Acupuncture Continuing Education

Acupuncture

1–28 Governing Vessel Acupuncture

Samples of CEU/PDA Course Materials

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Governing Vessel: Pathways

The governing vessel (du mai, GV) guides qi circulation from the lower to the higher: from GV1 to GV20. The qi then flows anteriorly to the conception vessel (ren mai). The governing vessel (GV) assists the conception vessel in moving the qi from...

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Sample from Course Materials on Meeting Points:

Meeting Points Section

CV24
(Chengjiang, Jade Fluid Receptacle, 承漿)

CV24 is in the depression in the center of the mentolabial groove.

202413 cv24

CV24 is a meeting point of the conception vessel with the governing vessel. In addition, CV24 is a meeting point of the large intestine and stomach channels with the conception vessel. CV24 is a Sun Si-miao ghost point.

The jade fluid is purified saliva as discussed in the description of CV23. The kidney water of the governing vessel goes up to the crown of the head and then descends to this point and contributes to the jing-essence of the jade fluid. This is the transfer of jing-substance from kidney water to the jade fluid as it embraces qi. Taoist textbooks note that the qi of the governing vessel descends to this acupoint, which is the transfer of... 

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Sample from Course Materials on Acupoints:

GV13 (Taodao, Kiln Path, 陶道)

240213 gv13taodao

Location
GV13 is on the midline of the back, below the spinous process of the 1st thoracic vertebra. Standard needling is oblique and upward insertion, approximately 0.5 to 1.0 cun. Caution: the spinal canal is approximately 1.25–1.75 cun deep to the skin surface.
 
Taodao (陶道)
Taodao (陶道) may be translated as pottery kiln path, the way of happiness, or the path of Tao. A kiln is fiery hot. This translation emphasizes treating deficiency or excess fire.
This point also supports healthy fire and therefore has anti-aging properties. This point is also translated as a happiness path, because GV13 nourishes kidney yang and calms the spirit. This acupoint is specifically indicated for the treatment of unhappiness.
 
Meeting Point
This point is the meeting point of the governing vessel with the bladder channel.
 
Primary Functions
GV13 regulates the governing vessel, clears heat, relieves exterior conditions, and calms the spirit. 
 
Indications
Indications include steaming bone syndrome, chills, fever, headaches, heaviness of the head, blurry vision, spasms or stiffness of the spine, anhidrosis (absence of sweating), unhappiness, disorientation, and malaria.
 
Deficiency Fire: Steaming Bone
Steaming bone syndrome is a deficiency fire condition. Patients often experience one or more of the following:
 
• sensation of heat in the bones but the skin is a normal temperature
• afternoon tidal fever
• chronic low-grade fever
• severe night sweats
• dark red cheeks
 
A common herbal formula used for the treatment of steaming bone deficiency fire is Qing Gu San (cool the bones pills). This herbal formula is contraindicated during pregnancy. Qing Gu San contains the following herbs:
 
• Yin Chai Hu
• Zhi Mu
• Hu Huang Lian
• Di Gu Pi
• Qing Hao
• Qin Jiao
• Bie Jia
• Gan Cao
 
Wellness Visits
This acupoint is effective for relieving exterior conditions and clearing heat. As a result, GV13 combines with GV14 and GV12 for the treatment and prevention of external pernicious influences, including bacterial infections, viral infections, and other exteriorly contracted illnesses. GV14, 13, and 12 are often combined with LI11 and ST36 for...
 
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Sample from Course Materials—Outline of Research Section:

Research Section

Governing Vessels Acupoints in Research
The following section reviews several pieces of research. Each study includes the use of governing vessel acupoints. The following is a list of articles covered in the research section:

  • MRIs Predict Acupuncture Migraine Treatment Success
  • Acupuncture Surpasses Drugs For Asthma
  • Acupuncture And Herbs Found Effective For Pneumonia Relief
  • Acupuncture Found Effective For Lumbar Disc Herniations

COVID-19
This is a special section on COVID-19 research. (For additional research, visit the HealthCMi newsroom at the website for more research publications.)

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Sample of Course Material from the Research Section:

MRIs Predict Acupuncture Migraine Treatment Success

20240213 mriscan

 

Acupuncture is effective for the treatment of migraines. Researchers from Harvard Medical School, Xidian University, and Capital Medical University find acupuncture effective for the reduction of migraine attacks. They discovered that a patient’s pre-treatment brain structure is predictive of the success rate achieved by acupuncture for the reduction or elimination of migraines. Using MRIs and machine learning, specific patterns in brain gray matter prior to treatment were correlated with improved response rates to treatment. The acupuncture points applied to all patients were the following:
 
• GV20 (Baihui)
• GV24 (Shenting)
• GB13 (Benshen)
• GB8 (Shuaigu)
• GB20 (Fengchi)
 
Patients received three acupuncture treatments per week for a total of four weeks. Each acupuncture treatment lasted for a total of thirty minutes.  Patients receiving acupuncture were…
 
References:
1. Yang, X.J., Liu, L., Xu, Z.L., Zhang, Y.J., Liu, D.P., Fishers, M., Zhang, L., Sun, J.B., Liu, P., Zeng, X. and Wang, L.P., 2020. Baseline Brain Gray Matter Volume as a Predictor of Acupuncture Outcome in Treating Migraine. Frontiers in Neurology, 11, p.111.
 
Author Affiliations:
Department of Neurology, Beth Israel Deaconess Medical Centre and Harvard Medical School (Boston, Massachusetts).
Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Xidian University.
Beijing Hospital of Traditional Chinese Medicine, Capital Medical University.
China Academy of Chinese Medical Sciences. 
 
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CPR #4

Online Course Samples

 

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Sample #1

Sudden Cardiac Arrest

Like every muscle in your body, the heart muscle moves when stimulated by an electrical impulse. The heart, however, does not rely on your brain to send these impulses like all other muscles; it creates its own electrical current from nodes located inside the heart. The sinoatrial node, located in the upper right portion of the heart, is primarily responsible for creating this impulse that then travels through conduction pathways through the muscle in an organized manner. As this impulse travels it stimulates the different…

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Sample #2

CPR Compression Techniques

  • To perform compressions, position yourself at the patient’s side.
  • Place the heel of one hand on the sternum in the center of the chest between the nipple line.
  • Place your other hand on top of the other, interlocking your fingers.
  • Slightly pull your fingers back so that only the heel of your hand is on the patient’s chest.
  • Lean over the patient so that your shoulders are directly over your hands and lock your elbows.
  • Begin by pushing straight down onto the chest hard and fast. Press down approximately at least two inches (5 cm).
  • Lift up, bringing your weight completely off the chest but keeping the hands in place. Let the chest completely rise.
  • Continue to do this at a rate of 100 per minute.

