Accupunture for Fatty Liver

Fatty liver (hepatic steatosis) refers to excessive accumulation of lipids in the hepatocytes. Fatty liver occurs when lipid accumulation exceeds the normal 5% of liver weight. Alcoholism, obesity, and diabetes are the most common causes of macrovesicular fatty liver in developed countries. Therefore, this is a commonly seen complication of diabetes. Approximately 45% of patients with diabetes over 60 years of age have a fatty liver. It is believed that fatty liver is due to loss of balance between triglycerides. Fifty to 80% of patients with type 2 diabetes are obese, and a fatty liver and obesity are closely related. Diabetic fatty liver is most often found on physical examination as nontender, smooth, diffuse hepatomegaly in a diabetic patient. While there may be accompanying right upper quadrant pain, tenderness, and/or jaundice, fatty liver may be asymptomatic. Ultrasonography and CT scan may reveal excess fat, but fatty liver is diagnosed with certainty only by liver biopsy. Macrovesicular fatty liver is usually not harmful in itself, and no specific Western medical treatment exists for it other than to treat the underlying disorder. Management includes weight loss for obese patients, and glycemic control for those with diabetes.

According to Li Sai-mei et al. in Tang Niao Bing Zhong Xi Yi Zhen Liao Yu Tiao Yang (Diabetes, Its Western & Chinese Medical Diagnosis, Treatment & Care, Guangdong Tourism Publishing Co., Guangzhou, 2000), diabetic fatty liver is divided into four stages and its Chinese medical treatment based pattern discrimination is related to these four stages.

Treatment based on pattern discrimination:

Stages I & II

1. Liver qi depression & binding

Main symptoms: Right rib-side distention, fullness, and discomfort mostly caused and/or aggravated by emotional stress or psychological stimulation accompanied by a dry mouth with a bitter taste, a red tongue with thin, white fur, and a bowstring, fine pulse

Treatment principles: Course the liver and resolve depression

Rx: Si Ni San Jia Jian (Four Counterflows Powder with Additions & Subtractions)

Radix Bupleuri (Chai Hu), 6g, Fructus Immaturus Citri Aurantii (Zhi Shi), 6g, Fructus Citri Aurantii (Zhi Ke), 6g, Radix Rubrus Paeoniae Lactiflorae (Chi Shao), 10g, Radix Albus Paeoniae Lactiflorae (Bai Shao), 10g, uncooked Radix Glycyrrhizae (Gan Cao), 6g, Rhizoma Cyperi Rotundi (Xiang Fu), 10g, Rhizoma Alismatis (Ze Xie), 10g, Radix Salviae Miltiorrhizae (Dan Shen), 20g, Folium Nelumbinis Nuciferae (He Ye), 6g, Fructus Citri Sacrodactylis (Fo Shou), 10g, Radix Scrophulariae Ningpoensis (Xuan Shen), 10g, Radix Trichosanthis Kirlowii (TianHua Fen), 20g, Cortex Magnoliae Officinalis (Hou Po), 6g

2. Yin vacuity-yang effulgence

Main symptoms: Dry mouth, polydipsia, polyuria colored yellow, constipation, tenseness, agiation, easy anger, dizziness and vertigo, if severe, abdominal distention, right upper abdominal discomfort, bleching, decreased appetite, a red tongue with yellow fur, and a weak pulse

Treatment principles: Nourish yin and emolliate the liver

Rx: Zeng Ye Tang Jia Wei (Increase Fluids Decoctions with Added Flavors)

Radix Scrophulariae Ningpoensis (Xuan Shen), 20g, uncooked Radix Rehmanniae (Sheng Di), 20g, Tuber Ophiopogonis Japonici (Mai Men Dong), 10g, Radix Albus Paeoniae Lactiflorae (Bai Shao), 20g, uncooked Radix Polygoni Multiflori (He Shou Wu), 15g, Radix Puerariae (Ge Gen), 10g, Radix Trichosanthis Kirlowii (Tian Hua Fen), 20g, uncooked Radix Glycyrrhizae (Gan Cao), 3g

Stage III

1. Phlegm turbidity congestion & exuberance

Main symptoms: Ductal and abdominal distention and fullness, torpid intake, loose stools, heavy, encumbered body and limbs, scanty qi, lack of strength, a dry mouth and thirst, a fat body, a pale but dark tongue with thick, slimy, white fur, and a bowstring, slippery pulse

Treatment principles: Fortify the spleen and harmonize the stomach, dispel phlegm and transform turbidity

Rx: Wen Dan Tang Jia Wei (Warm the Gallbladder Decoction with Added Flavors)

Rhizoma Pinelliae Ternatae (Ban Xia), 10g, Sclerotium Poriae Cocos (Fu Ling), 12g, Rhizoma Atractylodis Macrocephalae (Bai Zhu), 10g, Caulis Bambusae In Taeniis (Zhu Ru), 10g, Tuber Curcumae (Yu Jin), 10g, Rhizoma Alismatis (ZE Xie), 15g, Radix Puerariae (Ge Gen), 12g, Pericarpium Citri Reticulatae (Chen Pi), 10g, Rhizoma Atractylodis (Cang Zhu), 10g, Cortex Magnoliae Officinalis (Hou Po), 10g, Semen Pruni Persicae (Tao Ren), 10g, Fructus Crataegi (Shan Zha), 15g, Radix Salviae Miltiorrhizae (Dan Shen), 20g

2. Damp heat depression & binding

Main symptoms: Chest, ductal, and abdominal distention, bloating and distention after meals, thirst but no polydipsia, muscular soreness and distention, a heavy feeling in the four limbs, a bitter taste in the mouth, nausea, if severe, jaundice, yellow urine, a pale, fat, slightly red tongue with thick, slimy, yellow fur, and a slippery, bowstring, rapid pulse

Treatment principles: Fortify the spleen and transform dampness, clear heat and disinhibit water

Rx: Yin Chen Hao Tang (Artemisia Capillaris Decoction) plus San Miao San (three Wonders Powder) with additions and subtractions

Rhizoma Atractylodis (Cang Zhu), 10g, Radix Puerariae (Ge Gen), 10g, Semen Coicis Lachryma-jobi (Yi Yi Ren), 30g, Sclerotium Polypori Umbellati (Zhu Ling), 20g, Sclerotium Poriae Cocos (Fu Ling), 20g, Cortex Phellodendri (Huang Bai), 10g, Radix Achyranthis Bidentatae (Niu Xi), 12g, Cortex Magnoliae Officinalis (Hou Po), 6g, Herba Artemisiae Capillaris (Yin Chen Hao), 20g, Pericarpium Citri Reticulatae (Chen Pi), 10g, Radix Trichisanthis Kirlowii (Tian Hua Fen), 20g, Rhizoma Coptidis Chinensis (Huang Lian), 10g

3. Liver depression & blood stasis

Main symptoms: Dry mouth, parched throat, rib-side and abdominal distention and fullness, a fat body, lower and upper back soreness and pain, dark red lips and tongue, and a bowstring, slippery pulse

Treatment principles: Course the liver and rectify the qi, quicken the blood and transform stasis

Rx: Chai Hu Shu Gan San Jia Wei (Bupleurum Course the Liver Powder with Added Flavors)

Rhizoma Polygonati (Huang Jing), 30g, Radix Bupleuri (Chai Hu), 10g, Radix Rubrus Paeoniae Lactiflorae (Chi Shao), 30g, Radix Albus Paeoniae Lactiflorae (Bai Shao), 20g, Fructus Citri Aurantii (Zhi Ke), 6g, Fructus Immaturus Citri Aurantii (Zhi Shi), 6g, Radix Salviae Miltiorrhizae (Dan Shen), 30g, Semen Pruni Persicae (Tao Ren), 20g, Radix Angelicae Sinensis (Dang Gui), 10g, Fructus Schisandrae Chinensis (Wu Wei Zi), 10g, Herba Artemisiae Capillaris (Yin Chen Hao), 20g, uncooked Radix Rehmanniae (Sheng Di), 15g, Semen Polygoni Orientalis (Shui Hong Yao Zi), 10g

