A Practical Guide to Acu-points

Chris Jarmey and Ilaira Bouratinos

Lotus Publishing Chichester, England

Lotus Publishing Lotus

North Atlantic Books Publishing Berkeley, California

Copyright 2008 by Chris Jarmey and Ilaira Bouratinos. All rights reserved. No portion of this book, except for brief review, may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without the written permission of the publisher. For information, contact Lotus Publishing or North Atlantic Books. First published in 2008 by Lotus Publishing 3. Chapel Street, Chichester, PO19 1BU and North Atlantic Books P O Box 12327 Berkeley, California 94712 Illustrations John Tyropolis, Michael Evdemon and Ilaira Bouratinos Text Design Wendy Craig, Michael Evdemon and Ilaira Bouratinos Cover Design Jim Wilkie Printed and Bound in Singapore by Tien Wah Press Acknowledgements The authors would like to thank the teaching staff of the European Shiatsu School and the European Institute of Oriental Medicine, and also the following persons, without whose valuable input and support this project would not have been possible: Vassilis Basios, Emilios Bouratinos, Katia Boustani, Tew Bunnag, George Dellar, Julie Holland, Jonathan Hutchings, Christos Kondis, Christina Kouli, Giorgio Maioletti, Tim Mulvagh, Andrew Parfitt, Vita Revelli, and Peggy Zarrou. A Practical Guide to Acu-points is sponsored by the Society for the Study of Native Arts and Sciences, a nonprofit educational corporation whose goals are to develop an educational and cross-cultural perspective linking various scientific, social, and artistic fields; to nurture a holistic view of arts, sciences, humanities, and healing; and to publish and distribute literature on the relationship of mind, body, and nature. British Library Cataloguing in Publication Data A CIP record for this book is available from the British Library ISBN 978 0 9543188 4 0 (Lotus Publishing) ISBN 978 1 55643 696 3 (North Atlantic Books) Library of Congress Cataloguing-in-Publication Data Jarmey, Chris. A practical guide to acu-points / by Chris Jarmey and Ilaira Bouratinos. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-1-55643-696-3 (pbk. : North Atlantic Books) ISBN-10: 1-55643-696-3 (pbk. : North Atlantic Books) ISBN-10: 0-9543188-4-6 (pbk. : Lotus Publishing) 1. Acupuncture points. I. Bouratinos, Ilaira. II. Title. [DNLM: 1. Acupuncture Points. 2. Acupressure. 3. Acupuncture Therapy. 4. Meridians. WB 369.5.M5 J37c 2006] RM184.5.J372 2006 615.892--dc22 2006031085

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Contents
Introduction How to Use This Book Chapter 1 Needling Considerations Precautions to be Taken Before Needling Needling Depth Needling Angles Needle Sizes Needle Quality Needling Contraindications Dangerous Areas for Needling Dangerous Points for Puncture Untoward Reactions and Accidents Chapter 2 Manual Techniques Considerations Pressure Techniques Friction Techniques Stretching and Opening Techniques Other Manual Techniques Manual Techniques Contraindications Chapter 3 Moxibustion Considerations General Cautions Points Contraindicated for Moxibustion First Aid for Burns Chapter 4 Cupping Considerations Functions of Cupping Guidelines and Precautions After Cupping Methods of Cupping Chapter 5 Deqi The Importance of Deqi Specific Therapeutic Deqi 5 7 11 11 11 12 12 12 12 13 13 14 15 15 15 15 15 16 17 17 18 18 19 19 19 20 20 21 21 22 Chapter 6 Classication of Points The Top Most Commonly Used Points The Back-Shu and Front-Mu Points The Source-Yuan Points The Accumulation Cleft-Xi Points The Connecting-Luo Points The Four and Six Command Points The Eight Gathering Hui Points The Five Transporting Shu Points Five Phase Point Selection The Window of Heaven Points The Nine Points for Returning Yang The Thirteen Ghost Points The Twelve Heavenly Star Points The Points of the Four Seas The Eight Extraordinary Vessels The Eight Opening and Coupled Points The Six Divisions The Chinese Clock Chapter 7 Principles of Point Selection How to Choose Points Selecting Points According to Area (Local and Distal Points) Selecting Points According to Syndromes Selecting Points According to Diseases and Conditions from Empirical Knowledge and Clinical Practice Chapter 8 Cun Measurements General Guidelines Cun Measurements According to Body Area Chapter 9 Considerations, Cautions and Contraindications General Contraindications Considering Sensitive, Dangerous and Contraindicated Points 25 25 26 26 26 26 27 27 27 29 30 30 30 30 30 30 31 32 32 33 33 34 34 34 41 41 42 45 45 46