 

CPR

 

It is important to ensure that your compressions are hard and fast. With each compression you are building pressure inside the chest to help push blood to vital organs. Compressions that are too shallow or too slow do not build the necessary pressure and will not improve the chance of survival. It is also important to release the pressure on the chest so that the heart can refill with blood before your next compression. In review:

  • The hard and fast compression move the chest downward approximately 2 inches to push blood to vital organs.
  • The release of pressure refills the heart with blood and is accomplished by letting the chest completely rise.

Some rescuers have been trained to provide ventilations to a patient after 30 compressions. If you have...

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Sample #3

Automated External Defibrillators

cpr4aed

What are They?
Automated External Defibrillators, or AED, is a device that determines if a patient in SCA needs an electrical shock and then delivers that shock. Recent research has shown that the use of an AED nearly doubles the chance of survival in SCA. They are safe and easy to use and should be used whenever possible during SCA.​

How to Use Them
Once you have determined in your assessment that a patient appears to be suffering from SCA (unconscious, unresponsive, and displays no signs of life), you should attempt to find an AED while calling for help. When returning to the patient, use the AED as soon as it is available. The first step in using an AED is to turn...

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Dietetics Soups

Samples of Course Materials
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Two Soups & Ingredients

We start our dietetics journey in Prof. Jeffrey Pang’s office, discussing the two soups to be reviewed. This section provides a guide to what you see in the video and helps to clarify topics covered in the preparation and cooking process.

Two soups are presented, Ba Wang Hua (霸王花) soup and Shan Yao soup. The Ba Wang Hua soup focuses on clearing heat & toxins, stopping coughing, and dissolving hot phlegm.

The Shan Yao (山藥) soup mildly tonifies the spleen and benefits digestion. Hei Mu Er (黑木耳, black fungus) can be added as one of the ingredients. Hei Mu Er adds a mild invigorate blood function. Notably, the Shan Yao soup is good for the treatment of...

 

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Sample of Video Materials

This continuing education course is a multimedia experience with two major components: a cooking video and written materials. Enjoy this tasty culinary adventure about healling soups and Chinese medicine dietetics!
 

  

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Sample From Ingredients Section

Ba Wang Hua (霸王花)

ba wang hua forsoup

This herb is soaked in water to rehydrate and soften, and later cooked. Ba Wang Hua is sweet and enters the lung and liver channels. Ba Wang Hua (also called Jian Hua, Ba Huang Hua, Hylocereus undatus, Flos Hylocerus flower) dissolves hot phlegm nodules under the skin, which makes it appropriate for the treatment of swollen glands, lymph, and tonsils. Ba Wang Hua clears heat and toxins and….

 

 

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Sample From Ingredients Section 

Xi Yang Cai (西洋菜, watercress)

watercress forsoup

Xi Yang Cai is cold, nourishes the lungs, alleviates constipation, and is valued for its significant nutritional and medicinal benefits. Watercress contains PEITC-NAC (N-acetylcysteine conjugate of phenethyl isothiocyanate) that has been shown in the following research to inhibit the proliferation of...

 

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Sample From Ingredients Section

Asian Pear (Xue Li)

asianpearforso

Xue means snow and Li refers to pear. Sometimes Asian pears are referred to as apple pears. The skin can be green, yellow, or white. A good quality Asian pear is juicy and crisp. Asian pears are sweet, cooling, and enter the lung and stomach channels. Asian pears nourish yin to promote the production of jin-ye (bodily fluids) and clear heat. The Asian pear treats dry coughs and...

 

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Sample of Course Materials

Shan Yao Soup

shan yao tonify qi

As we noted before, the Shan Yao (山藥) soup tonifies the spleen and benefits digestion. Notably, the Shan Yao soup is good for the treatment of weakness and is used to strengthen the body. The soup is also a good choice for strengthening the constitution of children, recovering from a dry cough or chronic illness, and balancing the body.

The total cooking and preparation time is approximately 30 minutes. Fill a pot with water and bring to a boil. Take pork spare ribs and cut into cubes (about 6–8 cubes) with a clever. Spare ribs have a mild tonify property and therefore combines well with the functions of Shan Yao. The use of spare ribs is for flavor. A vegetarian alternative to pork is the use of dried shitake mushrooms...

 

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Sample of Course Materials

Ba Wang Hua Soup 

ba wang hua soup diet01

Ba Wang Hua soup focuses on clearing heat & toxins, stopping coughing, moistening the lungs, and dissolving hot phlegm. This is appropriate for coughing with sore throat or fever. Some nicknames and labels in markets say things like aloe flower, dried Da Wang flower, and similar packaging labels.
In a bowl, soak the Ba Wang Hua (霸王花) for one hour to soften the dried herb. Empty the water from the bowl fill it again with...

 

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Sample of Course Materials

Pu-erh Tea

pu erh tea dietsoup01

Pu-erh tea is made from a large leaf variety of Camellia sinensis, primarily grown in the mountains of Yunnan province. It is often pressed into bricks but is also available in loose-leaf form after completing a special process of pressing. The special preparations involved in Pu-erh production allow the tea to mature with age. Unlike other teas, the flavor of pu-erh improves with age.

Pu-erh, like many forms of tea, is known for its antioxidant properties. This is due in part to the presence of catechins and flavonoids in the tea. [1] Pu-erh has the special ability to raise the ‘good’ HDL cholesterol while lowering levels of the ‘bad’ LDL cholesterol...

Reference:
1. Pin-Der Duh, Gow-Chin Yen, Wen-Jye Yen, Bor-Sen Wang, and Lee-Wen Chang. Effects of Pu-erh Tea on Oxidative Damage and Nitric Oxide Scavenging. J. Agric. Food Chem., 2004, 52 (26), pp 8169–8176.

 

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Herbs: Purity & Potency

Samples of Course Materials

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Medicinal herbs travel from seed to the medical practitioner’s office. Here, we explore how purity, potency, and sustainability are impacted by this journey. From seed to bottle, we look at farming practices, extraction techniques, protection of endangered flora and fauna, quality certifications and testing, traceability, herbal medicine research, and methods for verifying the geo-authenticity of herbal medicines. Ultimately, this entire chain affects the ability of medicinal herbs to deliver positive patient outcomes.

