Hara Diagnosis: Kiiko Matsumoto Style This article is also available as a PDF in its published form CJOM, Vol. 10, No. 4, Fall 1999 (pdf) An Introduction to Hara Diagnosis, Kiiko Matsumoto Style The Nagano-Matsumoto style of treatment is the one of the most powerful tools available to acupuncturists, yet few people seem to utilise it. This might be because Master Kiyoshi Nagano has not been actively pursuing fame in the great centers of acupuncture around Tokyo and his technique has gotten wider exposure through Kiiko Matsumoto’s work. However, I suspect this is primarily because many acupuncturists find this style to be confusing and difficult both intellectually and physically. One cannot learn a whole system of acupuncture from one or two article, nor from one or two seminars. It has taken me years of following Kiiko to “get it.” However, it is possible to improve the results one gets by incorporating elements of this style and slowly increasing one’s understanding. The purpose of this article is to introduce the reader to some of the most common abdominal findings and their treatment. I have been teaching this style for the past 5 years, and those attending always attest to the effectiveness of these treatments. As beginners, they will often say they still use TCM or other methods (e.g., Miriam Lee/Richard Tan style), but that the addition of these simple procedures increases treatment effectiveness many fold. The basics of abdominal diagnosis are the same as for pulse diagnosis: anything you find or feel has significance. When a baby is born, if they are totally healthy (and assuming a clean karma) the pulse should be smooth, without glitches, reflecting nothing but a clean slate upon which life will imprint its experiences. The newborn baby would likewise have a smooth abdomen, a Buddha belly, so to speak. As life goes on, experiences are accumulated, pathologies settle in, patterns are being created, all of which will imprint their signature on the cellular memory of the body and can be reflected in various places. It is the nature of Chinese medicine that it recognises that the microcosm reflects the macrocosm. Thus, the pulse reflects the whole body, as do the palms, feet, and, of course, the abdomen. It is the ability to attune ourselves to a particular modality of diagnosis, perhaps to combine more than one tool, that makes us good at what we do. The reality of pulse taking is that it is an extremely subtle art. Most practitioners can read gross qualities, such as wiry, slippery, strong, weak, etc., but the reading of a life history requires lifelong practice. Abdominal diagnosis, on the other hand, is easier. Here the patient can give you feedback. If an area pressed is hard, or ropy, or produces pain, that is hard to dispute, there is nothing “subtle” or mysterious about it. The problem in using this form of diagnosis is that the patient is fully aware of the process: they can tell when the abdomen is getting better and the pressure pain disappears. Unlike pulse diagnosis, the practitioner has no information that the client does not. This makes us, practitioners, rather vulnerable and appear less “smart,” possibly another reason for resistance to this style. On a healthy abdomen, one should be able to press the abdomen to the depth of one knuckle (that is from the finger tip to the distal interphalangeal joint) without producing pain, and without the practitioner feeling resistance, hardness, ropiness, cold, or other “weird” sensations. I use 3 fingers, the index, middle, and ring fingers all together. This gives the patient a more comfortable feel when I press. Never press the abdomen with the thumb, this can feel very violating (and violent) to the patient. By using 3 fingers, I minimise the discomfort felt. However, my attention is at the tip of my middle finger: this is where most of the pressure is focused, and this is also my sensing finger (it is possible to do this with any other finger, it is a matter of individual preference). I tend to first touch the area to be pressed and then move in. At first you may want to move your fingers from side to side as if making space: this will ensure that you are not moving in too fast. As you gain more experience you will learn the pace that is comfortable to the patient. At any area that you find pain, “weird” feeling (some patients say it feels like “finger nails” – be sure yours are closely clipped, if a patient feels “finger nails” it is considered a “finding”), ropy, hard, etc., indicates a pathology: we call this a “reflex area.” We have many maps of the abdomen, depending on the patient history as well as other findings. Any one area in the abdomen can reflect more than one pathology. For example, the area around the navel reflects the Spleen (Nan Ching), but the points just below Kid16 reflect the Adrenals. Furthermore, in physical kidney disease (e.g., kidney stones or kidney infections) the area around the navel will be painful/ropy, especially Kid16. It is possible that the patient be only Spleen deficient with allergies, and have no kidney or adrenal involvement, thus the area around the navel will show. On the other hand this allergy patient may well have depleted adrenals, in which case the area below Kid16 (we call this 4 o’clock and 8 o’clock) reflects simultaneously the Spleen and the adrenals, while pressure pain elsewhere around the navel is a reflection of the Spleen only. Another example is pressure pain on Ren9. This can reflect S.I./digestion problems, Water problems (edema – the name is Dividing Water), or sadness (almost as a substitute to Ren8 – the Gateway to the Shen). Which of these problems the pressure pain on Ren9 reflects can only be ascertained when we try to treat it: if the water treatment works, it was a reflection of water, if digestion points release Ren9, it must be that Ren9 reflected digestion, etc. Once we have identified the various abdominal areas that show pressure pain, we interpret them, taking the whole picture into consideration. Our treatment goal is to eliminate all pressure pain (on the abdomen, the neck, throat, and back). Once this happens, the symptoms the patient is complaining about tend to subside. We can then further work more symptomatically on specific complaints once the abdomen has been cleared. Clearing the abdomen (neck, throat, and back) is our “root treatment.” The way we determine the points to needle is by pressing on the point and ensuring that it has a good effect on the abdominal reflex(that is it alleviates the pressure pain). Here is how this works. Suppose we found pressure pain on left ST27 area. We call this Oketsu (see below), and normally treat this with Liv4 and LU5 (both on the left). We let go of the pressure on left ST27 and ask the patient to remember what it felt like. We press on left Liv4 (upwards in the direction of the channel), and then press again on left ST27, while still holding on with pressure on Liv4. If the pressure pain on left ST27 is improved, we found the correct Liv4, if not, we look for a slightly better location. Finding the exact location for a point has absolutely nothing to do with its description in the book. It also has little to do with how painful the point is. All that really matters is that the point selected (and the angle of pressure) does indeed alleviate the pressure pain on the reflex. I often spend time finding the point that does the best job at clearing the reflex (preferably 100% clearing!). It is not uncommon to find a point that clears an abdominal reflex by 50%, but a point 3mm off it that clears it by 90%. Obviously one chooses the latter. When you press on a reflex point, you need to remember at what depth and angle the pain was elicited and what it feels like to your fingers. It helps to have an image of the tissue under your fingers. Once you press on the remote treatment point, you need to reproduce the same location, angle, depth, and pressure, at the reflex point and make sure it has been cleared. I recommend that you leave your hand just touching the skin at the reflex point and that with your other hand palpate and press the treatment point. Once you are pressing the treatment point, re-apply the pressure on the reflex area. This way there is no argument about the location. It is common for the novice patient to claim that you are not pressing as hard or that you are pressing on a different spot. The changes are truly dramatic when pressure pain disappears, and thus you want to be sure you got the correct reflex area. Although I cannot elucidate all abdominal findings, the following 4 treatment ideas should prove to be a great start. These are the most common findings and most commonly used points in the Matsumoto style. The most common finding is called Oketsu. Oketsu means non-physiological, sluggish, dirty, piled-up blood. It can be translated as Stagnant Blood, however, this connotes the TCM understanding of a pathology resolved by herbs such as Hong Hua and Tao Ren, which is not our understanding. We understand Oketsu to be an impingement of microcirculation (this is very similar to modern Chinese emphasis on blood vitalizers to improve microcirculation to counter the effects of aging). This can be due to a fever, infection, repeated trauma, operations or bruises, etc. 70-80% of all patients show Oketsu, regardless of their complaint or other abdominal findings. Oketsu shows on the area of left ST26, ST27, Kid15. Be aware that this is an area, not a matter of exact point location. This is originally Liver reflex according to the Nan Jing. We understand this to be so because the portal vein that leads to the liver comes from the left side, and thus an “obstruction” in the liver will cause a more sluggish flow that will show on the left side. While it is true that Oketsu will show in Liver disorders (hepatitis, cancer, etc.), it most often shows without any liver involvement. (We diagnose Liver on right Liv14 and below on the right subcostal line.) If you find Oketsu, you must clear it. There is no point in treating other issues if microcirculation is sluggish. After all, if Qi and Blood are not moving well, it makes it harder to address other issues. Once Oketsu is cleared, many other abdominal findings will improve, or even clear up, without adding other needles. The standard treatment of Oketsu is left Liv4 with left LU5. We take Liv4 as a thumb’s width below the medial malleolous, on the medial side of the tibialis anterior (somewhat close to SP5). We needle it at a 10o-30 o upwards with the meridian flow, with 10-15mm of the needle. Obviously when we press on the point to test it, we press it in the same direction (toward the ankle bone). LU5 is taken almost a thumb’s width laterally to where TCM textbooks describe it, that is, it is closer to L.I.11 than you might expect. There is a “weird” tendinous feeling at the correct point. We needle it superficially towards the thumb (that is with the flow). We then recheck the Oketsu reflex area (left ST27 area) and ascertain that the Oketsu is indeed cleared. If there is a little bit left, tiny manipulation of LU5, just moving the needle up and down in a shaking-like fashion, will probably clear the rest. The patient need not feel anything. We are not after a Qi sensation, but after breaking down gummy connective tissue which will communicate to other tissue the effect of the stimulation. (I use Seirin #2 needles: they are very fine but not too much so.) Sometimes you feel a hard lump feeling at the Oketsu area. We call this Oketsu Kai (Oketsu Lump). When you feel Oketsu Kai, the combination of left Liv4 with left LU5 is likely to alleviate the Oketsu reflex area by only 30% or so. This is often because of blocked circulation at the inguinal joint. After you tested and needled Liv4 and LU5, palpate the left inguinal ligament. This is the area between G.B.27/28 and ST30. Press this area toward the left leg (that is laterally and downwards). Find the ropy area and press it. Now test the Oketsu reflex area, and it should improve. Needle into the ropy area that helps release Oketsu the most. The area of the left inguinal groove (inner thigh – around left Liv12) might also be blocked and obstruct the clearing of Oketsu. Press this area up toward the pubic bone (this is also the direction of the needle). Both the inguinal ligament and the inguinal groove are needled shallowly, you need only tap the needle in. (Note that if there is a lot of pain on either the inguinal ligament or inguinal groove, we would treat those areas as reflexes first and release that pressure pain, prior to needling them.) The treatment of Oketsu is absolutely essential and must come before any other treatment as it not only clears other abdominal findings it also clears the way for other treatments. Be aware that Oketsu can be complicated by other syndromes, primarily Immune and poor circulation, and might not fully clear until those elements are addressed. I will discuss the Immune points below. There are two main circulation problems, the first is lack of blood flow, which we consider to be a Spleen problem. This typically shows in patients who have a pulse that has no third position (Kidney position – Nagano calls this “not enough blood to fill the pulse,” and categorises it as Spleen). In this case tonifying the Spleen (by use of SP9, needled superficially upwards, toward Inner Knee Eye, and SP10, both bilaterally) will help clear the Oketsu. The other circulatory problem is related to the autonomic nervous system and blood pressure. This tends to show as a tight pulse (a tight pulse by Nagano is what TCM practitioners might call wiry, thin, and superficial, and which looses this quality when pressed deeply), especially if rapid. The subject of treating ANS is rather complicated and is beyond the scope of this article. Adrenal Shock is another extremely common pattern. When we suffer fear or shock, or feel we are deeply threatened without possibility of escape, we contract the body inwards, toward the navel (think of your physical reaction at your worst nightmare, chances are you contract your navel). Thus, shock shows just below Kid16. This reflex is one of the few that has a strict location, in that it cannot be above Kid16, and it must show on both sides (people do not experience a shock or adrenal depletion on one side only). We call these reflex points 4 o’clock and 8 o’clock. This is a reference to a clock around the navel, with Ren9 being 12 o’clock, left is Kid16 3 o’clock, Ren7 represents 6 o’clock, and right Kid16 is 9 o’clock. These points reflect not just shock and trauma (such as car accident, trauma, etc.), but also slower and continuous exhaustion of the adrenal glands, hence we find them so commonly in our fast-paced culture. It is important to remember that the whole area around the navel (including 4 o’clock and 8 o’clock) reflects the Spleen and allergies, so when a patient has pressure pain on the Adrenal-Shock reflex it does not immediately indicate shock or adrenal exhaustion. A patient can have both Spleen deficiency and Adrenal-Shock, or one witout the other and have pressure pain on 4 o’clock and 8 o’clock. The only way to ascertain what these points reflect is to attempt to release them. If they reflect Spleen deficiency with allergies, they will respond (pressure pain will be reduced) to Spleen points (usually SP9), while if they reflect the adrenals they will respond to Kidney points. (Note, if you find only 4 & 8 o’clock, and no other points around the navel, this is probably the adrenal pattern, and not the Spleen pattern.) The Kidney channel goes up the spine and into the Kidneys, coming out to the front at Kid16 (Huang Shu – Missing/Hidden Organ Shu) where one branch moves downwards (Kid15 to Kid11) and the other moves up (Kid17 to Kid27). We can see Adrenal-Shock as severing of the Kidney channel, or the Kidney channel’s inability to nourish the Jing (in its movement downwards). The treatment of Adrenal- Shock is Kid6 with Kid27, bilaterally. One can think of it as a way of reinforcing/uniting the Kidney channel, or a Yin Qiao treatment variation. Master Nagano says that Kid6 treats the adrenals and Kid27 calms down the parathyroid. (When the ovaries have weakened in menopause, the parathyroid appears to become hyperactive and depletes calcium from the bones to the blood, thus Nagano believes it is important to calm the parathyroid when boosting the adrenals/ovaries). Kid6 is needled superficially and toward the achilles tendon (down toward the table), and Kid27 is needled superficially toward the Ren line: we use ¼ of an inch of the needle, or less. Manipulation (tiny up and down movement, like shaking, again – the patient should not feel this manipulation) on Kid27 might be needed. In some cases we substitute other Kidney points for Kid6: 1. We use Kid7 for people with a slow pulse, if there is bone pain, if there is pressure pain on G.B.26, if there is a history of ovary problems (reflect on ST28), post-menopause, or if there is pressure pain on Kid2. Kid7 is not at a fixed location. As you slide up from the ankle bone and close to the achilles tendon, look for the puffy/weird feeling: this is Kid7. It can be from 2 fingers above the internal malleolus, up to 4 cun above it. We needle Kid7 at a 30 o angle upwards, using up to 30mm (1 inch) of the needle, and manipulating it (our typical up and down “shaking” – Kiiko calls it “old lady” shaking the needle). Pressure pain on Kid2 indicates Fire in the Kidney channel, and is best treated by the combination of Kid7 and Kid10 (we call this Metal/Water overcoming Fire). When you find pressure pain on Kid2 (with 3kg pressure) as well as Adrenal- Shock (4 o’clock and 8 o’clock) you need to choose between the Kid7/27 combination and Kid7/10 combination by determining which combination releases the most abdominal findings most effectively. Kid2 is typically painful in hyperthyroid, ovary diseases, and advanced diabetes. 