I had the wonderful opportunity to finish my last acupuncture course at South Baylo University School of Oriental Medicine this past quarter. It has been a labor of love. Three years later, still with questions, I have come to appreciate the depth and complexity of traditional Chinese medicine, and I'm fully aware that my knowledge and skills are in its infancy.
I finished up my last acupuncture course with Acupuncture Theory & Therapy B with Dr. Zhao Wang. Dr. Wang, an acupuncture purist, challenged the entire class to focus on the treatment of diseases and condition from the classics. I would like to share highlights from one of his lectures as a different approach in treating bi syndromes, but before sharing those highlights, we must remember that as our health care system in the United States becomes more intertwined with many other disciplines, it is important for all practioners to recognize and differentiate different diseases from both the Eastern and Western mind frame.
According to the classics, bi syndrome is the imbalance of the yin qi and wei qi meridians. The imbalance of these two meridians creates a circulatory dysfunction of qi, which manifests itself in specific clinical symptoms. To understand and treat bi syndrome, one must consider factors such as time, season and symptoms. For example, in the summer time, the zang/fu organ that is mostly affected is the heart, and the tissue structures involved are the vessels from which the patient will present the symptoms closely related to vessel bi syndrome. In the spring, the zang/fu organ mostly affected is the liver, and the tissue structures involved are the tendons from which the patient will present with symptoms closely related to tendon bi syndrome. The following chart is a review of the Five Element phases, which reveal the interconnectedness of tissues, organs and our environment.
Skin & Hair
The most common symptom associated with muscle bi syndrome is the sensation of numbness. For skin bi syndrome, it is the sensation of coldness; for bone bi syndrome, it is the sensation of heaviness. Bi syndromes generally do not always have to have the association of pain or discomfort as a symptom.
According to the classics, the reason why there is a close association of cause and effect of a bi syndrome and the zang/fu organ is simply because external pathogenic factors can affect the internal zang/fu organs through the meridians and channels. Therefore, liver problems can cause tendon bi syndrome, just as chronic tendon problems can cause liver problems. The table below synopsizes the various types of bi syndrome and its relationship with the zang/fu organ and its associated symptoms.
Skin & Hair
Cough, asthma, sensation of chest fullness
Palpitation, asthma, shortness of breath
Easy to wake up at night, need to drink a lot of H2O, frequent urination, distention on the side of the chest
Four-limb weakness and tightness, coughing & vomiting
Skin, Hair or Vessels
Large intestine or small intestine
Need to drink a lot of water, difficulty urinating, diarrhea
Weak foot strength, difficulty walking and abdominal distention
Lower abdominal heat sensation, difficult urination, runny nose
When treating bi syndrome, it is vitally important to focus on your differential diagnosis with both your Western medical and TCM skills. According to the classics, bi syndromes have been traditionally treated focusing on the 5-shu points and also the back shu/front mu points. For example, for wind bi syndromes, UB17 is always used; for damp bi syndromes, SP9 is always used; and for cold bi syndromes, UB23 and Ren 3/4 have been traditionally used. To achieve maximum results, bi syndromes must be treated from the root with the focus of the body as a whole.
Point selection is critical. One must first identify the dysfunctional meridian/channel and focus on regulating it. If any of the five zang organs are involved, then you must use back shu/ front mu and the 5-shu points. If any of the six fu organs are involved, then you must use he-sea and lower he-sea points to regulate the dysfunctional meridian/channel. For example, if a patient has been diagnosed with tennis elbow, locate the Large Intestine meridian. Find the Liver point (tendon problem) on the large intestine meridian and use the 5-shu points, because the condition is closely related to the five zang organs. Below is a table of the 5-shu points and their relationship with the five zang organs.
Not only is point selection critical, acupuncture technique is also crucial. The table below shows the five methods of acupuncture in relation to the five zang organs.
Puncture shallow (under the skin), do not damage the muscles & quickly withdraw
Dispel pathogenic qi from the exterior
Skin bi syndrome
Puncture several needles around the point, puncture deeply and through the meridian to cause minimal bleeding after the withdrawal of the needle
Dispel blood stagnation at the meridian
Vessel bi syndrome
Select points around the joint where the muscles and tendons attach, puncture deeply but avoid any bleeding
Used for tendons or joint pain
Tendon bi syndrome
Use three needles, the first one perpendicularly and the other two obliquely, and retain the needle
Dispel pathogenic qi from the muscle
Muscle bi syndrome
Puncture perpendicularly deeply to the bone
Symptoms related to bone problems
Bone bi syndrome
It is essential to practice skillfully and wisely, because just as acupuncture can heal, it can also damage. As health care practitioners we have been entrusted with the health of our patients, which is not only honorable but a sacred task. We must continually strive to be the best practitioners we can be. Michael Jordan in an interview was asked, "How does it feel to be the greatest basketball player that has ever played the game?" He responded, "I am not the greatest player that has ever played the game, because I'm still learning the game." Humility is an attribute of a scholar.
Click here for more information about Hubert Chang.
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