Acupuncture Continuing Education


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Sample 1

Early Menopause

Although menopause is a natural part of life, early menopause may be triggered by the following:

  • Chemotherapy or pelvic radiation treatments for cancer
  • Surgical removal of the ovaries, especially surgical removal of both ovaries (bilateral oophorectomy)
  • Surgical removal of the uterus (hysterectomy)
  • Chromosome defects
  • Genetics (family history of early menopause)
  • Autoimmune diseases (including thyroid disease and rheumatoid arthritis)

If menopause occurs in the 30s or earlier, it is termed premature menopause. If caused by chemotherapy, radiation, anorexia, or other medical factors, it is termed medical …

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Sample 2

Fertility Cycle
The arrival of Tian Gui is the beginning of reproductive years for women marked by menarche. Tian Gui arrives at approximately at 14 years of age when the kidney qi, Chong, and Ren channels are abundant. Tian Gui is often translated as heavenly water, heavenly dew, or celestial water. According to the Neijing Suwen:

At the age of fourteen the Kidney Qi is full, Tian Gui arrives, the Ren vessel courses, and the Chong vessel becomes rich and full. When the menstrual cycle becomes regular, she is fertile.

At approximately age 49, kidney qi, Chong, Ren, and jing (essence) are in decline as part of the normal life cycle. At this time, Tian Gui becomes exhausted, which is the arrival of menopause and the end of the reproductive years. Menopause occurs 12 months after the end of menstrual cycles. The Neijing Suwen notes:

  • At age 35, the Yangming channel weakens. Consequently, the complexion starts to wither and the hair starts to fall out.
  • At the age of 42, the three Yang channels weaken in the top portion of the body. The complexion withers and the hair beings to turn white.
  • At the age of 49, the Ren vessel is deficient, the Chong vessel dwindles, Tian Gui stops, the body starts to weaken, and fertility ceases.

Kidney qi governs both the Ren and Chong channels. The Ren (Conception Vessel) is the Sea of Yin while the Chong (Penetrating Vessel) is the Sea of Blood. When they are abundant, there is fertility. This also implies that menstruation and fertility disorders may be treated by addressing the kidneys, Chong, and …

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Sample 3

Pattern Differentiation
In this section, we will take a look a menopause in relation to the following diagnostic patterns:

  • Kidney and Heart Yin Deficiency
  • Kidney and Liver Yin Deficiency
  • Kidney Yang Deficiency
  • Kidney Yin and Yang Deficiency
  • Liver Qi Stagnation
  • Heart and Spleen Deficiency

1. Kidney and Heart Yin Deficiency
This is a pattern wherein kidney water and heart fire do not communicate properly. If there is kidney yin deficiency, this may cause excess heart fire. Yin deficiency results in internal heat thereby causing the shen (spirit) to become unsettled.



  • insomnia
  • night sweats
  • feels hot at night or five palms heat (feet, hands, chest)
  • hot flashes
  • burning heel pain
  • palpitations
  • mental restlessness
  • dream disturbed sleep
  • cognitive impairment, including poor memory
  • dry mouth at night or thirsty
  • irregular menstruation or dysmenorrhea


red, little or no coating, possible ulcerations


rapid, deep, thin (thready)


Treatment Principles
Nourish and harmonize the heart and kidneys
Settle the shen (spirit)


Acupuncture Points
BL23 (Shenshu)
This point is located 1.5 cun lateral to L-2, at the level of the lower border of the spinous process. This is the kidney back shu point (Beishu). BL23 regulates kidney qi, benefits the lumbar vertebrae, and benefits the eyes and ears. Common indicates for use include irregular menstruation, tinnitus, edema, low back pain, and weak knees.


BL15 (Xinshu)
This point is located 1.5 cun lateral to T-5, at the level of the lower border of the spinous process. Oblique or transverse-oblique insertion towards the spine is indicated. Avoid perpendicular or oblique needling away from the spine to avoid pneumothorax. BL15 is the heart back shu point. BL15 benefits the heart, calms the spirit, and regulates qi and blood. Common indications for use include cardiac or chest pain, cognitive disorders, mental illness, and night sweats.