2. Kid3 is used in lieu of Kid6 if the pulse is very rapid, in cases of asthma with difficulty on inhalation, or where the disease history clearly involves mumps or salivary glands, though it is not common to do so. Kid3 is needles toward the achilles tendon. 3. Kid9 replaces Kid6 in the Adrenal-Shock treatment for the very elderly, very exhausted patients, or those with chemical/drug toxicity (I find it useful also if there is liver damage). It is found at the base of the gastrocnemous muscle, and I look for a nodule/gummy like feeling to find the exact point. Immune issues can be involved in just about any problem. Specifically, we may find immune weakness whenever we find Oketsu (as Oketsu can be a result of infections, lung problems, and other immune problems), and treating the Immune points is often the key to treating Oketsu (after Liv4 and LU5). Also, people who are continuously battling with weak immunity easily reach a threshold and start to tax their adrenals. If they are continuously battling an infection or are in constant pain, they can easily develop adrenal exhaustion as well as an autonomic nervous imbalance. Nagano says that our first line of defense are the nose and tonsils. Many people who have had their tonsils removed belong to the category of “immune type” (as do appendectomy and sinus allergy patients). Typically, immune problems reflect behind the SCM, on S.J.16 and below (a point known as East Wind). This is a Wind-related area by Chinese medical thinking, and a gland reflection by western thinking. I press this area from behind the SCM up toward the nose (the patient is lying face up), pressing three different areas from the mastoid down the SCM (down to about half way down the neck), finding the sore/gummy spot. The Immune points will release this area (left releases left, and right releases right). The Immune point is a point between L.I.10 and L.I.11 but closer to the San Jiao channel, on the edge of the bone. Look for the gummy adhesion on the edge of the bone. The needle is directed towards the bone, and direct moxa is always added (to “melt” the adhesions). When you find S.J.16/East Wind (gland reflex), this is a great opportunity to practice your palpation sensitivity. Leave your fingers just touching S.J.16, and with your other hand look for the Immune point. When you find the Immune point and press on it, you will feel the tissue at S.J.16 expanding or melting: when this happens you found the correct Immune point. You can now re-press S.J.16 and make sure it has indeed been released. (Often there will be very tender points in the area of the Immune point, but they do not necessarily release S.J.16. Beware of points that are tender, as they masquerade themselves as treatment points, but they fail when taken to the test against the reflex site they are supposed to release.) Immune issues may also reflect on the abdomen in the area around right ST26/ST27. However, this area can also reflect lung issues (treat LU5/LU8), digestion (treat SP9), or a tailbone shift (treat LU8). Pain along the posterior edge of the iliac crest is also immune related and responds to the Immune points (this area again has something to do with adhesions at the edge of the bone). Weak ligaments, and thus knee problems, achilles tendinitis, plantar fascitis, etc.) are often a result of weak immunity. We always treat both front and back. The diagnosis on the back is somewhat more simplistic, as the reflex points often become treatment points (the back does not have the same complex network of channels as the front). We check the back Shu points, but we are especially interested in the Hua Tuo points as those correspond to the control of the organs and structure. (We take the Hua Tuo point not just level with the lower border of the spinous process, between vertebrae, but also level with the vertebra, looking for pain, gummyness, or squeezed vertebrae.) Perhaps the most common finding on the back is Sugar. The Sugar points are the Hua Tuo of T11, T12 (give or take a vertebra – do not be dogmatic on your point location). When you find pain, weirdness, gummy tissue, or sqeezed-together vertebra, it must be treated. We needle these points 45o toward the spine, using 15mm (1/2 inch) of the needle, or slightly more. We add direct moxa on these points, or on the Du line if we find sensitivity on the Du line at that level. Sugar issues are pervasive in our culture as our busy schedules and lots of “convenience” eating, not to mention Chips Ahoy and other sweets, continuously challenge our metabolic systems. When sugar imbalance occurs, it will naturally affect every cell and every system in the body, of special note is the effect sugar imbalance has on weakening muscles and contributing to numbness and muscular pain. Thus it is extremely important to treat. Treating the sugar points may not seem in some cases as dramatic as some of the other treatments outlined above, but it is often the part of the treatment that really stabilizes the treatment and facilitates it, and makes it last longer. In this article I tried to outline four treatment ideas by Master Kiiko Matsumoto. This style of treatment does require a different kind of approach than TCM or other systems, however it is extremely powerful and well worth studying. Even the application of the above four simple treatments is likely to improve your patients healing success. Do not be afraid to mix this style with what you already practice. Master Matsumoto is not a purist, her method is a synthesis of many other Masters. While Master Matsumoto concentrates on palpatory findings, Master Nagano is an expert pulse diagnostician. Nonetheless, Nagano clearly agrees with Matsumoto’s interpretation and supports this style. This tells us that there can be many approaches to solving any particular problem and that we need not be afraid of experimenting. Unfortunately, a full discussion of this treatment style would take hundreds of pages. The good news is that Ms. Matsumoto will be publishing a book, accompanied by video, on this style in the next year, making it easier to learn.

Back Pain This article is also available as a PDF in its published form CJOM, Vol. 10, No. 3, Summer 1999 (pdf) Treating Back Pain with the Kiiko Matsumoto Technique One of the most common problems acupuncturists see is low back pain. Often we see people who have tried a variety of other modalities with little or no success, and their condition is chronic, highly painful and destructive to their lives. In this article I attempt to demonstrate the approaches used by Kiiko Matsumoto for the treatment of low back pain. Kiiko Matsumoto is one of the foremost acupuncturists practicing today. She has earned a tremendous reputation even in Japan in spite of her obvious “shortcoming” as belonging to the “wrong” gender, a testament to the effectiveness of her treatment style. One tenant of the Matsumoto style is that one should always treat the person’s underlying and internal conditions prior to treating the current problem. The idea is that the body keeps an energetic record (stagnation) of previous injuries/assaults/illnesses even if they appear to have been cured. Any new injury/assault that is not healing properly is likely to be lingering because the body’s energies are caught up in the past (past medical history) and are not available to deal with the present, current, situation. What we attempt to do is to address the first trauma the body has sustained with the expectation that this will facilitate the clearing of more recent ones. The word “injury” here refers to any medical condition. Thus when a person comes in with a shoulder pain that they say was a result of a skiing accident three months previously, we ask ourselves why it is that the shoulder is not healing. What prevents the body from dealing with the skiing accident in a timely manner? Usually the answer is an incident from the past. Often we would start to treat the person’s allergies, or thyroid condition, or the fact that parents and/or grandparents suffered from heart conditions first. The person would often express surprise claiming that their allergies (or thyroid condition, or whatever) is no longer bothering them due to medication or lifestyle change, yet, once we needle points that clear the abdominal findings which reflect the former (supposedly “handled”) condition, the shoulder improves. The person is happily surprised. We consider this approach to be “holistic” in the sense that we look at the whole history of the person, considering all possibilities, rather than to treat the actual complaint first. If we were to just apply some known “trick” for shoulder pain, we would have a lower chance of success, and the success we would have may not last because the body is still carrying old baggage (stagnation) that can still trap the shoulder pain. We believe that we are freeing the body from the hold the past has on it, so it can be fully present in the here and now. This only takes a few minutes: I am not suggesting that one must treat the person holistically for three months prior to treating their shoulder. We do this all within the same treatment, but first addressing the underlying/constitutional issues. This tends to release the current problem, sometimes fully, sometimes partially. Once these needles are placed, we can go on to address more recent problems, and ultimately the “official complaint,” the one which brought the person in, all in one treatment. The Matsumoto system of treating the whole body, heavily based on the work of Master Kiyoshi Nagano, is a comprehensive system and cannot be explained in one or two articles. In this article I only discuss palpatory findings and point selections that are specific to the condition at hand – low back pain. However, prior to doing so, two other tenants of this style must be mentioned. We never needle into the injured site. TCM practitioners talk in terms of remote and local (as well as adjacent) points. We always choose remote points, not local ones. We first determine where the current problem reflects on the body in terms of pressure pain. In the case of back pain, it is often the site of pain that can be used as the reflex by which we judge our success. However, there are times when the pain at the site is too elusive or too great to be used as a reliable reflex, and in such cases it is important to find some other reflex to be used (I shall discuss areas on the front which reflect back problems). It is important that you always press a reflex area with the same amount of pressure. Your goal is to find a remote point that alleviates the reflex area. Patients often claim that “you are not pressing as hard” when the reflex area is released, so you must develop the skill of controlling the pressure as well as being able to feel changes in the tissue under the skin. The remote points we choose must affect the reflex/target. We do not choose points based on a theoretical understanding, and consider that to be a wasted needle. To check if a point is relevant, press on the reflection area, let go of the pressure and remember the location, the angle, the amount of pressure and the texture. Then press on the remote point you wish to examine and with you other hand re- press of the reflex area. There should be an improvement on the reflex area. Ideally the patient says “wow, gone,” however, an improvement of 50% or higher is significant and merits needling the remote point. Our points are not fixed locations, and one often has to play around to find the exact location and angle that releases the reflex. Almost always we start treating the front of the body, even if the complaint is back pain. This allows us to ascertain which historical illnesses still reflect on the abdomen (not discussed here). My own understanding is that we treat the abdomen as the site reflecting the potential of life, and the back as a reflection of the movement of life, and thus we always treat both sides, with the front treatment almost always first. Many people who come for back pain automatically lie face-down and are a bit surprised when I ask them to turn face-up. As in the case of treating their underlying issues first, they may be resistant to the idea at first, but inevitably this strategy proves itself to be extremely useful. Almost universally, when I ask the person to turn over they exclaim “wow, my back pain is so much better!” Often they say there is no longer any pain, though I still treat the back. Aside from comprehensive abdominal diagnosis, the three most important areas to check on the front in cases of low back pain are G.B.26 (taken as the area level with the navel all the way to the side, and can be extended down to the iliac crest bone), the inguinal ligament (G.B.28 to ST30 area), and the inguinal groove (Liv12 area). When twisting is involved, the area that serves as the axis for twisting is G.B.26, and G.B.26 will feel tight or ropy with the person showing signs of pain. Some people do not like to say that your pressing is painful, but their reaction will be clear. We press to the depth of one knuckle (that is no further than the distal interphalangeal joint): in a healthy tissue, the person would feel you fingers but no pain, no tightness, no “weird” feeling. We use three fingers (index, middle, and ring) together so that the area is not too narrow and making the pressing uncomfortable, but we place our attention primarily on one finger, this marks our target. Make sure that pressure on G.B.26 does indeed alleviate the back pain. If it does you will want to needle it. However, if G.B.26 is very painful or ropy, it is important to release it first. Usually Kid7 will release G.B.26 (same side) – we see G.B.26 as lying in the Kidney domain (level with Kidney Shu, Mu, etc.). Press on Kid7, and ensure that this releases G.B.26. Needle Kid7 30o upwards, with the channel flow (make sure you have the best Kid7, the one that release G.B.26 area the most). If the back pain is G.B.26-involving, you will find that the back is greatly improved also. Once G.B.26 is released, you can also needle it directly. (Using G.B.26 is extremely important also for shoulder pain, especially pain on lifting the arm or along the L.I. line and for Inner Knee Eye pain. In fact, because of its importance as twisting reflex, it should be checked for all structural issues.) When the lower back is misaligned, that misalignment will show on the front on either the inguinal groove, or the inguinal ligament, or both. This is because the pressure of the misalignment will collapse at the bottom of the torso (inguinal ligament), or displace the alignment of the torso on the thighs, showing on the inguinal groove and below. It is extremely important to release these two areas. When pressing on the inguinal ligament, we press towards the leg (that is laterally and distally from the torso), checking the whole length of the ligament, from G.B.27/28 to ST30. Again, you may feel tightness or a rope-like feeling, or the person will tell you it is painful. We call the inguinal ligament pressure pain viscero-ptosis reflex. To release the inguinal ligament, we use ST13 (needled superficially outwards toward LU2), with the idea of “lifting” the torso from the other end. This point is especially useful on large breasted women (this treatment is also important for shoulder pain due to heavy breasts) or large individual who have a “greater interaction” with gravity. We also use G.B.26 to release the inguinal ligament (again, use Kid7 if G.B.26 is too painful, and again, this will in turn release the inguinal area), and Inner Yin, a point on the Kidney channel that is level with Liv9 (about 5 fingers above Kid10 – this point is also an excellent point to release the trapezius muscle). There is no need to press on the inguinal groove proper: this is a ticklish area that many people consider taboo. You can press about one inch below the groove, as the adductor muscles will also show the tightness. We press three areas, the Kidney channel, the Liver channel, and the Spleen channel, all upwards toward the pubic bone (that is toward the torso). To release the inguinal groove (or inner thigh, the actual area pressed – below the groove), use Liv4. We find Liv4 the width of a thumb below the internal malleolous, on the medial side of the tibialis anterior (very close to SP5), and needle it superficially upwards (with the flow). Press on Liv4, up toward the ankle crease, and recheck the inner thigh. Sometimes Liv4 is not enough to release the inner thigh. To release the Kidney line, use Kid7, and to release the Spleen line use SP9 (we needle SP9 superficially upwards). Lumbar spine (Du or Hua Tuo) pain often responds to SP9. This is especially true if there is more than one vertebra involved. We believe that once more than one vertebra is involved the problem cannot be purely structural, and has an internal component. You can check SP9 directly against L4- L5-S1 (Du, Hua Tuo, or even paraspinals). Palpate those with one hand (reaching under the person), and with the other hand press on SP9 up towards Inner Knee Eye. You may need to move your location of SP9. Once you find the exact SP9 which releases the lumbar pain, needle it superficially (10o) upwards (with the flow – toward Inner Knee Eye), above the bone, breaking down the “gummy” adhesions where the muscle is attached to the bone. We use a 40mm needle, using at least 30mm of the needle. (I normally use #2 Seirin needles – this is a highly sensitive area and other type needles might be painful, especially on skinny patients). Pain along the posterior edge of the iliac crest is considered to be immune related. This type person complains of pain that is not in the center of the back but that spreads sideways along the iliac crest, just below the crest line. They may have a history of immune related issues, starting with tonsillectomy, mononucleosis, lung infections, etc. The main reflex for immune issues is S.J.16 and below: this is the area behind the SCM and reflects glands (or Wind area by TCM terminology). The treatment point is the Immune Point, which is located somewhere between L.I.10 and L.I.11 on the edge of the bone, closer to the San Jiao channel. (Note it is the adhesion of the muscle to the bone that creates a “gummy” feeling here, similar to the muscle attachment on the iliac crest). This point is needled at 60-degree angle toward the bone (i.e. toward the S.I. channel) with the addition of direct moxa. The exact point will release both the gland reflex (S.J.16) and the iliac crest. This point can also release the inguinal ligament, as weak immunity can be the cause of weak ligaments (thus it can be added to ST13, G.B.26, Inner Yin combination to release the inguinal ligament). After treating the front, have the person turn over to lie face down. I often have people walk or move a little so as to test their back pain and ascertain the effectiveness of the front treatment. Now you are ready to address the exact pain location more specifically. The most common injury is at L5-S1 level. For L4-L5-S1 injuries, we needle into the sacro-iliac ligaments. Tight sacro- iliac ligaments will cause tight para-spinal muscles and therefore vertebreal shifts. Palpate the lower lumbar vertebra on the center (straight down pressure) and on each side of the spine (Hua Tuo line, press toward the spine at 45o). If there is pain only on one side of the spine (not center, and one side only), we call this S.I. channel pain. Women who sit on one hip (as they often do traditionally in Japan) can develop one hip higher than the other, affecting a shoulder pain along the S.I. channel, as well as back pain showing on one side of the spine. HT3 (same side – needled superficially and down with the flow) does an excellent job for this pattern (we also use HT3 for other S.I. channel pain). To that we often add G.B.26 as well as U.B.27 (S.I. Shu). We take U.B.27 as the gummy/ropy area at the lateral-superior edge of the sacrum: this is one part of the sacro-iliac ligament, and is always further than 1.5 cun out of the spine. If the pain is on both sides of the spine, or includes the center line also, needle into the sacro-iliac ligaments on both sides (up to 4 needles on each side). You must find the gummy/ropy section of the ligament, and break it down with the needle. You aim the needle so that it is angled under the bone toward the opposite G.B.26, but because of the tightness, the angle often reverts to almost 90o. If the sacro- iliac ligaments are too painful to needle into, try and release them by the use of Liv8. If the whole sacrum is painful, use Kid6 and U.B.62 bilaterally. The sacro-iliac treatment is an excellent treatment for L4-L5- S1 problems, whether it is a bulging disc, degenerative discs, and even spondolythesis. It is an excellent treatment to relax the para-spinals all along the spine, not just at the lumbar level. For true L4-L5-S1 pain, this treatment is almost always successful. If you fail using this treatment, it is likely that you have not found the right gummy spots to release along the sacro-iliac ligament, or that you have not properly addressed other previous issues that the body is still carrying, or that there is a tail-bone or sacrum injury. It is important to treat tail-bone injuries prior to the rest of the back. This is equivalent to the notion of fixing the basement before fixing the roof. Tail bone shifts may show on the front on right ST27 which can be released by LU8. (Needle superficially toward LU9: we take LU8 somewhat closer to the Pericardium channel than most TCM practitioners – you need to find the exact location that releases right ST27, either side LU8 might do the job). However, be aware that aside from tail- bone shifts, right ST27 can also reflect Lung, immunity, or digestive issues. When the person lies face-down, you can palpate the tail- bone directly (I do it on top of their underwear). Many people do not remember childhood tail-bone injuries until they feel the pain when their tail-bone is pressed. Many people have tail-bones that are curved at an almost 90o angle to the front (that is a “collapsed” DU1). The best points to release the tail- bone are LU8 (as per above, but in this case you can check it directly against the tail-bone), U.B.66, and Hua Tuo of C6-C7- T1: you may need to use one or more of these three points to release the tail-bone. Sacrum pain is best resolved by use of Kid6 and U.B.62. Those are needled each superficially in the direction of their respective channels; that is Kid6 toward the back of the heel and U.B.62 toward the little toe. This treatment originates with Master Kawaii who places the red clip of an ion pumping cord on U.B.62 and the black on Kid6. He also sparks Kid6 with the pachi-pachi. However, those of us in California find that just needling these points is also effective. The Ito style calls for S.I.3 and U.B.62 (Ito preferred magnets and placed the north magnet on S.I.3 and the south on U.B.62). Lumbar, sacrum, and tail-bone shifts can all also result in lower cervical or upper thoracic shift. It is often the case that people with low back problems display pressure pain on the Hua Tuo line of C6 to T1. If these are not too painful, they can also be needled so as to affect the lower back, or they can be used as a reflection of the back pain when choosing points (especially HT3). (In other words, when choosing a remote point, that point should alleviate both the cervical and the lumbar pain for it to be considered the “best” point, otherwise we might look around that point for a slightly better result. Remember, sometimes a change of a few millimeters in location can change the results drastically.) The Quadratus Lumborum is considered to be the Kidney muscle. Pain along this muscle (both U.B. lines, U.B.21 down to U.B.24) can be treated using LU10 (based on the understanding that the Lung is the mother of, thus tonifies, the Kidney). Our LU10 is located not at the border of the red and white skin, but on the fleshy part of the thenar eminence. This is a direct-moxa point, not a needling point. In general, when treating pain we take into consideration the tissue of the pain. For muscle pain we use SP3.2. We call this point SP3.2 because it is further along the channel, towards SP4, than the point located at the edge of the bone. For joint pain we check for pressure pain on SP2, If SP2 is painful we treat SP5 and SP9. This is based on the principle that if the Fire point is painful (upon 3kg pressure), it can be treated through the Metal and Water points, as Water counters Fire and Metal is the mother of Water and thus enhances Water’s ability to counter Fire. Ligament pain is treated with Liv8 (this is the Water point of Wood, Wood being responsible for Ligaments), as well as the Immune points (because weak immunity can cause weak ligaments). Bone pain is treated with Kid7 (tonification point of the Kidney). This is regardless of the actual location of the pain, and based purely on the tissue type. The Matsumoto style calls for treatment of original (or previous) assaults on the body system, a subject that needs to be learned thoroughly and cannot be addressed here. Nonetheless it is still possible to obtain tremendously beneficial results using the above treatments. It is my hope that these treatment ideas will facilitate better results for readers of all styles, levels, and skills.

Gynecology Gynecology It is possible to regard gynecology as a specialty, however, I find that this is not a useful notion as I rely heavily on treating the whole person, not just one symptom. Thus when treating gynecological symptoms, one cannot ignore previous medical problems that the patient has experienced in the past, or is still experiencing, and one often finds that one must treat those in order to fully address the gynecological issue at hand. This is done by clearing abdominal findings (see article in CJOM Fall 1999 10/4). It is therefore extremely important to clear all abdominal findings and not just those related to gynecological disorders. Sometimes, addressing the abdomen as a whole, using non- gynecological approaches resolves the gynecological reflexes, while sometimes it is only through addressing the gynecological reflexes that the rest of the abdomen is released. Often it is a combination of both. In this style, we attempt to clear all pressure pain in the abdomen, neck, and back, so as to ensure that the whole body has been addressed and that no issue has been left untouched. When we leave an issue without being addressed, it is possible for that weakness to take hold of the body, to divert energy to itself, and to prevent healing. The main gynecological reflexes are ST28 and Kid13. Pressure pain on ST28 reflects an ovary problem, while pressure pain on Kid13 reflect a uterus problems. Generally speaking, the ovaries are within the Kidney domain (in spite of reflecting on the Stomach channel), while the uterus is in the domain of the Spleen and the Liver channels. Beware that ST28 also reflects water stagnation (together with Ren9) as its name, Shui Dao – Water Pathways, indicates. Thus, one cannot assume an ovarian problem simply because there is pressure pain on ST28. General Point Selection by Channel Generally, one can check the Fire point of the related channel (that is Liv2, SP2, Kid2), and if there is pressure pain on the Fire point with 3kg pressure, than the Metal and Water points of that channel should be treated. Thus, we often treat Kid7 and Kid10 when there is pressure pain on ST28. Kid7 is the primary Kidney point to be checked in gynecological issues (regardless of pressure pain on Kid2), as it directly influences the ovaries. It is located where one feels a gummyness or puffiness and is needled upwards at a 30o angle. Liv8, the Water point of Wood, is an important point for cysts. We locate the point at the edge of the crease when the knee is slightly bent, looking for a nodule-like feeling. It is needled perpendicularly and direct moxa is added. Liv4, the Metal point, is located one thumb’s width below the internal malleolous, medial to the tibialis anterior, and is needled superficially upwards with the channel flow. Liv4 is always used on the left side, with left LU5, if there is pressure pain on left ST26-ST27 area which indicates Oketsu (stagnant blood). Liv4 is used on both sides to release the inner thigh (Liv12) area, an area that is extremely important to release in gynecological complaints. However, Liv5 is often the point of choice on the Liver channel for gynecological complaints, especially when involving inflammation or endometriosis. Liv5 is an anti- inflammatory point and strengthens the mucosal membrane in the lower Jiao. It is located just below half way from Liv8 to Liv4, on the bone, and where there is a dent. When one finds a dent on Liv5, it should be treated. The name of Liv5 is Worm Hole, which means that a worm (termite) is eating away at the wood channel. Use direct moxa on Liv5, with the patient feeling the moxa 21 times (the use of moxa can be thought of as smoking off the termites). On the Spleen channel, SP5 and SP9 are the Metal/Water points. SP9 is needled superficially under the skin upwards toward the knee, using up to 1 inch of the needle. SP5 is also an anti-inflammatory and mucosal-membrane strengthening point (add moxa – patient should feel it 15 times). SP9 is the point of choice for congestion in the abdomen, allergies, and pain on G.B.21. The combination of SP5 with