This continuing education course is a multimedia experience with two major components. Written materials are one component, the other is a 1.5 hour video. The following are samples from course materials:

 

Sample from course materials:

China Pharmaceutical University

This history is important because Tianjiang created an educational consortium with China Pharmaceutical University’s Department of Genetics and Breeding, that specializes in Chinese medicinal herb cultivation. This resulted in the first publication of a work that identified the historically correct species of Chinese medicinal herbs, confirmed by various testing methods, including TLC (thin-layer chromatography). In this way, correct seed stocks are identified and maintained. That work is entitled TLC Atlas of Concentrated Granule Prescription. The following pictures are from a two volume set:

TCMatlas2volset

 

 

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Sample from course materials:

Seeds

The TLC Atlas allows for determining exact botanical identity. Herb producers throughout China and the Chinese government have adopted the TLC Atlas as a definitive standard of Chinese herbal medicine identification. Using TLC and mass spectrometer multi-constituent testing, Tianjiang (in partnership with China Pharmaceutical University) has differentiated specific herb varieties with the greatest concentrations of therapeutic components.

Several decades ago, this level of determining herbal authenticity was unavailable. However, the nascent Chinese herbal medicine industry has grown significantly enough to document this important information.

Requirements for testing and maintenance of seeds is an active process, involving...

 

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Daodi

Daodi regions are the first choice for growing herbs, unless potency and purity are superior in other regions. The term daodi is similar to the French term terrior (environmental conditions, including soil and climate, for growing grapes).

Daodi has a broader scope in that the term also includes individual herb organoleptic qualities and clinical efficacy. Daodi refers to the traditional regions and...

 

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Dry Granulation & Optimal Parameters

Tianjiang uses a dry granulation technique, which is superior to wet spray. Dry granulation does not require an excipient and can be achieved at low temperatures, thereby preserving the active ingredients in many herbs.

Tianjiang sets optimal parameters based on variables such as temperature, pressure, length of time, and number of extractions. These parameters have been repeatedly tested in several ways. For example, HPLC (high-performance liquid chromatography) is used to measure the active ingredients in herbs before and after processing to ensure that the active ingredients are...

 

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A special 1.5 hour video has been developed for this course. Here is a preview of the video materials included in your online CEU course package:

 

 

 

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Ethics In Acupuncture #5

Sample of Course Materials

confucian temple acupuncture

Confucian Temple (Taichung, Taiwan)

 

 

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Sample #1

“I have just three things to teach: simplicity, patience, compassion. These three are your greatest treasures.” — Lao Tzu

Confucianism

Basic principles of medial ethics have their their roots in ancient traditional Chinese medicine. Daquing Zhang and Zhifan Cheng note in "Medicine Is a Humane Art: The Basic Principles of Professional Ethics in Chinese Medicine":

The value system of medical ethics in China has a long tradition that can be traced back to ancient times. Those values are reflected in the (Confucian) precept that "medicine is a humane art." That is, medicine is not only a means to save people's lives, but also a moral commitment to love people and free them from suffering through personal caring and medical… [1]

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1. Zhang, Daqing, and Zhifan Cheng. "Medicine is a humane art the basic principles of professional ethics in Chinese medicine." The Hastings Center Report 30, no. 4 (2000): S8-S12.


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Sample #2

Hippocratic Oath

Hippocrates (460–375 BCE) was an ancient Greek physician. Authorship of the Hippocratic Oath, an ancient ethical code, is attributed to Hippocrates. To this day, classical and contemporary versions of the Hippocratic Oath are included in some medical school graduation ceremonies. By today’s standards, there are several aspects of the Hippocratic Oath that are considered significantly controversial. The following is a translation of the Hippocratic Oath from the original Greek by Francis Adams in 1849:

I swear by Apollo the physician, and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation—to reckon him who taught me…


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Sample #3

Taoism & Buddhism

taoist temple garden

Taoist Temple Garden at Weibao Mountain (Yunnan, China)

 

In addition to Confucianism, Chinese medicine ethics has its roots in both Taoist and Buddhist values:

Taoism and Buddhism also influenced the development of medical ethics in China, themselves vigorously promoting the practice of medicine as a means of doing good. Taoism favors life and resents death. It regards being alive as the happiest thing and pursues immortality. Taoists pursue long life in either of two ways: by taking special medicines made from plants, animals, or minerals and by doing good deeds that benefit others. Five commandments are at the heart of Taoist religious codes. A Taoist is forbidden to... [2]

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2. Zhang, Daqing, and Zhifan Cheng. "Medicine is a humane art the basic principles of professional ethics in Chinese medicine." The Hastings Center Report 30, no. 4 (2000): S8-S12.

 

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Sample #4

Chinese Medicine Physicians

A famous 7th century physician, Sun Simiao, wrote a treatise entitled “On the Absolute Sincerity of Great Physicians.” This was a section of the work entitled The Important Prescription Worth a Thousand Pieces of Gold. The treatise is sometimes referred to as the Chinese Hippocratic Oath, although there are significant differences between the Hippocratic Oath and the values documented by Sun Simiao. The treatise “requires the physician to develop first a sense of compassion and piety, and then to make a commitment to try to save every living creature, to treat every patient on equal grounds, and to…

 

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Sample #5

Fairness

It is maintained by many scholars of Chinese medicine that patients deserve fair and equitable access to healthcare and quality treatments. In this respect, patients must be treated with equal respect. The concept that patients deserve equal access to care has historical roots in Chinese medicine:

Chen Shih-kung (AD1605) also presented the similar idea of treating high or low, rich or poor equally. He particularly mentioned that prostitutes should be treated in the same way as daughters from a good family, which entails both equality and respect. Moreover: "Medicine should be given free to the poor. Extra financial help should be extended to the destitute patients; if possible..." [3]

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3. Tsai, D. F. "Ancient Chinese medical ethics and the four principles of biomedical ethics." Journal of medical ethics 25, no. 4 (1999): 315-321.

