to see immediate change from the treatment?” Yes. There should be some change in the condition at the time of the treatment. This is not to say that the treatment is ineffective if you do not see immediate change, but immediate results are a very good indication that you have found an appropriate treatment. I suggest that you continue to try different approaches to the problem until you get immediate results. This is Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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not always possible, and the patient will often find improvement after some time, but it is preferable to get those “right-before-youreyes” changes. So keep trying different techniques until you hit the one that clicks for that particular patient, at that particular time. While we are on the subject, consider that a strong acupuncture treatment for painful condition, will often leave the treated area sore, from the stimulation. This soreness should resolve in 12-24 hours. My brother tells all of his patients to wait 24 hours before judging the effect of a treatment. I think this is wise advice.

Palpation It would be difficult to overstate the usefulness of palpation. I have seen many practitioners, some of whom I admire and respect, practicing with little or no palpation. While they may get good results, I don’t understand how they know what to treat. To me it is vitally important to know exactly where the Qi is, where it is not, where it flows smoothly, and where it is stuck. Simple palpation of the meridians, acupoints, and trigger points, can easily reveal much of this information. In order to locate a trigger point, it is usually best to palpate muscles with deep cross-fiber palpation. Once a trigger point is located, be sure you keep track of it with your fingers, so you can be sure to accurately treat it with the needle. This is what I mean by precise point location. Be sure you’ve located the point of disharmony before you place the needle.

Local Treatment Should one treat the local area or avoid it? This is often debated amongst practitioners. I say treat it, in most cases. I hedge my bets here, because the practitioner must determine what will make the problem worse and what will make it better. If, for example, the patient reports that massage makes the problem worse, or if previous treatment to the area has resulted in an exacerbation of 175

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the problem, these could be indications that direct treatment may be cautioned, or contraindicated. However, I seldom see direct treatment exacerbate a painful condition, and even in those occasional situations, a few days of respite from treatment has allowed the condition to return to its pre-treatment level of discomfort, or better. The caveat here is that some problems benefit more from local, adjacent, and distal treatment, while others respond better to distal treatment only. How to asses the difference prior to treatment is not always clear. You’ll have to trust your experience and intuition.

Moving Stagnation In order to alleviate pain, the stagnation needs to be moved. While this is obvious, it must be consistently focused upon. Whether it is Qi or Xue stagnation, often the best course of action is simply to move it. I believe that moving stagnation takes precedence over building deficiencies, when treating pain, in almost every case. This is an important treatment strategy. If one attempts to build deficiencies in the presence of stagnation, it can lead to increased stagnation, hence more pain, or pain that is more difficult to treat. I have often found that. once the stagnation is successfully resolved, then deficiencies can be tonified. If the patient is extremely deficient, there may be cause for concern, but most of the time the deficiency can be better addressed after the pain has been treated. Most individuals will easily tolerate a bit of a decrease in Qi if it results in significant pain relief. Remember that pain itself affects an individual’s Qi. Relieving the pain with a dispersing treatment can make the patient feel better, and often stronger as well. My wife asserts that she regularly feels a deficient patient’s weak pulses become stronger after strong Qi-moving therapies, like cupping. She believes this may be because Qi that was previously stagnant becomes available to the body, increasing the overall Qi of the body.

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Treating Pain: Local, Adjacent, & Distal Points This is the standard approach for Treating Pain. The first question I look to answer is: “Where is the primary disharmony?” This is may seem obvious and, keeping in mind what I said earlier about not getting too complex, there is usually some looking to do. Diagnosis is like being a detective of sorts. One must find a number of clues before coming to a conclusion. If the problem is orthopedic in nature, the primary disharmony is usually at or near the site of the pain. When the primary disharmony exists someplace other than at the site of the pain, it is often found proximally. How does one assess if the primary disharmony is at the pain site or proximally, or distally for that matter? Palpation. I recommend that the practitioner look at the usual trigger points that are associated with the area of pain. (Get yourself a trigger point chart, if you don’t know them.) Then explore the local and adjacent musculature. If that isn’t sufficient, follow the dermatomes to the area on the back that corresponds to the more distal or more anterior pain, and then palpate. These dermatomes do not need to adhered to 100%. Rather, one should have an understanding of the pathways of the dermatomes and how they relate to the 12 main meridians and their corresponding Sinew (tendino-muscular) meridians and integrate the information gained from palpation to establish the most likely candidate areas for treatment. All three of the following point types should be explored when treating pain. Distal means you should use points that are distal to the pain and which affect the area of the pain. For instance: ! Bleeding a Jing point on the effected meridian (and/or) ! Using LI 4 and Lu 7 for Pain in the head and/or neck (and/or) ! Opening the Posterior Zone with SI 3 & UB 62 for back pain

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Local means using points at the pain site: Trigger Points. It’s sometimes half-jokingly put this way: “If it hurts, put a needle in it.” I don’t mean to say that trigger points are the most important. The practitioner is well served by being conscious of the acupuncture points, and established trigger points and their proper location. The proper location is like using a map. A map shows you where the place is, but it is only approximate. The location indicated is only as good as the map. And the map is only a symbol. So the best practice is to know the location of the local acupuncture points and established trigger points to get you to the area where the Qi can be most easily accessed, and then palpate for the exact location of the point to be needled. Adjacent means to palpate - radiating out from the painful site -for adjacent points that are reactive. In short, finding the associated trigger points. Some sources consider related points at adjacent joints to be adjacent points. For example, using LI 10 for shoulder pain. I have no problem with this, but it’s not a substitute for trigger point palpation. It’s not a bad idea to choose local, adjacent, and distal points from standard points on the Yang meridians, whenever possible. The Yang meridians are best for treating Yang disorders, and most musculoskeletal and neurological pain syndromes are generally considered Yang disorders. Major Yang Meridian Points to keep in the forefront of your mind, for easy and regular application as local, distal and adjacent points: ! LI 1, 4, 10, 14, 15, 20 ! ST 6, 7, 30, 36, 44, 45 ! SJ 1, 3, 5 ! GB 2, 8, 14, 20, 21, 26, 34, 41, 44 ! SI 1, 3, 11, 18 ! UB 1, 2, 10, 13, 18, 23, 40, 60, 62, 67 ! DU 4, 14, 20 ! LR 1, 3, 13 (The Liver is the Exception the the Rule. Liver points work as well as Yang Meridian points, for treating pain.)

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Sinew (Tendino-Muscular) Meridians Keep the Pathways of the Yang Sinew Meridians in mind, and treat Jing Points to clear pain from them. The Sinew Meridians can make a tremendous difference when treating pain. Bleeding 3-10 drops from the jing points on the affected meridians is often my first treatment for pain, especially in acute injuries.

Zonal Treatment for Treating Pain by Area The following zones can be opened or activated by treating the distal points associated with them. Opening these zones is one of the best ways to begin a treatment for pain. ! ! ! ! ! !

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Posterior Zone: SI 3, UB 62 Lateral Zone / Low Back/Hip/Sciatica: GB 41, SJ 5 Anterior (Internal) Zone: Lu7, KD 6 Anterior (External) Zone: LI4 - ST 36 Medial (Internal) Zone: Sp 4, PC 6 Medial (External) Zone: PC 6 – LR 3

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Zonal Treatment Procedure: 1. Determine in which Zone the disorder is manifesting 2. Treat appropriate zonal point that lies closest to the pain 3. Treat the second associated zonal point on the opposite side 4. Proceed with the rest of the treatment (Local, Distal, Adjacent, Microsystems, etc.) Example: Pain in Right Buttock 1. Posterior Zone, (Lower Right Quadrant) 2. Needle: UB 62 on the Right (Posterior Zone, Right Side, Lower Body) 3. Needle: SI 3 on the Left 4. Palpate, and treat Local and Trigger Points as necessary, etc. !

This is a simple procedure that has a big pay off.

Microsystems I use points from the Ear, and Scalp in most all treatments for pain. While I have not covered them in this book, microsystems are very useful, and one should consider using them for all painful conditions. Microsystem points are particularly helpful in that, when treated correctly, they often have instant effects. Hence, you get clear and direct feedback on the effectiveness of your technique and diagnosis. You should know a good selection of points and lines from the following microsystems of acupuncture: Auricular Acupuncture, Scalp Acupuncture Points & Lines, and Chinese Hand Acupuncture. There are many good charts for finding these points. The indications for most all Microsystem points are apparent from their names. For example, the foot point on the ear is good for 181

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treating any problems associated with the foot. next edition I will cover them in some detail.

Perhaps in the

Scalp Acupuncture can be especially effective, and when done correctly, it it’s no less comfortable than other forms of acupuncture. If you haven’t learned APS-USA (AcuPractice Seminars Unified Scalp Acupuncture), or YNSA (Yamamoto New Scalp Acupuncture), then I recommend that you learn one or the other. You’ll be glad you did.

The next page lists a group of points that are the main local points on various areas of the body, that are particularly useful for treating pain. All practitioners should be thoroughly familiar with them. They are points that you will likely be using over and over again in your practice.

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The Main Local Points for Treating Pain ! ! ! !

! ! !

Head ! St 3, 5, 6, 7, 8 ! ! LI 20 ! GB 8, 14, 20!! ! DU (GV) 20 ! SI 18 _____________________________________________ Neck ! GB 20, 21! ! ! UB 10 ! DU 14!! ! ! LI 17 area _____________________________________________ Shoulder ! GB 21!! ! ! LI 14, 15, 16 ! SJ 14, 15! ! ! SI 9,10,11,12 Jian Nei Ling (½ way between LI 15 and the superior anterior end of the axial crease) _____________________________________________ Elbow ! LI 11,12! ! ! SI 8 ! SJ 10 _____________________________________________ Wrist ! LI4, 5! ! ! ! SJ 4 ! SI 3, 4, 5, 6 _____________________________________________ Hip ! GB 26,27,29,30 _____________________________________________ Knee ! St 35, 36! ! ! GB 34 ! SP 9 (Yin) _____________________________________________ Ankle ! St 41! ! ! ! GB 40 ! UB 60, 61, 62

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! ! ! ! ! !