SP9 is the treatment of choice of any lower lymph system problems, hence it is useful for all gynecological issues involving infections. Other Spleen points to consider in gynecological complaints are SP7, especially if profuse bleeding or edema are involved, and SP3, especially if muscle cramps/spasms are involved (including uterine cramps). SP7 is located where the dent or nodule can be felt in the back of the bone, and direct moxa is applied here (needle in a slightly upward direction). SP3 is located slightly closer to SP4 than the TCM location, hence we call it SP3.2, and it is needled towards SP4, with direct moxa added if the foot is cold. Another gynecological point combination I have adapted from Yi Tian Ni is Ren12, SP6 and S.J.4. I use direct moxa on these points (thread moxa on Shiunkou burn cream). Unlike the late Dr. Ni, I do not use pulse diagnosis to determine the points but rather palpation. Ren12 directly releases the gynecological reflexes in the lower abdomen. It is common to find tightness, hardness, or a nodule at Ren12 (or a line of tightness along the Ren channel around Ren12). Often SP6 will release that tightness at Ren12, and then Ren12, in turn, will release the gynecological reflexes. I use S.J.4 on the left side only in a position that is slightly distal to the TCM textbook location and in the centre the hand (rather than lateral to the tendon). This point tends to resolve any left over pressure pain on the right side of the abdomen, even though it is used on the left (I do not use right S.J.4 in this combination). If Ren12 is extremely tight and is not released by direct moxa on SP6, I use an Infinity treatment by Master Kawai using regular ion pumping cords. Needle LU7 on the left side (select LU7 in-line with the channel, close to the tendon) and attach the red clip of an ion pumping cord to it. Needle Kid6 on the right and attach the black clip of the IP cord to it. Using a second IP cord, connect left U.B.62 (red clip) to right S.I.3 (black clip). This creates an Infinity-sign shape loop from left LU7 (red clip) to right Kid6 (black clip) going below the legs to the left U.B.62 (red clip) across to S.I.3 on the right (black clip) and up above the arms to close the loop to left LU7 (the two IP cords cross the body, with each having the red clip on the left and the black on the right). I ensure this is the correct treatment by pressing on LU7 and ascertaining that this indeed relieves the pressure pain on Ren12 and on the gynecological reflexes in the lower abdomen. Then I proceed to apply direct moxa on SP6, Ren12, and S.J.4. Consideration of Other Disorders When addressing many gynecological complaints, it is extremely important to consider other health issues as causative, or contributing factors. These include thyroid conditions, low blood pressure, viscero-ptosis, structural issues, hormonal manipulation (as in taking or having taken birth control), edema, weak immunity, and mental depression, amongst others. Often one will not be able to treat the gynecological issue successfully using only the leg Yin channels, as described above, until one has successfully addressed such contributing or causative factors. In fact it is hard to say whether one should address the gynecological findings first or the other issues first, and the determination is made by evaluating which strategy releases the most stagnation in the abdomen and neck. It is my strongest recommendation that one should address all causative factors in the same treatment as much as possible, as one can never tell which factor might pull the body’s energies back toward a disease stage. Thyroid Conditions: Thyroid conditions are extremely prevalent in women. Some estimate that 30% of all women have abnormal thyroid activity that is often undetected. One should always suspect thyroid issues in fatigue, depression, dry skin and hair, and muscle aches, especially in the neck and shoulder area. The thyroid, adrenals, and ovaries work in synergy and are antagonised by the parathyroid and pituitary (as well as insulin). In Chinese terms, the thyroid is located at ST9, Ren Yin, meaning the point where one welcomes ones humanity, or, perhaps, puberty. It thus influences the whole body and particularly the rest of the stomach channel, influencing the internal organs. The thyroid itself, much like the ovaries, is in the influence sphere of the Kidneys, which channel circles the throat and is intimately related to all glands. Thyroid conditions will reflect on the thyroid area itself, that is ST9, L.I.18 and below – the lower third of the throat, as well as pressure pain on the abdomen on the Stomach channel, anywhere between ST20 and ST30 (of course pressure pain here can be a reflection of many other conditions, depending on location). The main thyroid releasing points by Master Kawai are on the back of the ear. The points are found when the ear is folded toward the front. The first point is under the tendon that sticks out when the ear is pulled forward, where the ear meets the skull. This is the point the “Shanghai text” (Acupuncture – A Comprehensive Text, page 491) refers to as Yang Linking. The other point is in the groove that is on the back of the shoulder area in the ear, directly behind the point the Shanghai text calls Thyroid #1. People with thyroid conditions often show a darker discoloration in this area. These points are used regardless of hyper- or hypo-thyroidism. Master Nagano differentiates hyper- and hypo-thyroidism, though both are considered to be in the Kidney domain. In hyperthyroid patients, it is common to find pressure pain on Kid2, and hence Kid7 and Kid10 are needled, as well as ~S.J.8, one third down from the elbow on the San Jiao channel. In hypo-thyroidism, Kid3 is needled, toward the achilles tendon, with S.J.4. Master Nagano further emphasizes the use of the Du channel in hypothyroidism, using any painful spots along DU2, DU4, DU6, DU9, and DU14: if the point under the vertebra is painful it is needled upwards with the channel flow, while if the Hua Tuo area is painful, it is needled at a 45o angle toward the spine. Select only the points that are tender upon palpation. One can use both the Kawai and the Nagano approaches. With each point selected, make sure that the pressure pain on the thyroid area (below ST9, L.I.18) is diminished when pressing on the selected treatment point, and that the treatment point also alleviates pressure pain on the gynecological reflexes (Kid13, ST28). Because of the intimate relationship between ovaries and thyroid, thyroid points are likely to greatly influence pressure pain on ST28, the ovary reflex, and may do a lesser job for the uterine reflex of Kid13. Blood Pressure Blood pressure problems play an enormous role in all disease processes, because blood pressure is an indication of the flow of Qi and Blood. If blood pressure is too low, Qi and Blood are not moving well, and thus no amount of needling will produce results until that is corrected. Many systems depend on proper blood pressure for their proper functioning, including the lungs, digestion, and kidney filtration. These in turn will influence other systems. Blood pressure disorders are also viewed as an autonomic system disorder with systolic pressure representing sympathetic NS and diastolic pressure representing the parasympathetic NS. The understanding of high blood pressure is not absolute. Up until recently European doctors would not prescribe hypertensive medication in the elderly as freely as their American counterparts. This is because of the belief that blood pressure naturally rises with age. Nonetheless, I assume all patients who come with a medical diagnosis of HTN to indeed have high blood pressure that needs to be addressed. People with low blood pressure are often not even aware of that fact, because unless they go into shock, the medical establishment has little to offer and does not view it as a disease. Unfortunately low blood pressure patients suffer not only dizzy spells, but also often complain of digestive and gynecological problems. The differential between systolic and diastolic pressure should be at about 40 mm Hg. If this differential is greater than 50 or less than 30, one must consider the blood pressure as a possible problem. There is no one specific reflex for blood pressure, where one can say that pressure pain on this area/point indicates high/low blood pressure. The diagnosis is done through standard blood pressure measurements. However, pressure pain on the occipital ridge is common in blood pressure disorders (as well as in other diseases, such as pituitary disorders). In treating blood pressure disorders, we do not differentiate between high and low pressure, and both are treated in the same manner. The main treatment point is a point under the third toe, in the centre of the phalangeal-tarsal crease. I only use Seirin #1 needles here. Other points are SP6, SP9 and Pericardium points. The Pericardium point to be needled is chosen based on response to pressure on P.8. If P.8 is painful upon 3kg pressure, then P.3 and P.5 are needled, both with the flow of the channel. P.3 is taken as between the two tendons of the bicep, not medially to the meidal tendon as in the TCM location. If the patient likes the pressure on P.8, P.8 is needled (again I use Seirin #1). If the patient likes the pressure on P.8 but refuses to have it needled, then needle the point we call P.4, which is 3 fingers below P.3 (described above) where the depression is found upon very light palpation. If the patient neither likes nor dislikes 3kg pressure on P.8, P.6 is needled. All pericardium points are needle lightly and with the flow of the channel. On the back, you will find tension/pressure pain in the area between S.I.9 and S.I.10. Needle this area up and out (toward the deltoid). This area will release upper body pain, especially between the scapulas. Although the use of blood pressure treatment is determined primarily by the patient’s blood pressure readings, all points can be checked against other abdominal findings. If blood pressure is indeed a major contributor to the disease process, pressing on the various blood pressure points, as per above, will indeed release the abdomen, at least to some extent, regardless of what the abdominal findings represent. Autonomic Nervous System The autonomic nervous system (ANS) influences all systems in the body and is highly correlated to the hormonal system. We find a primitive analogue in that the nervous system can be said to conduct signals electrically while the hormonal system does the same chemically. Signs of a mal-adjusted ANS can be sweating easily, easily nervous, palpitations, temperature imbalance, insomnia, and lack of time adjustment (that is, sleepy during the day yet overly awake at night and unable to sleep). A typical pulse in ANS disorders is a pulse Master Nagano calls a tight pulse. This pulse is often thready and has a “wiry” or tight quality. Most significantly this pulse either disappears or changes quality upon deeper palpation. There are many abdominal and other reflex areas that will display pressure pain in an ANS disorder. However, none of them are conclusive. Ren17 is called “anxiety reflex” and typically shows in ANS type patients. Pressure pain (with 3kg pressure) on P.8 may be an indication of ANS disorder: if on one side P.8 is painful but on the other side it is not, this is a clear indication of ANS disorder as we consider the Pericardium channel to be the ANS channel. The occipital region can also reflect ANS problems, especially blood pressure imbalances (both low and high blood pressure). Tightness in the SCM muscle is commonly seen as well, as the vagus nerve runs through the SCM, and tightness in the SCM congests the parasympathetic action of the vagus nerve. It is not necessary to have an ANS pulse or any particular body reflex for the diagnosis of an ANS imbalance. One can diagnose an ANS disorder from the symptoms, and we confirm the diagnosis by ascertaining that ANS treatment points indeed resolve, or help resolve, the abdominal findings and other reflexes. If there is SCM tightness, this should be resolved first, to allow parasympathtic function to flow into the organs. We release the SCM using opposite side Shao Yang points. If the patient has a rapid pulse we use S.J.5 and G.B.41 opposite the tight SCM, making sure that the tightness is softened and the pressure pain is eased. If the pulse is normal or slow, we us ~S.J.8 and G.B.40 (still on the opposite side of the SCM to be released). The point we call “~S.J.8” is about one-third down form the elbow to the wrist, and is at the mound of the muscle (it is in fact above S.J.9). If the point releases the SCM on the opposite side, then it is the right point. Ren17 pain is released by use of Pericardium channel points. However prior to using the Pericardium channel, we use S.J.5 with G.B.41, bilaterally, especially if the patient has a rapid pulse. The use of Pericardium points is extremely important in ANS disorders, and is determined as explained in the blood pressure section. We always differentiate between rapid pulse and slow pulse for ANS patients, as the pulse rate determines the treatment strategy. Rapid pulse patient requires emphasis on the abdomen, while slow pulse type patient is treated on the back. Rapid pulse is considered 85 beats per minutes or faster. Slow pulse is 65 BPM or less. We normally treat patients with a pulse rate of 65-85 BPM as if they had a rapid pulse. It is very important to not mix the two strategies. For the rapid pulse type, we treat the point under the 3rd toe, in the centre of the phalangeal-metatarsal joint (plantar side). This point often releases Ren17, as well as the occiput (on the opposite side of the toe used). The third toe does not have any points on it and is in the domain of the Stomach sinew meridian. Akabane determined that it relates to the chest and diaphragm. We also use Ren6 and Liv12 for rapid pulse type. We needle Liv12 superficially and towards the pubic bone. It is important to find the tight spot around Liv12. Tightness on Liv12 may be disrupting blood circulation into the abdomen, and can be a cause of gynecological disorders. If the patient has a slow pulse rate, then DU2, needled superficially upwards, is used in lieu of Ren6 and Liv12. (It is important to not stimulate the abdomen when a patient has a slow pulse as abdominal stimulation can further slow the pulse rate.) Structural Issues Affecting Gynecology Blockages in the inguinal, inner thigh, sacral-iliac, and gluteal regions have a tremendous impact on gynecological complaints. Tightness in these areas can lead to poor abdominal circulation, and to gynecological problems. Press on all these areas and ensure there is no tightness there and that the patient does not feel any discomfort upon your pressure. These areas can develop into tight ropes which further constrict circulation into the abdomen. Tightness in the inner thigh (Liv12 area) can be on the Kidney, Liver, or Spleen channels. Check the area just below the pubic bone, about 1 inch below. Liv4 usually releases tightness in the inner thigh, but if other channels are involved, consider Kid7 or SP9 as well. After the area has been released, it can be needled directly for greater effect. Needle the inner thigh shallowly towards the pubic bone. G.B.31 is a point which releases the inner thigh, groin and perineum, and should be used as a supporting point in all gynecological complaints where inner thigh tension or perineum irritation are present. Inguinal tightness and blockage can lead to hardness below the navel, big pulsation around the navel, and compression of the lymph nodes. Release this are by use of Kid7, G.B.26, and Inner Yin, a point on the Kidney channel level with Liv9, about 