Stage IV

1. Spleen-kidney yang vacuity, phlegm & stasis collecting internally

Main symptoms: Fear of cold, chilled limbs, lower extremity superficial edema, diarrhea, hypochondral piercing pain, distention, and fullness, lack of strength, a dry mouth and tongue, no thirst but profuse drinking, lower and upper back soreness and aching, impotence, a fat, dark red tongue with white fur, and a deep, fine, forceless pulse

Treatment principles: Warm and supplement the spleen and kidneys, free the flow of the network vessels and quicken the blood

Rx: [Unnamed formula]

uncooked Radix Astragali Membranacei (Huang Qi), 20g, Radix Angelicae Sinensis (Dang Gui), 10g, Radix Rubrus Panacis Ginseng (Ren Shen), 5g, Radix Lateralis Praeparatus Aconiti Carmichaeli (Fu Zi), 5g, Sclerotium Polypori Umbellati (Zhu Ling), 20g, Rhizoma Atractylodis (Cang Zhu), 10g, cooked Radix Rehmanniae (Shu Di), 10g, Fructus Amomi (Sha Ren), 6g, Rhizoma Cibotii Barometsis (Gou Ji), 15g, Fructus Chaenomelis Lagenariae (Mu Gua), 15g, Radix Dipsaci (Xu Duan), 10g, Radix Puerariae (Ge Gen), 10g, Radix Salviae Miltiorrhizae (Dan Shen), 20g, Scolopendra Subspinipes (Wu Gong), 2 strips, Radix Rubrus Paeoniae Lactiflorae (Chi Shao), 30g, Pericarpium Citrti Reticulatae (Chen Pi), 10g

2. Liver-kidney yin vacuity, static blood obstructing the network vessels

Main symptoms: Lassitude of the spirit, lack of strength, a sallow yellow facial complexion, dizziness and vertigo, low back soreness and low limb limpness, if severe, epistaxis, bleeding gums, liver palms, spider nevi, a dry mouth and parched tongue, a dark red tongue with scanty fur, and a fine, rapid pulse

Treatment principles: Enrich yin and nourish the blood, boost the qi and quicken the blood

Rx: [Unnamed formula]

Radix Pseudostellariae Heterophyllae (Tai Zi Shen), 20g, Sclerotium Polypori Umbellati (Zhu Ling), 20g, Rhizoma Atractylodis Macrocephalae (Bai Zhu), 10g, mix-fried Radix Glycyrrhizae (Gan Cao), 6g, Radix Angelicae Sinensis (Dang Gui), 10g, Radix Ligustici Wallichii (Chuan Xiong), 10g, Radix Rubrus Paeoniae Lactiflorae (Chi Shao), 20g, Radix Albus Paeoniae Lactiflorae (Bai Shao), 20g, Radix Achyranthis Bidentatae (Niu Xi), 15g, uncooked Radix Rehmanniae (Sheng Di), 20g, uncooked Radix Astragali Membranacei (Huang Qi), 20g, Radix Salviae Miltiorrhizae (Dan Shen), 20g, Gelatinum Plastri Testudinis (Gui Ban Jiao), 10g, cooked Radix Rehmanniae (Shu Di), 15g, Fructus Corni Officinalis (Shan Zhu Yu), 10g, Cortex Eucommiae Ulmoidis (Du Zhong), 10g, Fructus Lycii Chinensis (Gou Qi Zi), 10g

Body acupuncture:

Main points: Qi Men (Liv 14), Zu San Li (St 36), Zhong Wan (CV 12), Nei Guan (Per 6), Yang Ling Quan (GB 34)

Auxiliary points: Zhang Men (Liv 13), Zhi Gou (TB 6), Pi Shu (Bl 20), San Yin Jiao (Sp 6), Guan Yuan (CV 4)

Needling hand technique: Even supplementing-even draining. After obtaining the qi, retain the needles for 30 minutes. Treat once per day, with 15 days equaling one course of treatment.

Ear acupuncture:

Main points: Liver, Gallbladder, Endocrine, Sympathetic, Kidney

Auxiliary points: Pancreas, Spleen, Subcortex, Shen Men

Needling hand technique: Choose 2-3 points each time, using medium stimulation, and retain the needles for 20-30 minutes. Treat once per day, with 10 days equaling one course of treatment. One can also use ear point bean treatment, [i.e., pellets taped over acupuncture points in the ear].

A Scientific Test of Chiropractic's Subluxation Theory

A Scientific Test of Chiropractic's Subluxation Theory
The first experimental study of the basis of the
theory demonstrates that it is erroneous.
Edmund S. Crelin, Ph.D.
Chiropractic is defined in the dictionary as "a therapeutic system based upon the premise that disease is caused by the interference with nerve function, the method being to restore normal condition by adjusting the segments of the spinal column." [1] The International Chiropractors Association defines chiropractic as follows:

The philosophy of chiropractic is based upon the premise that disease or abnormal function is caused by interference with nerve transmission and expression, due to pressure, strain or tension upon the spinal cord or spinal nerves, as a result of body segments of the vertebral column deviating from their normal juxtaposition. The practice of chiropractic consists of analysis of an interference with normal nerve transmission and expression, and the correction thereof by an adjustment with the hands of the abnormal deviations of the bony articulations of the vertebral column for the restoration and maintenance of health, without the use of drugs or surgery. The term "analysis" is construed to include the use of X-ray and other analytical instruments generally used in the practice of chiropractic [2,3,7].

The definition given by the American Chiropractic Association is:

Chiropractic practice is the specific adjustment and manipulation of the articulations and adjacent tissues of the body, particularly of the spinal column, for the correction of nerve interference and includes the use of recognized diagnostic methods, as indicated. Patient care is conducted with due regard for environmental, nutritional, and psychotherapeutic factors, as well as first aid, hygiene, sanitation, rehabilitation and related procedures designed to restore or maintain normal nerve function [2,4,7].

According to chiropractic, the deviation of the body segments of the vertebral column from their normal juxtaposition that interferes with nerve transmission and expression is called subluxation. Two chiropractic descriptions of subluxation are:

"The vertebrae are . . . within their normal range of motion, although not functioning at their optimum." [5]
"A vertebral subluxation may be interpreted as 'off-centering of a vertebral segment.' [A subluxation] is a fixation of the joint within its normal range of movement, usually at the extremity of this range." [6]
In other words, subluxed vertebrae (spinal bones) are characterized by fixation and misalignment within the normal range of motion.

Daniel David Palmer, a tradesman who posed as a magnetic healer, "discovered" chiropractic in 1895. Magnetic healing was a popular form of quackery in the nineteenth century in which the healers believed that their personal magnetism was so great that it gave them the power to cure disease [7]. Palmer said:

I am the originator, the Fountain Head of the essential principle that disease is the result of too much or not enough functionating [sic]. I created the art of adjusting vertebrae, using the spinous and transverse processes as levers, and named the mental act of accumulating knowledge, the cumulative function, corresponding to the physical vegetative function -- growth of intellectual and physical-together, with the science, art and philosophy -- Chiropractic. . . . It was I who combined the science and art and developed the principles thereof. I have answered the question -- what is life? [8]

The chiropractic philosophy originated by Palmer is the frame of reference of modern-day chiropractic thinking as exemplified in the most widely used chiropractic textbook [5] at the present time. Palmer put forth the concepts of Universal Intelligence, Innate Intelligence, and Educated Intelligence. Universal Intelligence is God. Innate Intelligence is the "Soul, Spirit or Spark of Life" or "Nature, intuition, instinct, spiritual and subconscious mind." It is the "something" within the body which controls the healing process, growth, and repair and "is beyond the finite knowledge." While Innate Intelligence utilizes the autonomic nervous system, the Educated Intelligence, or "conscious," utilizes "the cerebrospinal division for the volitional expression of its function."