! ! ! ! ! ! ! ! ! ! !

The Recipes: Treating Specific Painful Conditions How To Use These Recipes First, I will often begin a course of treatments by bleeding 8-10 drops from the Jing point(s) on the affected meridian(s). I usually find that this works well for the first treatment or two, and can substantially reduce pain and discomfort. Subsequent treatment of Jing points generally offers only marginal results. Secondly, I usually open the appropriate Zone. The next step I’m likely to take is to add in other distal points, chosen from the recipes below. Then I’ll likely proceed with local and adjacent treatment as determined by palpation, informed by my knowledge of the appropriate acupuncture points and trigger points and their referral patterns. While this is a good approach in many, if not most cases, it won’t work every time. If it doesn’t, it’s time to look more carefully at the particular patient and pattern, to determine the best course of treatment.

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Headaches

!

Note: During a headache, use only light/gentle stimulus on local points General Headache Points: Use these points for all headaches, add specific points (below) for specific headaches ! LI 4, LU 7, SJ 5, GB 41, LR 3, Ear Shen Men !

! ! !

Frontal Headache: !

St 36, St 8, GB 14, UB 2, Yu Yao

!

Eye Headache / Pain: UB 2, GB 2 on affected side

!

Occipital Headache: !

!

Vertex Headache: Du 20, Si Shen Cong

One-Sided Headache: Tai Yang, GB 8 on the affected side

GB 20

Of course many headaches are chronic, and may require a deeper look into the pattern of disharmony that is causing the headaches. Still, these treatments work well in many cases.

Facial Pain ! TMJ and/or Tooth Pain: LI 4, LU 7, ST 44, !

!

! ! !

! St 3, St 4, St 5, St 6, St 7, SI 18 ! Scalp: ! Lower 2/5th of the Sensory Area ! ! on the opposite side Trigeminal Neuralgia: Same as above: Use caution on same side of pain. Often it’s best to focus on distal points

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Add 1 or more of the following based on pain location:

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and use local points on the opposite side from the pain, to avoid triggering the pain.

Neck Pain & Stiffness “Nape & Neck” and “Shoulder” Points on the Hand (located in both proximal metaphyses of the metacarpophalangeal joint of the index finger) should always be tried when treating neck pain & stiffness. !

Anterior Neck Pain/ Stiffness LI 4, LU 7, ST 36 Palpate and treat as necessary, local and adjacent trigger points, especially along the SCM and Scalene, following down to the pectoral region.

!

Lateral Neck Pain / Stiffness LI 4, LU 7, SJ 5, GB 41, Palpate and treat as necessary, local and adjacent trigger points especially along the SCM and Scalene. Posterior Neck Pain / Stiffness SI 3, UB 62, Palpate and treat as necessary, local and adjacent trigger points, especially along the trapezius and following tight muscles down into the back. The trigger points often cross the midline in the upper, mid and lower back, so be sure to palpate both sides of the spine.

Wrist & Hand Pain This is often associated with trigger points in the forearm. Palpate and treat as necessary, local and adjacent trigger points starting at the elbow and working your way down to the wrist. Of course you can and should treat local points, especially choosing from the effected Meridians. Perhaps choosing from the following: ! LI 4, 5: !! LU 7, 8, 9, 10 ! SJ 3, 4 Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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!

SI 2, 3, 4, 5, 6 !

PC 7, 8

Arm & Shoulder Pain Anterior Arm/Shoulder Pain LI 4, ST 36, LI 14, LI 15, Jian Nei Ling Palpate and treat as necessary, local and adjacent trigger points. LU 7 and KD 6 might be substituted for LI 4 & St 36, if the pain is closer to the LU meridian, or if the first set of points are not effective. Lateral Arm/Shoulder Pain SJ 5, GB 41, LI 14, LI 15, GB 21, Palpate and treat as necessary, local and adjacent trigger points. Posterior Arm/Shoulder Pain SI 3, UB 62, SI 9 and/or SI 10, SI 11 and/or SI 12, Palpate and treat as necessary, local and adjacent trigger points.

Upper and Mid Back Pain SI 3, UB62 to open the Posterior Zone There are a number of good acupuncture points for treating the mid and upper back, including the traps, but the Treatments of choice for this area are Cupping and Gua Sha. Cupping and Gua Sha can often release stagnation in this area quite effectively, and should usually be part of the treatment approach. Trigger points primarily, especially in the region of: ! SI 11, and GB 21. Also chose points from: ! Du 8 -14 and the associated Hua To Jia Ji Points 187

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Low Back & Hip Pain and Sciatica There are many influences on the low back and hips. Consider that the following Meridians all pass through and influence the lower back: Urinary Bladder Du Mai (Governing Vessel) Dai Mai (Belt Vessel) Gall Bladder In addition the strength of the low back is dependent on the vitality of the Kidneys. Given all that, I have found that Opening the Dai Mai with GB 41 & SJ 5 can be a highly effective treatment. That’s how I often begin a course of treatment. If you try this approach, you will be surprised at how often it gives very good results. Another very good approach is to begin by Opening the Posterior Zone, with SI 3 & UB 62. The following points all are useful local points for treating the low back and hips, and should be considered for treatment. Along with the usual palpation and treatment of Ashi and Trigger Points. ! GB 26, Du 4, UB 23, UB 52, UB 25, UB 32. ! Distal Points include UB 40, UB 60, UB 67

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Knee Pain Knees can be a little stubborn for a number of reasons. First, they take a lot of abuse from bearing excess weight, suffering from improper foot position when walking, and the relatively Yin location of the knees. Remember Yin is substantial, and the further down in the body one goes, the more substantial the problem becomes, and subsequently the tougher to move. That said, there are some good points to treat the knees. Distally, in addition to the usual Jing points and Zonal points, you can stimulate Shi Mian (center of the heel). I usually use moxa for this, but you can also needle it. Adjacent treatment generally consists of palpation above and below the knee, especially focusing on the calf to find trigger points. Local Points: ST 36, 35, 34, GB 34, Sp 9, 10, Xi Yan, UB 40

Foot & Ankle Pain Once again, the Yin location of the feet sometimes makes them difficult to treat, so I recommend you use a lot of points on the feet. I feel patients benefit from even 10 -12 points on each foot, if needed. I mainly choose from the Yang meridians, but don’t limit myself to them. The Liver meridian can be very useful here too. Local points to choose from include: Check the calf carefully for trigger points SP 6 and GB 39 together to open the meridians in the foot & Ankle Any of the Jing Points: UB 67, GB 44, ST 45, LR 1, Sp 1, ST 44, 42, 41 GB 43, 42, 40 UB 60, 61, 62, 63, 64, 65 LR 2, 3, 4 SP 2, 3, 4, 5 Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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KD 2, 3, 4, 5, 6

Abdominal Pain Abdominal Pain is clearly an internal medical problem and there are many reasons for it. With so many diagnosis resulting in abdominal pain, it’s difficult to offer comprehensive treatment advice in this work. However, there are a few treatments that can often help. As with all disorders, be sure you’ve diagnosed the patient carefully before beginning treatment. Open the Dai Mai GB 41, SJ 5 ! And/Or Open the Chong Mai SP 4, PC 6 Choose from: Ren 2, 4, 6, ST 25, REN 12

7. Review: National Board Exam & Program A. Introduction 1. This class will cover the information needed to effectively apply acupuncture in clinical settings, and to pass the National Boards in Acupuncture 2. Differing levels of understanding of the material apply to the various national exams. a) NBCE b) ACA / ABCA c) NCCAOM 3. Reference Material a) CookbookAcupuncture: by Jim Ventresca b) The Web That Has No Weaver: by Ted Kaptchuck c) Acupuncture Clean Needle Technique Manual http://www.ccaom.org/cntprogram.asp d) The Foundations of Chinese Medicine: by Giovani Maccocia

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e) A Manual of Acupuncture: by Peter Deadman and Mazin Al-Khafaji with Kevin Baker 4. History: a) Nei Jing: Yellow Emperor’s Internal Classic of Medicine (1) Oldest extant book on Acupuncture & Chinese Medicine (2) Probably written between 300 and 100 BCE b) The Nan Jing (1) Written in the Han Dynasty 206 BCE - 220 CE c) Chiropractic Acupuncture in US Since 1970s 5. The Five Branches of Oriental Medicine a) Acupuncture/Moxibustion b) Herbal Medicine c) Exercise : Qi Gong Tai Ji(ABCA d) Diet/Lifestyle e) Massage & Manipulation

B. General Theory 1. Yin Yang a) Everything consists of Yin & Yang (1) Relative terms that exist only in relationship to one another (2) Nothing is totally Yin or totally Yang (3) Yang produces Yin and Yin produces yang (4) If Yin increases, Yang decreases and vice versa (5) Each is necessary for the other’s existence (6) Infinitely Divisible (7) Inter-transformational Inter-consuming & Inter-supporting (8) At extremes Yin and Yang transform into one another b) Functions of Yin & Yang Energies in the Body c) Yin/Yang Table of Correspondences d) Anatomy of Yin/Yang Relationship Within Body

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b) c)

d)

e)

(2) Excess / Deficient (3) Internal / External (4) Hot / Cold Yin / Yang (1) Based on the other 6 principles Excess / Deficient (1) There are Many Various Signs of Excesses and Deficiencies in Organs, Substances, and Meridians. Internal / External (1) Location of Disease or Etiology (2) Internal (a) Many manifestations within the Organs Bones & Blood (3) External (a) Skin (b) Muscles (c) Meridians (Channels & Collaterals) (d) Lungs: i) Special Case: Upper Respiratory Infection (OPI/EPI/EPF) Hot / Cold

3. Five Elements a) Cycles & Pathology (1) Within each phase/element are Yin and Yang aspects, sometimes referred to as the husband-wife relationship (2) REVIEW Creative or Generating Cycle (Sheng) (a) AKA: Mother / Son Cycle (3) REVIEW Control Cycle (Ko) (a) AKA: Grandmother / Grandson relationship b) REVIEW: AcuPractice’s Table of 5 Element Correspondences