5 fingers above Kid10. Often the combination of Liv3 with G.B.41 with the use of ion pumping cords releases the inguinal ligament area. Place the red cord on G.B.41 and the black cord on Liv3. Tight sacro-iliac ligaments can be released first by use of Liv8, and then one can needle into the gummy spots in the sacro- iliac joint. The sacrum is extremely important in gynecological issues. A puffy sacrum often indicates hormonal imbalances. The sacrum itself can treat hormonal imbalances, specifically U.B.32. If the sacrum itself is extremely tight and painful, it can be released using Kid6 and U.B.62 with ion pumping cords. Kid6 is needled toward the achilles attachment and holds the black clip, while U.B.62 is needled toward the small toe and receives the red clip of the IP cords. Once the sacrum is released, it should be needled. If when pressing on the sacrum, sacro-iliac ligaments, or the area below the posterior iliac spine, the area feels cold, then Kyutoshin (warm needle) technique is necessary. A cold buttock will lead to lack of warmth in the uterus. It is common, especially in women with ANS imbalance, to have the skin feel warm, but when pressing in, the tissue under the skin feels extremely cold. In such cases you must still use Kyutoshin. Tight gluteal/piriformis area and coldness will also lead to frigid uterus, lacking circulation. Release the piriformis with Fukaya G.B.31, a point that is 2 fingers above G.B.31 and then two fingers back toward the U.B. channel. This point can be needled, and works best with direct moxa (patient should feel the moxa 7 times). Then the gluteal region can be needled, and warmed with moxa. Another area to release is G.B.26 which can be released using Kid7. Again, if G.B.26 is cold, deeper – not at skin level, needle it with the use of Kyutoshin. Because cold contracts and stagnates, it is extremely important to break down all tight areas leading structurally to the pelvis and to warm them up. If the patient wears tight underwear which restricts circulation (this includes pantyhose, tights, as well as panties, all of which might leave a mark on the skin when moved), advise them to wear looser clothes around the pelvis and inner thigh. If the area is cold, advise them to wear flannel or other warm underwear. Teach the patient self massage with either a rolling pin or a tennis ball to release tight inner thigh (use a rolling pin), buttocks and sacro-iliac ligamenst (use a tennis ball). They can also warm up cold areas by use of a heated brick or a microwaved sock with barley or other grains in it. These devices generate a penetrating heat that will go deeper than a heating pad. Many women with cysts, fibroids, and other gynecological disorders have very tight para-spinal muscles, especially in the lumbar area. Always check L4, L5 both on the Du line and the Hua Tuo line. Tight para-spinal muscles create a “valley back” where the spine looks like it is in a valley surrounded on both sides by hills of tight muscles. An exaggerated lordotic lumbar curve can also contribute to gynecological problems. In both cases check the sacro-iliac ligaments and the area below the posterior iliac crest carefully, and needle the most gummy spots, which release lumbar pressure pain, and apply Kyutoshin if cold. Tight para-spinal columns throughout the length of the spine can indicate a hormonal/pituitary imbalance. Add S.I.13, which we call posterior-pituitary Shu, to release the paraspinals. Tight muscles can also be a result of a sugar imbalance, in which case treat SP3 and Nagano ST22, which in on the right side, midway between the lower edge of the ribs and the navel, on the line drawn at a 45o angle to the horizon. (Imagine a line going from the navel to the liver, creating a 45o angle with the Ren line as well as with the Dai line – place the point on this line about half way between the ribs and the navel). On the back treat Hua Tuo of T11, T12, at a 45o degree toward the spine. Shifts in the tailbone will create further problems up along the spine and can thus affect gynecological complaints. Most commonly a tailbone shift can occur during childbirth, and can be a contributing factor in post-partum depression. Palpate the tailbone on all sides (it is common to have the tailbone curved forward at an almost 90o angle: this is not normal) with the patient’s underwear on. Tailbone shifts can also reflect on the abdomen at right ST27 area. Use LU8, U.B.66, or Hua Tuo of C7, T1 to fix tailbone pain. LU8 is taken quite a bit closer to the tendon (towards the Pericardium channel) then the TCM location, and it is needled towards LU9. Although it is generally best to address internal imbalances before addressing structural ones (both should be addressed, if present, in one treatment), sometimes a structural imbalance is the predominant factor. However, because in this style we tend to treat the front side first, and only then the back (in the same patient visit), and since much of the structural imbalances are addressed on the back, it does follow that we treat the internal organs first. Nonetheless, structural imbalances on the back can reflect on both the inguinal ligament and the inner thigh on the front. Those should be resolved while the patient is lying face up. Viscero-Ptosis This is a special category of structural imbalance that is often created by gynecological issues such as hysterectomies, C- sections, or multiple childbirths. The tightness and pressure pain on the inguinal ligament, the area between G.B.28 and ST30, is created by the falling down of the organs, either through pushing in childbirth or because of the vacated space created by a hysterectomy. Women with very large breasts often also display tightness in the inguinal ligament and suffer from back pain. Release the inguinal ligament by use of ST13, needled superficially outwards, toward LU1, supported by G.B.26, and Inner Yin. Weak immunity can also contribute to a weakness in the inguinal ligament, thus add the Immune Point which is between L.I.10 and L.I.11 on the San Jiao channel, on the edge of the bone. Direct moxa is always added on this point. If multiple abdominal operations are the cause of the ptosis, consider the use of P.4 (3 fingers below P.3) which is considered to supply blood to the abdomen. Pituitary/Hormonal Involvement Many women who have taken birth control pills, or have otherwise been manipulated hormonally, have a pituitary involvement. This is especially true with women who have taken birth control in the earlier days when dosages were rather large, yet, individual sensitivities are such that one woman can be adversely affected by a pill which does not seem to produce any results in another. Some women take a double dose as a “morning after” pill, and this one time- episode can be enough to produce symptoms. In fact women who have gotten off the pill because the pill made them feel ill, are far more likely to display pituitary involvement then those taking the pill for years with great satisfaction. Always check for pituitary involvement in women with a history of having taken birth control, and in women with multiple hormonal problems, e.g., thyroid with diabetes, with cysts, etc. Pituitary involvement can result not only in gynecological symptoms but in many other complaints, from back pain to digestive problems. Pituitary involvement usually shows as pressure pain around U.B.2 and on the occipital ridge (U.B.10 area). However, occasionally one can diagnose pituitary involvement without tenderness on these areas by determining that pituitary points do indeed resolve various abdominal findings. Typically, if there is pituitary involvement, pressing both U.B.1 points together (squeezing toward Yin Tang), or pressure on U.B.2 will alleviate the gynecological reflexes on the abdomen, or other abdominal findings. U.B.1 has been called Ming Men, and hence comes the assumption that it is connected with control of hormones (gate of life). U.B.2 is used instead for convenience. U.B.2 is considered to be the Pituitary Mu and U.B.10 the Pituitary Shu. (In applied kinesiology techniques, both points are used to adjust the pituitary gland also.) S.I.3 is the master point of the Du, and by extension of the brain, and hence it is used for pituitary issues. It is needled up toward the bone. We do not needle U.B.10, and use it primarily for diagnosis. U.B.2 is used for diagnosis as well as treatment. Find the painful spot around U.B.2 (this may be closer to Yu Yao), and ensure it releases abdominal findings. Then release U.B.2 with S.I.3, and then if the abdominal findings are still present, needle U.B.2. I needle U.B.2 shallowly toward the eye, using Seirin #1 needle. There is usually a slight depression in the tender area. On the back we consider S.I.13 to be the Pituitary Shu, more commonly representing the posterior pituitary, which deals with vasopresin and oxytocin (that is with urination, uterine contraction, and lactation). Typically we use this point if the patient complains of night urination even when they drink no water in the evening, and when the paraspinals are very tight. (Yi Tian Ni used S.J.15 – Tian Liao, Heavenly Hole – for hormonal purposes and to affect the pituitary: it turned out we were using the same point. One can think of hormonal issues as belonging to the San Jiao, the regulator of fluids, and of S.J.15, the Heavenly Hole, as affecting the pituitary, a heavenly gland, or one can think of hormonal issues as belonging to the small intestine which separates the pure from the turbid. It is also worth noting that S.J.15, Tian Liao can affect U.B.10, Tian Zhu, the Heavenly Pillar which reflects hormonal status.) Do not confuse all hormonal issues, or hormonal points, with pituitary control. For example, U.B.66 is the water point on the water channel, and is used for many hormonal issues, yet it is not considered a pituitary point, and while acne is often a manifestation of a hormonal imbalance, it does not necessarily indicate a pituitary issue. Water Accumulation and Edema Many women with gynecological complaints have puffy limbs, especially in the legs. Often when you press on leg points, you will notice pitting edema. This may be one of the symptoms that has brought them to see you, or it may be something that you notice. Water accumulation needs to be treated regardless of the main complaint because with excess water the Qi and Blood cannot move properly, circulation is constricted, and the heart is being placed under heavier demand. Water stagnation typically reflects on Ren9 (Shui Fen – Dividing Water) and ST28 (Shui Dao – Water Pathways). Ren9 can also reflect digestive disorders or sadness. If it is part of a number of points that are tight around the navel, then it might represent allergies. ST28 reflects ovaries as well as water stagnation. What a particular point reflects depends on the patient history and presentation. Sometimes, pressure point on a particular point can reflect multiple issues. Treat water stagnation with SP3, SP7 and SP11 to move the water. SP7 is the point in the back of the bone that leaves a dent when you press on it. You might also feel a nodule-like feeling on this point, but in cases of edema the more significant finding is the dent (pitting edema). This point is needled (I needle it slightly upwards) and direct moxa is added. SP11 is taken quite a bit lower than the TCM location. Look for the point where the skin feels overly stretched, where it is hard to pinch the skin. U.B.63 is a supporting point for this treatment (or any Spleen treatment involving too much water or blood). It is a point that is used to remove excess accumulations such as boils, diarrhea with blood and puss, etc. Once the water has been moved, using the Spleen points, the Kidneys need to be stimulated in order to excrete the water. This is done by stimulating the quadratus lumborum, the kidney muscle. With the patient lying on the side, needle G.B.25 down towards the spine, and then add U.B.20, U.B.23, and U.B.25 all needled toward the buttock, with the channel flow. Any points that feel cold, should have Kyutoshin (moxa on top of the needle) added. You can retain the needles on one side for 10 minutes, and then turn the patient around, so as to repeat on the other side and stimulate the other quadratus lumborum muscle. After this treatment, it is normal for the patient to urinate more and for the urine to have a slightly stronger smell, as this indicates that the stagnant water is moving. Immune Issues Weak immunity is not unique to gynecological complaints. In fact weak immunity can be the cause or contributing factor of almost any disorder. Weak immunity will lead to weak ligaments and other connective tissue, and thus expose the patient to a myriad of disorders that do not seem related to an original infection. It is quite common for a patient to not respond to any treatment points, and once the Immune Points are needled, all the other treatment points seem to bear fruit. This is because the body-energetics is being caught up with an immune problem, and only once the weak immunity is being addressed, is the body able to respond to other stimulii. The main immune reflex is in the area of S.J.16, the gland area behind the SCM. The main treatment points are the Immune Points, the area between L.I.10 and L.I.11 on the San Jiao channel, on the edge of the bone. Look for the weird adhesions on the muscle attachment to the bone. This point should release the gland area as well as many abdominal findings. Direct moxa is always added on this point (patient should feel the moxa 7 times). Other immune points include the Hua Tuo of C7 (these are also moxa points), and Kid6 (needled down toward the posterior edge of the calcanous). In severe cases, direct moxa on S.J.16 is required (after the area has been released with the Immune Points). Pain, weakness, and tightness below the posterior iliac crest are common in menopause and in women with cysts. This area is also a reflection of weak immunity. Resolve the pressure pain below the PSIS by using the Immune Points, and then needle into the gummy area, and add Kyutoshin if you feel cold inside. Depression Although many practitioners associate depression and other mental states with gynecological issues, in many cases the correlation is not exact. However, post-partum depression is clearly a result of a gynecological issue. In TCM it might be said the depression is due to loss of Blood and Jing. We believe that the factors in post-partum depression are disruption to the lower Dan Tian, which is similar in nature to the Blood/Jing Deficiency theory, and tail bone shift, which is structural in nature. When the lower Dan Tian is disrupted in the process of labour or in cases of a C-section, it looses strength and the trauma flushes upwards, first through the middle Dan Tian, represented as pressure pain on Ren17, and then in the upper Dan Tian, represented as pressure pain on DU20 (or Si Shen Cong). At this stage we call it Blood Stagnation in the Head. Blood Stagnation in the Head reflects as pressure pain, looseness of the skin, or warmth in the DU20 area, with each finding representing an increase in severity: pressure pain being the least severe and warmth being the most severe. The treatment for Blood Stagnation in the Head is SP6, SP9, LU5, and Pericardium. We choose the Pericardium points according to pressure pain on P.8, as described above in the section on blood pressure. SP6 is a point that directly relates to DU20. We choose this point closer to the bone than many TCM practitioners. LU5 is taken more laterally than the TCM location and is described as midway between the lateral edge of the crease and the bicep tendon. It is needled down with the flow of the channel. Tail bone injuries/shifts, can by virtue of affecting the spine, affect