Acupuncture Patterns and Practice.pdf

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Acupuncture
PAT T E R N S
PRACTICE
Li Xuemei & Zhao Jingyi
Contents
Foreword • ••• v
Acknowledgements ••••
vii
Preface ••••
ix
COLD
1
COUGH
DIZZINESS
19
37
HEADACHE
LOWER BACK PAIN
57
83
PAINFUL OBSTRUCTION
WINDSTROKE
101
127
INSOMNIA
PALPITATIONS
149
169
Select Bibliography •••• 189
Point Index •••• 191
General Index
193
m
Common
Cold
case l: Male, age 30
Main complaint
History
Fever
Two-day history of fever. The patient was exposed to cold in the course of a
business trip. He felt cold and had anaversion to cold. His temperature was 38.6°C.
There was nasalobstruction with watery nasaldischarge, an absence of sweating,
no sore throat but a slight cough with some whitesputum, and generalized aching.
He was not thirsty. His appetite was poor. Urination and bowels were normal.
Tongue
Pulse
Slightly red body, thin, white, rather moist coating
Floating and a little tight
Analysis of symptoms
1. Feeling chilled, accompanied by fever—
invasion of superficial tissues by pathogenic factors.
2. Absence of sweating—obstruction of the pores.
3. Nasal obstruction with watery nasal discharge, cough with white sputum-
obstruction of Lung qi.
4. Generalized aching—poor movement of qi in the channels.
5. Light red tongue with thin coating and floating pulse—exterior pattern.
6. White, moist coating, tight pulse—cold.
Basic theory of case
In Chinese medicine there are six important environmental factors: wind, cold,
summerheat, dampness, dryness, and fire. Under certain conditions these natural
factors can become pathogenic, i.e., cause disease. Each pathogenic factor has
different characteristics, thus the signs and symptoms caused by each of them are
likewise different.
Cold is one of the most common pathogenic factors. Among its characteristics
are the following:
• Cold is a yin pathogenic factor. It obstructs the circulation of yang qi, and also
readily consumes the yang of the body.
• Cold has a tendency to 'freeze' and therefore to slow down circulation of qi
and blood, leading to obstruction in the channels.
Common Cold
• Cold is characterized by constriction, which closes the pores in the skin and
constricts the interstices and pores, leading to an absence of sweating. Constric
tion in the channels and collaterals results in generalizedaches and pains, while
muscle spasm occurs when there is constriction of the muscles and sinews.
Cause of disease
Pathogenic cold
There is a clear history of exposure to cold, and the symptoms include aversion
to cold with an absence of sweating and generalized aching. These symptoms imply
that the protective qi and the pores are blocked by the cold, leading to poor
circulation of qi and blood in the channels and collaterals.
Site of disease
Superficial tissues, namely the skin, interstices and pores, channels and collaterals.
The main evidence to support this finding is the aversion to cold and fever
occurring together, absence of sweating, light red tongue with thin white coating,
and floating pulse.
When external pathogenic factors in the environment invade the body, it is the
Pathological change
Fig. 1
superficial tissues that are affected first. Under normal conditions the protective
qi circulates and spreads over the body surface, regulating body temperature, so
that in good health a person does not feel unduly cold.
In this case the invasion of pathogenic cold has injured the protective qi,
interfering with its function and preventing it from reaching the body surface, such
that the patient feels cold. The characteristic of this type of cold is that the patient
feels cold and may even shiver, but the cold is not alleviated by putting on more
clothing.
There are two reasons why the patient also has a fever. Protective qi is part
of the yang of the body and therefore has a tendency to move and to be warm.
When it is prevented from reaching the body surface by pathogenic cold, it becomes
stagnant and confined to a deeper level of the body, thus producing heat. At the
same time, the conflict between the protective (antipathogenic) qi trying to reach
the body surface and drive out the pathogenic cold which is blocking its progress
also generates heat and raises the temperature. The presence of both fever and
aversion to cold is characteristic of the invasion by pathogenic cold.
Protective qi fails
Body surface
loses its warmth
AVERSION
Pathogenic cold —* Body surface
Stagnation of
protective qi
r
to reach surface
>6 COLD
i
Aversion to cold and fever at the
same time (aversion to cold > fever)
-
Stagnation of protective
qi inside becomes heat
t
•^ FEVER
Cold constricts and the patient does not sweat because the pores in the skin
are constricted and closed. The tendency of cold to cause constriction or 'freezing'
also leads to the stagnation of qi and blood in the channels and collaterals, which
in turn causes general aching.
The Lung governs the skin and body hair and has the function of dispersing
the protective qi over the body surface. When there is invasion by pathogenic cold
this is no longer possible, so there is a tendency for the Lung qi to stagnate,
producing a mild cough. The Lung opens through the nose, thus dysfunction of
the Lung in dispersing leads to nasal obstruction and discharge.
Common Cold
A light red tongue with a thin white coating is normal. Here it signifies that
the pathogenic factor is only on the surface and has not influenced the function
of the Organs. The moist coating likewise indicates that the body fluids are not
injured.
The pulse is floating because the pathogenic factor is on the surface of the
body, and because cold causes constriction, the pulse is also tight.
Pattern of disease
The pathogenic factor has invaded the superficial tissues but has not affected the
Organs, thus this is an exterior pattern.
The patient feels aversion to cold but is not sweating, has white sputum, a
white tongue coating, and a tight pulse. These syjnptoms all indicate cold.
The history is only two days long, and all of the symptoms are caused by
invasion of the pathogenic factor, with no obvious injury to the antipathogenic
factor or body resistance. The pathogenic factor is strong and this implies a pattern
of excess.
Additional notes
1. Why does the patient have a poor appetite?
The Spleen has the function of bringing body fluids and food essence upwards
to the Lung. The pathogenic cold has interfered with the Lung's ability to dis
perse, and this in turn has to some extent affected the fimction of the Spleen.
2. Is there evidence of an interior pattern in this case?
The Lung's function of dispersing and the Spleen's function of transporting food
essence are affected, so why is this an exterior pattern? The pathogenic factor at
present is confined to the skin,interstices and pores, channels and collaterals and
has not invaded either the Lung or Spleen. The dysfunction of Lung and Spleen
are merely secondary to the surface stagnation. They are not the main complaint,
and there is no other evidence of an interior problem.
Conclusion
1. According to the eight principles:
This pattern is exterior, cold, and excessive.
2. According to etiology:
Invasion of superficial tissues by pathogenic cold.
Treatment principle
1. Expel the pathogenic cold.
2. Relieve the superficial obstruction.
L-7
(lie que)
B-12
(feng men)
G-20
(feng chi)
Selection of points
Explanation of points
L-7
(lie que)
is the connecting point of the Lung channel which has the function
of promoting the dispersing action of the Lung to relieve obstruction in an exterior
pattern.
B-12
(feng men)
is a point on the greater yang channel. Its name means 'gate of
wind'. According to the six-stage theory of disease, the greater yang is responsible
for the surface of the body. This point regulates the qi in the channel, expels
pathogenic wind and cold, and removes obstruction. It is a very good point for
treating chills, fever, and aching.
G-20
(feng chi):
Here this point is used because it is a meeting point between
the lesser yang channel and the yang linking vessel. The yang Unking vessel is
responsible for yang function and relieves exterior symptoms. It is situated on the
nape of the neck and is therefore good for removing headache, obstruction in the
channels, and exterior patterns involving stiffness in the upper back and nape.

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