4. Chronotherapy (The Horary Cycle) a) b) c) d) 193

3-5AM / LU 5-7AM / LI 7-9AM / ST 9-11AM / SP

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e) f) g) h) i) j) k) l)

11AM-1PM / HT 1-3PM / SI 3-5PM / UB 5-7PM / KD 7-9 PM / PC 9-11PM / SJ 11PM - 1AM / GB 1-3AM / LR

C. The Essential Substances : 1. Qi, Xue (Blood), Jing (Essence), Shen (Spirit), Jin Ye (Fluids)

2. Qi a) b) c) d)

Energy, Prana, Life-force, Innate The Body Is It’s Physical Manifestation Circulates Inside and Outside the Meridians Origin (1) Constitution (2) Food / Drink (3) Air/ Environment e) Functions Of Qi! (1) Activation Or Movement (2) Warmth (3) Transformation (4) Defense (5) Containment f) Imbalances Of Qi (1) Deficient Qi (Qi Deficiency) (a) Signs & Symptoms (S&S) (b) Fatigue (c) Malaise (d) Pale Face (e) Weak Pulse (f) Pale & Swollen (Puffy) Tongue (g) Organ Dysfunction (2) Collapsed Qi (a) S&S (Two Presentations) (b) Qi Deficiency S & S + Prolapse

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(c) Qi Deficiency S & S + Heart Attack (3) Stagnant Qi (Qi Yu) (a) S&S (b) Dull Achy Pain / Unfixed in Time And Space (c) Intermittent Or Traveling Pain (d) Feels Better With Massage Strokes (e) Intercostal Neuralgia (LR Qi Yu) (4) Rebellious Qi (a) Moving In The Opposite Direction (b) S&S (c) Nausea / Vomiting / Acid Reflux (d) Cough / Sneezing

3. Jing a) b) c) d) e)

AKA: Pre-Heaven Qi, Constitutional Qi Formed At Conception; Inherited From The Parents Governs Growth and Development Stored In The Kidneys Imbalance: Jing Deficiency (1) Poor Development In Children (2) Poor Concentration / Memory (3) Reproductive Disorders (4) Loose Teeth (5) Brittle Bones (6) Gray-Thinning Hair (7) Senility

4. Blood a) b) c) d)

Blood Is Yin In Relationship To Qi Blood Is A Fluid and a Type of Qi Liquid Form Of Qi (Yin In Nature) Functions: (1) Nourishes All Parts Of The Body (2) Moistens All Parts Of The Body (3) Esp. Tendons, Eyes, Hair (4) Maintains Physical Structure (5) Cools (6) Calms (7) Provides Rest & Ability to Rest e) Relationships Of Blood: 195

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(1) Heart: Moves It Through Body (2) Liver: Stores and Releases (includes Menstrual Blood) (3) Spleen: Produces Blood & Holds It In the Vessels f) Disharmonies Of Blood: (1) Deficient Blood (Xue Deficiency) (a) Similar to Qi Deficiency, but with the addition of Lack of Nourishment, and Moistening (b) Fatigue (c) Malaise (d) Pale Lusterless Face (e) Weak Thin Pulse (f) Pale & Thin Tongue (g) Organ Dysfunction (h) Dry Skin (i) Brittle Hair (j) Twitches And Spasms (Due To Drying Out Of Tendons) (k) Scanty/Light/Shortened/Infrequent Menses (l) Dizziness (m)Difficulty Falling Asleep (Yin Substance) (n) Dry Eyes (Liver) (2) Stuck Blood (Xue Yu) (a) Sharp, Stabbing Pain Fixed in Time & Space (b) Tumors Or Cysts (Non-Moving) (c) Swollen Organs (d) Hematoma (3) Hot Blood (a) Red Dry Skin (b) Pimples (c) Rashes (d) Hemorrhage Of Fresh Red Blood (Hemorrhoids, Uterine Bleeding, Urine)

5. Fluids: Jin Ye b) Includes All Normal Bodily Fluids Except Blood c) Jin: Clear, More Yang, Watery d) Ye: Thick, Internal, More Yin 6. Shen (Spirit) Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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a) Spirit That Is Stored In The Heart and Reflected in the Eyes b) Emotional Problems, Psychological And Emotional Shock, Disturbances Of Psychological/Mental Nature

D. The Causes of Disease or Pathogenic Factors 1. External Pathogenic Factors AKA The Evil Winds a) b) c) d) e) f)

Wind Cold Damp Dryness Heat Summer Heat 2. Internal Pathogenic Factors AKA The Emotions a) Anger b) Joy c) Melancholy & Grief d) Meditation (Over thinking) e) Fear f) Fright 3. Miscellaneous Pathogenic Factors a) Inappropriate Diet b) Inappropriate Exercise c) Inappropriate Timing d) Parasites e) Trauma f) Insect / Animal Bites g) Epidemics h) Wrong Treatment

E. Organs 1. Lungs a) b) c) d) e)

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AKA: Tender Organ, Master Of Qi Opens To The Nose & Throat Most Easily Affected By OPI Dislikes Cold And Dryness Properties & Functions

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(1) Liquefies, Descends, Disseminates & Circulates Fluids (2) Governs Qi & Respiration (3) Rules The Exterior f) Common Disharmonies: (1) LU Qi Deficiency (2) LU Yin Deficiency (3) Rebellious Qi in LU (4) OPI (5) Dampness. Phlegm in LU g) Major S&S: Respiratory 2. Large Intestine a) The Official In Charge Of The Dregs b) Dependent Upon Lungs For Descending

3. Spleen a) AKA: The Official In Charge Of Transportation And Transformation (T&T) b) Governs T&T of Qi, Blood & Jin Ye c) Holds Blood & Organs in Place d) Opens To The Mouth: Manifests In The Lips e) Dislikes Dampness & Cold f) Rules The Flesh & Muscles g) Common Disharmonies: (1) SP Qi Deficiency (2) SP Blood Deficiency (3) SP Yang Deficiency (4) Dampness in SP h) Major S&S (1) Lower Digestive (2) Fatigue 4. Stomach a) The Official In Charge Of Rotting And Ripening b) Prepares Food and Drink for T&T by the Spleen c) Common Disharmonies: (1) Rebellious ST Qi (2) Heat in the ST d) Major S&S: Upper Digestive

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a) b) c) d) e) f)

Houses The Consciousness / Shen Rules Blood And Blood Vessels Dislikes Heat Opens To The Tongue Manifests In The Complexion Common Disharmonies: (1) Heart Blood Deficiency (2) Heart Yin Deficiency (3) Blood Stagnation in the Heart or Chest (4) Heat in the Heart g) Major S&S (1) Psychological Disorders (2) Palpitations 6. Small Intestine a) Separates The Pure From The Impure

7. Liver a) AKA The General AKA Free & Easy Wanderer b) In Charge of Planning c) Responsible for the Smooth and Easy Flow of Qi & Emotions d) Rules the Tendons & Muscles (1) Tight/Tense Muscles (2) Tics, Twitches & Tremors Sea of Blood (Stores) e) The Master Alchemist / transmutes and detoxifies f) Opens To The Eyes g) Dislikes WIND (Heat / Stagnation) h) Houses the Hun (ego) i) Common Disharmonies: (1) Liver Qi Stagnation (2) Liver Invading (a) Stomach (b) Spleen (c) Lung (3) Liver Blood Stagnation (a) Painful periods, Clots, Sharp Stabbing Pain j) Major S&S: (1) Stress Related Disorders (2) Anger / Irritability 199

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(3) Gynecological problems (4) Meridian related Sx. (a) Damp-Heat in the Liver and Gall Bladder 8. Gall Bladder a) The Official in Charge of Decision Making b) Very Closely Related to the LR

9. Kidney a) b) c) d)

AKA Root of Yin & Yang / Root of Life Opens To The Ears Dislikes Cold Functions (1) Stores Jing (2) It houses the Will (3) Rules the Bones (4) Housed in the Low Back (5) Rules the Knees & Ankles (6) Governs birth, growth and reproduction. (7) Nourishes and Warms (supplies Yin & Yang to) the Lower Warmer e) Common Disharmonies: (1) Deficiencies ONLY: NO Excess Conditions (2) KD Qi Deficiency (3) KD Yang Deficiency (4) KD Yin Deficiency (5) KD Jing Deficiency f) Major S&S: (1) General Qi & Yang Deficiency S & Sx (2) General Yin Deficiency S & Sx (3) Low Back / Knee Pain and Weakness (4) Impotence and Infertility (5) Incontinence / Urinary Frequency (6) S&S of Premature Ageing 10.Urinary Bladder a) Transforming and excreting fluids via the power of KD Qi

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b) Maintains The Order Of The Heart Energy c) Treats All Heart Disorders Organic & Spirit

12.San Jiao a) AKA: Triple Heater, Triple Warmer, Triple Energizer Triple Burner b) Literally Three Burning Spaces c) Upper Jiao (1) LU & HT (2) Respiration & Circulation d) Middle Jiao (1) SP & ST (2) Digestion & Assimilation e) Lower Jiao (1) KD, UB & Reproductive Organs (2) Elimination & Reproduction f) The Three Jiaos are collectively responsible for Water Metabolism (1) Classically Described As A System Of Sluices Or Waterways (2) Lung Adjusts Water (a) Descends & Disseminates - Sends it down (3) Spleen Transforms Water (a) T & T - Sends it Up (4) Kidney Rules Water (a) Powers the Process

13.Extraordinary (Curious) Organs a) Fu Shape /Store Essences b) Six Curious Organs (1) Gall Bladder (2) Brain (3) Marrow (4) Bone (5) Blood Vessels (6) Uterus

F. Tongue and Pulse Diagnosis 1. REVIEW Tongue a) Areas 201

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b) Color c) Shape d) Coating e) Moisture f) Features 2. REVIEW Pules a) Speed b) Strength c) Positions d) Qualities 3. REVIEW Tongue & Pulse Usual Combinations