 

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Sample #6 

Medical Records

Acupuncturists are required by law to maintain medical records for several years in many states, provinces, and countries. Additional requirements for medical record retention may be made by malpractice insurance carriers. Health insurance companies may also require…

 

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“#1 – 20” True Meaning of Large Intestine Acupoints

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Sample from the Acupoint Section

LI2 (Erjian, Second Space) 二间


LI3 (Sanjian, Third Space) 三间

LI2 is on the radial side of the index finger, distal to the metacarpal-phalangeal joint, at the junction of the red and white skin. This point is located with the finger slightly flexed. LI3 is located when a loose fist is made, the point is on the radial side of the index finger, in the depression proximal to the head of the second metacarpal bone.

 

LI2 EjianLI3 Sanjian

LI2 is a ying-spring, water, and son point. Traditional indications include epistaxis, toothache, sore throat, and fever. LI3 is a shu-stream and wood point. Traditional indications include toothache, eye disorders, sore throat, and inflammation of the hand.

The flow of qi from LI2 to LI3 is similar to the flow of qi from in front of a small hill to behind the hill. At LI2, the qi is resting and getting ready to traverse the hill. At LI3, the qi is ready and is exposed, it will eventually grow in power to the valley of LI4 (Hegu). This is a reflection of the point’s anatomical location. The qi flows from the depression distal to the metacarpo-phalangeal joint (front of the hill) to the depression proximal to the joint (behind the hill). The qi is growing in power as it moves toward LI4. We say the qi is maturing from LI2 to LI3. We can also say it is developing, from a relatively undeveloped state to a more developed state. We say the qi is gathering strength from the underground spring (ying-spring point) to the stream (shu-stream point) above ground.

The energy behind the bone matures and blossoms at LI3 as it travels from LI2; therefore, LI3 is more for mature (developed) symptom presentations. LI2 is more for immature (undeveloped) symptoms because the qi has not yet grown. For example, a skin rash that is hiding under the skin is immature and therefore LI2 is appropriate. Once the rashes expresses, we say it has matured and therefore LI3 is a better choice.

Similar to the underground spring, unexpressed symptoms are more appropriately addressed with LI2. Similar to the above ground stream, expressed symptoms are more appropriately treated with LI3. Another example, asymptomatic common cold infections are immature and therefore LI2 is a good choice over LI3. However, once there are presentations of symptoms, the disease is maturing; therefore...

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Sample from the Acupoint Section

LI4 (Hegu, Gathering Valley) 合谷


LI4 is on the dorsum of the hand, between the first and second metacarpal bones, approximately at the midpoint of the second metacarpal bone on the radial side. When squeezing the thumb against the index finger, LI4 is at the highest point of the muscle bulge, approximately level with the end of the crease.

LI4 hegu samplehcmi

LI4 is a yuan-source point and an entry point. LI4 disperses the wind, release the exterior, eliminates pain, and clears the channels. Traditional indications include headaches, eye pain, epistaxis, toothaches, deafness, facial edema, facial paralysis, sore throat, trismus (locked jaw), fever, delayed labor, local pain, and general pain. Combined with KD7, this point is used for insufficient sweating. In addition, this point is often used with SP6 with electroacupuncture for the treatment of delayed labor.

LI4 is a Gao Wu command point for the treatment of face and mouth disorders. LI4 is a Ma Dan-yang heavenly star point, indicating that this point is an important and powerful point, especially for indications such as headaches, facial swelling, malaria, fever, chills, and toothaches. This acupuncture point is contraindicated during pregnancy, especially when there is qi and blood deficiency.

The lung and large intestine are paired organs in the Chinese medicine system. Both organs have the function of clearing and expelling stagnation. The lungs are capable of expelling stagnant foreign objects and phlegm and the large intestine are responsible for eliminating stagnated stool. This point powerfully eliminates stagnation and has the energy of both the lungs and large intestine.

 

Tiger Power
According to five element theory, the lungs are correlated with the white tiger. The tiger is strong and gets rid of anything he/she does not like. LI4 shares the lung channel power of the tiger and is used to eliminate excess and exterior conditions. This is, in part, due to the lung and large intestine being paired organs.

The lung channel “white tiger” and LI4 share the tiger’s power and name. One historical name for LI4 is tiger mouth. The reference to tiger mouth comes from ancient Chinese culture, especially from the martial arts. In the martial arts, applying pressure to this point creates powerful reactions and can subdue an opponent. This is one power of the tiger. In addition, the shape of LI4 is a reference to a tiger’s mouth. It is where the thumb and index finger open like a tiger’s mouth.

The large intestine has the power of moving stagnation and this power is expressed in this acupoint’s ability to eliminate things that are not healthy. With the power of the lung tiger and large intestine, LI4 powerfully...

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Sample from the Acupoint Section

LI10 (Shousanli, Arm Three Miles )
 手三里

LI10 is on the line joining LI5 and LI11, 2 cun distal to LI11.

LI10 Shousanli ArmThreeMiles

Although the character li (里) in the name of the point is translated as mile, it is technically shorter than a mile. Although there have been variations in this traditional measurement over time, 1 li is approximately 0.3 miles or 0.5 km.

Note: the literal translation of Shou (手) is hand, but this is also used to refer to the arm as in Shouwuli (LI13, Arm Five Miles). The character for hand is also cultural reference to the arm when used for the name of LI13.

LI10 is synchronized with ST36 (Zusanli, Leg Three Miles). The reference to the synchronization is within the names of the points: Arm Three Miles, Leg Three Miles. Anatomically, LI10 and ST36 are in similar locations distal to the elbow and knee respectively. As a result, they communicate with each other, which is reflected in the names. These are paired points that are used to tonify qi. LI10 clears the large intestine channel pathway and assists the strengthening function of ST36 to benefit the stomach and spleen.

ST36 zusanli legthreemiles

LI10 has a powerful function to reduce stagnation and is therefore effective for invigorating qi and blood circulation to the arm, elbow, rotator cuff, and scapula. For example, when a patient has frozen shoulder syndrome, this point can be needled while passive or active motion is exerted, which frees mobility in the arm and shoulder. For any shoulder or arm pain, this point provides a deep...

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Sample from the Safety & Ethics Section

Sun Simiao

A famous 7th century physician, Sun Simiao, wrote a treatise entitled On the Absolute Sincerity of Great Physicians. This was a section of the work entitled The Important Prescription Worth a Thousand Pieces of Gold. The treatise is sometimes referred to as the Chinese Hippocratic Oath. The treatise “requires the physician to develop first a sense of compassion and piety, and then to make a commitment to try to save every living creature, to treat every patient on equal grounds, and to avoid seeking wealth because of his expertise.” [1] Sun Simiao commented on relations with colleagues, “it is inappropriate to emphasize one’s reputation, to belittle the rest of the physicians and to praise only one’s own virtue.”
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1. Veatch, Robert M. Cross-cultural perspectives in medical ethics. Jones & Bartlett Learning, p 320-321, 2000.