Nature, or Innate Intelligence, has a great capacity to maintain or restore health if it is allowed normal expression within the body. However, mental, chemical, or mechanical stress can produce a greater or lesser displacement of the vertebrae, or vertebral disrelationship, and this displacement interferes with the planned expression of Innate Intelligence through the nerves. This interference then produces pathology. The chiropractor, by correcting the displacement, allows the Innate Intelligence to effect the cure [5,9]. The pathology that chiropractors treat by manual manipulation of the spine totals over ninety diseases, including gastrointestinal, genitourinary, respiratory, vascular, and emotional disorders; diabetes; deafness; eye disorders; cancer; arthritis; and infectious diseases such as polio, mumps, hepatitis, diphtheria, and the common cold [7,10].

No one, and this includes chiropractors, has ever experimentally determined how much vertebral displacement is necessary before a spinal nerve is impinged or encroached upon at the intervertebral foramen to produce pathology by interfering with the planned expression of Innate Intelligence. This study was performed to answer that question.

Of the 43 pairs of nerves that pass from the brain and spinal cord to the various parts of the body, only 24 pairs could ever be impinged or encroached upon by the displacement of one vertebra against another as the nerves pass out of the intervertebral foramina. There is a superior and an inferior articular process posterolaterally on each side of a vertebra. Anterior to each articular process there is a notch; therefore, when the processes articulate with those of adjacent vertebrae above and below to form the vertebral column, a series of holes is formed -- the intervertebral foramina. [Note: "Foramen" is the medical term for an opening through a bony structure or membrane. The plural is foramina. The intervertebral foramina are the openings between the spinal bones through which the spinal nerves emerge from the spinal cord to connect to other parts of the body.]

Part of the anterior margin of an intervertebral foramen is formed by the intervertebral disc that joins the two bodies of adjacent vertebrae together. In addition to the way the bony parts articulate with one another, numerous ligaments and muscles, both long and short, serve to bind adjacent vertebrae together to restrict their movement. Although the displacement between adjacent vertebrae is small, the range of total motion of the entire vertebral column is considerable.

Throughout life the intervertebral foramina are quite large in relationship to the spinal nerves that pass through them [11]. The cross-sectional figures below illustrate the fact that there is ample room. Figure A compares the size of the 6th cervical spinal nerve to the opening between the 5th and 6th cervical vertebrae. Figure B compares the 9th thoracic nerve to the opening between the 9th and 10th thoracic vertebrae. Figure C compares the 3rd lumbar spinal nerve to the opening between the 3rd and 4th lumbar vertebrae. A tiny artery and an intervertebral vein usually accompanying each spinal nerve through the foramen. The remainder of the space of each foramen contains very flimsy, loose areolar tissue.







Materials and Methods

The vertebral columns of six individuals were studied. Three were infants, one a full-term newborn female that failed to breathe after birth; the other two, a male and a female, were full-term infants who died of a respiratory disorder within a week after birth. The remainder were adults: a 35-year-old male who died following a heart attack, a 73-year-old male who died of pneumonitis, and a 76-year-old female who died of infectious hepatitis. The vertebral column of each individual was excised within 3 to 6 hours after death. Shortly after death each cadaver was cooled to 40°F until the vertebral column was excised.

From a posterior approach the first cervical vertebra was disarticulated from the skull, and the fifth lumbar vertebra was disarticulated from the sacrum. Each spinal nerve was transected at a point 8 cm after it emerged from its intervertebral foramen. The ribs were also transected, leaving 5 cm of their proximal ends attached to the vertebral column. All of the deep musculature of the vertebral column was left intact except the bulk of the psoas major muscles and the caudal part of the erector spinae muscles. None of the ligaments and joint capsules of the vertebral column was disturbed. Therefore, the test of the displacement of individual vertebrae in. this experiment was actually a test of the passive action of the attached ligaments to limit any displacement. In a living individual there would have been the added resistance of the attached muscles contracting in a reflex manner to inhibit vertebral displacement, or subluxation.

As soon as the vertebral column was excised it was immersed in a physiological saline solution at body temperature to insure maximum flexibility of its joints during the testing that immediately followed. A careful inspection both before and after the testing revealed that each vertebral column was normal for the age of the individual from which it was excised.

A standard drill press was used for the tests. It had a rotating handle that allowed the forceful lowering of the chuck, to which was attached a Dillon force gauge certified to be accurate to within ±1% of full scale reading. It was a compression model with marked dial increments of 10 pounds up to a capacity of 1,000 pounds. The two pressure feet used were solid metal rods that could be screwed onto the bottom of the force gauge. The end of one of the rods that exerted pressure on the vertebral column was tapered and flat; the other was forked.

The drill press had a handle that allowed the pressure foot to be locked in position while exerting continuous compression on individual vertebrae of the column. Two metal vises were clamped to the platform of the drill press to support the vertebral column while it was subjected to a compressive force. The column was only lightly clamped by the two vises supporting it. This allowed five vertebral segments of the newborn column and three of the adult column, suspended between the vises, to move freely when force was applied. The pressure foot with a forked end was used to apply compression on both sides of each vertebra by fitting it over the transverse process; it was also used to apply compression to the back of each-vertebra by fitting the forked end over the spinous process. The pressure foot with the tapered flat end was used to apply compression to the front of each vertebra of a newborn column. However, a flat piece of metal the same width as each vertebral body of the adult column had to be interposed between the pressure foot and the body because almost as soon as force was applied the tapered end began to break the bone and pass into the body.

When the part of the vertebra to which the pressure foot was applied began to break or collapse, the force was stopped. After a couple of transverse or spinous processes broke early in the testing, I learned to determine by sight, sound, and feel just about the time it was going to happen again. Each vertebral body was quite compressible: it could be compressed to about two-thirds its anteroposterior width and still rebound to its original width when the pressure was released. If compressed beyond this point, it would remain in a collapsed condition.

A Dresser torque wrench was used to quantify the amount of torsional force applied when the vertebral column was twisted. The wrench face was marked in increments of 5 foot-pounds up to 140 pounds and certified to be accurate within ±1%. The adult column was held snugly in a vise with its anterior surface facing upward. The transverse processes were hooked under the jaws of the vise to prevent the column from turning when torsional force was applied to the portion of the column projecting beyond the vise. A chain clamp was firmly applied to each vertebra in turn, beginning with the first cervical and ending with the fifth lumbar. The chain clamp had a fitting into which the end of the torque wrench was inserted. A twisting force was applied both to the right and left. The maximum force applied was at the point when it was obvious that the tissues of the column were about to rupture. While the maximal torsional force was being exerted, the spinal nerves and their intervertebral foramina were observed. The entire newborn column was easily twisted manually both to the right and left and then held in the extreme position by clamping each end of the column in a vise while the spinal nerves and intervertebral foramina were observed.

An Ametek push-pull gauge was used to quantify the amount of force applied when the vertebral column was bent in all directions. The dial was marked in 2-pound increments up to 200 pounds and certified to be accurate to within ± 0.5% of full scale. The adult column was held in a vise in the same manner as it was for the application of a torsional force. The portion of the column projecting beyond the vise was attached to the push-pull gauge by a cord wrapped around it. Segments of the column were made to project beyond the vise and maximally flexed, extended, and laterally bent both left and right to the point that the tissues of the column were about to rupture. While the segment of the column was maximally bent in one direction, the spinal nerves and their intervertebral foramina were observed. As shown in the picture below, the newborn column was so flexible that it could easily be bent in a half-circle in flexion, extension, and left and right laterally [11]. It could be held in any position of maximal bending by placing it between the pressure foot and the platform of the drill press while the spinal nerves and their intervertebral foramina were observed.

A Mura volt-ohm-microampere meter was used when the first vertebral column, from the 35-year-old male adult, was tested. The meter was used to determine whether the border of the intervertebral foramen came into contact with the spinal nerve when compressive, bending, or twisting forces

were applied to the vertebral column. The wire from the positive pole of the meter was wrapped around the spinal nerve that was placed against one side of the intervertebral foramen; the wire from the negative pole of the meter was placed against the opposite side of the foramen. The meter was set at 1,000 ohms, and if the wires barely touched each other the recording needle would make a full swing across the face of the dial. The tests of the first vertebral column revealed that the relationship of a spinal nerve to the borders of its intervertebral foramen could very easily be determined with the naked eye at all times during the continuous application of force. Therefore it was not necessary to use the meter when testing the other columns.