the brain. The tailbone is also the ground of the chakra emotional system. Rigidity in the tailbone and pelvis can result in rigidity in ones emotional outlook. Tailbone injuries can cause symptoms many years afterwards, including neck and back pain, disc problems, constipation, etc. The tailbone is treated by use of any or all of LU8, U.B.66, and Hua Tuo of C7-T1. There are three main emotional reflexes on the abdomen: Ren17 which is called “anxiety reflex,” Ren15 which is called “worry reflex,” and Ren9 which is called “sadness reflex.” Note that all of these can also reflect other issues, and one cannot indiscriminately assume that pressure pain on any of these implies an emotional disposition. Ren17 pressure pain is treated by first resolving the lower abdomen, and then resolving any pressure pain left on Ren17. The Pericardium channel is used to treat Ren17, in accordance with P.8 pressure point diagnosis (see section on blood pressure). However, prior to using Pericardium points, in case of rapid pulse, use S.J.5 and G.B.41. If the pulse is slow, release the SCM if it is tight. Also, in case of a rapid pulse, use the point under the third toe (see blood pressure section). Then choose Pericardium points. Because it is impossible to needle Pericardium points while San Jiao points are still being needled, leave the patient with the Yang points needled for about 10 minutes, take the San Jiao needles out, turn the arm over, and work the Pericardium channel after the San Jiao points have been used. Ren15 pressure pain is treated by use of SP3 and P.4 (3 fingers below P.3), or other Pericardium points (according to P.8 pressure pain diagnosis). Ren9 pressure pain or pulsing, is treated by using right ST24 (the Slippery Flesh Gate, which is used to treat pulsing/slippery flesh under the navel, the watchtower of the Shen). Any abdominal scars should be addressed, especially if there is still pressure pain on the scar, if the scar still has a discoloration, or if the scar is very thick and ropy. After releasing the scar pressure pain with remote points, you can place diode rings or a diode chain on it. After addressing all general abdominal findings and medical issues, one can then address the specific gynecological condition. Cysts Cysts and fibroids are seen as the result of congestion of Qi, blood, or other tissue. It is common for women to develop cysts if they have cold feet, low blood pressure, structural imbalances that constrict blood flow to the abdomen (tight inguinal ligament, tight sacral ligaments, tight inner thigh), if they use tight clothing that restrict circulation, or have used hormonal pills. For cysts in the breast, check the pectoralis muscle (LU1 area) for tightness constricting circulation into the breast. Tight paraspinals in the lumbar area, puffy sacrum, lordotic back and puffiness in the back of the knees (U.B.40 area) are typically found in cystic patients. Ovarian cysts and uterine fibroids patients will display pressure pain on ST28 (ovary reflex) and Kid13 (uterus reflex), as well as on Kid16 (Adrenal reflex). L4-L5 Hua Tuo reflect female hormone imbalance. If the fibroid is palpable, I use the fibroid itself as a reflex. There is usually no pain on the actual fibroid, but the patient can feel it (especially in the breast) and feel whether it shrinks with the use of certain points. Always choose the points that the patient says make the fibroid smallest. It is important to release the inguinal groove (G.B.28 to ST30 area), the inner thigh (Liv12 area), the gluteal region, and the sacral-iliac ligaments. The main point for treating ovarian cysts is Kid7. For cysts and fibroids in ovaries, uterus, or breasts, treat Liv8 (with direct moxa) and Pi Gen. Liv8 is taken as the nodule at the edge of the crease when the knee is bent. I also find that the area above Liv8 (for about 3-4 inches) is often gummy, noduly, tight, or puffy in women with hormonal issues and/or cysts, in which the area needs to be massage daily (one can use a rolling pin). Pi Gen is a cyst shrinking point which can be either G.B.43 or the point between G.B.43 and ST44 (that is it is like a Ying Spring point between the 3rd and 4th toes). Do not use Pi Gen until you have needled all other points. This is because Pi Gen can shrink a fibroid to the point of it not being palpable, and thus one looses a reflex area prior to addressing the Liver and Kidney deficiency aspect, making it harder to determine the exact, most effective, location of Kid7 and Liv8. For tension in the inner thigh, use G.B.31. You can also needle Kid16 (Adrenal reflex) after it has been released with Kid7. Always check G.B.26 area for tightness and cold. Release G.B.26 with Kid7, and then needle it adding Kyutoshin if cold. After releasing ST30, it can be needled at a 45o angle toward the leg. On the back, release the sacrum first and then needle U.B.32 (with Kyutoshin if cold). Find the most sensitive, gummy, or puffy spot for U.B.32. Needle (and add Kytoshin if cold) the ropy areas on the sacro-iliac ligaments, and on the area below the posterior iliac crest. Use the sacro-iliac ligaments to release tightness on the lumbar paraspinals and then needle the tight Hua Tuo of L2-L5. For cystic breasts use Hua Tuo of T2-T6 and S.I.11. I do moxa on S.I.11 with the patient sitting up so that she can palpate the breast and give me feedback as to which point around S.I.11 shrinks the cyst the most. S.I.11 is a direct moxa point. Endometriosis The treatment of endometriosis is also the treatment for inflammation of the fallopian tubes as well as PID and other inflammatory conditions in the lower Jiao (including UTIs). In these conditions the whole lower Dan Tian area feels uncomfortable, often even without you pressing on it. However, ST28, the ovary reflex, usually shows most painful most clearly. Kid13, the uterus reflex, shows also, but is usually less painful. The main treatment points are SP5, Liv5 and Kid7. You can needle SP5, but direct moxa is the treatment of choice. Liv5 is a moxa point only and is located on the bone, below half way from Liv8 to Liv4, where one feels a dent/hole in the bone. SP5 and Liv5 are both anti-inflammatory points for the lower Jiao, and also help strengthen mucosal membrane and connective tissue. Because we want to disperse an inflammatory conditions, the patient should feel the moxa on these points at least 21 times. It is also typical for this type patient to have pressure pain on Kid2, in which case Kid10 is added to Kid7. Endometriosis patients often show tightness around U.B.14/U.B.15 (Heart and Pericardium Shu), and I tend to needle, and apply direct moxa on, those points as well as on the gummy/tight area found around U.B.17/U.B.16. G.B. points below the knee can also be used as supporting points. Kiiko Matsumoto recommends the use of G.B.34 with direct moxa as well as S.J.4 or S.J.5. However, I prefer the use of points below G.B.34, around G.B.36 (called Wai Qiu – Qiu meaning accumulation or mound) with direct moxa. Bleeding Heavy bleeding and hemorrhaging can be pure Spleen deficiency but also the results of fibroids, cysts, and hormonal imbalances. The main Spleen point for abnormal bleeding is SP7 (with direct moxa), which we find on the back of the bone, where there is a nodule-like feeling or a dent. For hormonal type bleeding, use Hua Tuo of L2 (make sure you find the exact tight/gummy spot) at a 45o angle toward the spine, and leave press tacks, or preferably intradermals – to sustain the needle angle, after the treatment. U.B.66 is another hormonal point normally used for heavy menstruation rather than light. It is most common that the feet will be cold, calling for the use of direct moxa. Direct moxa on Liv2 can also help with bleeding problems. Late menstruation which is not a result of a pituitary miscommunication, is often accompanied by coldness in the pelvis, or lack of blood. Release and warm the tight pelvis (sacro-iliac, gluteal, iliac crest, G.B.26, inner thigh, inguinal, all as described above n the section on structural imbalances). In lack of blood the pulse is short: the third position of the pulse (Kidney position) is missing. This is not the same as a weak third position signifying Kidney deficiency. In these cases, no matter how deep one feels for the pulse, it cannot be found. This is considered a Spleen deficiency, where the Spleen is unable to produce enough blood to fill the pulse. Treat SP6 (with Kyutoshin) and SP10 (moxa or Kyutoshin) with P.4, the point that supplies blood to the abdomen. Vaginal Discharge Treat Liv5 and P.4 (3 fingers below P.3) and have the patient do moxa (tiger warmer) daily on these (except during menstruation). Check Liv2 for pressure pain and treat Liv4 and Liv8. G.B.31 is often a useful point in discharge with tension in the inner thigh, or pubic area. U.B.67 can be used for any irritation in the Ren1 area, including itching, burning, yeast infection, sperm allergies, and herpes. PMS Pre-menstrual symptoms can involve any of the cofactors listed above, such as low blood pressure, ANS disorders, hormonal imbalances, etc. Once those are treated, check the Fire points of the leg Yin channels (Kid2, SP2, Liv2) and treat the perspective Metal/Water points. I find that Kid7 is an extremely important point for all premenstrual complaints. Menstrual cramps are often be treated by SP3.2, Nagano ST22 (Oddi point – described in the section on structural issues), and the Sugar points (T11, T12 Hua Tuo). In such cases advise the patient to avoid sugar. Menstrual headaches will often respond to SP6 in combination with P.6 (or another Pericardium point as per above), or with LU7. Treat water accumulation by use of SP3, 7, 11 (see above). Puffy hands and fingers can be treated by use of Kid6. Fertility Aside from thyroid, pituitary and general vitality issues, always check all structural problems in the pelvis. If the pelvis is cold, then it is hard for the uterus to harbor enough warmth for the arrival of spring (conception). Sacral shifts are extremely common in infertility problems, as is occipital tension (which can be structural or reflecting a hormonal imbalance), and inner thigh tension (all the way down to Liv8). After addressing all these issues, do direct moxa on Fukaya’s fertility points which are below the navel, at the corners of an equal-sided triangle with the top corner at the navel. The sides of the triangle are measured as the width of the patient’s mouth. TBM (Total Body Modification – a chiropractic technique developed by Dr. Victor Frank, using applied kinesiology techniques) offers some of the best fertility treatments I have encountered. The scope of this article does not allow a detailed explanation of those, however, these adjustments demonstrate the importance of releasing tight sacro-iliac ligaments and buttocks, releasing the inner thigh (adductors), and releasing the occiput. Menopause Menopause is still seen in this style as a Kidney deficiency, and the Adrenal treatment (Kid6 with Kid27 – with Kid6 being needled superficially down toward the achilles tendon, and Kid27 needled superficially in, towards Ren21) is often the treatment of choice. Kid2 is commonly painful in menopausal women, and calls for the treatment of Kid7 and Kid10. Substitute Kid7 for Kid6 in the Adrenal treatment if the pulse is slow, if there are ovarian problems, or if there is bone pain or osteoporosis. Because menopausal women often take many chemicals (even if so-called natural ones), and will often show Liver signs due to weakness in breaking down estrogenic compounds, I often use Kid9 with Kid27 (Liver signs here mean pressure pain on right Liv14 or under the right ribs). Thyroid issues are also common during menopause, and should be addressed (see above in thyroid section). Aside from ST28 and Kid13, the ovarian and uterine reflexes, Ren15, the subcostal area, and Liv14 may also show pressure pain in hot flushes, as well as pressure pain on G.B.29 (defined as the area between G.B.28 and ST30). If the patient has a rapid or tight (ANS type) pulse, release G.B.29 by use of SP9, and then needle G.B.29 down and out toward the leg. Left G.B.29 tends to release Ren15, and right G.B.29 releases Liv14 area. Then, if indicated, add the Adrenal or Kidney Metal/Water treatment. In cases of puffy sacrum and ropy sacro-iliac ligaments, use Kid6 with U.B.62 with ion pumping cords (red on U.B.62, black on Kid6), and then needle the ropy spots on the sacro- iliac ligaments, adding Kyutoshin if cold. Also find any gummy/ropy spots under the posterior iliac crest, and needle those (with Kyutoshin if cold). Needle U.B.32 or U.B.33 and add Kyutoshin if cold. These are essential points for hormonal imbalance. Have the patient use tiger-warmer on SP6 and P.6 daily. For any dryness issues, use U.B.66 (hormonal moistening point). Although the main dogma for menopause is Kidney deficiency, an aspect of Spleen deficiency is very common, as evidenced by the treatment strategy of using SP9. This Spleen deficiency will often be exacerbated by sugar and plain carbohydrate consumption, calling for the Sugar treatment (SP3.2, Nagano ST22, T11, T12). A Spleen deficiency can then create a Gall Bladder Excess according to the overacting cycle rule of Wood Yang invading Earth Yin. It is therefore more common to see menopausal and post-menopausal women with gall bladder problems. But even without clear manifestations of gall bladder problems, it is common to find amongst this age/gender group pressure pain on right side G.B.24. This is treated using Stomach Qi, the bumps and dents along the stomach channel, the adhesions of the tibialis anterior to the tibia, between ST37 and ST41. The bumps are needled down and slightly toward the bone, and the dents are treated with direct moxa. Find the exact spot that releases the gall bladder. Breasts The main diagnostic areas for the breast are the pectoralis (LU1 area) and T2-T6 vertebrae. It is common to find upper thoracic compression in breast problems, and whenever finding two upper thoracic vertebra which seem squeezed together, that area should be treated as prevention. Congestion and tightness in the pectoralis will congest the lymph system and block circulation into the breast. Release this tightness by use of G.B.26 (if G.B.26 is too tight to needle, release it first by use of Kid7). Teach the patient to massage the pectoralis muscle and loosen it, so as to increase circulation and lymph flow. Also, ensure the patient does not wear metal supported bras, and that their bra is not too tight. On the back, it is important to release any upper thoracic vertebrae that are compressed. Release the pressure pain on these vertebra (or Hua Tuo) by use of the area between S.I.9 and S.I.10, needled up and out toward the deltoid. Needle between the squeezed-together vertebra, 45o into the spine. It is common to find extra-spaced vertebra either above or below the squeezed-together ones. Moxa the extra wide space. Breast cysts are treated similarly to lower Jiao cysts and fibroid, using Liv8, and then adding S.I.11, the “breast Shu.” Liv9 is the main point to be used in cases of breast cancer or family history of breast cancer. It is also used for any other type of cancer. In cancer always be sure to check both the Liver and thyroid, and treat according to your findings. In summary, in using this style one does not treat gynecological problems as a specialty requiring special, unique, points. We address gynecological problems as we would any other problem: by addressing any previous traumas, medical history, sensitivities and tendencies. There are very few special “tricks” regarding gynecological issues, with the main technique being aware of the many connections involved: thyroid, blood flow, hormonal imbalances, structural imbalances, and constitutional tendencies.