 

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Sample from the Research Section

Acupuncture Nerve Regeneration

Acupuncture repairs injured nerves. Findings published in Neural Regeneration Research demonstrate that acupuncture causes injured lower and upper limb motor nerves to repair. Electromyographic nerve conduction tests of acupuncture patients with nerve injuries document “an effective response” in 80% of patients participating in the study. Electromyography confirms that acupuncture significantly improves motor nerve conduction velocity and amplitude and also promotes functional nerve repair.

The researchers made an important discovery. A special set of acupuncture points resulted in good to excellent clinical responses at a very high rate. Using only local acupuncture points, patients had an effective rate of 38.5%. By adding acupuncture points to the…

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Sample from the Research Section

Allergic Rhinitis: Acupuncture Downregulates IgE

Ige acupuncture HealthCMi

Acupuncture alleviates nasal and eye itching, sneezing, and runny nose for patients with allergic rhinitis. Researchers confirm that acupuncture successfully downregulates IgE (immunoglobulin E), an antibody active in hypersensitivity reactions, while simultaneously reducing symptoms of allergic rhinitis. In a controlled investigation published in the Annals of Allergy, Asthma & Immunology, university researchers demonstrate that acupuncture downregulates allergen specific IgE for dust mites.

Researchers from Stanford University, RMIT University, Griffith University, and Western Sydney University conclude that acupuncture…

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Sample from the Research Section

Acupuncture For Carpal Tunnel Syndrome

carpaltunneltx healthcmi

Acupuncture relieves carpal tunnel syndrome pain and restores function. Two independent studies reveal the benefits of warm needle acupuncture for CTS (carpal tunnel syndrome). Participants in both studies experienced significant improvements in pain levels and wrist function following acupuncture treatment combined with…

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Sample from the Research Section

Acupuncture Modulates Brain Activity

MRI studies reveal the neurological mechanisms of acupuncture on human health. Research published in Autonomic Neuroscience demonstrates that stimulation of specific acupuncture points induces hemodynamic changes in specific brain networks. The researchers add that brain networks accessed by specific acupuncture points relate to specific medical disorders and suggest an “acupoint-brain-organ” pathway.

Functional magnetic resonance imaging (fMRI) studies reveal specific acupuncture point effects…

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Oncology

Acupuncture Course Samples

Prof. Jeffrey Pang, L.Ac.Ken Pang, L.Ac. and Prof. Jeffrey Pang, L.Ac.

 

 

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Sample from Biomedical section:

Forms of Cancer

There are in excess of 100 types of cancer. Many are named after the original area where the cancer formed or the type of cells involved. In this section we review common types of cancer.

Carcinoma
This is one of the most common forms of cancer, formed by epithelial cells, which are the cells that cover bodily surfaces including the skin, blood vessels, organs, and urinary tract. Different names are given to carcinomas based on the origin of what type of epithelial cell gave rise to the cancer. For example, 

"Adenocarcinoma is a cancer that forms in epithelial cells that produce fluids or mucus... Basal cell carcinoma is a cancer that begins in the lower or basal (base) layer of the epidermis, which is a person’s outer layer of skin…. Squamous cell carcinoma is a cancer that forms in squamous cells, which are epithelial cells that lie just beneath the outer surface of the skin. Squamous cells also line many other organs, including the stomach, intestines, lungs, bladder, and kidneys." [1]

1. cancer.gov/about-cancer/understanding/what-is-cancer. 4-15-2020. About Cancer.

adenocarcinoma20082321 

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Sarcoma
Cancers that form in soft tissue and bone are sarcomas. This includes lymph vessels, tendons, ligaments, fat, and blood vessels.

sarcoma oncology

 

Leukemia
Leukemia is cancer originating in the blood-forming tissue of bone marrow. This type of cancer does not form tumors. Leukemia is characterized by “large numbers of abnormal white blood cells (leukemia cells and leukemic blast cells) build up in the blood and bone marrow, crowding out normal blood cells.” This creates issues with the proliferation of normal blood cells and impairs oxygen distribution and fighting infections.

Lymphoblastic leukemia is when the bone marrow produces too many lymphocytes (a white blood cell type). Myeloid leukemia is when the bone marrow produces excess white blood cells and myeloblasts (immature white blood cells) buildup in the bone marrow and blood. This “impairs development of other blood cells, leading to a shortage of red blood cells (anemia) and platelets.”

 

Melanoma
Melanoma is cancer that forms in pigmented tissues, primarily in the skin. However, any pigmented tissue may be involved, including tissue in the eye. Melanoma originates in cells that become melanocytes, which are responsible for creating melanin (pigment).

The following illustration depicts melanoma that enters the bloodstream and lymphatic tract:

melanoma oncology

Lymphoma
Lymphoma is a type of cancer originating from T cells or B cells (lymphocytes). These are white blood cells that are abnormal and build-up in lymph nodes and vessels and other areas of the body. Hodgkin lymphoma is the term….

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Chinese Medicine

The treatment of cancer patients is covered in the course material and is based on Pang family treatment strategies and the years of experience in treating cancer patients by Ken Pang, L.Ac. and Prof. Jeffrey Pang, L.Ac. It is our belief that combining Chinese medicine with western medicine is the best choice for patients and increases the ability of the immune system to fight cancer.

Disclaimer: Nothing in this course is intended to indicate that acupuncture or herbal medicine treats or cures cancer. The course materials present TCM and its perspective on supporting cancer patients.


TCM Etiology Of Tumors

  • Qi Stagnation
  • Blood Stasis
  • Dampness
  • Heat and Toxins
  • Phlegm Stagnation
  • Zheng Qi Xu (Good/Upright Qi Deficiency)
    
In this course, we use the term zheng qi. It is translated as good qi or upright qi, and refers to qi that protects the body and maintains health.

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General Acupuncture Points

Cancer patients suffer from emotional trauma after being diagnosed with cancer. As a result, the following points apply for all cancer patients:

  • DU20 (GV20), Yin Tang, PC6, HT7, LV3, LV14, LI4
  • Ear Points: Shenmen and points for the Zang-Fu organs related to the specific cancer diagnosis (e.g., Heart, Liver, Kidney, etc.)