A Practical Guide to Acu-points

Chapter 10 Points of the Lung Channel Chapter 11 Points of the Large Intestine Channel

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Chapter 12 Points of the Stomach Channel 77 Chapter 13 Points of the Spleen Channel Chapter 14 Points of the Heart Channel Chapter 15 Points of the Small Intestine Channel 115 135 145

Introduction
Stimulation of specific points on the body surface with the intention of obtaining particular/specific therapeutic effects has been used for thousands of years in many traditional healing systems. There are numerous ancient and modern techniques that have been applied to these points for the purpose of influencing the functional capacity of the body to correct physical and energetic dysfunctions. The application of physical pressure (acupressure), the insertion of needles (acupuncture) and the use of suction cups, magnets, or special herbs and oils, are all traditional methods commonly employed in Eastern therapeutic systems. This text presents clinically useful, practical information for a wide range of specialists including acupuncturists, shiatsu practitioners, physiotherapists and massage therapists. It describes the common techniques that can be applied to the major acu-points, such as acupuncture, moxibustion, guasha, cupping, magnet therapy and manually applied techniques, as well as describing the different therapeutic effects that can be achieved via those treatment methods. The various techniques are clearly delineated in headed subsections. It is recommended that all the sections on the different modes of treatment are studied, even if the intention is to use some, but not all, of those methods. This will facilitate a deeper understanding of each point. For example, shiatsu practitioners, tuina practitioners and other bodywork therapists will improve their understanding of the different layers and depths associated with pressure by studying the needling section. Acupuncturists will greatly benefit from using manual techniques, either in the clinic or as self-treatment recommendations for their patients. Most practitioners of Eastern healing systems will benefit from the moxibustion, cupping, guasha and magnet therapy guidelines offered in the text. Furthermore, physiotherapists, nurses and many medical specialists will benefit from the manual techniques section. Chris Jarmey and Ilaira Bouratinos, 2008

Chapter 16 Points of the Bladder Channel 159 Chapter 17 Points of the Kidney Channel Chapter 18 Points of the Pericardium Channel Chapter 19 Points of the Sanjiao (Triple Burner) Channel Chapter 20 Points of the Gallbladder Channel Chapter 21 Points of the Liver Channel Chapter 22 Points of the Ren Mai (Conception Vessel) Channel Chapter 23 Points of the Du Mai (Governing Vessel) Channel 201 215 225 239 271 287 303

Chapter 24 Extraordinary (Miscellaneous) Non-channel Points 321 Resources Index of Points 345 347

How to Use This Book

Introduction to the Text Format The text for each point begins with a clear title giving its name and number, followed by a calligraphic image of the Chinese ideogram. Below the title, the classification of the point is mentioned (where relevant). The main text outlines a comprehensive description of the location of the point. The remaining text is presented in different sections, discussing the treatment and applications. They include the following:
Best treatment positions Needling Manual techniques and shiatsu Moxibustion Cupping Guasha Magnets Stimulation sensation Actions and indications Synopsis of the main functions and