G. Clean Needle Technique 1. 2. 3. 4. 5.

Hand Washing Sterile Needles Clean Field Isolate Used Needles Immediately Universal Precautions: Prevention of Exposure and Prevention of Disease if Exposure Occurs. 6. Clean Technique a) Using Sterilization, Disinfection, Antisepsis, washing, etc. b) Clean Field c) Biohazard Container 7. Risks to Acupuncture Providers 8. Risks to Acupuncture Patients a) Needle Sickness / Fainting b) Pain / Bruising / Swelling at Needle Site c) Stuck Needle d) Forgotten Needle e) Neuritis f) Moxa Burns g) Abscess h) Allergic Dermatitis i) Broken Needle j) Auricular Chondritis k) Pneumothorax l) Organ Puncture m) Seizures Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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9. Contraindications and Cautions a) Always use Caution when treating Patients who are or may be (1) Pregnant (2) Elderly (3) Imunocomprimised (4) Diabetic (5) Very Tired (6) Very Hungry (7) Under the influence of any Mind Altering/Pain Relieving Medications (8) Numb in an area to be treated b) Points Contraindicated in Pregnancy c) LI 4 (1) SP 6 (2) GB 21 (Caution) (3) Points on the Abdomen (Caution) (4) Points on the Lower Back (Caution) (5) GB 21 Contraindicated for patients with Heart Conditions d) Electro-Acupuncture Contraindicated for patients with (1) Pacemakers and other electrical implants (2) History of Seizure Disorders (3) Strongly Recommended not to apply electro-acupuncture across the heart (i.e. Chest to Back/ Left to Right/ Arm to Arm)

H. Acupuncture Techniques 1. Acupuncture/Moxibustion a) Needles (1) Standard (2) Retained (3) Bleeding b) Moxa (1) Direct (2) Indirect c) Electro-Acupuncture (1) Milliamp & Microamp (2) Invasive / Non-Invasive 203

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2. Non-invasive Techniques a) Cupping b) Guasha c) LASER d) Pressballs / Seeds e) Magnets 3. Moxa

I. Acupuncture Points and Meridians 1. Body Measurements and General Point Location 2. Point Categories a) Front Mu /Alarm: Treat the Organ (Yin) b) c) Back Shu /Associated: Treat the Organ (Yang) d) Yuan / Source: Treat the Yuan/Jing Level of the Organ e) Horary: Element Point that matches the Organ f) Luo /Connecting: Connects Husband/Wife Meridians g) Xi Cleft /Accumulation: Pain along the Meridian h) 5 Element/Command (1) Wood/Mu (2) Fire/Huo (3) Earth/Tu (4) Metal/Jin (5) Water/Shui i) Tonification / Mother (previous 5-element Sheng cycle point) j) Sedation / Son (subsequent 5-element Sheng cycle point) k) Transport (Shu Points) (1) Jing-Well aka Ting or Tsing (2) TM Meridian Clearing (3) Ying-Spring (4) Shu-Stream (5) Used with Jing-well for TM tx. (6) Jing-River (7) He-Sea l) Ah Shi Points: Locally Reactive Points (Trigger Points) 3. Du Meridian “Governing Vessel”

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a) The pathway of the Du Meridian runs from the perineum, up through the middle of the spine over the head and ending at the upper lip. All its points are on the posterior midline of the body. It is also the most Yang meridian on the body. Since Yang Meridians are often used to treat disorders along the pathway of the meridian, the Du is important, for treating any and all disorders of the back and specifically the spine. 4. Ren Meridian “Conception Vessel.” a) The pathway of the Ren Meridian runs from the perineum, up the midline of the front of the body ending just under the lower lip. All its points are on the anterior midline of the body. It is also the most Yin meridian on the body. Since Yin Meridians are often used to treat internal disorders, the Ren is important, for treating many internal disorders and especially those associated with reproductive functions. 5. Lung/Fei a) The pathway of the Lung Meridian runs from the second intercostal space 2/3 the distance from the middle of the sternum to the acromion process, down the anterior surface of the arm and ending at the proximal radial corner of the nail of the thumb. Since Yin Meridians are often used to treat internal disorders, the Lung Meridian is important, for treating many internal disorders associated with the Lungs. These include all respiratory disorders and symptoms associated with colds and flus. 6. Large Intestine/ Da Chang a) The pathway of the Large Intestine Meridian runs from the proximal radial corner of the index finger along the arm on the lateral border of the radial bone to the top of the shoulder, crossing the SCM on the neck to the lower border of the ala nsai, on the opposite side. Since Yang Meridians are often used to treat disorders along the pathway of the meridian, the Large Intestine is important, for treating any and all disorders of arm, neck and head. 205

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7. Stomach/Wei a) The pathway of the Stomach meridian runs from the middle of the lower border of the eye socket down to the outer corner of the mouth, then back to the mandible and up to the corner of the hairline. From there it proceeds down the front of the body along the mid-clavicular line over the ribcage, where it moves closer to the midline and down to the upper border of the pubic bone. From here it travels out to the leg and along a trajectory just lateral to the crest of the tibia, and on to the foot, ending at the proximal medial corner of the nail of second toe. Since Yang Meridians are often used to treat disorders along the pathway of the meridian, the Stomach meridian is important, for treating any and all disorders of and eye, head, teeth, and leg. 8. Spleen/Pi a) The pathway of the Spleen Meridian runs from the proximal medial corner of the nail of the great toe along the medial edge of the foot, up the leg following the posterior border of the tibia. At he waist it runs parallel to the midline along the mid-clavicular line until it departs to end at the mid-axillary line midway between the axilla and the free end of the 11th rib. Since Yin Meridians are often used to treat internal disorders, the Spleen Meridian is important, for treating many internal disorders associated with the Spleen. These include all digestive disorders and symptoms associated with fatigue, and dampness. 9. Heart / Xin a) The pathway of the Heart Meridian runs from the middle of the axiclla down the medial surface of the arm and ending at the proximal radial corner of the nail of the pinky finger. Since Yin Meridians are often used to treat internal disorders, the Heart Meridian is important, for treating disorders associated with the Heart. These include all mental / emotional disorders and symptoms associated with sleep. Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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10.Small Intestine/Xiao Chang a) The pathway of the Small Intestine Meridian runs from the proximal ulnar corner of the pinky finger along the arm on the lateral border of the ulnar bone to the back of the shoulder, through the scapula, up to the back of the neck past the ear and ending lateral to the eye. Since Yang Meridians are often used to treat disorders along the pathway of the meridian, the Small Intestine is important, for treating any and all disorders along its pathway, especially around the scapula, and neck. 11.Urinary Bladder / Pang Guang a) The pathway of the Urinary Bladder Meridian runs from the medial inner canthus up over the head just lateral to the midline, down the side of the neck where it separates into tow pathways, both running parallel to the midline of the back. One pathway is located at the distance of the medial border of the scapula, and the other is halfway between the medial border of the scapula and the midline. At the sacrum the meridian moves out to the buttocks and down to the center of popliteal crease, and throughout the back of the calf, to the ankle where it runs just under the lateral maleoleous ending at the lateral proximal corner of the little toe. Since Yang Meridians are often used to treat disorders along the pathway of the meridian, the Urinary Bladder is important, for treating any and all disorders of back, and legs. It should also be noted that this meridian contains the “Back Shu Points.” These are specific points for each of the Organs. 12.Kidney / Shen a) The pathway of the Kidney Meridian runs from the center of the ball of the foot along the medial edge of the foot, under the medial malleolus, up the medial aspect of the leg posterior to the tibia. At the waist it runs parallel and just lateral to the midline ending at the top of the sternum. Since Yin Meridians are often used to treat internal disorders, the Kidney Meridian is important, for treating many internal disorders 207

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associated with the Kidney. These include all growth development and ageing, reproductive and urinary disorders and symptoms associated with fatigue, and general weakness. 13.Pericardium/ Xin Bao Luo a) The pathway of the Pericardium Meridian runs from the chest down the medial surface of the arm and ending at the tip of the middle finger. Since Yin Meridians are often used to treat internal disorders, and the Pericardium is closely related to the Heart Meridian, it is most commonly used to treat disorders associated with the Heart. These include all mental / emotional disorders and symptoms associated with sleep, as well as organic heart disorders. 14.Triple Heater / Triple Warmer / San Jiao a) The pathway of the San Jiao is similar to that of the Small Intestine but more radial.. It runs from the proximal ulnar corner of the ring finger along the arm on the lateral border of the ulnar bone to the back of the shoulder, along the top posterior aspect of the trapezius, up to the back of the neck around the ear and ending just anterior to the tragus of the ear. Since Yang Meridians are often used to treat disorders along the pathway of the meridian, the San Jiao is important, for treating any and all disorders along it’s pathway, especially around the shoulder, and ear. 15.Gall Bladder / Dan a) The pathway of the Gall Bladder Meridian runs from the Lateral outer canthus back and forth coursing the sides of the head, down the side of the neck where it follows the top of the trapezius, down to the side of the ribcage, throughout the flanks, to the hip, and down along the most lateral aspect of the leg, to the ankle where it runs under the lateral maleoleous ending at the lateral proximal corner of the fourth toe. Since Yang Meridians are often used to treat disorders along the pathway of the meridian, the Gall Bladder is

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important, for treating any and all disorders of sides of the head, trunk, hip, and legs 16.Liver / Gan a) The pathway of the Liver Meridian runs from the proximal lateral corner of the nail of the great toe along the medial edge of the foot, up to the posterior to the border of the tibia between the Spleen and Kidney meridians. At he waist it runs parallel to the midline until it departs to the free end of the 11th rib, ending at the sixth intercostals space on the mid-clavicular line. The Liver Meridian is important, for treating many internal disorders associated with the Liver. These include many emotional disorders and symptoms associated with stagnation and wind. 17.Extraordinary Points 18.Additional Meridians a) The Eight Extraordinary Meridians.  (1) Access the deepest energies of the individual (2) Equalizing Qi Reservoirs (3) Link Meridians and Organs (4) Zonal / Planar Tx. Of Pain (5) Master & Couple Points (a) SI3 and BL62 (b) TH5 and GB41 (c) LU7 and KI6 (d) SP4 and P6.  (e) Ren Mai i) Master Point Lu 7 (f) Du Mai i) Master Point SI 3 (g) Chong Mai i) Master Point SP 4 (h) Dai Mai i) Master Point GB 41 (i) Yang Wei Mai i) Master Point SJ 5 (j) Yin Wei Mai i) Master Point PC 6 209

