Abdominal Acupuncture

Submitted by elotus on Tue, 11/20/2018 - 2:34pm

Abdominal Acupuncture

Abdominal Acupuncture, created by Dr. Zhiyun Bo, is an easy modality to learn and apply. It is not only gentle and relaxing, it is also very effective because it works with the qi in the core of the body. In addition, it directly affects the digestive system.

The following overview to Abdominal Acupuncture is compiled from the online courses by Dave Shipsey (in English), and online resources by Dr. Zhiyun Bo (in Chinese).

INTRODUCTION

Abdominal Acupuncture utilizes a hologram of the abdomen of a tortoise on its back. Abdominal points prescriptions follow the same concept of herbal prescriptions in which there are Jun, Chen, Zuo, Shi (Chief, Deputy, Assistant, Envoy) points, with each playing an important and essential function.

Chief points treat the patient’s chief complaints, and regulate and harmonize the organs. Usually 1-2 points are selected.
Deputy points enhance the organ regulating effects of the Chief points.
Assistant points enhance Chief and Deputy functions, as well as regulate affected channels.
Envoy points provide symptomatic relief. They often image the corresponding pain areas, and can also be guiding points.

There is no set number of points to use for each category above, however, there are usually more Envoy points than Chief points. Depending on the condition, some point prescriptions may only contain points from one or two of the categories.

In addition, different combinations of the same points can yield different effects. Take Guanyuan (CV 4), Xiawan (CV 10), and Zhongwan (CV 12) for example. Guanyuan (CV 4) and Zhongwan (CV 12) combined tonify the Spleen and the Kidney; whereas, Guanyuan (CV 4) and Xiawan (CV 10) combined harmonize the Stomach and strengthen the Spleen; and Xiawan (CV 10) and Zhongwan (CV 12) combined treat a broader range of gastrointestinal disorders, as opposed to using only one of the points.

Point locations and needling depths are the keys to successful treatment outcomes.

POINT LOCATIONS WITH CORRESPONDING IMAGING AREAS

The ren (conception) channel images the spine. Therefore, the CV points on the abdomen correspond to the vertebra and GV points.

Zhongwan (CV 12) = Head – Treats head, brain, and sensory organs

Jianli (CV 11) = C1 or Fengfu (GV 16) – Used for brain problems and treats C1 vertebra area

Xiawan (CV 10) = C7 or Dazhuiv (GV 14) – Helps Zhongwan (CV 12) for SP and ST problems, and treats C7 vertebra area

Shuifen (CV 9) = T7 – Reduces swelling during the acute stages of back/neck pain

Shenque (CV 8) or navel = T12; this is the center

Qihai (CV 6) = L1 – Treats all kinds of chronic qi diseases

Guanyuan (CV 4) = L4 & L5 or Yaoyangguan (GV 3)

Zhongji (CV 3) = Sacrum

In addition to the CV points above, there are also points on the abdomen that image the upper and lower extremities.

Huaroumen (ST 24) = Shoulder point – Use for any arm/hand issues. Strengthens the upper back.

Elbow point (AB1) is ½ cun superolateral to the Shoulder point. This point is also the Upper Rheumatism Point.
Wrist point (AB2) is 1 cun lateral to the Shoulder point, or ½ cun inferolateral to the Elbow point. This point is also the Upper Lateral Rheumatism Point.
Thumb point (AB3) is 1 cun superior to the Wrist point. This point is also the Upper Rheumatism Point.

Wailing (ST 26) = Hip point – Use for any back/leg issues. Strengthens the lower back.

Knee point (AB4) is ½ cun inferolateral to the Hip point. This point is also the Lower Rheumatism Point.
Medial Knee point (AB5) is ½ cun inferomedial to the Hip point.
Ankle point (AB6) is ½ cun inferolateral to the Knee point (AB4). This point is also the Lower Lower Rheumatism Point.
Foot/Toes point (AB7) is ½ cun inferomedial to the Ankle point (AB6).

Summary of the points that are Vertically Lined Up

Shoulder point and Hip point are lined up vertically on the ST channel (2 cun lateral to ren (conception) channel).
Elbow point (AB1) and Knee point (AB4) are lined up vertically 2.5 cun lateral to ren (conception) channel.
Wrist point (AB2), Thumb point (AB3), and Ankle point (AB6) are lined up vertically 3 cun lateral to ren (conception) channel.

Summary of the points that are Horizontally Lined Up

Thumb point (3 cun lateral) is lined up horizontally with Xiawan (CV 10).
Shoulder point (2 cun lateral) and Wrist point (3 cun lateral) are lined up horizontally with Shuifen (CV 9).
Hip point (2 cun lateral) is lined up horizontally with Yinjiao (CV 7).
Medial Knee point (1.5 cun lateral) and Knee point (2.5 cun lateral) are lined up horizontally with Qihai (CV 6).
Ankle point (3 cun lateral) is lined up horizontally with Shimen (CV 5).

Kidney channel images the Urinary Bladder channel, so the KI points on the abdomen are anatomical reflections of points on the back BL channel, and can be used likewise. These points are also used to re-enforce the actions of the CV points. In addition, the KI points also affect the opposite side upper and lower extremities by moving the qi from the Kidneys to the reflected area (see Chart below). KI points that are often used in Abdominal Acupuncture are Qixue (KI 13), Shangqu (KI 17), Shiguan (KI 18), and Yindu (KI 19).