Main Text Format Classification Classification terms are given in English, followed by the Chinese term. For example, Source-Yuan point. For more details, see Chapter 6. For points of the Five Phase categories, the Tonification, Sedation and Horary nature is mentioned in brackets. Location description Classical Chinese locations have been used throughout the text. Where there are in effect two or more locations for a point, this is clearly described in the text. Variations of location according to other systems and the authors own experiences are also mentioned where relevant. This section also mentions useful tips for locating the point. Every effort has been made to be as anatomically precise as possible and thus resolve the contradictions sometimes found in existing point location descriptions. areas affected The described locations mention the relevant bones, muscles and soft tissues, as well as the superficial anatomical landmarks. The major blood vessels and nerves are mentioned in the needling cautions section (marked with an exclamation mark [!]). The precision of anatomical description does not, however, relieve the practitioner of the responsibility for careful observation and palpation of the area to be treated, so that underlying structures such as blood vessels are protected and the most therapeutically reactive sites are located precisely. The fundamental importance of the role of palpation in point location must not be neglected. Best treatment positions This section discusses the best choice of treatment positions to ensure that the point is effectively accessed. Furthermore, it gives special tips in relation to the above. At the end of this section, the general sensitivity levels of the point are specified, plus general cautions and contraindications in relation to all treatment methods, where relevant. For more information, see the section on sensitive, dangerous and contraindicated points, page 13.

Title Format Point name-numbers The Standard International Acupuncture Nomenclature is used throughout the text. Each points name consists of the name of the channel and the number of the point from the beginning of the channel, e.g. Lu-9. Chinese point names The Chinese point names are written in Pinyin, e.g. Taiyuan. Chinese characters E.g. . The traditional ideograms have been chosen. English translation These interpretations of the Chinese point names are those the authors understand as most representative of their meaning, e.g. Great Deep Pool.

A Practical Guide to Acu-points

How to Use This Book

Cautionary notes are marked with an exclamation mark [!]. Text marked with a double exclamation mark [!!] denotes potentially dangerous techniques and contraindications. Needling This section details the main needling techniques, including the minimum and maximum depths, angles and directions for insertion. The text marked with an exclamation mark [!] cautions the acupuncturist to avoid the blood vessels, nerves and other sensitive structures found at the needling site. Furthermore, text marked with a double exclamation mark [!!] denotes dangerous techniques and contraindications. For more details, see Chapter 1. Manual techniques and shiatsu Most points can be treated by manual techniques, whether it is sustained or moving pressure, superficial or deep friction, oil massage or other useful physical manipulation methods such as stretching and mobilisation. This section details the most effective ways to apply a choice of manual techniques to points where these methods are applicable. Variations and different techniques are discussed in relation to their therapeutic effect and the desired outcome. The text marked with an exclamation mark [!] mentions the relevant cautions, whereas a double exclamation mark [!!] indicates dangerous techniques and contraindications, accordingly. For more details, see Chapter 2. Moxibustion This section details the points indicated for moxibustion and those contraindicated. As a general rule, where there is no mention of it at all, moxibustion should not be used. The times, quantities and types of moxa mentioned are based mainly on Chinese recommendations. Where indirect moxa is mentioned, both traditional moxa poles and other more modern methods of moxa application are intended for use. For more details, see Chapter 3. Cupping Cupping is mentioned only where applicable. Where it is not mentioned, it should not be used. For more details, see Chapter 4. Guasha The basic guasha method is mentioned where considered most useful and applicable. Where it is not mentioned, it should not generally be used.

Magnets This section mentions basic usage of magnets and certain point combinations. Although there are many different points of view on the subject of magnet usage, it is important to understand that the mechanism via which they work is still not fully understood. Although there are differing opinions on which pole of the magnet is more tonifying or sedating, it is taken in this text that the North Pole is more tonifying and the South more dispersing, when in the Earths Northern Hemisphere (the opposite applies in the Southern Hemisphere). Throughout the text, it is taken that the treatment is applied in the Northern Hemisphere. Stimulation sensation This section discusses the most common manifestations of deqi acquired from stimulating the point. It details the quality, intensity, direction and areas the sensation should reach depending on the required therapeutic results. It also mentions other manifestations of deqi such as changes in the pulse, or breathing rate. Although deqi is mostly relevant to the application of acupuncture and manual techniques such as massage and shiatsu, it may also apply to magnet therapy and moxibustion. This section is based on the major acupuncture texts as well as the authors experience. For more details, see Chapter 5. Actions and indications This section discusses the applications for each point. It requires that the reader have an understanding of Traditional Chinese Medicine (TCM) diagnosis and differentiation of syndromes. The main actions (functions) are clearly presented and accompanied by the relevant indications (including signs, symptoms and diseases). The major functions are emphasised in italic text. They are based mainly, but not exclusively, on classical Chinese medical theory. Furthermore, there are numerous comments mentioning various interesting and important facts relating to the point. At the end of the text for each point* there is a quick reference section (synopsis), clearly defined in a text box, highlighting the body areas, organs and functions that are deemed of most use in the clinic.