All the spinal nerves emerging from their intervertebral foramina were exposed prior to the testing of each vertebral column. Gentle teasing with a pair of small forceps easily removed the flimsy areolar tissue surrounding the nerves to expose the borders of their relatively spacious intervertebral foramina (Figures 2 and 6). At any time during the testing when a constant force of compression, twisting, or bending was being applied to the column, the very soft and extremely flexible spinal nerves could easily be moved about. The cut ends of the nerves were grasped with forceps and held in all positions to determine by direct observation any encroachment or impingement smaller foramina might have on the nerves.

Findings

The range of maximum compressive force, or breaking point, that could be applied to the individual vertebrae of the cervical, thoracic, and lumbar regions of the newborn and adult columns before they became irreversibly collapsed is shown in the table below.


Range of Maximum Compressive Force before
Breaking Point of Individual Vertebrae SITE OF FORCE POUNDS OF COMPRESSIVE FORCE
NEWBORN ADULT
Vertebral bodies
Cervical
30-50
100-115
Thoracic
30-50
130-300
Lumbar
30-50
210-295

Transverse processes
Cervical
20-25
Thoracic
20-25
Lumbar
20-25

Spinous processes
Cervical
15-20
100-115
Thoracic
15-20
95-110
Lumbar
15-20
100-150


While a continuous maximum force was applied to a vertebra by locking the drill press handle in position, the adjacent spinal nerves and their intervertebral foramina were examined and measured. There was a slight lateral displacement of an individual vertebra when maximum pressure was applied to one of its transverse processes, along with a slight increase in the size of the adjacent intervertebral foramen in relationship to its nerve.

There was slight displacement of an individual vertebra that resulted in a reduction in the size of the adjacent foramina when the highly unphysiologic maximum pressure was applied to its body or spinous process. However, the nerves passing through these foramina could be freely moved about while the force was being continuously applied, because in the adult columns the foramina were quite spacious in relation to their spinal nerves. There was never less than 1.5 mm of space completely surrounding the cervical nerves, 3 mm of space surrounding the thoracic nerves, and 4 mm surrounding the lumbar nerves. In the newborn columns there was also a relatively large amount of space surrounding the spinal nerves during the application of a maximum compressive force. There was never less than 1 mm of space surrounding the cervical nerves and 2 mm clearance surrounding the thoracic and lumbar nerves. Upon release of the compressive force the vertebrae of both the adult and newborn columns immediately returned to their original position, and the adjacent foramina immediately returned to their original size.

The greatest amount of twisting motion of the entire adult vertebral column occurred in the upper cervical region at a maximum torsional force of 35 to 45 pounds. The next greatest amount was in the upper lumbar region, and the least in the thoracic region. When the maximal torsional force of about 10 pounds was applied to the newborn columns, the degree of twisting motion was the same throughout their length and was comparatively much greater than that of the adult column, especially in the thoracic region.

Any reduction in the size of the intervertebral foramina during the application of torsional force to both the adult and newborn columns was insignificant in relation to the spinal nerves passing through the foramina. There was always a relatively large amount of space surrounding the nerves in the foramina, As the torsional force was gradually applied, careful observation revealed that the amount of sliding motion of the nerves was insignificant in relation to the foramina. My observations indicated that the nerves did not become unduly stretched when the column was maximally twisted.

The greatest amount of flexion of the adult columns occurred in the lower cervical and the mid-lumbar regions when a maximal bending force of 50 to 60 pounds was applied. There was only moderate flexion in the thoracic region of the column from the 35-year-old male and even less in the thoracic region of the columns from the two older individuals. The greatest extension of the adult columns was seen in the cervical region, with the next greatest in the lumbar region when a maximum bending force of 50 pounds was applied. A moderate extension occurred in the thoracic region of the column from the 35-year-old male, whereas that in the thoracic region of the columns from the two older individuals was hardly detectable. The greatest lateral bending was in the cervical region of the adult columns, with the next greatest in the lumbar region when a maximum force of 50 to 60 pounds was applied. There was only a moderate amount in the thoracic region.

Any reduction in the size of the intervertebral foramina during the application of a bending force to produce flexion, extension, and lateral bending of the adult columns was insignificant in relation to the spinal nerves passing through the foramina. This was true also on the concave side of the lateral bend, where the greatest reduction in foramen size occurred. Under all conditions a relatively large amount of space surrounded the nerves in the foramina. The nerves were observed as the column was bent, and the sliding motion was seen to be insignificant relative to the possibility that the nerves might be unduly stretched when the column was maximally bent.


When 30 to 40 pounds of pressure was applied by the drill press foot to the cervical end of the newborn columns, they became maximally curved in flexion, extension, and lateral bending to form a half-circle. No reduction in the size of the intervertebral foramina in maximum flexion and extension was significant, because there was always a relatively large space surrounding the nerves in the foramina.

The cervical end is at the top. A black piece of paper was placed behind the 5th to 9th left thoracic spinal nerves where they emerge from their intervertebral foramina to make them more visible.




On the convex side of the laterally bent newborn column there was a significant increase in the size of the foramina, whereas on the concave side there was a significant decrease, to the point that the borders of the foramina made contact with nerves passing through them. However, the nerves were not markedly impinged upon and could be made to slide back and forth within the foramina when they were grasped with forceps. The extreme degree of lateral bending needed to cause encroachment of the foramina on the nerves could not occur in an intact infant because the internal organs and the body wall with its ribs would not permit it.

This experimental study demonstrates conclusively that the subluxation of a vertebra as defined by chiropractic-the exertion of pressure on a spinal nerve which by interfering with the planned expression of Innate Intelligence produces pathology-does not occur. This is what should be expected when one recognizes that the vertebral column has been evolving for over 400 million years to support the body and protect the central nervous system. By a process of natural selection the vertebral column of mammals has evolved into one in which the articulations allow an overall range of motion so that individuals may function well for survival within their environment. At the same time the selective process has favored vertebral columns that have spacious intervertebral foramina in combination with the barest minimum of displacement between adjacent vertebrae-two factors that preclude impingement upon the spinal nerves as they pass through the foramina.

References
1. The Random House Dictionary of the English Language. 1966. New York: Random House.
2. Data Sheet on Chiropractic. 1970. Chicago: Department of Investigation, American Medical Association.
3. International Chiropractors Review. International Chiropractors Association. March 1964, p. 2.
4. Journal of the American Chiropractic Association. Nov 1963, p. 13.
5. Homewood AE. 1962. The Neurodynamics of the Vertebral Subluxation. Published by the author.
6. Harper WD. 1964. Anything Can Cause Anything. San Antonio, Texas: published by the author.
7. Smith RL. At Your Own Risk: The Case against Chiropractic. New York: Pocket Books, 1969.
8. Palmer DD. The Science, Art and Philosophy of Chiropractic. Reprint of 1910 edition. Portland, Oregon: Portland Printing House, 1966.
9. Cohen WJ. Independent Practitioners under Medicare: A Report to Congress. Washington, DC: Department of Health, Education, and Welfare, 1968.
10. Chiropractic Survey and Statistical Study. 1963. A report to the Board of Directors, National Chiropractic Association. (Mimeographed) Des Moines: Bratten and Associates, 1963, pp 32-35.
11. Crelin ES 1973. Functional Anatomy of the Newborn. New Haven, Conn.: Yale University Press, 1973.
12. Crelin ES. Anatomy of the Newborn: An Atlas. Philadelphia: Lea and Febiger, 1969.
_____________________

This article was published with additional illustrations in the September/October 1973 issue of American Scientist, the journal of the Society of Sigma Xi. At that time, Dr. Crelin was Professor of Anatomy and Chairman of the Human Growth and Development Study Unit at the Yale University School of Medicine. He had published over 100 papers on the development, structure, and physiology of bones and joints and was the author of the first atlas of the anatomy of the human newborn ever published.

Accupressure Point

The charts below show ancient medicinal energy points often treated with Acupuncture needles or Accupressure massage. A growing number of practitioners accept that applying magnets to these energy points can be just as effective as needles or other forms of stimulation.