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b)

c)

d) e)

f)

(k) Yang Qiao Mai i) Master Point UB 62 (l) Yin Qiao Mai i) Master Point KD 6 12 Tendino-Muscular (Sinew) Meridians (1) Circulate on the periphery of the body. (2) Do not penetrate to the Zangfu. (3) Are associated with and take their names from the twelve primary channels. (4) Originate at the extremities / Jing-Well Points (5) Broadly follow the course of their associated primary channels but are wider. (6) Pain / Trauma 12 Divergent Meridians (1) Connect with their paired channel (2) Deeper than Main Meridians (3) Govern the inside of the body 12 Skin Regions (1) Related to the Main Meridians (2) Explain Dx & Tx via the skin 15 Luo Connecting Channels (1) One small branching channel for each of the 12 primary channels, one each for the Ren & Du, and one for the Great Luo of the Spleen Minute Collaterals

J. Auricular Acupuncture and Other Microsystems 1. Ear, Scalp, Hand a) Find point exactly b) Apply Active or Passive Movement During the Treatment c) Look For Immediate Change 2. Auricular Acupuncture a) Ear Anatomy is Crutial for Locating Points on Any Exam b) Major Points (1) Shen Men Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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(2) Heart (3) Liver (4) Kidney (5) Sympathetic N (6) Thirst (7) Hunger (8) Nicotine (9) Shoulder-Arm-Hand-Finger (10)Back (11)Hip-Leg-Foot-Toe (12)Sciatica (13)Uterus (14)Toothache (15)Aspirin Pt. K. Name That Disharmony / Diagnosis Review L. A Patient Presents with the following signs and symptoms: Fatigue, loose stools, pale thin tongue with a white coat, pale and lusterless face, lack of appetite, weak limbs, and a weak and thin pulse. M. A patient presents with the following signs and symptoms: Chronic neck and shoulder tension, pain in rib cage, plumb pit throat, pain on palpation on lower left side of the abdomen, angry disposition, slightly purple tongue, wiry pulse. N. A patient presents with the following signs and symptoms: Palpitations, malaise, fatigue,, a weak thin pulse, forgetfulness, confusion, and pale thin tongue with white coat, a pale lusterless face, and a thin weak pulse. O. A patient presents with the following signs and symptoms: Insomnia, chronic dry, sore throat, malor flush, restlessness, palpitations, weak legs, low back pain, dark scanty urination, thin red tongue with a peeled coat, thin rapid pulse. P. A Patient Presents with the following signs and symptoms: Sore Low Back which feels weak, and somewhat better with heat, frequent clear copious urination, low sex drive, fatigue, pale face, weak and slow pulse, pale and puffy tongue with a wet coat.

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Q. A patient presents with the following signs and symptoms: Asthma, restlessness, insomnia, thin and rapid pulse, thin red tongue with no coat. R. A patient presents with the following signs and symptoms: Insomnia, thin pale tongue especially at the center and tip, pale lusterless face, palpitations, chronic diarrhea, fatigue, thin weak pulse.

7.

Internal Medicine A.

Introduction 1. 2. 3. 4. 5. 6.

Respiratory Digestive Genitourinary Emotional Disorders Women’s Health Herbal Medicine 7. Internal medical diagnosis, and treatment with all Chinese Medical techniques, including Acupuncture, Herbs, Diet and Lifestyle. 8. Repetition of Disharmonies a) You will notice a necessary repetition of disharmonies in different disorders, which will assist you in learning and easily recognizing, and treating these problems. (1) i.e. Spleen Qi Deficiency may manifest as many different disorders, including (a) ! Digestive: Looses Stools, Lack of Appetite (b) ! Emotional: Depression (c) ! Women’s Health: Tendency to Miscarry

9. Theoretical Principles Review a) b) c) d) e) f) g) h)

Eight Principles Four Sets of Parameters Yin / Yang Internal / External Excess / Deficient Hot / Cold Five Elements The Essential Substances

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i) Qi (1) Qi Generation (2) Functions of Qi! (3) Imbalances of Qi j) Jing & Yuan Qi k) Blood (1) Functions: (2) Relationships Of Blood: (a) Heart, Liver & Spleen (3) Disharmonies Of Blood: l) Jin Ye m) Shen n) The Causes of Disease or Pathogenic Factors (1) External Pathogenic Factors (2) Internal Pathogenic Factors (3) Miscellaneous Pathogenic Factors

10. Meridian Review a) Points from the Yin Meridians are the ones most often chosen to treat internal disorders (1) LU, SP, KD, LR, Ht & PC b) Some Yang Meridians are also commonly used (1) UB, ST c) Extraordinary Meridians (1) Ren, Du, Chong, & Dai

11.Organs Review a) b) c) d) e) f) g)

Lung (Fei) - Large Intestine (Da Chang) Spleen (Pi) - Stomach (Wei) Heart (Xin) - Small Intestine (Xiao Chang) Liver (Gan) - Gall Bladder (Dan) Kidney (Shen) - Urinary Bladder (Pang Guang) KIDNEY (SHEN) Pericardium (Xinbaoluo) -San Jiao (Triple Warmer/Burner/Heater/Energizer)

12.Extraordinary Meridians a) Origin b) General Functions c) Zonal Meridian Treatment

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d) e) f) g) h) i) j) k) l)

Psychological Transformation Du Mai (Governing Vessel) Ren Mai (Conception Vessel) Chong Mai (Penetrating Vessel) Dai Mai (Belt Meridian) Yang Wei Mai Yin Wei Mai Yin Qiao Mai Yang Qiao Mai

13.Extraordinary / Curious Organs a) b) c) d) e) f)

Gall Bladder Brain Marrow Bone Blood Vessels Uterus

B. Respiratory System and Conditions 1. Upper Respiratory Conditions a) Sinus (1) Congestion (a) Pathology / Basic Patterns i) Wind ii) Phlegm iii) Heat iv) Cold (b) Meridian Techniques (c) Dietary / Lifestyle / Herbal Recommendations b) Headaches (1) Pathology (2) Phlegm (3) Meridian Techniques (4) Dietary / Lifestyle / Herbal Recommendations c) Other Headaches (1) Qi Yu (2) Yang Ming (3) Tai Yang (4) Xiao Yang Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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(5) Liver (6) Infections (7) Pathology / Basic Patterns (a) Wind / Heat / Phlegm (b) Wind / Cold / Phlegm (8) Meridian Techniques (9) Dietary / Lifestyle / Herbal Recommendations d) Ear Involvement (1) Pathology /Basic Patterns (a) Heat (b) Cold (2) Meridian Techniques (3) Dietary / Lifestyle / Herbal Recommendations e) Common Cold/ Viruses (1) Wind Cold (a) Pathology i) Sneezing / Runny/Stuffy Nose ii) White Mucous iii) Chills iv) Headache v) Body Ache (b) Meridian Techniques (c) Dietary / Lifestyle / Herbal Recommendations (2) Wind Heat (a) Tai Yang / Shao Yang / Yang Ming i) Pathology ii) Fever iii) Sore throat iv) Laryngitis v) Yellow/Green Mucous (b) Basic Patterns (c) Meridian Techniques (d) Dietary / Lifestyle / Herbal Recommendations

2. Lower Respiratory Conditions (1) Chest Cold / Heat (a) Pathology (b) Basic Patterns (c) Meridian Techniques 215

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(d) Dietary / Lifestyle / Herbal Recommendations (2) Chest Cold / Cold (a) Pathology (b) Basic Patterns (c) Meridian Techniques (d) Dietary / Lifestyle / Herbal Recommendations (3) Bronchitis (deeper level (a) Pathology / Basic Patterns i) Lung Qi Deficiency ii) Lung Yin Deficiency (b) Meridian Techniques (c) Dietary / Lifestyle / Herbal Recommendations

3. Allergies a) EENT (sinus, ears, eyes, post nasal) (1) Pathology (a) Wind Damp (2) Basic Patterns (3) Meridian Techniques (4) Dietary / Lifestyle / Herbal Recommendations b) Seasonal (1) Pathology (a) Wind Damp (2) Basic Patterns (3) Meridian Techniques (4) Dietary / Lifestyle / Herbal Recommendations c) Environmental (1) Pathology (2) Basic Patterns (3) Meridian Techniques (4) Dietary / Lifestyle / Herbal Recommendations d) Dietary (1) Pathology / Basic Patterns (a) Spleen and or Kidney Qi /Yang Deficiency (2) Meridian Techniques (3) Dietary / Lifestyle / Herbal Recommendations

4. COPD: Asthma, Chronic Bronchitis, Emphysema, etc. Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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a) Pathology / Basic Patterns (1) Lung Qi Deficiency (2) Lung Yin Deficiency (3) Spleen Qi/Yang Deficiency (4) Kidney Qi/Yang Deficiency b) Meridian Techniques c) Dietary / Lifestyle / Herbal Recommendations

5. Immune System Weakness a) Pathology / Basic Patterns (1) Kidney & Liver Yin Deficiency (2) Lung Qi/Yang/Yin Deficiency (3) Wei Qi Deficiency b) Meridian Techniques c) Dietary / Lifestyle / Herbal Recommendations

6. Smoking Cessation a) Pathology /Basic Patterns (1) Kid, LR, LU Yin Deficiency b) Meridian Techniques c) Dietary / Lifestyle / Herbal Recommendations

C. Gastro-Intestinal System & Conditions 1. Oral Cavity (mouth, tongue, teeth, lips) a) Ulcers / Burning Pain (1) Pathology / Basic Patterns (a) Stomach Heat / Fire (2) Meridian Techniques (3) Dietary / Lifestyle / Herbal Recommendations b) Tooth pain – dental anesthesia (1) Pathology / Basic Patterns (a) Yang Ming Excess (2) Meridian Techniques (3) Dietary / Lifestyle / Herbal Recommendations c) Post-surgical Pain (1) Pathology / Basic Patterns (a) Qi & Blood Yu (2) Meridian Techniques (3) Dietary / Lifestyle / Herbal Recommendations