About the Illustrations

Main Areas: Mentions the main body areas, tissues, organs, systems and Zangfu affected by the point. Main Functions: Mentions the main functions of the point to complement and re-emphasise the italicised functions in the actions and indications section.

These illustrations aim to be as anatomically precise as possible and to show the relevant structures. The needle insertion site is illustrated with a dot. A broader area around this dot is illustrated with light blue shading. This area displays the site where manual techniques, moxibustion, guasha and cupping can be applied (where relevant). Most of the point illustrations have the shaded area, except where, for reasons of clarity, it was excluded. Also, where there is more than one illustration for any given point, the shaded area is not always repeated. These shaded areas may also illustrate other possible sites for needling, acupressure and other treatment methods. Possible reasons for treating outside the main point as illustrated with the dot include:

The main functions listed in the synopsis text box are often the same as the major functions that are italicised in the section on actions and indications. This means that these repeated functions are of most clinical relevance. In some cases, the synopsis of functions differs from the italicised text. This means that those functions mentioned in the text box are the most clinically relevant. The reason for this is that the italicised functions in the main text are mostly major traditional Chinese functions. For example, regulating qi and Blood is a traditional function, whereas lowering blood pressure is not (see St-9). Therefore, the italicised functions in the main text and synopsis box must be compared. The reader must note, however, that because Eastern medicine is an art rather than a precise science, there is immense variation in the actions of the points, both in terms of the different traditional schools of thought and the individual practitioner. Therefore, the synopsis of main functions and italicised text serves as a general guide only. Furthermore, the functions that are emphasised, have been chosen as those deemed most clinically applicable according to the authors own experience and understanding. In this sense, they can be altered or substituted by each practitioner, as he/she considers most appropriate. Every effort has been made to include the most accurate information from principal traditional and contemporary sources. For example, the synopsis for point Lu-9:

 f deqi cannot be achieved at the specified point, the I practitioner must palpate this area carefully to ascertain a more reactive location to insert the needle or apply the pressure, magnet, moxibustion, etc.  f there is distortion of the main needling site (for I example: swelling, skin eruptions, scar tissue, extreme tightness, distended blood vessels), then the practitioner must insert the needle at a different site.

Also, the shaded area may illustrate the area the needle shaft may reach at a deeper level, particularly when applying oblique or transverse needling. For example, the large shaded area between the middle and anterior fibres of the deltoid muscle for the point LI-15 not only illustrates the manual techniques region, but also the area where the needle will be located when using the second needling method mentioned (i.e. needle up to 2 cun at a transverse angle distally, between the anterior and medial fibres of the muscle). The reader may also notice that some of the dots illustrating a point appear to be slightly smaller (or larger) than others. This is because points do vary somewhat in size. For example, the Well-Jing points at the tips of the fingers are smaller than large fleshy points such as Sp-6 or GB-30.

Main Areas: Chest. Lungs. Blood vessels. Main Functions: Tonifies chest qi. Strengthens the breath and voice. Nourishes Lung yin. Transforms phlegm. Benefits the vessels and improves circulation.

* Except for a small number of less commonly used points.