Respiratory Organs
Common Cold 4, 17, 52, 59
Chronic Bronchitis 13, 17, 45, 54, 59
Asthma 5, 6, 8, 9, 16, 17, 54
Circulatory System
General Improvements 16, 18, 19, 40, 55
Blood pressure too high 36, 40, 43, 49, 60
Blood pressure too low 16, 18, 24, 36
Digestive System
Ailing Stomach/duodenum 24, 27, 36, 47, 61
Liver complaints 16, 36, 37, 57, 60
Kidney and Bladder
Nighttime bedwetting 31, 36, 40, 62, 64
Inflammations / Swelling 31, 34, 43, 62, 64
Rheumatic Complaints
Joint aches 12, 37, 42, 46, 58
Neck pains 42, 50, 51, 58
Shoulder pains 7, 12, 38, 68
Elbow pains 12, 37, 58
Lower back pain 42, 62, 64, 67
Gout pains 41, 63, 65, 66, 67, 68
Hip pains 37, 42, 66
Knee pains 35, 37, 42
Ankle pains 42, 43, 44
Reproductive System
Menstrual problems 28, 29, 30, 31, 40, 62
Climactic problems 2, 16, 19, 53, 64
Imbalance Due to Stress or Emotion
Relieving the problems 16, 19, 20, 36, 40, 55
Pain Relief
Headache - General 1, 50, 58, 59
Headache - Forehead 1, 59
Headache - Top of Head 42, 49
Headache - Temples 2, 58
Headache - Back of Head 42, 50
Toothache 43, 59, 62, A, B
Dizziness 43, 48, 51, 52
Insomnia 16, 19, 40, 43, 55
Hard-of-Hearing, Tinnitus 58, 69, 70
Constipation 26, 57, 63
Diarrhea 26, 27, 36, 47
Wind 24, 26, 40, 47
Nausea, vomiting 16, 19, 36
Allergy, skin rash 16, 36, 40, 49
Fatigue 24, 31, 36, 59
Greater body efficiency 36, 45, 56
Anxiety 16, 19, 36, 40, 43
Sleepiness 19, 40, 43, 45
Sexual problems 16, 31, 36, 40, 43, 62
Breaking Bad Habits
Lose weight 22, 24, 25, S
Quit smoking 5, 17, 20, 36, 45
Quit drinking alcohol 4, 16, 19, 36, 40
General Health
Face and body care 1, 2, 34, 36, 40

Extra48-Zi Gong Xue

Location
On the lower abdomen, 3 cun lateral to the midline, level with Zhongji (REN-3, 4 cun down from the umbilicus).

Action
Regulates menstruation and clears heat and damp heat.

Symptoms
Infertility (especially in women), irregular menstruation, dysmenorrhea, menorrhagia, cystitis, pelvic inflammatory diseases, uterine prolapse.

Combinations
Zigong/ Ren-3/ Sp-9 = leucorrhea.

Remarks
1 Cun lateral to St-29.

Extra44-Yu Yao

Location
In the center of the eyebrow, in the depression directly above the pupil.

Action
Invigorates Qi and blood, dispels wind and heat.

Symptoms
Myopia, acute conjunctivitis, ophtalmoplegia, facial paralysis, supraorbital pain.

Combinations
Li-4/ Yuyao = myopia, Sj-9/ B-2/ P-6/ yuyao = supraorbital neuralgia, Yuyao/ G-1/ B-2/ B-1 = cataract.

Remarks
Located on the eye brow exactly at its midpoint directly above the pupil.

Extra41-Yao Yan

Location
In the depression approximately 3.5 cun lateral to the lower border of L4 Yao Yang Guan (DU-3).

Action
Regulates Qi and blood and menstruation.

Symptoms
Lower back pain, stiffness, or arthritis, lower back sprain, irregular menstruation, dysmenorrhea.

Remarks
Located in the depression lateral to the area between B-24 to B-26.

Extra34-Si Shen Chong

Location
Four points at the vertex of the scalp, grouped around Baihui (DU-20) and located 1 cun anterior, posterior and lateral to it.

Action
Regulates Qi and blood in the head, calms the spirit.

Symptoms
Headache, dizziness and vertigo, epilepsy.

Remarks
4 points. Located 1 Cun proximally and distally and laterally to Du-20.

Extra15-Hua Tuo Jia Ji

Location
0.5 to 1 cun lateral to the depressions below the spinous processes of the twelve thoracic and five lumbar vertebrae.

Action
Regulates Qi and blood.

Symptoms
All internal organs disorders, spine stiffness and pain, adjacent tissues pain, numbness and stiffness - including extremities.

Combinations
M-BW-35 (of B-21/B-22/B-23)/ B-46/ B-47/ B-53 = Urinary calculi and stones.

Remarks
Located 1 Cun lateral to the inferior end of each spinous process along the spine.

Extra6-Bi Tong

Location
At the highest point of the naso-labial groove.

Action
Opens the nasal passages.

Extra3-Ba Xie

Location
When the hand is made into a fist, six of these points lie in the depressions between the metacarpal heads, proximal to the web margins. The remaining two points lie equidistant between the thumb and index metacarpals, proximal to the web margins.

Action
Dispels wind and heat and regulates Qi and blood.

Symptoms
Various fingers disorders, arthritis, finger Bi rheumatism, pain and numbness, snake bite, headache, fingers paralysis due to CVA, toothache, torticollis, sore throat.

Combinations
Baxie/ Sj-5 = fingers numbness.

Remarks
Located on the dorsum of the hand at the proximal end of each web between the fingers.

PC-7 Daling

Location
In the wrist (carpal) joint, between the palmaris longus and the flexor carpi radialis tendons.

Action
Regulates and clears fire from the heart, regulates the stomach and chest, calms the spirit, clears heat and cools the blood.

Symptoms
Palpitations, intercostal neuralgia, chest and hypochondriac pain, fever without perspiration, stomatitis, tongue root pain, axillary swelling, body hot, sadness, weariness, sommerheat diseases, ulcerative colitis, appendicitis, gastritis, eczema, acne, conjunctivitis, mania, hysteria, insomnia, seizures, panic, fear.

Combinations
P-7/ Yuye/ St-44 = stomatitis, P-7/ P-6/ P-4/ H-8 = premature cardiac contractions, P-7/ Du-20/ YinTang/ K-3 = insomnia, P-7/ Ren-4 = bloody urine.

BL27-Xiaochangshu

Location
Level with the 1st sacral foramen, 1.5 cun lateral to the back midline.

Action
Regulates the intestines, resolves dampness, regulates the water pathways.

Symptoms
Dysentery with pus and blood, enteritis, peritonitis, colitis, lower abdominal pain and distention, leucorrhea, hemorrhoids, swollen feet, urethritis, constipation, lower back pain and sciatica, dysuria, bloody urine, urinary incontinence, urine with spermatorrhea.

Combinations
B-27/ Ren-4 = small intestine disorders and fluids absorption (shu mu technique).

ST39-Xiajuxu

Location
9 cun inferior to the patella, 1 fingerbreadth (3rd finger) lateral to the anterior sharp crest of the tibia.

Action
Regulates stomach and intestines, drains damp heat, redirects rebellious Qi downward, drains excess yang Qi in the upper body downward to the legs.

Symptoms
Lower abdominal pain, acute intestinal obstruction, back pain radiating to the testicles, diarrhea, dispnea, cough, drains excess yang Qi to the legs, painful throat obstruction, hypersalivation, dry lips, generalized pain, madness, no perspiration, hair loss.

Combinations
St-25/ St-36/ St-37/ St-39 = purges the intestines

ST37-Shangjuxu

Location
6 cun inferior to the patella, 1 fingerbreadth (3rd finger) lateral to the anterior sharp crest of the tibia.

Action
Regulates stomach and intestines, transforms damp heat, brings fullness of Yang Qi down.

Symptoms
For all acute and chronic diseases of the colon, disentery, diarrhea, appendicitis, enteritis, colitis, abdominal pain and distention, borborygmus, ulcerative colitis, dizziness, leg pain and numbness, generalized distention.

Combinations
St-25/ St-37 = colitis, St-25/ St-36/ St-37/ St-39 = purges the intestines.