Male Ureo-genital diseases This article is also available as a PDF in its published form EJOM, Vol 3, No. 3, Summer 2000 (pdf) Male Ureo-genital Disorders Abstract: In this article I introduce the reader to other forms of diagnosis and treatment of male ureo-genital problems. The standard TCM concepts of Kidney Deficiency, Yin Fire, and Damp Heat, while often useful, do not always provide the best treatment strategies for all patients. With the ability to utilise other points of view, it is my hope that readers will benefit patients with problems that have not responded to the standard TCM approaches. For a variety of socio-anthropological reasons most acupuncturists treat more women than men. One of the primary differences between male and female patients is in the field of gynecology and endocrinology. Women tend to be far more sensitive to hormonal issues. This is true not only in terms of menstrual hormones, but also in terms of incidence of thyroid diseases as well as prevalence of autoimmune disorders which are often related to endocrinological status. However, we cannot say that men do not have gynecological problems. It is only that men have different kinds of problems than women do as related to their reproductive organs. The term male gynecology may upset some women, but I see it as promoting equality, rather than separateness, between the genders. In this article I will outline the Kiiko Matsumopto style treatment protocols for three male disorders: prostatitis, testicular problems, and erectile dysfunction. The Matsumoto style relies heavily upon palpation as a form of diagnosis.Whenever we find pressure pain in the abdomen, we take note of it and we attempt to reduce the pressure pain during the treatment. We choose remote points that will reduce the pressure pain in the abdomen. The abdomen is not the only area used for diagnosis: we also palpate the chest, the neck and throat, and the back. The two principles of the Matsumoto style is to treat everything one finds and not just the presenting symptoms, and to attempt to treat the oldest injury/trauma/illness in the patient’s history if it still reflects in the body. This is based on the idea that as long as some past incident has a hold on the body-energetics, the body might not be able to deal with more recent issues. In other words, by letting go of the past we are able to deal well with the present. Technically, we adhere to another principle, which is that we treat the abdomen mostly from the bottom up, as if fixing the basement before fixing the roof. There are often exceptions to this “rule,” that relate to how important or how deep an issue is. Although ureo-genital issues reflect in the lower abdomen, they do not always take precedents in treatment, and other issues might need to be addressed first. In traditional female-gynecology, the three leg Yin channels are of primary importance. The Kidney rules our reproductive energies, while the Liver circles the genitals. Because women’s gynecology is strongly correlated to blood, the Spleen and Heart (or Pericardium) play a more significant role than they would in male gynecology. According to Master Nagano, in women, ST28 reflects the ovaries and Kid13 reflects the uterus. The ovaries are considered to be in the Kidney domain, hence we treat pressure pain on ST28 via Kidney points (most commonly Kid7). The uterus, which relates more to blood is considered to be influenced by the Liver and Spleen, and we tend to use Liver and Spleen points to release pressure pain on Kid13 (most commonly Liv4, Liv8, SP3, or SP7). In male gynecology, the reflexes used are also Kid13 and ST28 but also Kid11 and ST30, as well as the midline (Ren) points. Master Nagano says that male gynecology involves the Liver and Kidney meridians. Treating Prostatitis: According to Master Nagano this is a Liver and Kidney disorder. The treatment points are Kid6, Liv8, and G.B.31. These should be tested and ensure that they release the pressure pain found in the lower abdomen. One often needs to change the location of the point slightly in order to find the exact point that truly releases the abdominal findings. Liv8 (Qu Quan – Bending Spring) requires that the knee be slightly bent when locating and needling it. Look for the slight nodule/gummy feeling at the edge of the crease. Many TCM practitioners take Liv8 quite a bit higher than we do (perhaps in an attempt to place it in the notch created by the femoral epicondyle). Liv8 is a “cyst shrinking” point: it is imperative that you find the exact Liv8 that eliminates the abdominal pressure pain. We also add direct moxa on this point. (We use very fine, yellow/gold coloured moxa with tiny sesame size grains and we make sure that the moxa is not pressed hard, so the heat is not intense. This kind of moxa can be used in Yin Deficiency and Heat conditions). (In women the whole area above Liv8 can indicate hormonal imbalances if one finds puffy, thick tissue here. This area stretches for about 2-3 cun above Liv8 on the Liver channel. I have not found this correlation in men.) Often, prostatitis patients have pressure pain on Liv2. We press on Liv2 (towards the thumb) with 3kg pressure. If this amount of pressure is painful, we needle both Liv4 and Liv8. This is a principle we call “treating Metal/Water in order to reduce Fire” (Water counters Fire, and Metal, as the mother of Water, enhances this ability). We locate Liv4 about one thumb’s width below the internal malleolus, just medial to the tibialis anterior, and we needle it superficially upwards with the flow of the channel. Kid6 is needled superficially towards the achilles tendon, and G.B.31 is needled perpendicularly. It is possible that the patient will also have pressure pain on Kid2, upon 3kg pressure. This finding is more common in women than in men. Our Kid2 is not quite as close to the navicular bone as the TCM point location, but lies in the more fleshy part of the arch of the foot (slightly forward and below the TCM location). If Kid2 is painful, we compare the effect of Kid6 on releasing the abdomen against the effect of Kid7 with Kid10 in releasing the abdomen. This is because, if a Fire point is painful, the preferred treatment is the Metal and Water points. We define Kid7 as the “puffy” spot, from 2 to 4 fingers above the malleolous, and needle it at a 30-degree angle upwards toward the knee. Kid10 is needled superficially upwards. Although we do not emphasise the treatment of the Spleen in male gynecology, if we find a nodule, puffiness, or a dent, on SP7, we use SP7 as well (preferably with direct moxa). Master Nagano says that SP7 is a Spleen channel point which affects the Kidneys, and thus uses it for water retention and ear infections. Our SP7 is on the back edge of the tibia, and some TCM practitioners will associate this point with Liv6 (we take the Liver channel on the bone itself). Patients who are taking female hormones for the treatment of prostatitis, should be checked for hormonal imbalance, and S.I.3 can be added. A hormonal/pituitary imbalance often shows as pressure pain on U.B.2, and pressing on U.B.2 will often release the gynecological abdominal findings, confirming a pituitary connection. S.I.3 is the master point of the Du, and hence is chosen to fix brain/pituitary problems. We use U.B.2 as both a reflex and treatment point of hormonal problems, rather that U.B.1 simply as a matter of convenience. U.B.1 has been called Ming Men in ancient texts and hence can be considered to have a relationship to Ming Men and hormones (that which maintains the gates of life). Because of the relationship of the Liver and the eyes, points around the eyes can treat liver channel disorders. U.B.66 is another hormonal point, as it is Water on Water. It is especially useful in the elderly population. We also use U.B.66 for dryness associated with hormonal depletion in old age, as well as to fix tailbone shifts. Treating the sacrum is extremely important in male gynecological problems. Generally men have far tighter sacro- iliac ligaments than women do. It is my understanding that this may be due to their higher center of gravity, caused by broader shoulders and narrower hips, resulting in greater tension in the sacral area. U.B.33 is a point we consider to be the “male sexual dysfunction” point (for women we use U.B.32). It is common to find gummy spots on the sacrum, almost as if the bones have a rough edge, in prostatitis and other male ureo-genital problems. It is my contention that breaking these areas of stagnation and smoothing them out helps the ureo-genital system. A point just outside U.B.35 (Hui Yang – the Meeting of Yang, an important point for men) is called “prostate shrinking” point. You know you got the right point when you feel as if there is a nut inside the muscle. Because of the typical male tightness in the sacro-iliac area, men often jump when you palpate this area. Do not assume that because the point is tight, it is the correct point. Look for the point that has a nodule/gummy feeling, like a nut, under your fingers, and needle it, breaking down the gumminess. Treating Testicles: It is now common practice to remove a testicle if there is a growth is suspected. The biopsy is done after the testicle was removed. Men’s balance is partially dependant on their testicles, since this is the lowest organ. The removal of a testicle can create structural problems resulting in back and then shoulder pain. Because the Liver channel controls the testicles, we understand that removal of a testicle creates an imbalance in the Liver channel between both sides: the channel both sides circle the genitals intermingling in the testicles. By dogma it is consider that the side of the removed testicle is more deficient compared to the healthy side. Therefore we restore the balance to the Liver channel by needling Liv1 on the unhealthy side, and Liv2 on the healthy side. Liv1 is needled superficially in the direction of the channel flow (I use only Seirin #1 needles here), and Liv2 (on the opposite side) is needled towards Liv1, creating a vector across the Liver channel on both legs. However, this “dogma” can be proven wrong, and I have had cases where Liv1 on the healthy side combined with Liv2 on the unhealthy side has done the best job for the client. I believe that this is because the imbalance between the two sides of the channel is what is most important, and that which way the imbalance presents is not always uniform. In all cancers we check Liv9. Originally Kiiko was using this point for breast cancer, but its use has expanded to all cancers. Liv9 is Yin Bao, the Yin Wrapping (or the Yin Bladder), which we can interpret as related to cancer, cancer being a Yin substance that envelops itself. Erectile Dysfunction Despite the pitches of a former presidential candidate on American television, erectile dysfunction is probably best treated without the use of Viagra. The process of gaining an erection involves the dilation of blood vessels but at the same time requires a certain amount of tension/excitement within the nervous system. Although the erection itself is within the domain of the sympathetic nervous system, it requires the cooperation of the parasympathetic nervous system as well. Orgasm is a unique process where these two normally antagonistic systems are activated together. Although some erectile dysfunction can be rooted in structural blockages and other issues, in many cases it is an autonomic nervous system disorder. Other symptoms typical to an ANS disorder can be easily sweating, easily nervous, palpitations, temperature imbalance, insomnia, and lack of time adjustment (that is, sleepy during the day yet overly awake at night and unable to sleep). A typical pulse in ANS disorders is a pulse Master Nagano calls a tight pulse. This pulse is often thready and has a “wiry” or tight quality. Most significantly this pulse either disappears or changes quality upon deeper palpation. There are many abdominal and other reflex areas that will display pressure pain in an ANS disorder. However, none of them are conclusive. Ren17 is called “anxiety reflex” and typically shows in ANS type patients. Pressure pain (with 3kg pressure) on P.8 may be an indication of ANS disorder: if on one side P.8 is painful but on the other side it is not, this is a clear indication of ANS disorder as we consider the Pericardium channel to be the ANS channel. The occipital region can also reflect ANS problems, especially blood pressure imbalances (both low and high blood pressure). Tightness in the SCM muscle is commonly seen as well, as the vagus nerve runs through the SCM, and tightness in the SCM congests the parasympathetic action of the vagus nerve. It is not necessary to have an ANS pulse or any particular body reflex for the diagnosis of an ANS imbalance. Most often we diagnose an ANS disorder from the symptoms, and we confirm the diagnosis by ascertaining that ANS points indeed resolve, or help resolve, the abdominal findings and other reflexes. If there is SCM tightness, this should be resolved first, to allow parasympathtic function to flow into the organs. We release the SCM using opposite side Shao Yang points. If the patient has a rapid pulse we use S.J.5 and G.B.41 opposite the tight SCM, making sure that the tightness is softened and the pressure pain is eased. If the pulse is normal or slow, we us ~S.J.8 and G.B.40 (still on the opposite side of the SCM to be released). The point we call “~S.J.8” is about one-third down form the elbow to the wrist, and is at the mound of the muscle (it is in fact above S.J.9). If the point releases the SCM on the opposite side, then it is the right point. Ren17 pain is released by use of Pericardium channel points. However prior to using the Pericardium channel, we use S.J.5 with G.B.41, bilaterally, especially if the patient has a rapid pulse. We determine which points to use on the Pericardium channel as follows: If there is pressure pain (with 3kg pressure) on P.8, we needle P.3 and P.5, according to the “Metal/Water overcoming Fire” principle. If the patient likes the pressure on P.8, P.8 is needled, however, many patients dislike the idea of a needle in the centre of the palm, and in such cases P.4 can be used instead. This P.4 is 3 fingers below P.3. If the patient does not like nor dislikes the pressure on P.8, then P.6 is needled. All Pericardium points are needled shallowly and with the flow of the channel. I use Seirin #1 on P.8. (A note on the location of P.3 and P.4: The Japanese P.3 is located between the two tendons of the bicep muscles, in the centre of the crease, and not medial to the medial tendon as per TCM. P.3 is located 3 fingers below that. In thin and muscular people you will be able to see a depression in the muscle, otherwise, brush your hand lightly down the Pericardium channel to feel this depression.) We always differentiate between rapid pulse and slow pulse for ANS patients, as the pulse rate determines the treatment strategy. Rapid pulse patient requires emphasis on the abdomen, while slow pulse type patient is treated on the back. Rapid pulse is considered 85 beats per minutes or faster. Slow pulse is 65 BPM or less. We normally treat patients with a pulse rate of 65-85 BPM as if they had a rapid pulse. It is very important to not mix the two strategies. For the rapid pulse type, we treat the point under the 3rd toe, in the centre of the phalangeal-metatarsal joint (plantar side). This is our main blood pressure imbalance point, used for both high and low blood pressure. This point often releases Ren17, as well as the occiput (on the opposite side of the toe used). The third toe does not have any points on it and is in the domain of the Stomach sinew meridian. Akabane determined that it relates to the chest and diaphragm. We also use Ren6 and Liv12 for rapid pulse type. We needle Liv12 superficially and towards the pubic bone. It is important to find the tight spot around Liv12. (In the case of erectile dysfunction, the tightness on Liv12 may be disrupting blood circulation into the genitals.) If the patient has a slow pulse rate, then DU2, needled superficially upwards, is used in lieu of Ren6 and Liv12. (It is important to not stimulate the abdomen when a patient has a slow pulse as abdominal stimulation can further slow the pulse rate.) Liv12 is called Ji Mai, the urgent or anxious pulse, which represents sympathetic dominance. We can easily see how this point reflects the autonomic nervous system by assuming a Tai Chi posture with the tailbone suspended and dropping straight down. This is a neutral position. When we tilt the pelvis forward, pressing into the thigh (Liv12 area) we can feel that this creates an anticipation, a sense of urgency, in us. Tilting the pelvis back (sticking the tailbone backwards) also changes our emotional disposition and we feel less calm. From this we can understand that the tailbone (DU2) and the inner thigh (Liv12) play a major role in the state of the autonomic nervous system. Master Kawai uses special diode rings that he places on the middle finger (pericardium channel). These are extremely useful in all cases of ANS disorders, and because they can be worn at all times, can serve as homework for the patient. (Diode rings can be obtained from Kiiko Matsumoto at 8 Centre Street, Natick, MA 01760, USA. The cost is $73, including shipping, paid in US dollars.) For gynecological issues, Master Kawai uses a diode ring on the small finger. Master Kawai has also constructed a special “cock ring” consisting of a double diode ring, specifically for erectile dysfunction. This ring is worn as a “cock ring” and stimulates healthy circulation in the area. However, these rings are not available except to Master Kawai’s patients in Japan. The importance of treating the autonomic nervous system in all patients who present as such cannot be over-emphasised. A 30 year old man who complained of a “leaky penis” (meaning he was leaking urine, not semen, in small dribs) and urinary frequency and urgency (an inability to hold urine even for a minute or so). He showed no standard ureo-genital abdominal findings, nor did he display Kidney deficiency signs. However, his clammy hands, tight pulse, and tight SCM, led me to believe that this indeed was an ANS disorder, and that perhaps it was nervousness that caused the leaky penis. After two treatments concentrating on releasing the SCM and adjusting the autonomic nervous system, this patient reported his penis stopped leaking and that he was able to finish conversations rather than to run to the bathroom when pressure arose. Three months later he called to confirm that he was still doing fine in the “leaking” department. Because of the importance of releasing the sacrum in male ureo-genital problems, it often becomes necessary to release the occipital and neck region, in accordance with the cranio- sacral principle that the two areas are related. I always check the cervical vertebrae and the occiput (U.B.10, G.B.20 area) on all patients. Because pressure pain here can be a reflection of the vertebreal artery (Hua Tuo of cervicals C2- C5) or the basilar artery (below the occiput), this area can serve as a reflection of the rest of the spine all the way down to the sacrum, since the basilar arteries join and turn downwards to form the spinal artery which nourishes the spine (they also move forward into the circle of Willis to nourish the brain). The points that release the occiput and cervicals are Liv8, Kid10, and ~S.J.8 (the same point which releases the SCM), all on the side of tightness. On the back we treat U.B.58, U.B.40 (taken closer to U.B.39), and U.B.60, all on the tight side, with U.B.60 needled against the flow of the channel with some stimulation and U.B.58 and U.B.40 needled perpendicularly and shallowly. In spite of great advances in societal outlook on gender roles, we can still differentiate between the genders in the way they handle (or mishandle) their emotions. This can reflect in the body also. I find that men display broken vessels (visible Luo vessels) in the subcostal area, far more frequently than women. This is the area of Ren15 through Liv14, and even more laterally, as well as just under the ribs. Whenever I notice these blood vessels, whether red or blue, I use a gentle seven-star technique on them, and stop when the tiniest drop of blood is released. One can also just rub the area until it is red to activate the blood vessels. Luo vessels are the vessels of blood, and the blood is the carrier of the Shen and emotions. Often suppressed emotions will result in the appearance of Luo vessels, and activating the Luo and bleeding them, allows those emotions to be circulated and vented. I have found a high correlation between the Qiao vessels (the statement of how I reflect on who I am, how I stand up to myself and to the world, pelvic constriction, back pain, as well as physical ankle pain) and the Luo vessels across the lower ribs (Liv14, Ren15 area). There is no classical text explanation for this. Nowadays, we would view Luo vessels in this area as possibly related to the Ren Luo (Ren15), and hence the importance of releasing these blood vessels for ureo-genital reasons becomes apparent. However, I associate these Luo vessels with the Qiao vessels, specifically with the Yin Qiao, which also relates intimately with the genital region. Before the idea of a Luo vessel for the Ren and the Du (Ren15, DU1) was developed, there was the idea of the Qiao vessels being the Luo of the Ren and the Du. It is possible that this is what the classics had in mind. We can also see these blood vessels as obstruction in the diaphragm/chest/heart, and hence they are important to release as they will further release the belt (Dai) and genitals. We know that there are two watchtowers in the body, Ren8 (Shen Que) and Ren14 (Ju Que). These are watchtowers that guard over the two main obstacles of life, the belt/genitals and the diaphragm/heart which can be said to represent the separate self (the will to live of the kidney) and the larger, universal self (represented by the penetrating compassion of the Heart). When one watchtower is released, the area under guard by the other can be released also.