2. Pharynx and Esophageal 217

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a) Swallowing Problems (1) Pathology/Basic Patterns (2) (3) Meridian Techniques (4) Dietary / Lifestyle / Herbal Recommendations b) Reflux Esophagitis (1) Pathology / Basic Patterns (a) Rebellious Stomach Qi (b) Stomach Heat / Fire (c) Stomach Yin Deficiency (d) Liver Invading Stomach (2) Meridian Techniques (3) Dietary / Lifestyle / Herbal Recommendations c) Hiatial Hernia (1) Pathology / Basic Patterns (a) Stomach Heat / Fire (b) Stomach Yin Deficiency (c) Liver Invading Stomach (2) Meridian Techniques (3) Dietary / Lifestyle / Herbal Recommendations d) Hiccups, Burping, Vomiting (1) Pathology /Basic Patterns (a) Rebellious Stomach Qi (b) Chong Mai Disharmony (2) Meridian Techniques (3) Dietary / Lifestyle / Herbal Recommendations

3. Stomach (1) Upset Stomach, Poor/ Weak Digestion (2) Pathology /Basic Patterns (a) Stomach Yin Deficiency (b) Spleen Qi / Yang Deficiency (3) Meridian Techniques (4) Dietary / Lifestyle / Herbal Recommendations b) Food Poisoning (1) Pathology / Basic Patterns (a) Summer Heat in Stomach and Intestines (b) True Cold in Stomach and Intestines (2) Meridian Techniques Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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(3) Dietary / Lifestyle / Herbal Recommendations c) Gastritis (1) Pathology / Basic Patterns (a) Stomach Heat / Fire (b) Stomach Yin Deficiency (c) Liver Invading Stomach (2) Meridian Techniques (3) Dietary / Lifestyle / Herbal Recommendations d) Ulcers (1) Pathology / Basic Patterns (a) Stomach Heat / Fire (b) Stomach Yin Deficiency (c) Liver Invading Stomach (2) Meridian Techniques (3) Dietary / Lifestyle / Herbal Recommendations e) Motion/Morning Sickness (1) Pathology / Basic Patterns (a) Chong Mai Disharmony (b) Stomach Qi Rebellion (c) Liver Invading Stomach (2) Meridian Techniques (3) Dietary / Lifestyle / Herbal Recommendations

4. Intestinal / Colorectal a) Poor Digestion (1) Pathology Basic Patterns (a) SP QI & Yang Deficiency (b) KD Qi & Yang Deficiency (c) Liver Invading Spleen (2) Meridian Techniques (3) Dietary / Lifestyle / Herbal Recommendations b) Gas and Distention (1) Pathology Basic Patterns (a) SP QI & Yang Deficiency (b) KD Qi & Yang Deficiency (c) Liver Invading Spleen (2) Meridian Techniques (3) Dietary / Lifestyle / Herbal Recommendations c) IBS, and Chron’s Disease 219

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(1) Pathology Basic Patterns (a) Liver Invading Spleen (b) SP QI & Yang Deficiency (c) KD Qi & Yang Deficiency (2) Meridian Techniques (3) Dietary / Lifestyle / Herbal Recommendations d) Hemorrhoids, Fissures, Fistulae (1) Pathology Basic Patterns (a) Spleen Qi Collapse (b) SP QI & Yang Deficiency (c) Heat in Lower Warmer (2) Meridian Techniques (3) Dietary / Lifestyle / Herbal Recommendations e) Parasites (1) Pathology / Basic Patterns (a) Damp Heat in Lower Warmer (b) Cold Damp in Lower Warmer (c) Summer Heat in Large Intestine (2) Meridian Techniques (3) Dietary / Lifestyle / Herbal Recommendations

D. Genito-Urinary System & Conditions 1. Kidney Disease / Failure a) Pathology / Basic Patterns (1) Kidney Yang Deficiency (2) Kidney Jing Deficiency b) Meridian Techniques c) Dietary / Lifestyle / Herbal Recommendations

2. Low Sex Drive, Impotence, Frigidity a) Pathology /Basic Patterns (1) Shen Involvement (2) Kidney Qi / Yang Deficiency (3) Blood Deficiency b) Meridian Techniques c) Dietary / Lifestyle / Herbal Recommendations d) Heightened Sex Drive (1) Pathology /Basic Patterns (a) Kidney Yin Deficiency Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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(b) Liver Qi Stagnation (c) Liver Yin Deficiency (d) Liver Fire

3. Urinary Tract Infections b) Pathology / Basic Patterns (1) Heat in Lower Warmer (2) Damp Heat in Lower Warmer (3) Cold Damp in Lower Warmer b) Meridian Techniques c) Dietary / Lifestyle / Herbal Recommendations

4. Urinary Retention a) Pathology /Basic Patterns (1) Dampness in Lower Warmer b) Meridian Techniques c) Dietary / Lifestyle / Herbal Recommendations

5. Male GU Conditions a) Low sperm counts, Abnormal Motility/ Morphology, Sterility (1) Pathology /Basic Patterns (a) Kidney Qi / Yang Deficiency (b) Kidney Yin Deficiency (c) Blood Deficiency (d) Liver Qi Stagnation (e) Liver Blood Stagnation (2) Meridian Techniques (3) Dietary / Lifestyle / Herbal Recommendations b) BPH (1) Pathology /Basic Patterns (a) Dampness in Lower Warmer (b) Kidney Qi / Yang Deficiency (c) Liver Qi / Blood Stagnation (2) Meridian Techniques (3) Dietary / Lifestyle / Herbal Recommendations c) Prostatitis (1) Pathology /Basic Patterns (a) Kidney Yin Deficiency (b) Liver Qi / Blood Stagnation

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(c) Liver Yin Deficiency (d) Liver Fire (2) Meridian Techniques (3) Dietary / Lifestyle / Herbal Recommendations

6. Female GU Conditions a) Endometriosis (1) Pathology / Basic Patterns (a) Liver Blood & Qi Stagnation in Lower Warmer (2) Meridian Techniques (3) Dietary / Lifestyle / Herbal Recommendations b) Ovarian, Uterine Cysts and Tumors (1) Pathology / Basic Patterns (a) Blood Stagnation (b) Phlegm (2) Meridian Techniques (3) Dietary / Lifestyle / Herbal Recommendations c) Prolapsed Urinary Bladder (1) Pathology Basic Patterns (a) Spleen Qi Collapse (b) SP QI & Yang Deficiency (c) Liver Invading Spleen (2) Meridian Techniques (3) Dietary / Lifestyle / Herbal Recommendations d) Menstrual Pain (1) Pathology / Basic Patterns (2) Liver Qi Stagnation (3) Liver Blood Stagnation (4) Chong Mai Disharmony (5) Dai Mai Disharmony (6) Meridian Techniques (7) Dietary / Lifestyle / Herbal Recommendations e) Infertility, Egg Production / Quality, Ovarian – Fallopian –Uterine – Vaginal Issues (1) Pathology / Basic Patterns (a) Kidney Qi / Yang Deficiency (b) Spleen Qi / Yang Deficiency (c) Heart Qi / Yang Deficiency (d) Liver Qi Stagnation Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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(e) Liver Blood Stagnation (f) Chong Mai Disharmony (g) Dai Mai Disharmony (h) Ren Mai Disharmony (i) Du Mai Disharmony (j) Shen Involvement (2) Meridian Techniques (3) Dietary / Lifestyle / Herbal Recommendations

8. WOMEN’S HEALTH A. Introduction 1. Women’s health take into account almost all the systems, organs, and substances in Oriental medicine, as well and most al of the treatment techniques. 2. Recommended Book Balance Your Hormones Balance Your Life: Claudia Welch

B. Review Major Relevant Points: 1. 2. 3. 4. 5. 6. 7. 8. 9.

Liver Spleen Kidney Heart Du Ren Chong Dai Lower Abdomen

C. Organs, Meridians, and Substances 1. Jing (Essence) a) Tian Gui b) “Minister Fire”/ “Motive Force”/ Mingmen fire c) Stored in the Mingmen (1) Lower Dan Tian (2) Lower Field of Elixir (3) In Women it Includes The Uterus (a) Zi Bao, Bao Gong,

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2.

3.

4. 5.

6.

i) Fetal Wrapper, Fetal Palace, Blood Chamber d) In men it includes the “Room of Sperm” Kidneys a) Store Jing b) Relevant Kidney pathology (1) Jing Deficiency (2) QI / Yang Deficiency (3) Yin Deficiency Menarche/Menopause a) “At 14 years if the Blood, Jing, Ren, and Chong are full, the Tian Gui (Heavenly Dew) descends” b) “At 49 years when the Ren, Chong, Fluids, and Blood become insufficient the Tian Gui withdraws” c) Blood “Women’s physiology is rooted in blood. Men’s in Qi” Conception Relies on Blood, from Mother a) Blood (post-natal Qi), essence (pre-natal Qi), Kid, LR, Ren, Chong, Yin b) In Pregnancy Blood nourishes fetus so it does not irrigate Chong. (1) No menses (2) Blood becomes milk. Liver a) Responsible for smooth flow of Qi & Emotions b) Stores Blood (1) Menstrual Blood and. regular Blood (2) Delivers Blood to uterus c) Moves the Qi that moves the Blood d) LR Channel flows through breasts (1) Breast pain & tenderness e) Relevant Liver Pathology (1) LR Qi Stagnation (2) Yang rising (3) Liver wind (4) LR Blood Stagnation (5) LR Blood Deficiency (6) Damp Heat in Liver channel