ST40-Fenglong

Location
8 cun inferior to the patella, 2 fingerbreadths (2nd and 3rd finger) lateral to the anterior sharp crest of the tibia.

Action
Resolves phlegm, damp, phlegm heat, phlegm fire, dries damp and damp cold, regulates stomach Qi and intestines.

Symptoms
Seizures, bronchitis, lung abscess, asthma, pertusis, pneumonia, damp bi, menopausal syndrome, pms, dizziness, vertigo, morning sickness, epigastric distention and pain, loose stools, diarrhea, difficult defecation, leg Qi, obesity, phlegm type depression and mania, madness, incoherent speech, insomnia, throat bi, fatigued extremeties, intercostal neuralgia, headache, epilepsy.

Combinations
St-40/ Sp-9/ Ren-9 = ascites and swollen abdomen, St-40/ B-13/ G-40 = chest pain with phlegmatic cough, St-40/ Anmian/ H-7 = insomnia and vertigo, Sp-3/ St-40 - Tonifies the spleen and resolves phlegm (Yuan - Luo combination).

LI6-Pianli

Location
When the hand rests on the belly, on the line connecting LI 5 with LI 11, 3 cun proximal to LI 5.

Action
Clears Heat and Dryness ,dispels wind.

Symptoms
Edema - especially of arms and face, edema with absent of perspiration and difficult urination, ascites with borborygmus, Eye vision poor, dimness of vision, madness, seizures, urine retention, constipation,dry throat.

Combinations
Li-6/ Li-5/ Li-1/ B-8/ Si-4/ Si-2 = tinnitus, Li-6/ Si-2/ Si-3 = deafness, L-9/ Li-6 = Edema in the upper part of the body with absence of perspiration and urinary retention(Yuan - Luo combination).

ST25-Tianshu

Location
2 cun lateral to the umbilicus center.

Action
Regulates spleen Qi and yang, regulates stomach Qi and yin,regulates and moistens the intestines, tonifies Wei Qi, Clears Heat and dampness, regulates Qi and blood, transforms damp and cold.

Symptoms
Intestinal abscess, dysentery with or without blood, abdominal masses, digestive ulcers, colitis, appendicitis, enteritis, pancreatitis, borborygmus, nausea, diarrhea, constipation, abdominal pain and distention, , Infertility, endometriosis, irregular menstruation, dysmenorrhea, leucorrhea, intestinal parasites, urinary tract stones and calculi.,weary and frightened.

Combinations
St-25/ St-37 = colitis, St-25/ St-36/ St-37/ St-39 = purges the intestines, B-25/ St-25 = for acute syndromes of the colon. (Shu - mu technique).

RE12-Zhongwan

Location
4 cun superior to the umbilicus center.

Action
Regulates and tonifies the spleen, stomach and middle jiao, redirects rebellious Qi and clears stomach fire and heat, raises middle Qi.

Symptoms
Abdominal pain and distention, all gastric diseases, nausea and vomiting, diarrhea, constipation, borborygmus, intestinal abscess, jaundice, dysentery, diabetes, childhood nutritional impairment, anorexia, ulcers, epigastric pain and distention, morning sickness, acid regurgitations, hiccups, gastroptosis or other organs prolapse, dizziness or vertigo, sinusitis, restless fetus, pulmonary TB, headache, hypertension, madness, Wei syndrome, emaciation, weak limbs.

Combinations
P-6/ Ren-12/ St-36/ Sp-4 = nausea, vomiting, morning sickness, B-21/ Ren-12 = all gastric diseases, (shu mu technique), B-22/ Ren-7/ Ren-12/ Ren-17 = regulates Triple burner activities in all burners.

LR13-Zhangmen

Location
Anterior and inferior to the 11th rib free end.

Action
Regulates and tonifies the spleen, stomach and middle jiao, regulates and spreads liver Qi, regulates and invigorates Qi and blood, harmonizes liver and spleen, softens hard masses.

Symptoms
Hepatitis, pancreatitis, vomiting, indigestion, borborygmus, flatulence, jaundice, epigastric pain, diarrhea and constipation, ascites, abdominal pain and distention, intercostal neuralgia, body tremors, fatigued extremities, lassitude, enlarged spleen and or liver, abdominal tumors.

Combinations
B-20/ Liv-13 = All spleen and Tzang diseases (shu mu technique), Liv-13/ Sp-3/ K-6/ Sj-6 = constipation, LIV-13/ REN-12/ BL-17 = vomiting, LIV-13/ SP-4/ SJ-6/ GB-34 = pain of the lateral costal region.

RE14-Juque

Location
6 cun superior to the umbilicus center.

Action
Regulates the heart and transforms phlegm, calms the spirit, regulates the stomach and redirects rebellious Qi.

Symptoms
Epigastric pain, vomiting, hiccup, acid regurgitations, jaundice, spasms of the diaphragm, cold extremeties, diarrhea, difficult swallowing, sour taste in mouth, dyspnea, collapse syndrome with cold hands and feet, forgetfulness, lassitude, chest painful and distended, palpitations and anxiety, hysteria, fear, insanity, depression.

Combinations
P-5/ Ren-14/ Du-26/ H-7/ St-40/ Liv-3 = angina pectoris with phlegm in the heart orifices, B-15/ Ren-14 = shu mu technique for heart diseases, Ren-14/ Sj-10/ B-15 = mental instability.

RE14-Guanyuan

Location
3 cun inferior to the umbilicus center.

Action
Tonifies the kidneys, Yuan Qi and the lower jiao, tonifies Qi and blood, enriches Yin Qi and invigorates Yang Qi, regulates the Small intestine and resolves damp heat, damp cold and dampness.

Symptoms
A general tonification point, diabetes, asthma, pulmonary TB, hyper or hypotension, neurasthenia, forgetfulness, insomnia, dizziness, vertigo, emaciation, lassitude, abnormal uterine bleeding, abdominal hard masses, leucorrhea, spermatorrhea, irregular menstruation, infertility, orchitis, urinary frequency or retention, impotence, organ prolapse , diarrhea, hernial disorders, tenesmus, chronic nephritis, cystitis, windstroke with collapse, shock, tidal fever, hotflashes.

Combinations
St-36/ Ren-4/ Ren-6 = General tonification, B-12/ Du-12/ St-36/ Ren-4 = strengthen Wei Qi for wind diseases, L-9/ B-13/ St-36/ Ren-4 = tonify lungs and immune system, K-3/ B-23/ Sp-6/ Ren-4/ St-29 = infertility, B-27/ Ren-4 = small intestine disorders and fluids absorption (shu mu technique), Ren-4/ K-1 = acute pain with urinary retention, Ren- 4/ Liv-1 = unilateral testicle distention.

REN3-Zhongji

Location
4 cun inferior to the umbilicus center.

Action
Regulates the bladder and water pathways, tonifies the kidney, resolves damp heat and cools the blood.

Symptoms
All urinary diseases, retention or incontinence of urine, cystitis, enuresis, genital pain and itching, impotence, infertility, spermatorrhea, orchitis, urethritis, premature ejaculation, hernia, uterus cold, endometriosis, leucorrhea with blood, dysmenorrhea, amenorrhea, irregular menstruation, lower abdominal pain and distention, ascites, edema, prostatitis, lassitude, pelvic inflammation, bladder stones.

Combinations
H-8/ Ren-3/ Ren-2/ Sp-10/ Sp-8 = bloody urine with cystitis, B-28/ Ren-3 = urinary diseases, B-36/ K-10/ Sp-9/ St-29/ Ren-3 = prostatitis, Liv-5/ Ren-3/ G-26 = leucorrhea with pruritis vulva, Ren-3/ K-11/ Sp-9 = spermatorrhea, impotence or premature ejaculation, Ren-3/ Sp-9/ Sp-6 = enuresis, Ren-3/ B-23/ Li-4/ Sp-6 = amenorrhea.

RE17-Tanzhong

Location
On the sternum midline, level with the 4th intercostal space medial end.

Action
Regulates the lungs and upper jiao, transforms phlegm and redirects rebellious Qi, facilitates lactation.