Headaches Headaches: The most common reason for headache is the narrowing of blood vessels. Master Nagano says that the blood vessels get tight from stress, causing what we commonly call “stress headache.” This results in too much CO2 and not enough oxygen in the body. Regardless of the nature of the headache you can always use the Ba Feng points (the extra points in the webs of the feet), as these open up the blood vessels to the head and neck. These are Nagano’s “essential depression point” and are used for headaches, depression, post-stroke, and brain damage (the depression here refers to “mild depression” where the patient is not on heavy medication). Since healing always requires oxygen, one cannot go wrong by using the Ba Feng point, they can only aid healing by activating circulation and oxygenating the head/brain. If the pulse is very weak, this confirms the possibility of vessel constriction. Your first mode of attack would be to strengthen the pulse by using Sp 6, Sp 9, and Pericardium. Check P 8 (Fire point). If it is painful, use P 3 + P 5 (Metal/Water). If the patient likes the pressure on P 8, needle it, however, if the patient likes the pressure but dislikes the idea of a needle in P 8, needle P 4 instead (our P 4 is 3 fingers below P 3!). If the patient does not care about the pressure on P 8 either way, needle P 6. For any headache check the Hua Tuo of T2, T3, T4, for weird, gummy or squeezed-together vertebra feeling, and needle it, breaking down the gummy and separating the vertebrae. This area, that is prone to kyphosis in the elderly, can block circulation to the head (this is why this area is so important in all facial problems, including eyes). If you find two vertebrae that are squeezed together, chances are that you will find a widened space above or below. Needle the narrower space (squeezed-together feeling space) 45o towards the spine, and moxa on the Du line where there is a wider space. Always check the scalenes in patients complaining of headaches. Again, this is because the scalenes reflect the brachio-radial plexus that is involved in blood circulation to the trapezius, neck and head. Press the scalenes (St 11 area) with the flat part of your fingers, not pressing too hard or too pointedly. If the patient complains of pain or you feel a tightness or a ropy feeling, release the scalenes by use of Sp 3.2, Lu 8, or H 3 (any of these, or a combination). Sp 3.2 is slightly proxymal to Sp 3, in the direction of SP4. HT3 is taken at the edge of the elbow crease (making it slightly more lateral than the TCM location that is closer to the bone) and is needled at a 10o angle in the direction of the meridian flow. For any type of headache consider the role of blood pressure, low, high, or “weird” (we consider weird ratio between cystolic and diastolic to indicate a blood pressure problem: ideally the difference should be around 40). These might reflect as gummyness, or even puffyness in severe cases, in the occipital region. Use the points under the 3rd toe (where the tow meets the ball of the foot – the phalangeal-tarsal joint), with Sp 6, Sp 9 and Pericardium (as per above). On the back treat the gummy areas between SI 9 and SI 10, needing these points up and out. Finally, for any kind of headache, you may need to release the SCM and/or the trapezius. Check the SCM with the flat part of your fingers. Check the whole length of the SCM. Release the SCM with the opposite ~SJ 8 and GB 40 (both on the opposite side). The point we call “~SJ 8” is about one third down from the elbow to the wrist on the Triple Warmer channel, at the mound of the muscle: you must find the exact spot that releases the opposite side SCM. Trapezius tightness may show in the neck as well as in the shoulder. If it shows at the neck level, close to the cervicals, it can be released with the opposite ~SJ 8/GB 40 combination with the addition of GB 26 (same side as the neck tension). Trapezius pain/tightness at the shoulder level is released by use of Inner Yin, a point on the Kidney channel that is level with Liv 9 (or 5 fingers above K 10). Once these are checked, we can also analyse headaches by their location, similar to the manner by which TCM categorises headaches. Occipital Headache: This can be a result of the following: • C1 (Atlas) shift. This reflects on the Mastoid bone and is treated via Liv13. • Blood pressure. This is treated via Under-3rd-Toe, Sp 6, Sp 9, Pericardium. • Circulation problems (very thin pulse). Treated via Sp 6, Sp 9, Pericardium. • Cardiac problems. This is a vast subject: generally cardiac issues reflect on left SI 11, and/or the inner border of the left scapula. The gummyness on the left scapula must be resolved. For Rapid pulse treat Ren4, for slow pulse treat UB 27. Then you can moxa the gummy areas on the left scapula. • Hormonal issues. Treat SI 3, UB 2, SI 13. • Head injuries. If the injury is in the Tai Yang zone, treat Ihikun (UB 58, UB 40, UB 60 – it is important to find the exact spot for UB 58 which may be above its text book location. UB 40 is taken quite close to UB 39, that is on the lateral side of the popliteal fossa). For injury on the Shao Yang zone, check the SCM and treat opposite side ~SJ 8 + GB 40 (or SJ 5 + GB 41 if the pulse is rapid). Because many head injuries involve more than one zone, it is common to treat both combinations. • Eyesight problems. Treat UB 2 or Yu Yao, and treat the eye problem thoroughly. • Teeth/TMJ problems. This affect the postural musculature in the occiput. For TMJ, treat K 6, K 27 (Adrenal treatment), and a point behind GB 21 (the point which releases the TMJ. For teeth/gum problems, add UB 11 (meeting point of bones). • Menopause (DU 20 and UB 2 are also common pain areas in menopause). Treat K 7, K 27, with the possible addition of SI 3. Temporal Headache: For temporal headache, use the Tai Yang point, or an area close to it as a reflex for the headache. If your treatment releases the pressure pain on the Tai Yang point, it is likely to be affecting the headache. Several treatment possibilities are as follows: • TMJ related. Treat K 6, K 27 (Adrenal treatment) and the point behind GB 21 (this point should release the jaw). Then tape Kawai’s rings on the painful spot on the jaw (a minimum of 20 minutes). • The Shao Yang/SCM type. Treat via opposite side ~SJ 8 and GB 40. If the pulse is rapid, SJ 5 and GB 41 (both on the opposite side to the headache) is the preferred combination, however, choose the points by confirming their effect on the SCM and the Tai Yang point on the opposite side. • Weak and thin pulse. Treat Sp 6, Sp 9, Pericardium. • Naso-pharyngitis infections. Treat the Immune points (LI 10-11 on the edge of the bone, close to the Triple Warmer channel). Tape Kawai’s rings on LI 20/BiTong area. Frontal headache: This is most commonly related to sinus problem: allergies, infections, etc. Find the sore spot around LI 20, St 3 area and use it as a reflex. (Although the sinus pain can be above the eyes, one should use points below the eyes as reflexes of the sinuses.) Treat with the Immune points (with moxa). Check the Fire points of Yang Ming (LI 5 and St 41), and, if painful, treat the corresponding Metal/Water points (LI 1, LI 2, or St 44, St 45). Because the L.I. channel crosses over to the opposite side, the opposite LI 1/LI 2 (resolving their own side Fire point) can sometimes release sinus pressure, or it can be same side. Vertex headache: This type headache can be related to stress (insomnia, irritability), to hormonal problems (as in menopause), or to an injury/trauma to the Lower Dan Tian. • If it is related to stress, insomnia, etc., check Ren17 and Ren15 as Anxiety and Insomnia reflexes. Ren15 pressure pain (that is not related to cardiac) can be resolved through Sp 3.2 and P 4 (3 fingers below P 3). Pressure pain on Ren17 can be alleviated by SJ 5 and GB 41 (bilaterally), and then the use of a Pericardium point (determine which point by poking P 8 as per above). • A disruption to the Lower Dan Tian will move up to the Middle Dan Tian (Ren17), and then the Upper Dan Tian (DU20 area). One sees this commonly in post-partum depression where a C-section, or hard labour, disrupted the Lower Dan Tian and resulted in symptoms in the head, showing as pressure pain on DU20 and the vicinity (Si Shen Cong). Treat this with Sp 6, Sp 9, Lu 5, and Pericardium (determine the points by Fire point, P 8, diagnosis). • DU20 headaches that are related to hormonal issues can be treated via Sp 6 and P 6. When gynecological issues are involved, Lu 7 often does a better job than P 6. • Generally Sp 6 has an effect on DU20, as does the chin (check for scars under the chin, and if you find pain, see if that releases DU20 area. Eye pain: UB 2 area pain is considered to be a hormonal headache. Use any of Liv 2, H 3, or UB 59 (UB 59 is needled against the channel), singly or in combination. Deep eye pain, often accompanies a wiry pulse (a wiry pulse by Master Nagano might be described in TCM as an aggressive slippery/wiry pulse – the main feature of this pulse is that it does not loose strength nor its quality when it is pressed deeply). In this case use GB 39 (needled against the channel with a slightly thicker needle, #3 or #5) and Sp 9 and/or Sp 10. This is considered Wood G.B. invading Spleen Earth. This type of pulse is common in Parkinson’s disease patients, stroke, and even Bell’s palsy. When this pulse is felt, the recommended treatment is dispersing GB 39 and tonifying the Spleen. For pain behind the eye, use Liv 9 (about one third from the knee to the groin – sometimes another point two thirds up the thigh is also useful: these are Hashimoto’s Liver Eye points). Whole head headache: Aside from lack of oxygen (treat the Ba Feng points), this is most commonly an issue of sympathetic dominance with a tight pulse (tight pulse by Master Nagano can be described in TCM terms as a thin and wiry pulse that looses this quality upon deep palpation – it either changes quality or disappears). If the pulse is rapid, treat SJ 3: for men, treat on the left, for women, treat on the right. Also use Ren12, Ren15, needled 30o upwards, with Ren6. If the pulse is slow, use the Liao points (UB 31 through UB 34). Dizziness: The most common causes of dizziness are low blood pressure, liver deficiency, ear problems, and T4/T5 shift. • For low blood pressure treat Sp 6, Sp 9, Pericardium, and Under-3rd-Toe. • Liver deficiency shows as dull pain on right Liv 14 (compare right to left) or dull pain when pressing under the ribs on the right side (again compare right to left). The skin over the right edge of the ribs will feel thicker, harder to pinch, than on the left. This is treated by direct moxa on right Liv 1. Liv 1 is especially useful when the pulse is rapid. Be aware that sharp pain on right Liv 14 or under the ribs on the right side indicates Liver Excess, a condition that is treated differently (using right K 7, Sp 7, H 3 and P 4). On the back, Liver imbalance (excess or deficiency) shows as pressure pain or bulging paraspinals on the right side at the level of T7 to T9 (this can be Hua Tuo or U.B.), and is treated with left UB 35 (we call this rectal vein congestion point – note that Liver often has a relationship to points on the left side below the navel). • Repeated ear infections as a child can predispose one to dizziness. It is important to treat the ears. Use SJ 17, or SJ 21, SI 19, GB 2, as reflexes, and treat ~SJ 8 and Sp 7 (same side as the ear). • T4 shift can also cause dizziness. Find the painful spot on the Hua Tuo of T4, T5 (or vicinity) and treat the ear brain stem point (on the side of pain) to release T4.