A Practical Guide to Acu-points

Points of the Gallbladder Channel

GB-25

Jingmen
Capital Gate

Manual techniques and shiatsu Gently applied sustained perpendicular pressure can be applied with the fingertips onto the tip of the twelfth rib, and directly below it. ! Only apply very gentle pressure to the false ribs. This location is very sensitive and can be very painful if pressed carelessly. Moxibustion Cones: 310. Pole: 1030 minutes. Cupping Cupping with medium or light suction or empty cupping can be very beneficial for kidney disorders and lumbar pain. Use a medium or large cup size. Guasha Gently applied guasha is applicable. Magnets Stick-on magnets are helpful for kidney disorders. Apply south pole to GB-25 and north to Bl-23 for lumbar pain and kidney disorders including colic and haematuria. Stimulation sensation Local ache, distension, tingling or numbness radiating across the lumbar area, possibly extending toward the groin or into the kidneys. Actions and indications Although GB-25 is not as commonly used as other Alarm-Mu points, it can be effective to tonify the Kidneys and strengthen the lumbar area, dispel dampness from the lower jiao and open the water passages as well as regulate the intestines. It also activates qi and Blood circulation and alleviates pain. Indications include acute or chronic lumbar pain, renal colic, frequent urination, dysuria, haematuria, lumbar pain, cold lower back, hip pain, abdominal rumbling, diarrhoea, vomiting, intercostal neuralgia, hypochondrial or abdominal distension and pain. Spontaneous pain at this location on one or both sides may be a diagnostic indication of kidney disease.
Main Areas: Kidneys. Lumbar area. Flank. Main Functions: Benefits the Kidneys. Transforms dampness and heat. Regulates qi and blood. Alleviates pain.

GB-26

Daimai
Girdle Vessel

On the lower back, at the free end of the twelfth rib. To aid location, it is usually tender on light palpation because it is a very sensitive location. Alternative location At the inferior border of the free end of the twelfth rib. Best treatment positions This location is best treated with the patient in a prone or side position. However, manual techniques can also be applied with the patient sitting up. Needling  0.3 to 1 cun oblique or transverse insertion, medially along lower border of twelfth rib. 0.3 to 0.5 cun perpendicular insertion. !! Do not needle deeply. Do not puncture the peritoneum. Deep needling may puncture the colon, liver, spleen or kidney.

On the lateral aspect of the abdomen, level with the umbilicus, below the free end of the eleventh rib, approximately on the mid-axillary line. Best treatment positions This location is best treated with the patient in a supine or side-lying position. However, prone or sitting up may also be employed. Needling 0.5 to 1 cun perpendicular insertion. !! Do not needle deeply. Do not puncture the peritoneum. Deep needling may puncture the colon, liver, spleen or kidney. Moxibustion Cones: 35. Pole: 1020 minutes. Rice-grain moxa is also useful. Magnets Small stick-on magnets can be effective. For weight loss and harmonising or tonifying the abdomen, alternate north and south poles on points level with the umbilicus including GB-26, Sp-15, St-25, Ren-8, Bl-23 and Du-4. Manual techniques and shiatsu It is generally not so easy to stimulate this location by pressure and massage because of the soft nature of the underlying tissues. However, it can be effective to press both sides simultaneously (this is not so easy to achieve on overweight patients) or one side only in a side-lying position. An effective shiatsu technique is to open this area by stretching the space between the pelvis and rib cage. This is achieved either in a side-lying position (grasp the iliac crest and stretch the pelvis down toward the feet, or apply crossed arm diagonal stretch with one palm resting on the pelvis and the other on the lower ribs), or, in a sitting position (side flex the torso toward the opposite side, while stabilising the pelvis). ! Only apply very light pressure to the floating ribs. Stimulation sensation Local distension, dull ache or tingling spreading across the abdomen and lower back, or down toward the hip on the side that is being treated.

Mid-axillary line

Alarm Mu point of the Kidney

Intersection of the Dai Mai and Gallbladder

Umbilicus

GB-26

Actions and indications GB-26 is an important point to activate qi and Blood circulation in the lower jiao and regulate the Dai Mai (Girdle Vessel), from which it takes its name. It is useful to clear dampness and heat from the abdomen, harmonise the lower jiao and regulate menstruation. Indications include pain, distension, swelling or flaccidity of the abdomen, lumbus and girdle area, lower abdominal pain in women, irregular menstruation, amenorrhoea, chronic leucorrhoea, blood-stained discharge, hernia, diarrhoea and abdominal rumbling. Treatment at GB-26 is useful in weight loss programmes because it helps tonify the intestines and strengthen the abdominal wall, helping to lose inches around the waist. In such cases it is most effective to combine treatment with embedding needles or stick-on magnets. Furthermore, self-moxibustion, applied daily for a few minutes, is helpful to tonify the Kidneys and Spleen in such cases.

Main Areas: Abdomen. Sides. Lumbar area. Uterus. Girdle Vessel. Main Functions: Clears dampness and heat. Benefits the lower jiao. Regulates menstruation.

GB-25

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