Symptoms
Asthma, cough, bronchitis, chest pain and distention, dyspnea, lung abscess, pulmonary TB, hematemesis, hemoptysis, insufficient lactation, breast abscess or mastitis, hypochondriac pain, facial pallor, palpitations, weak vocal cords, hiccups, esophageal constriction or dryness, anemia, cardiac pain.

Combinations
Si-1/ St-18/ Ren-17 = insufficient lactation, Li-4/ L-7/ B-13/ L-1/ Ren-22/ Ren-17 = for asthma, B-14/ Ren-17 = shu - mu for heart and pericardium diseases, especially sedation, B-22/ Ren-7/ Ren-12/ Ren-17 = regulates Triple burner activities in all burners, P-6/ P-1/ Du-14/ Ren-17 = asthma, Si-1/ G-21/ Ren-17/ St-18 = mastitis or breast abscess, L-1/ Dingchuan/ P-6/ Ren-17 = bronchial asthma.

Remarks
Anti smoking.

GB25-Jingmen

Location
Anterior and inferior to the 12th ribÆs free end.

Action
Tonifies and regulates the kidneys and water pathways, transforms dampness, calms the fetus,expels stones.

Symptoms
Diabetes, nephritis, nephrolythiasis, painful urinary dysfunction, hypochondriac, abdominal or lower back pain, kidney colic, borborygmus, diarrhea, can not stand for a long period, can not bend, restless fetus, kidney stones.

BL28-Pangguanshu

Location
Level with the 2nd sacral foramen, 1.5 cun lateral to the back midline.

Action
Regulates the bladder and water pathways, disperses heat and damp heat, expels stones.

Symptoms
Urogenital diseases in general, urinary retention or incontinence, painful urinary dysfunction, prostatitis, bloody urine, spermatorrhea, genital pain, lower abdominal pain, constipation, diarrhea, lower and sacral back pain and sciatica, urinary stones.

Combinations
B-28/ Ren-3 = urinary diseases (shu mu technique), B-28/ B-23/ Du-2/ Sp-6 = prostatitis.

BL25-Dachangshu

Location
1.5 cun lateral to L4 spinous process inferior edge.

Action
Regulates the stomach and intestines, resolves dampness, damp heat, strengthens lower back.

Symptoms
All intestinal disorders,acute and chronic diseases of the colon, disentery, diarrhea, appendicitis, enteritis, colitis, abdominal pain and distention, borborygmus, ulcerative colitis, dizziness, lower back pain and numbness, flatulence, difficult defecation or urination, rectal prolapse, hemorrhoids.

Combinations
B-25/ B-32 = bowel and urinary incontinence, B-25/ B-30/ Du-4/ St-38 through to B-57/ G-34/ Sp-9 = muscular dystrophy.

BL23-Shenshu

Location
1.5 cun lateral to L2 spinous process inferior edge.

Action
Tonifies and regulates the kidney, and yuan Qi, regulates the water pathways and lower jiao, stabilizes kidney Qi and reinforces the spirit and brain.

Symptoms
Kidney, bladder and urinary diseases,sexual problems, impotence, spermatorrhea, leucorrhea, irregualr menstruation, infertility, premenstrual syndrome, amenorrhae, dysmenorrhea, genital pain, nephritis, cystitis,ascites, edema,kidney stones, lower back pain and muscular strain, knee pain, anemia, alopecia hair loss, wei syndrome, weakness and lassitude, asthma, diarrhea, indigestion, deafness, tinnitus, blurred vision, optic nerve atrophy, forgetfulness, anxiety and palpitations,fear.

Combinations
B-23/ G-25 = all kidney sindromes (shu mu technique), B-23/ B-25/ B-40 = lower back pain, Sp-6/ B-23/ Ren-4/ Ren-6 = general weakness and debility, K-3/ B-23/ Sp-6/ Ren-4/ St-29 = infertility, B-23/ Ren-3/ Sp-6/ K-7/ B-58/ Zigong = nephritis, B-23/ Ren-4/ St-36 = diabetes.

BL22_sanjiaoshu

Location
1.5 cun lateral to L1 spinous process inferior edge.

Action
Regulates water pathways and resolves dampness, regulates the sanjiao, tonifies the kidneys.

Symptoms
Nephritis, ascites, edema, urinary retention, enuresis, kidney stones, painful urinary dysfunction, anxiety and palpitations, dizziness, indigestion, borborygmus, abdominal distention, diarrhea, stiff and painful back muscles.

Combinations
B-22/ Ren-7/ Ren-12/ Ren-17 = regulates Triple burner activities in all burners, B-22/ Ren-9/ Sp-9 = edema and ascites, B-22/ B-24/ B-25/ St-36 = nephritis.

BL21-Weishu

Location
1.5 cun lateral to T12 spinous process inferior edge.

Action
Regulates stomach and the middle jiao, clears stomach fire, transforms damp.

Symptoms
All stomach diseases, diarrhea, constipation,weakness and lassitude, diabetes, wei syndrome, neurasthenia, gastritis, enteritis, edema, ascites, pancreatitis, stomach and epigastric pain, dizziness and vertigo, stools with undigested particles, bloody stools with diarrhea, anorexia, belching, heartburn, vomiting, borborygmus, gas and flatulence, abdominal pain and distention.

Combinations
B-21/ Ren-12 = all gastric diseases (shu mu technique).

BL20-Pishu

Location
1.5 cun lateral to T11 spinous process inferior edge.

Action
Regulates and tonifies the spleen, stomach and middle jiao, nourishes blood and tonifies ying and Qi, transforms dampness and phlegm.

Symptoms
All digestive diseases, diarrhea, constipation, organ prolapse, chronic hemorrhages, anemia, weakness and lassitude, diabetes, wei syndrome, yin type jaundice, neurasthenia, gastritis, enteritis, edema, ascites, pancreatitis, stomach and epigastric pain, anxiety and palpitations, dizziness and vertigo, stools with undigested particles, abnormal uterine bleeding, bloody stool with diarrhea, hepato and splenomegaly, lymphadenitis, leucorrhea, insufficient lactation, anorexia.

Combinations
B-20/ Liv-13 = All spleen and Tzang diseases (shu mu technique), B-20/ Du-14/ St-36/ Sp-6 = leukopenia.

BL19-Danshu

Location
1.5 cun lateral to T10 spinous process inferior edge.

Action
Regulates liver and gall bladder, transforms damp heat, clears liver fire and subdues yang, regulates the stomach Qi and diaphragm.

Symptoms
Diseases of the liver and gall bladder, Jaundice, hepatitis, pulmonary TB, pancreatitis, cholecystitis, insomnia, alternate heat and chills, headache, migraine, bitter taste in the mouth, chest, costal and hypochondriac pain, hypertension, cholelithiasis, eye disorders, roundworms in the bile duct and intestines, scrofula, axillary lymphadenitis.

Combinations
B-17/ B-19 = the four flowers for wasting away syndrome, B-19/ Liv-13 = flank pain hindering sleep, B-19/ Du-9/ St-36/ Liv-3 = infectious hepatitis.

BL18-Ganshu

Location
1.5 cun lateral to T9 spinous process inferior edge.

Action
Regulates and tonifies the liver Qi and blood, transforms damp heat, subdues liver yang.

Symptoms
Jaundice, hepatitis, cholecystitis, intercostal neuralgia, hypochondriac pain and distention, hematemesis, epistaxis, depression,irritability, psychopathy, epilepsy, schizoprenia, dream disturbed sleep, dizziness and vertigo, chronic fatigue, muscular spasm, wei syndrome, eye disorders, night and color blindness, optic nerve atrophy, headache, insomnia, neurasthenia, premenstrual syndrome, amenorrhea, gastritis, abdominal pain, abdominal masses, cirrhosis.

Combinations
B-18/ B-23 = strengrthen the liver and kidney in consumptive diseases, B-18/ B-23/ G-39 = acute leukemia, B-18/ B-20/ Liv-14/ B-16/ Sp-10/ Sp-6/ G-34 = liver cirrhosis

BL16-Dushu

Location
1.5 cun lateral to T6 spinous process inferior edge.