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7. Spleen a) Produces Qi & Blood b) Closely associated with Liver c) Amount of blood d) Timing of cycle e) Holds Blood in the vessels f) Holds Organs & Fetus in place g) Spleen Pathology (1) SP Qi and Blood Deficiency (2) SP Qi and Blood Deficiency w/ Damp (3) SP Qi Not Holding (collapsed/sinking) 8. Heart a) Governs Blood b) Pumps it thought the vessels c) Turns it red d) Personality/identity e) Bao mai (1) HT-UT connection (2) Shen/ emotions 9. Stomach a) Connected to Uterus via Chong Mai b) Channel flows through breasts (1) Breast milk 10.Extraordinary Vessels (see pocket reference card at end of notes) a) “Source of Creation” 1st channels in embryo b) Du and Ren cut thru Dai, linking it w/ Ht, genitals, umbilicus and Chong c) Du, Ren, Chong Arise from Mingmen and flow thru uterus, D d) Primary Extraordinary Vessels (1) Dai Mai (Belt Vessel) (a) GB 41 / SJ 5 (b) Opens the Lower Warmer (c) Influences LR Qi flow (d) Guides and supports Uterus & LW Qi (2) Chong Mai (Penetrating Vessel) (a) SP4 / PC6 225

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(b) Sea of blood (c) Controls menses (d) Access thru ST 30 i) KI 11 to 27 (3) Ren Mai (Conception Vessel) (a) LU7 / KD6 (b) Sea of Yin (c) Connect to Yin, Jing and Fluids (d) Relate to int. and ext/ genitalia (e) Hormonal gateway (4) Du Mai (Governing Vessel) (a) SI 3 / UB 62 (b) Rules the Yang e) Secondary Extraordinary Vessels (1) Yin/ Yang Qiao (Heel Vessels) (a) Used for Excess patterns of LJ (b) Masses (c) Fibroids (d) Adhesions (e) difficult delivery (f) external genitalia (2) Yin/Yang Wei (Linking Vessels) (a) Calm mind /Shen (b) Nourish Blood

D. Essential Etiology 1. Exterior Pathogenic factors a) Cold (1) Pain (Cramping Nature) (2) Warm it with moxa / TDP Lamp (3) Move it with acupuncture (4) Warm it with Herbs b) Dampness (1) Heaviness (2) Transform it by tonifying the Spleen (3) Vaporize it by tonifying the Kidneys (4) Circulate it with the Lungs c) Heat (1) Enters the Blood Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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(2) Cool it with Acupuncture or Herbs 2. Internal: Emotions and Stress a) Anxiety & Stress (1) Most Common Cause of Stagnation (2) Liver Qi & Blood (3) Chong Mai (4) Dai Mai (5) Spleen (6) Blood Deficiency (7) Emotional Stress @ Puberty (a) Ren & Chong b) Sadness & Grief (1) Ht (2) LR c) Worry (1) SP d) Anger (1) LR Qi Stagnation (2) LR fire e) Fear (1) Kid f) Shock (1) Ht, SP, Kid g) Guilt (1) Dai Mai 3. Diet a) Blood & Qi Deficiency (1) Dampness Collects b) Overwork/exercise = too long w/o good rest, diet (1) KD Yin Deficiency 4. Pregnancy & Childbirth a) Not enough rest after b) Pre-existing Blood and/or KD Deficiency c) Blood Deficiency 5. Abortion a) Blood Stagnation b) Blood & Qi Deficiency c) KD Deficiency 227

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6. Excess or Deficiency of Sexual activity a) Excess: During puberty, During period, During pregnancy (1) KD Deficiency b) Deficiency: Repression c) LR Qi Stagnation 7. C-Sections, Other Abdominal Surgeries, & Hysterectomies a) Disruption of b) Ren c) Chong d) Dai e) Blood Stagnation f) Adhesions g) Spleen and Kidney Deficiencies 8. Contraceptive pills & shots a) Unpredictable

E. Essential Diagnosis 1. Reproductive Cycle a) Menstrual phase (1) Blood moving (2) Liver Qi (3) Liver Blood (4) Scanty: move blood (5) Heavy: Stop bleeding b) Post-menstrual phase (1) Blood/ Yin Deficiency (2) Depleted Chong and Ren (3) Western: follicle grows, estrogen levels rise due to FSH direction (4) Nourish Liver blood and K yin c) Mid-cycle phase (1) Blood and Yin gradually fill up in the Chong and Ren (2) Western: ovulation. Ovum released from follicle and corpus luteum develops due to LH (3) Promote ovulation by nourishing k Jing

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2.

3.

4.

5.

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(4) [also TX Du, Ren, Chong, due to their hormonal connection] d) Pre-menstrual phase (1) Yang Qi rises (2) Liver Qi gears up to move liver blood (3) Tonify Yang if Deficiency / Move Liver Qi if stagnant Questioning a) Menarche b) Cycle (1) Amount (2) Color (3) Consistency (4) Pain c) PMS (1) Pain d) Vaginal discharge e) Fertility and pregnancy (1) Childbirth (2) Miscarriage and abortion f) Other Palpation a) Pulse (1) Fast = Hot (2) Slow = Yang Deficient Cold b) Abdomen and Muscles (1) Lack of integrity (2) Deficiency of Spleen and Kidney (3) Congestion in the Tissues (4) Masses / Fibroids Observation a) Complexion & Lips (1) Pale =Deficiency (2) Red = Heat Tongue a) Body color (1) Pale = Deficiency (2) Red = Heat

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b) Shape (1) Puffy = Qi or Yang Deficiency (2) Thin = Blood or Yin Deficiency c) Coating (1) Yellow = Heat (2) White = Not Hot (3) Sticky/Greasy = Dampness (4) No Coat / Peeled = Yin Deficiency 6. Odor a) Vaginal discharge / Menstrual Blood (1) Strong or unpleasant odor = Heat (2) NO Strong or unpleasant odor = Not Hot

F. Treatment of the Most Common Disharmonies 1. Castor Oil Packs/Massage a) Move Stuck Qi, Blood, & Phlegm 2. Warm Oil Massage (Abhyanga) a) Tonify Yin & Quell Wind

G. Treatment of Internal Organs 1. Kidneys a) Tonify Yang (1) Du Mai: SI 3 & UB 62 (2) General Points: (3) KD3, UB23, DU4, REN4, KD16 (a) All with moxa and needles b) Basic Herbal Patent Formula: (1) Jin Gui Shen Qi Wan c) Tonify Yin (1) Ren Mai: LU7, KD 6 (2) General Points: (3) KD7, UB23, DU4, REN4, KD16 (a) All with needles (4) Basic Herbal Patent Formula: (a) Liu We Di Haung Wan d) Yin Deficiency/Heat (1) Wise Women’s Well (K’an) (2) Two Immortals (Health Concerns) e) Conserve Jing f) Diet/Lifestyle Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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2. Liver a) Nourish Yin and Blood (1) General Points: (2) LR3, UB18, DU8, LR14 (a) All with needles (3) Basic Herbal Patent Formula: (a) Yin: Liu We Di Haung Wan (b) Blood: Ba Zhen Tang b) Soothe LR Qi (1) General Points: (2) LR 3, GB41, GB34, UB18, DU8, LR 14 (a) All with needles (3) Basic Herbal Patent Formula: (a) Xiao Yao Wan c) Move LR Blood (1) General Points: (2) LR 3, LR 8, UB18, DU8, LR 14 (a) All with needles (3) Basic Herbal Patent Formula: (a) Tong Jing Wan i) (Calm in the Sea of Life Pills) d) Clear LR heat / fire (1) General Points: (2) LR 1, LR 2, UB18, DU8, LR 14 (3) All with needles (4) Basic Herbal Patent Formula: (a) Long Dan Xie Gan Wan i) Very Cold / Caution e) Quell LR Wind (1) General Points: (2) LR 3, GB34, GB20, UB18, DU8, LR 14 (a) All with needles 3. Spleen a) Tonify SP Qi and Blood (1) General Points: (a) SP3, SP6, ST36, UB20, DU6, REN6, i) All with moxa and needles (b) REN8 231

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i) Moxa only (c) Basic Herbal Patent Formula: Ba Zhen Wan or Gui Pi Wan b) Raise SP Qi (1) General Points: (a) DU20, i) Moxa Only (2) SP3, SP6, ST36, REN6, REN8 (a) All with moxa and needles (3) Basic Herbal Patent Formula: (a) Bu Zhong Yi Qi Wan i) Not for long term use c) Harmonize SP and LR (1) General Points: (a) SP6, LR3, LR13, UB18, UB20 i) All with needles (2) REN8 (a) Moxa Only (3) Basic Herbal Patent Formula: (a) Xiao Yao Wan d) Tonify the SP and Resolve Damp (1) Diet Is Most Important (2) General Points: (a) SP3, SP6, ST36, UB20, DU6, REN6, i) All with moxa and needles (b) REN8 i) Moxa only (3) Basic Herbal Patent Formula: (a) Lui Jun Zi Wan 4. Heart a) Tonify Blood Deficiency (1) General Points: (a) Ht7, SP6, St36, UB20, UB15 i) All with needles (b) REN8 i) Moxa Only (2) Basic Herbal Patent Formula: (a) Gui Pi Wan or Suan Zao Ren Wan Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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b) Tonify Yin Deficiency (1) General Points: (a) Ht7, KD3, LR3, UB15, UB23, UB18 i) All with needles (2) Basic Herbal Patent Formula: (3) Tian Wan Bu Xin Wan 5. Uterus a) Warm Cold (1) General Points: (a) REN2, KD11, SP12, ST30, REN4, REN6 i) All with needles and Moxa (b) REN8 i) Moxa Only (2) Basic Herbal Patent Formula: (a) Moxa Most Important Here b) Move Blood (1) General Points: (a) LR3, SP8, UB31-34, UB23, REN2, KD11, SP12, ST30, REN4, REN6 i) All with needles (2) Basic Herbal Patent Formula: (a) Tong Jing Wan c) Move QI (1) General Points: (a) LR3, SP6, UB31-34, UB23, REN2, KD11, SP12, ST30, REN4, REN6 i) All with needles (2) Basic Herbal Patent Formula: (a) Xiao Yao Wan

H. Specific Disorders 1. Menstrual Irregularities a) Most Common Tx principles (1) Harmonize Dai, Chong, & Ren (2) Harmonize Liver (3) Tonify Blood (4) Tonify Spleen (5) Tonify Kidneys (6) Move (invigorate) Blood 233