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Acupuncture For Cancer Pain

The following are points that assist in pain relief for specific types of cancer:

  • Lung Cancer: LU6, LU10, KD3, PC6, SP4
  • Liver Cancer: GB34, LV6
  • Stomach Cancer: CV12, ST36
  • Breast cancer: CV17, LV14, GB21, SI11

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TCM General Cancer Principles

The following are general treatment principles for supporting patients with cancer.


A. The Relationship of Tonifying Zheng Qi and Expelling Evil

1. Early stage: focus on expelling the evil and slightly tonifying the zheng qi.
2. Middle stage: equally tonify the zheng qi and expel the evil.
3. Late stage: focus on tonifying the zheng qi and slightly expelling the evil.

The aforementioned three principles are general guidelines; however, adjustments are made for specific diagnostic considerations. For example, a patient may be in the stage 1 “early stage” but may require stage 2 “middle stage” treatment strategies.

The term evil refers to unhealthy influences and processes that cause illness. This includes the six evils, which are also called the six pernicious influences: wind, cold, damp, heat, summer heat, dryness. Evil also refers other influences, including bloods stasis and heat toxins.

 

B. Bian Zheng vs. Bian Bing

Two important ways of looking at disease must be considered: bian zheng (pattern differentiation) and bian bing (disease differentiation). Bian zheng is the classic TCM (traditional Chinese medicine) differentiation of illness into syndrome patterns. This is based on principles including zang-fu syndromes (internal organ syndromes), eight principles/parameters, six stages, four levels, channel diagnostics, san jiao disorders, and qi, blood, and fluid disorders.

Bian bing refers to naming a specific disease based on location or other etiology by disease differentiation (e.g., lung cancer, liver cancer, breast cancer, prostate cancer).


Lung Cancer Clinical Example

Let’s take a look at a real world example from the Pang family clinic. A patient presented with the bian bing diagnosis of lung cancer; however, the bian zheng diagnosis was determined to be spleen qi deficiency with liver fire uprising.

  • Bian bing: lung cancer
  • Bian zheng: spleen qi deficiency with liver fire uprising

According to TCM principles of pattern differentiation…

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Channel Guiding Herbs

The following is a list of channel guiding herbs that help herbal formulas reach specific locations:

1. Liver channel: Chai Hu 柴胡, Qing Pi 靑皮, Chuan Xiong 川芎, Wu Zhu Yu 吳茱萸
2. Gallbladder channel: Chai Hu 柴胡, Qing Pi 靑皮
3. Heart channel: Huang Lian 黃連, Xi Xin 細辛
4. Small intestine channel: Huang Bai 黄柏, Gao Ben 藁本
5. Spleen channel: Sheng Ma 升麻, Cang Zhu 蒼朮
6. Stomach channel: Shi Gao 石膏, Bai Zhi 白芷, Ge Gen 葛根, Sheng Ma 升麻
7. Lung channel: Jie Geng, Sheng Ma 升麻, Cong Bai

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TCM Oncology Principles

The following are six specific treatment principles for the treatment of patients with cancer within the Chinese medicine system:

1. Clear Heat and Toxins
2. Invigorate Blood and Dissolve Blood Stasis
3. Support Zheng Qi and Tonify the Root
4. Soften the Firmness and Spread Out Nodules
5. Yi Du Gong Du: “Toxic to Toxic”
6. Permeate the Dampness and Dispel Toxicity

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Bian Bing Herbal Medicine Choices

The following are herbs used when considering bian bing (disease differentiation). Herbs listed as “comprehensive” are considered generally helpful for cancer patients. On the other hand, herbs listed citing specific conditions are considered helpful for supporting patients with that particular condition.

Disclaimer: Please note that many areas legally forbid listing any traditional medicine as beneficial for the treatment of cancer and this listing only indicates that the herbs support the patient that has cancer and does not specifically treat cancer. Check for local and national laws on the use of specific herbs as these regulation fluctuate.

1. Qing Dai 青黛 1 qian, three times per day: chronic leukemia
2. Zhi Zi 山梔子 acute leukemia with excess heat
3. Qian Cao 茜草 digestive system cancers
4. Qi Ye Yi Zhi Hua 七葉一枝花,蚤休,重樓 comprehensive
5. Bai Hua She She Cao 白花蛇舌草 comprehensive

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General Immunity Support

This following formula is for general immunity support for patients with tumors but is not listed for treating and removing tumors. Patients with tumors require referral to an appropriate medical professional for consultation and treatment of tumors.

Pang family traditional support formula:

Treatment Principle: Support the upright qi, expel evil qi

  • Ban Zhi Lian 半枝莲 30g
  • Bai Hua She She Cao 白花蛇舌草 30g
  • Kui Shu Zi 葵树子 15g
  • Yi Yi Ren 薏苡仁 30g
  • Zhu Ling 猪苓 30g
  • Fu Ling 茯苓 15g
  • Ling Zhi 灵芝 30g
  • Dang Shen 党参 15g
  • Xi Yang Shen 西洋参 15g
  • Bai Zhu 白术 15g
  • Huang Qi 黄芪 15g
  • Nu Zhen Zi 女贞子 9g
  • Chai Hu 柴胡 9g
  • Yu Jin 郁金 9g
  • Ji Nei Jin 鸡内金 6g
  • Zhi Gan Cao 炙甘草 9g

Preparation:
Cover the herbs in water and decoct. Because this is a large amount of herbs…

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TCM Dietetics Treatments for Reducing Toxicity from Chemo & Radiation Therapy

Patients undergoing chemotherapy and radiation therapy require support. The depleting nature of chemotherapy indicates that tonifying qi and blood becomes an important principle in supporting these patients. The fire and toxins from radiation therapy indicates that clearing the fire toxins is an important principle. The following are helpful dietetics suggests for inclusion into the dietary regimen of patients.

1. Green tea with Jiao Gu Lan tea 
(Jiao Gu Lan Cha)  绞股蓝茶療法
Jiao Gu Lan 绞股蓝 is slightly bitter, cold, and enters the lung and heart channels. It tonifies qi, moistens the lungs, and dispels phlegm. Jiao Gu Lan also clears heat, eliminates toxins, and reduces inflammation. Green tea (Lu Cha, Cha Ye) clears heat, dispels dampness, and eliminates toxins. Together, these two herbs support patients with gentle detoxification. This is a simple dietary addition that helps support the patient.