Action
Regualtes blood and Qi in the diaphragm, regulates Du mai, cools the blood.

Symptoms
Pericarditis, endocarditis, hiccup, fever with shivering, chest pain, diaphragmatic spasm, abdominal distention, psoriasis, boils and abscess.

Combinations
Li-4/ Li-11/ Du-16/ Du-14/ G-20/ Sp-10/ B-40 = psoriasis.

BL15-Xinshu

Location
1.5 cun lateral to T5 spinous process inferior edge.

Action
Regulates and tonifies the heart, clears heart fire, cools the blood, calms the spirit.

Symptoms
All heart syndromes and diseases, nourishes heart Qi, yin, yang and blood, disperses heart blood stagnation, arrhythmia, tachycardia, atrial fibrilation, angina pectoris, rheumatic heart disese, palpitation and anxiety, neurasthenia, insomnia, fear, tidal fever, poor memory, excessive dreaming, night perspiration, chest pain, mania, hallucination, depression.

Combinations
B-15/ Ren-14 = shu mu technique for heart diseases

BL14-Jueyinshu

Location
1.5 cun lateral to T4 spinous process inferior edge.

Action
Regulates and tonifies heart, spreads liver Qi.

Symptoms
Arrhythmia, tachycardia, rheumatic heart disease, pericarditis, angina pectoris, neurasthenia, chest pain, anxiety and palpitations, dyspnea, melancholia, hiccups, vomiting, heat stroke, mountain sickness.

Combinations
B-14/ Ren-17 = shu - mu for heart and pericardium diseases, especially sedation.

Remarks
Mountain sickness

BL13-Feishu

Location
1.5 cun lateral to T3 spinous process inferior edge.

Action
Regulates and tonifies lung Qi, dispels wind and phlegm of all kinds, redirects rebellious Qi downward.

Symptoms
All lung diseases shih and xu, common cold, flu, bronchitis, asthma, cough, pneumonia, fever, rhinitis, all wind afflictions, whooping cough, urticaria and other skin diseases, sneezing, acne, back abscess, fever, dyspnea, night sweats, steaming bone (lung yin xu), lung abscess, pulmonary TB, pleurisy, hemoptysis, neck and back pain, chest fullness, throat obstruction, boredom.

Combinations
L-1/ B-13- Shu Mu combination, Li-4/ L-7/ B-13/ L-1/ Ren-22/ Ren-17/ St-40/ Sp-9 = for asthma, L-9/ B-13/ St-36/ Ren-4 = tonify lungs and immune system.

Extra2-Ba Feng

Location
On the dorsum of the foot, between the toes, 0.5 cun proximal to the margin of the web.

Action
Dispels wind, heat and damp heat.

Symptoms
Fever and chills, snakebite, peripheral neuritis, headache, stomachache, toothache, lower leg pain and swelling, gangrene of leg and foot, toes Bi pain, numbness and eczema.

Remarks
Located on the foot dorsum, between the toes, proximal to the margin of each web.

Extra43-Yintang

Location
At the glabella, at the midpoint between the medial extremities of the eyebrows.

Action
Calms the spirit, dispels wind and heat, regulates Qi and blood.

Symptoms
Headache, vertigo, insomnia, neurasthenia, fear and anxiety, nervousness, convulsions, hypertension, fainting, eyes red and sore, vomiting, nasal obstruction, rhinitis, epistaxis and other nasal disorders.

Combinations
Li-20/ Yintang/ Du-23 = sinusitis, purulent rhinorrhea, H-7/ Sp-6/Yintang = insomnia, H-7/ P-6/ yintang/ Liv-3/ Sp-6 = anxiety and depression.

GB40-Qiuxu

Location
When the foot is loose and at a right angle to the leg, in the depression, at the ankle joint, posterior (and inferior) to the extensor digitorum longus tendon.

Action
Regulates the liver and gallbladder and transforms damp heat, invigorates Qi and blood and softens hard masses.

Symptoms
Ankle joint sprain, pain or Bi syndrome, tidal fever, malaria, axillary lymphadenitis and swelling, neck, chest and ribs pain, intercostal neuralgia, hemiplegia, sciatica, infantile paralysis, Wei syndrome, acid regurgitations, hiccups, cholecystitis, scrofula, goiter, conjunctivitis, otitis media with purulent ear fluid.

Combinations
G-40/ G-32/ Sj-8 = intercostal neuralgia, St-40/ B-13/ G-40 = chest pain with phlegmatic cough, Sj-3/ Li-1/ G-40 = chronic tidal fever, G-1/ G-40 = membrane over the eye, Du-23/ G-40/ St-43 = tidal fevers, Dannangxue/ P-6/ G-40 = cholecystitis.

SJ4/TB4-Yangchi

Location
On the wrist (carpal) joint, ulnar to the extensor digitorum tendon.

Action
Dispels wind, fire and heat, tonifies vitality.

Symptoms
Wrist pain and weakness, malaria, tidal fever, tonsillitis, conjunctivitis, fatigue, dry mouth and throat, diabetes, melancholy, general weakness.

KI3-Taixi

Location
In the gap, midway between the medial malleolus peak and the Achilles (calcaneal) tendon posterior border, level with the malleolus peak.

Action
Tonifies, regulates and stabilizes kidney Qi, tonifies Yin and regulates the water pathways, clears deficiency fire.

Symptoms
Dizziness, tinnitus, weakness and lassitude, insomnia, somnolence, neurasthenia, inpotence, spermatorrhea, asthma, chronic cough, sore throat, tonsillitis,fever without perspiration, chronic toothache, hypertension, restless fetus, diabetes, pulmonary TB, menopausal syndrome, nephritis, renal pain or colic, irregular menstruation, impotence, nocturnal emission, urinary incontinence or retention, heart pain, heel swollen and painful, cold feet, diaphragmatic spasm, anorexia.

Combinations
K-3/ B-23/ Sp-6/ Ren-4/ St-29 = infertility, K-3/ B-58 = adjust kidney and bladder functioning, tonifies kidney Yin and checks, floating Yang, K-3/ Anmian/ liv-3 = aural vertigo, K-3/ Si-1 = parched throat.

BL64-Jinggu

Location
Anterior to the 5th metatarsal bone base tuberosity, inferior to the bone neck.

Action
Dispels wind,calms the spirit.

Symptoms
Dizziness, head heaviness, corneal opacity, neck stiffness, torticollis, epilepsy, madness, cerebral congestion, cardiac arrhythmia, palpitations, cold legs, dyspnea, tidal fever.

Combinations
B-64/ P-6/ H-5/ H-8 = myocarditis.

SI4-Wangu

Location
In the depression, at the meeting point of three bones: the triquetral, the pisiform and the base of the 5th metacarpal.

Action
Invigorates Qi and blood in the sinews, resolves heat, damp heat and wind heat.

Symptoms
Wrist or finger pain, cholecystitis, hypochondriac pain and distention, jaundice, malaria, fever, neck pain and creaking, gastritis, convulsions, alternate hot and cold.

Combinations
Si-4/ B-62/ Sj-5/ K-1 = cold jaundice

SP3-Taibai

Location
Inferior and proximal to the 1st metatarsal bone head.

Action
Regulates and tonifies the spleen, regualtes the stomach and colon, clears heat, damp heat and dampness.

Symptoms
Abdomianl distention, edema, diarrhea, dysentery, gastric pain, nausea, hunger with no desire to eat, body heavy and arthritic pain, headache, borborygmus, belching, constipation, hemorrhoids, cardiac pain , arthritic pain with gastrointernal problems.

Combinations
Liv-13/ Sp-3/ K-6 = constipation, Sp-3/ St-40 - Tonifies the spleen and resolves phlegm(Yuan - Luo combination).

ST42-Chongyang

Location
In the depression, at the joint of 3 bones: the cuneiform and the 2nd and 3rd metatarsals.

Action
Regulates the stomach, calms the spirit, clears stomach fire and heat and wind.

Symptoms
Anorexia, epigastric pain and distention, constipation, hysteria, anxiety, restlessness, malaria, fever, facial paralysis and swelling, toothache, gingivitis, leg Qi, always cold and seeks warmth, yawning.