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b) Early periods (1) Cycle less than 28 days (2) etiology and pathology (a) Qi Deficiency (b) Blood heat i) Full ii) empty (3) Differentiation and tx (a) SP Qi Deficiency (b) KD Qi Deficiency (c) Full heat from LR Qi Stagnation turning to fire w/ Blood heat (d) Empty heat from LR and KD Yin Deficiency c) Late periods (1) >28-30 day cycles (2) Etiology and pathology (a) Pregnancy (b) Blood Deficiency (c) Cold in the uterus (d) Full cold (e) Empty cold (f) KD Yang Deficiency (g) Qi stag d) Irregular Periods (1) Sometimes early; sometimes late (2) Not pathological, immediately pre-menopausal. (3) Always related to LR., and often to KD (4) Etiology & Pathology (a) Emotional stress (b) LR Qi stag (c) LR Blood Deficiency (d) Overwork, too many children too close together (e) KD Yang Deficiency (f) KD Yin Deficiency e) Heavy periods (1) Periods that occur regularly but are heavier than normal (2) Can be subjective (30-80ml is broad range) Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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f)

g)

h)

i)

j)

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(3) Etiology and pathology: (a) Qi Deficiency (b) Blood Heat (c) Secondarily (d) Blood stasis Scanty periods (not “late”) (1) Bleeding is very light, or lasts only 2-3 days (2) Etiology and pathology (a) Blood Deficiency (of the liver, mostly) (b) KD Yang Deficiency: (c) KD Yin Deficiency: (d) Stasis of Blood (e) Phlegm obstructing the uterus Long periods (1) Prolonged bleeding which may last 7-10 days w/ normal amt of bleeding and reg. cycle (2) Etiology and pathology (a) Qi stag and Blood stasis (b) KD Yin Deficiency w/ empty heat Painful periods (1) Diagnosis (a) LR Qi stagnation (b) Blood Stasis (c) Cold in Uterus (d) Pain May be Secondary to: i) Damp-Heat ii) Stag LR Qi turns to fire iii) Qi, Blood, and or Yin Deficiency: Bleeding Between Periods (1) SP/KD Yang Deficiency (2) Blood stasis (3) Damp Heat (4) LR and KD Yin Deficiency w/ empty heat No Periods (1) Pregnancy (2) Blood Deficiency (3) Ht and SP Blood Deficiency (4) SP and KD Yang Deficiency

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(5) LR and/or HT and/or KD Yin Deficiency (6) Stag of Qi and Blood (7) Damp-Phlegm in Uterus k) Flooding and Trickling (1) “beng lou” (a) beng = flooding, bursting through (b) lou = trickle metorrhagia (2) Be sure to take the common western differentiations into consideration: (a) carcinoma of the cervix (b) carcinoma of the uterus (c) myomas (d) endometriosis (e) endometrial polyps (3) There can be mixes of conditions (full and empty together) (a) Full Blood Heat (b) Liver Qi stag Turning into Heat (c) Stasis of blood (d) Damp Heat in the Uterus (e) SP not Holding Blood (f) KD Yang Deficiency (g) KD Yin Deficiency 2. Yeast Infections a) Dampness in the Lower Warmer b) Dai Mai, Lower Warmer Points c) Cold (1) LR 3, KD 3, LR 5 (2) Er Chen Wan (3) Wen Dai Tang d) Heat (1) LR 2, KD 2, LR 5 (2) Yu Dai Wan (3) Long Dan Xie Gan Wan 3. Genital Herpes a) Damp Heat in the LR Meridian b) LR 2, KD 2, LR 5 c) Long Dan Xie Gan Wan Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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4. Problems at Period time a) PMS (1) LR Qi stag (2) Prognosis and Prevention b) Secondary (1) LR blood Deficiency (2) SP and KD Yang Deficiency (3) LR and KD Yin Deficiency (4) Phlegm fire harassing upwards c) Pre-Menstrual Breast distention (1) LR Qi stag (2) Liver Blood Stasis (3) Secondary (4) Phlegm with Qi Stag (5) LR and KD Yin Deficiency d) Headaches (1) Blood Deficiency (2) Secondary (a) Liver Fire Blazing (b) Liver Yang Rising (c) Blood Stasis e) Edema at period time (1) Face, hands, lower legs, ab. Usually before the period (2) LR Qi Stagnation f) Diarrhea: Before, during or after period (1) SP Qi Deficiency (2) Liver Qi stagnation invading the Spleen (3) KD Yang Deficiency g) Dizziness at Period Time (1) Includes blurry vision and may occur before, during or after the period (2) Blood Deficiency (3) KD and LR Yin Deficiency w/ Liver yang rising (4) Phlegm w/ SP Qi Deficiency 5. Disorders of Pregnancy a) Cautions & Contraindications if a Woman Is or May Be Pregnant 237

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b) Forbidden Points: (1) LI4 & SP6 (2) GB 21, UB 67, UB 60 c) Any strong downward moving treatment d) Points Below Umbilicus, Any Time During Pregnancy e) Points Below Ren 12, Any Time After the First Trimester f) Forbidden Treatments (1) Do Not Cause Sweating (2) No Diaphoretic Points or Herbs (3) Do Not Promote Downward Motion (4) No Purgative Points or Herbs (5) Do Not Promote Urination W/ Herbs That Drain Damp (6) No Diuretic Points or Herbs g) Restless Fetus (1) Kidney 9 Located 5 cun superior to KD 3 (2) “Happy Baby Point” Dr. So: needle at end of first and second trimester – baby will not have colic, and will respect his/her parents h) Morning Sickness (1) Chong Mai Disturbance (2) Secondary: Liver Qi invading the St i) Abdominal pain (1) Usually not severe but rule out ectopic pregnancy or threatened miscarriage. (2) Qi Stagnation (3) Blood Deficiency j) Breech Baby (1) UB 67 k) Threatened miscarriage / Habitual miscarriage (1) Etiology: (a) Qi and Blood Deficiency (b) Ren, Du, and/or Chong weakness, (c) KD Deficiency l) Falls, trauma (1) injure the Ren and Chong (2) Calm the Fetus, Chong ,and Ren Copyright Dr. Jim Ventresca / AcuPractice™ Seminars 1994 - 2015

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m) Constipation During Pregnancy (1) Common. Can’t use purging or downward Qi promoting herbs or points (2) Etiology: (a) Blood Deficiency (b) Liver- Qi stag (c) KD Yang Deficiency (d) KD Yin Deficiency

6. Disorders after childbirth: a) Postpartum Depression (1) Ht Blood Deficiency (2) Secondary: Ht Yin Deficiency b) Abdominal pain after childbirth (1) Blood Deficiency (2) Blood Stasis (3) Retention of Food c) Persistent Discharge of lochia (1) >6 Weeks (2) Qi Deficiency (3) Blood Stasis (4) Blood-Heat d) Lochial retention (1) Qi and Blood stagnation (2) Stagnation of Cold and stasis of Blood e) Prolapse and Hemorrhoids after Childbirth (1) Blood Deficiency (2) Spleen Qi Sinking (3) Kid-Yang Deficiency f) Constipation after Childbirth (1) Blood Deficiency (2) Spleen Qi Deficiency (3) Kid-Yang Deficiency (4) Kid-Yin Deficiency g) Breast Milk not Flowing / Acute mastitis (1) Qi & Blood Deficiency (2) Liver-Qi stagnation h) Acute Mastitis: (1) Toxic Heat affecting the Liver, St and GB 239

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7. Infertility a) b) c) d) e) f) g) h) i)

Chong Mai, Dai Mai, KD Yang Deficiency, KD Yin Deficiency Qi & Blood Deficiency Cold in Uterus Qi Stagnation Stasis of Blood Dampness in the Lower Jiao Blood Heat Note: Male infertility can be from any of the above, but is usually KD Yang Deficiency

8. Breast lumps a) Liver Qi Stag b) Disharmony of Ren and Chong c) Spleen Yang Deficiency w/ Phlegm

9. Abdominal Masses a) b) c) d) e)

Qi masses Liver Qi stag Retention of Food and Phlegm Blood masses Stagnation of Qi and Blood

10.Polycystic ovary disease a) KD Yang Deficiency, Phlegm, Dampness and Blood Stasis

11. Menopause a) KD Yin Deficiency (1) KD and Liver Yin Deficiency w/ Liver Yang rising (2) KD Yin and/or KD Yang Deficiency (3) KD and Ht Yin Deficiency 12.Osteoporosis b) Kidney Yin, Yang, or Jing Deficiency

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Women’s Health: Name That Disharmony 1. A 24 year old woman presents with the following signs and symptoms: Excessive Menstrual Bleeding, the menstrual flow is pale and dilute, the patient also has loose stools, fatigue, pale thin tongue with a white coat, pale and lusterless face, lack of appetite, weak limbs, and a weak and thin pulse 2. A 24 year old woman presents with the following signs and symptoms: PMS Mood Swings, severe tenderness, and abdominal pain all increasing until the first day of bleeding; chronic neck and shoulder tension, pain in rib cage, plumb pit throat, pain on palpation on abdomen lower left side, slightly purple tongue, wiry pulse. 3. A 36 year old woman presents with the following signs and symptoms: Postpartum Depression, fatigue, palpitations, a weak thin pulse, forgetfulness, confusion, pale thin tongue with white coat. and a pale lusterless face. 4. A 48 year old woman presents with the following signs and symptoms: Insomnia, chronic dry, sore throat, malor flush, restlessness, palpitations, weak legs, low back pain, dark scanty urination, thin red tongue with a peeled coat, thin rapid pulse 5. A 48 year old woman presents with the following signs and symptoms: Lowered Libido, sore low back which feels better with heat, frequent clear copious urination, , fatigue, pale face, weak and slow pulse, pale and puffy tongue with a wet coat. 6. A 24 year old woman presents with the following signs and symptoms: Excessive White Leucorrhea, fatigue , chronic

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diarrhea, palpitations, thin pale tongue with a greasy white coat, pale lusterless face, thin weak and slippery pulse.

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