2. Hai Dai Lu Dou Sheng Gan Cao Tang
海帶綠豆生甘草湯
This is a simple three herb formula of Hai Dai, Lu Dou 綠豆, and Sheng Gan Cao 甘草. The mung bean (Lu Dou) and raw licorice (Sheng Gan Cao) combination is taken as a hot tea or soup. It clears heat and relieves fire toxicity. Together, these herbs…

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Improper Diet Triggers: Fa Foods & Rich Tonics

Eating Fa foods too early or resumption of strong tonifying foods too early may cause difficulty in wound healing, especially after surgery when organs need to heal. The general principle is to maintain a balanced diet, eat things that are easy to digest, and no heavy tonifying foods. Fa foods are those that cause the growth of pathogens.

Fa foods are contraindicated if skin problems are present, after an injury or surgery, or if there is an infection. The same is true for patients with cancer or having recently recovered from cancer. The Fa foods may lead to unwanted growth. The one Fa food exception is mushrooms because, in many cases, this food may be beneficial.

Fa Foods

  • Shellfish, including shrimp and crab: these foods are particularly contraindicated for psoriasis, eczema, and patients with infections. Shellfish tend to turn red when cooked and the concept is that the red from the cooking equates into increased redness and inflammation for these patients. Science confirms that there are several forms of reactions to shellfish including the release of histamines from mast cells.
  • Alcohol
  • Green onions and chives may present problems due to their warming nature.
  • Roasted or barbecued foods: top contraindications are attributed to domestically raised roasted duck, goose, and Peking duck.
  • Chicken, especially rooster, is contraindicated because it tonifies yang.
  • Goat meat

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Sloan-Kettering Cancer Center Research & Lymphoedema

Memorial Sloan-Kettering Cancer Center research demonstrates that acupuncture significantly reduces lymphedema related arm swelling in women after breast cancer surgery. Lymphoedema is a when there is fluid retention and tissue swelling in the body due to disorders of the lymphatic system. The lymphatic system controls the return of interstitial fluid to the bloodstream. After breast cancer surgery, the lymphatic system can be damaged by lymph node surgery or radiation therapy. Symptoms may appear quickly or take several months or years to become apparent. Swelling of the arms and sides of the body is most common after lymphatic system damage due to breast cancer procedures.

The researchers at Sloan-Kettering (New York) note that existing conventional treatments for lymphoedema are only “marginally beneficial, rarely reducing arm swelling in any meaningful way.” The new study concludes that acupuncture...

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Reference: Acupunct Med. doi:10.1136/aim.2011.004069. A safety and efficacy pilot study of acupuncture for the treatment of chronic lymphedema. Barrie R Cassileth, Kimberly J Van Zee, Yi Chan, Marci I Coleton, Clifford A Hudis, Sara Cohen, James Lozada, Andrew J Vickers.

 

 

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Acupuncture Pancreatic Cancer Pain Research

Researchers conducted a randomized, placebo controlled study to investigate whether or not acupuncture reduces pain associated with pancreatic cancer. This type of cancer is often accompanied by severe abdominal or back pain. The researchers concluded that, “Electroacupuncture was an effective treatment for relieving pancreatic cancer pain.”

A total of 60 pancreatic cancer patients with severe pain were randomly divided into two groups. Group 1 was the placebo control group and group 2 received verum acupuncture. The acupuncture points used in the study were the…

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Heart Disease

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Congestive Heart Failure (CHF)

Biomedicine
This section focuses on the treatment of chronic CHF. According to the National Heart, Lung, and Blood Institute of the U.S. National Institutes of Health, heart failure (also termed congestive heart failure):

... is a condition in which the heart can't pump enough blood to meet the body's needs. In some cases, the heart can't fill with enough blood. In other cases, the heart can't pump blood to the rest of the body with enough...

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The NIH (National Institutes of Health) notes in the U.S. National Library of Medicine website:

The weakening of the heart's pumping ability causes:

  • Blood and fluid to back up into the lungs
  • The buildup of fluid in the feet, ankles and legs [edema]
  • Tiredness and shortness of breath

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Diagnostics include listening to heart sounds, lungs sounds indicating fluid buildup, and swelling of the legs, ankles, feet, abdomen, and veins of the neck. Tests include EKG (electrocardiogram), chest X-ray, a BNP hormone (B-type natriuretic peptide) blood test, echocardiography, ultrasound measurements of lung and heart blood flow, Holter monitor of the heart’s electrical activity over a 24–48 hour period, stress tests, nuclear heart scans, cardiac...

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CHF Diagnosis

  • Heart yin and yang deficiency
  • Spleen qi deficiency

Chronic CHF encompasses a complex of diagnostic considerations and there are variations in differential diagnostics per each individual case. Primary diagnostic considerations are heart yin and yang deficiency and spleen qi deficiency. Additional considerations include:

  • Water obstruction due to kidney yang deficiency affecting the heart
  • Blood stasis due to qi deficiency
  • Phlegm dampness obstructing the lungs

Patients often present with shortness of breath (especially upon exertion), fatigue, cyanosis of the lips or nail beds, palpitations…

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Acupuncture

Pang Family Acupuncture Point Prescription

  • PC6, HT7, ST36, SP9, SP6, BL15. Needle BL15 using warm needle moxa technique.
  • Auricular points: Shenmen, heart, kidney, spleen. For auricular points, selection of ear tacks for longer-term retention of needles is appropriate.

Acupoints
pc5pc6hd01

Neiguan, PC6 (Inner Pass)
This point is 2 cun above the transverse wrist crease, on the line connecting PC3 and PC7, between the tendons of the palmaris longus and flexor carpi radialis.

PC6 is the luo (connecting) point of the pericardium channel. It is the confluent point of the Yinwei vessel (Yin Linking Vessel). PC6 regulates the heart, calms the spirit, regulates qi, suppresses pain...

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Alternate Point Selections

Dirty Water Affecting The Heart Due To Kidney Yang Deficiency
When there is water affecting the heart due to kidney yang deficiency as a predominant presentation, the acupuncture formula may be modified. The principle is to warm the kidney yang and remove the dirty water.