SIZE AND GAUGE OF NEEDLES

Usually 32 gauge, 1 to 1.5 cun needles are used.

NEEDLING PROCEDURE

In Abdominal Acupuncture, the points are needled from top to bottom, and from inside to outside. Chief points used to “bring the qi home” should be needled deeper. Deputy and Assistant points should be moderately deep, and Envoy points should be shallow if treating pain.

Insert all the needles first and let them settle in so the body is aware it is being treated. Then use very gentle pressure to adjust the depths and directions of the needles so that they are all standing upright. Adjust the needles in the same order they were inserted.

Step 1: Chief Points

Choose 2 or 4 of the following points to bring the qi to the core or home. This is known as “Bringing the Qi Home” to strengthen the Spleen and the Kidneys.

Zhongwan (CV 12) – Tonifies the SP / ST

Xiawan (CV 10) – Tonifies the SP / ST

Qihai (CV 6) – Tonifies the KI

Guanyuan (CV 4) – Tonifies the KI

Step 2: Deputy and Assistant Points

Add any of the following points to enhance and support the functions of the Chief points.

Add Huaroumen (ST 24) and Wailing (ST 26), bilaterally, to promote more qi and blood circulation. They are the Abdominal Four Gates.
Add Tianshu (ST 25), bilaterally, if the patient also has digestive disorders.
Add Daheng (SP 15), bilaterally, if addressing disorders involving muscles, or to ease pain and eliminate dampness, or to harmonize the middle jiao more.
Add Qixue (KI 13), on the healthy side, to move qi in the lower jiao.
Add Shangqu (KI 17), on the healthy side, to move qi in the upper jiao.

Step 3: Envoy Points

Feel for nodes, grains, bubbles, or ashi points in the corresponding problematic area. Use up to 3 needles if necessary and adjust the depth of the needles for optimal results. Needle the same side as the affected area.

Upper and Lower Rheumatism points can be used to open channels and collaterals and relieve bi zheng (painful obstruction syndrome).

Step 4: Stimulation

There is no need to stimulate the needles up and down like in body acupuncture. As long as the needles are at the right depth, you can just let the needles work their magic. Any stimulation should be just back and forth in a gentle manner. Adjust the angle if needed.

Weaker stimulation tonifies while stronger stimulation sedates. Because Abdominal Acupuncture is most suitable for chronic disorders and most patients with chronic disorders are deficient, mild needle stimulation would be enough to achieve desired treatment results. Moxa can also be added to the points.

In general, there are three steps to “De Qi” in Abdominal Acupuncture.

Wait for the Qi (Hou Qi 候气):

This step is to insert the needle and wait 3-5 minutes for the qi to arrive to the local area.

Activate the Qi (Xing Qi 行气):

This step is to stimulate the points by adjusting the needles to the proper depth. Needles need to be adjusted in the same order they were inserted.

Hurry the Qi (Cui Qi 催气):

This step is to refine the point location by adjusting the angle or the depth of the needle in order to achieve maximum clinical effectiveness. Usually this step is not needed unless the result is not satisfactory.

Step 5: Removal of Needles

Remove the needles in the order of insertion. Slowly remove the needles from the depth they are in – do not further insert the needle before removal. Also, do not stimulate the point before removal. After needle removal, use a dry cotton ball to press on the points.

NEEDLE DEPTH

There are 3 depth levels in Abdominal Acupuncture: Heaven, Man, and Earth.

Heaven level is the most superficial of the 3 levels. It is less than 1 cun from the surface. Needle insertion at this superficial level is mostly used to treat periphery, acute, or painful disorders of the muscles, bones, etc. The tortoise hologram is 3 dimensional so the more superficial part of the Heaven level treats the front of the body while the deeper part of the Heaven level treats the bone or the posterior side of the body. Don’t go deeper than necessary.

The second level is Man, which is moderately deep. This depth is used to treat problems with the channels and collaterals.

The last and deepest level is Earth, and it is used to treat zang fu disorders.

As a general rule, depth of the Chief points on the ren (conception) channel should be deep. During treatment, these points can be marked with red ink on the patient's chart to indicate the depth is the deepest, Earth level. Deputy and Assistant points on the ST, SP, KI channels should be moderately deep, Man level, and indicated by blue ink on patients’ charts. Envoy points on the affected area should be shallow, on the Heaven level. One can also indicate the depth of the needles on patients’ charts by writing D (Deep), M (Medium) or S (Shallow) on the side of the points that are needled.

RETENTION OF NEEDLES

On average, needles should stay in for 20-30 minutes. Leave the needles in for a shorter period of time if treating chronic or weak patients. Alternatively, for acute or stronger patients, needles can be retained for a longer period of time.

CAUTION/CONTRAINDICATIONS

Avoid deep needling puncturing into the abdomen, vessels, or organs.
Contraindicated for acute abdominal disorders, acute peritonitis, splenomegaly, and hepatomegaly with visible veins. (Shallow needling around the rib area for patients with hepato- or splenomegaly.)
Contraindicated in extremely deficient patients or post-surgical patients, cancer patients, and pregnant women.

SAMPLE PRESCRIPTIONS

Headache