Friday, July 16, 2010

Resolving Dampness and Phlegm with acupuncture

When I give lectures I often hear that "ST-40 resolves Phlegm": I wish! Resolving Phlegm involves much more than simply using ST-40. In order to resolve Dampness or Phlegm, it is necessary to activate the Three Burners.
The Triple Burner is described in the Nei Jing as the official in charge of irrigation: this means that the Triple Burner is responsible for the transformation, transportation and excretion of fluids in all parts of the body and all organs. This is one of the most important functions of the Triple Burner.
The terms used in Chinese in connection with the Triple Burner’s influence on the body fluids are often shu 疏 which means “free flow” and tong 通 which means “free passage”. Therefore the Triple Burner is like a system of canals and waterways to channel irrigation water through the proper fields and then out: this ensures that body fluids are transformed, transported and excreted properly.
The Triple Burner’s function in relation to body fluids is closely dependent on its function of controlling the transportation and penetration of Qi. The Triple Burner influences the ascending/descending and entering/exiting of Qi in the Qi Mechanism:
it is the coordinated and harmonized ascending/descending and entering/exiting of Qi in all organs and structures that ensures that the body fluids also ascend/descend and enter/exit in the proper way in all places. Essentially, the transformation and movement of fluids depends on Qi.
This whole process is called “Qi Transformation by the Triple Burner”: the result of the Qi transformation is the production of Nutritive-Qi, Defensive-Qi, Blood and Body Fluids. That is also why the Triple Burner is said to control “all kinds of Qi”. This sums up the way in which acupuncture can influence the transformation, transportation and excretion of fluids: it can only achieve this through Qi.
Herbal medicine resolves Dampness by using herbs which are actually diuretic (e.g. Fu Ling, Zhu Ling, Ze Xie, Yi Yi Ren, etc.); and it resolves Phlegm by using herbs that are drying (e.g. Ban Xia, Dan Nan Xing, etc.). Acupuncture can resolve Dampness or Phlegm only by regulating the ascending/descending and entering/exiting of Qi in the Qi Mechanism.
Secondly, one must resolve Dampness or Phlegm by regulating the fluid movement, transformation and excretion by the Triple Burner. In my experience, in order to do this, it is necessary to activate all three Burners which means that one should not hesitate to use more points than one would normally use. For example, to resolve Phlegm from the prostate (i.e. Lower Burner), I would use many points from the Lower Burner (listed in previous slide) plus some from the Upper and Middle Burner.
Please note that when we say that we need to “regulate the Triple Burner”, we do not do that by using Triple Burner points necessarily. Many points regulate the fluid metabolism by the Triple Burner and especially points on the Ren Mai: indeed these are the most important ones.

- Upper Burner: Du-26 Shuigou, Ren-17, LU-7, LI-4, LI-6, TB-4, TB-6
- Middle Burner: Ren-9 Shuifen, Ren-12, ST-22, Ren-11
- Lower Burner: ST-28 Shuidao, Ren-5, BL-22,, BL-39, SP-9, SP-6, KI-7.

T.B.-4 and BL-64 in combination move Qi in the Triple Burner and activate Water Passages.

NOTE: the three points in blue (Du-26 Shuigou, Ren-9 Shuifen and ST-28 Shuidao) activate the fluid transformation in each Burner. Shui means “water” and those points are therefore “Water Ditch”, “Water Separation” and “Water Passages” respectively. The points in red are strategic points on the Ren Mai that have the same function, Ren-17, Ren-9 and Ren-5 for the Upper, Middle and Lower Burner respectively. As we can see, Ren-9 pertains to both groups of points and that is why this point is such an important point for the metabolism of fluids and a point I would always use to resolve Dampness or Phlegm.
This means that when I resolve Dampness and Phlegm, I do not hesitate to use quite a lot of points to activate all three Burners but giving predominance to the points where the Dampness or Phlegm is situated. For example, if there is Phlegm in the Lower Burner (e.g. prostatic hyperplasia), I would use many points from the Lower Burner but also some from the Middle and Upper Burner. This is an example of such a point combination: Ren-3, BL-22, Ren-5, ST-28, SP-9, ST-40 (Lower Burner), Ren-9 (Middle Burner) and LU-7 (Upper Burner). With variations, this point combination could also be used for Phlegm in the Uterus.

Thursday, July 8, 2010

Swollen tongue

I frequently hear that a Swollen tongue indicates Qi deficiency. It is not so! In my experience, a Swollen tongue indicates Phlegm. But let us start by describing it first. A tongue is "Swollen" when the whole body is larger than normal. Crucially, a Swollen tongue is also somewhat rounder than a normal tongue. In very severe cases of Swollen tongue, the tongue may be almost perfectly round.

Before describing the clinical significance of a Swollen tongue, let us look at the clinical significance of a Thin tongue (i.e. the opposite of a Swollen tongue). As we all know, a Thin tongue indicates a deficiency of fluids, which may be Blood (is the tongue is Pale) or Yin fluids (if the tongue lacks a coating). It follows, therefore, that a Swollen tongue, being the opposite of a thin tongue, indicates that there is an excess of fluids. These "excess" fluids are not normal fluids but the accumulation of pathological fluids, i.e. either Dampness or Phlegm. I personally relate the swelling of the tongue body more to Phlegm than to Dampness (the latter reflected more on the coating).

I attach huge importance to the Swollen tongue: indeed, if the tongue is very swollen, I relate that to Phlegm even in the absence of any other symptoms or signs. This is after all an important aspect of tongue diagnosis, i.e. its preventive value. If a patient presents with a Swollen tongue (as in the picture above) I definitely resolve Phlegm. Please note that resolving Phlegm will not only help any internal disease the patient might have but it would also lead to an improvement of a channel problem as Phlegm obstructs the channels.

Please note that a Swollen tongue may be without coating (we would normally expect a sticky coating). This is not at all unusual and it is seen frequently in the elderly: it simply means that there is both Phlegm and Yin deficiency.

With acupuncture, to resolve Phlegm I would use these essential points: LU-7, Ren-9, Ren-12, SP-6 and ST-40. Other points that may be added are: BL-22, Ren-5, ST-28, KI-7 depending on the type of Phlegm and symptoms.