Acupuncture Points:

  • HT7 (Shenmen)
  • PC6 (Neiguan)
  • BL15 (Xinshu)
  • SP9 (Shuifen)
  • ST36 (Zusanli)
  • BL23 (Shenshu)
  • GV4 (Mingmen)

This selection includes the addition of BL23 and GV4 to the Pang family point prescription…

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PC5 – PC6 Research

University of California School of Medicine researchers demonstrate that electroacupuncture applied to PC5–PC6 produces “point-specific effects on cardiovascular reflex responses.” [i] The researchers add that sympathetic cardiovascular rostral ventral lateral medulla neurons that respond to both visceral (reflex) and electroacupuncture nerve stimulation “manifest graded responses during stimulation of specific acupoints.” [ii]

The researchers conclude that electroacupuncture "demonstrates a range of cardiovascular responses" and the levels of "visceral reflex pressor responses are influenced by the anatomic location of somatic nerves beneath the acupoints." [iii] They identified specific responses; "deep nerves exerting strong influence and superficial cutaneous nerves demonstrating little or no attenuation of cardiovascular reflex responses." [iv] The results were published in the American Journal of Physiology – Regulatory, Integrative and Comparative Physiology.

The researchers note after testing multiple acupoints, including PC5 and PC6...


References from this section:
i. Tjen-A-Looi SC, Li P, Longhurst JC (2004) Medullary substrate and differential cardiovascular responses during stimulation of specific acupoints. Am J Physiol Regul Integr Comp Physiol ii87: R852-R862.
ii. Ibid.
iii. Ibid.
iv. Ibid.

 

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Sample of Research Materials On Coronary Heart Disease

Single Photon Emission Computed Tomography

An acupuncture study from the Department of Nuclear Medicine at Peking University Shenzhen Hospital successfully measured improvements in blood flow to the heart for patients with coronary heart disease (CHD).

Using single photon emission computed tomography (SPECT), researchers discovered that needling two specific acupuncture points caused significant improvements in patients with CHD. Acupuncture successfully increased “blood perfusion of ischemic myocardium.”

Coronary heart disease is...

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Arrhythmias and Pulses

According to Chinese medicine principles, it is usually easier to correct issues of the pulse when the heart beat is irregularly irregular. An irregularly irregular pulse involves irregular beats but they do not have a specific pattern. Generally, a regularly irregular pulse is considered a more intractable disorder. A regularly irregular pulse has a set pattern of irregularity. The following is a list of some of the types of irregular pulses that are commonly seen in a Chinese medicine clinic:

Hesitant-Choppy
In Chinese medicine literature, this pulse is described as a sick silkworm eating a mulberry leaf or a knife scraping bamboo. It is considered the opposite sensation of feeling a slippery pulse. It is uneven, rough, and sometimes irregular in strength and fullness. This may be caused by qi and blood stagnation. If this pulse is thin, it may be caused by jing, blood, or yin deficiency.

Abrupt-Hurried
This pulse is fast and irregularly skips...

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Hyperactive Heart Yang Tachycardia

A common presentation of tachycardia is due to hyperactivity of heart yang. Common presentations of heart yang pathologically floating upwards include tachycardia, palpitations, insomnia, and mental restlessness. Yin fails to nourish the heart due to yin and blood deficiency. Yin deficiency heat disturbs the chest and often results in mental restlessness. This presentation often results from excess stimulation and output from the sympathetic nervous system (SNS).

Diagnosis
Heart yang floating upwards

Treatment
Anchor the yang, Tonify qi

Pang family herbal formula
This herbal formula tonifies qi and anchors the floating yang. The herbs Ku Shen and Bai Zi Ren have a special function to slow the heart rate.

Dang Shen          (Radix Codonopsitis Pilosulae, 党参)      12 grams
Gan Jiang          (Dried Rhizoma Zingiberis, 干姜)           2 g
Mai Men Dong       (Ophiopogon Root Tuber, 麦门冬)           12 g
Rou Gui Fen        (Cortex Cinnamomi Cassiae powder, 肉桂)    1 g
                    put the cinnamon powder in the tea cup with cover
Sheng Di Huang     (Rehmannia Root, 地黄)                    12 g
Ku Shen            (Radix Sophorae Flavescentis, 苦参)       12 g
Huo Ma Ren         (Semen Cannabis Sativae, 火麻仁)          15 g
Huang Lian         (Rhizoma Coptidis, 黄连)                   4 g
Fu Ling            (Sclerotum Poriae Cocos, 茯苓)            30 g
Bai Zi Ren         (Semen Platycladi, 柏子仁)                12 g
Long Gu            (Os Draconis, 龙骨)                       30 g
Zhi Gan Cao        (Radix Glycyrrhizae, 炙甘草)               10g

 

Decoction Instructions
Cover the herbs with water plus 2–3 inches of additional water above the herb line in the pot. This is a large amount of herbs, so this formula can be boiled up to three times per bag. Each dose can be decocted and consumed separately. Alternatively, boil each bag three times and then mix the decocted herb tea from all three boilings. This creates a more even dosage. Then, separate the mixture into three doses. Drink one cup per day during periods of relative remission. During more serious states of the disease, drink one cup in the morning and one cup at night.

 

Individual Herbs Within The Formula

Dang Shen
Dang Shen is sweet, neutral, and enters the lung and spleen channels. This herb tonifies the middle jiao (burner) and tonifies lung and spleen qi. Dang Shen nourishes blood and promotes the generation of bodily fluids.

Gan Jiang
Gan Jiang is spicy, hot, and enters the heart, lung, spleen, and stomach channels. Gan Jiang warms the middle jiao, expels cold, dispels wind-dampness affecting the lower jiao (burner)...

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Master Tung #1

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This course focuses on two acupuncture point selections used for the treatment of gynecological disorders. The first point (11.06 Return to the Nest) is a single acupuncture point used by Master Tung and his family. The second (11.24 Gynecological Points) is a two-point combination also developed and used by Master Tung within his family tradition. Together, they are a powerful combination for the treatment of gynecological disorders. Supplementary points (including 11.17 Wood Anger) are also reviewed.

Used primarily for women, 11.06 Return to the Nest and 11.24 Gynecological Points are acupuncture points combined to treat all gynecological diseases, such as premenstrual syndrome, menopausal hot flashes and night sweats, infertility, ovarian disease, cyclic migraines, PCOS, and endometriosis. Both point selections are presented in detail, starting with 11.06 Return to the Nest.

 

11.06 Return to the Nest (Huan Chao)

master tung rtn2

master tung rtn3

master tung rtn1

 

Location
11.06 Return to the Nest is located on the ulnar side of the middle phalange of the ring finger, centered between the second and third finger creases, just palmar to the intersection of...

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