CV14 (Juque)
Located on the midline of the abdomen, 6 cun above the umbilicus and 2 cun below the sternocostal angle. Deep insertion is contraindicated because this may damage the liver or heart in some patients. Never needle towards the heart. Perpendicular or oblique insertion inferiorly is recommended. This is the front mu point of the heart. CV14 regulates the heart, opens the chest, stops heart pain, calms the shen (spirit), benefits the stomach, and descends rebellious lung and stomach qi.


KD3 (Taixi)
This point is located between the medial malleolus and the tendocalcaneous. KD3 is a shu stream, earth, and source (Yuan) point. K3 benefits the kidneys, cools heat, and strengthens the lower back and knees. Common indications for use include irregular menstruation, enuresis, toothache, sore throat, tinnitus, deafness, emphysema, asthma, sore throat, and thirst.


SP6 (Sanyinjiao)
SP6 is 3 cun directly above the tip of the medial malleolus, on the posterior border of the medial aspect of the tibia. Sanyinjiao is translated as 3 yin junction; this point is the meeting of the 3 lower yin meridians. SP6 strengthens the spleen, transforms dampness, spreads liver qi, and benefits the kidneys. SP6 is an important acupuncture point in obstetrics and gynecology. Indications for use include: dysmenorrhea, irregular menstruation, abnormal uterine bleeding, leukorrhea, prolapse of uterus, infertility, difficult or delayed labor. Other common indications for use include: abdominal pain and distention, diarrhea, nocturnal emissions, enuresis, dysuria, lower limb atrophy, lower limb motor impairment or hemiplegia, vertigo from blood deficiency (xue xu), insomnia.


SP6 is notable for appearing in a wide array of Chinese medicine literature, both ancient and modern, for the treatment of many perimenopause and menopause concerns. Later in this course in the Acupuncture Research section under the Acupuncture Perimenopause Relief subsection, we’ll examine modern findings on the use of this acupoint. One finding was by Qin et al., who conclude that electroacupuncture applied to acupoint SP6 (Sanyinjiao) effectively modulates reproductive endocrine system functions in perimenopausal women (Qin et al.).


HT7 (Shenmen)
HT7 is located at the ulnar end of the transverse crease of the wrist, in the depression on the radial side of the tendon of the flexor carpi ulnaris. Use caution when needling this point to avoid the ulnar artery and ulnar nerve. HT7 is a shu stream, earth, son, and source point. HT7 calms the spirit, pacifies the heart, and the clears channels. Common indications for use include insomnia, mental illness, irritability, cognitive impairment, palpitations, epilepsy or seizures, hypochondriac region pain, icteric sclera, five palms heat, and jaundice.


PC6 (Neiguan)
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, and harmonizes the stomach. Common indications for use include: nausea, vomiting, hiccups, pain (cardiac, chest, elbow, upper arm, head, neck, stomach), mental illness, seizures due to epilepsy, insomnia, fever, palpitations, irregular menstruation, dysuria, postpartum dizziness. As a confluent point of the Yinwei vessel, this point is paired with the confluent point of the Chong (Thoroughfare) vessel (SP4). Together, PC6 and SP4 are indicated for the treatment of heart, chest, and stomach disorders.


LV3 (Taichong)
This point is located on the dorsum of the foot in the depression distal to the junction of the first and second metatarsal bones. LV3 is a shu stream, earth, and source point. LV3 pacifies the liver, regulates blood, and opens the channels. Common indications for use include: headache, vertigo, insomnia, irregular menstruation, abnormal uterine bleeding, extremity and joint pain, eye pain, rib pain, retention of urine or enuresis.


Supplementary Acupuncture Points
• For night sweating, use SI3 (Houxi) with HT6 (Yinxin).
• For cognitive impairment, dizziness, or tinnitus add the Sea of Marrow points: GV20 (Baihui), GV16 (Fengfu). Alternately, choose Sishencong (M-HN-1).


Herbal Formula
Tian Wang Bu Xin Dan (Ginseng and Zizyphus Formula)

Sheng Di Huang (Rehmannia Root) 9 – 30 grams ....

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Sample 4

Acupuncture Research

1. Acupuncture Perimenopause Relief
Acupuncture is safe and effective for the treatment of perimenopause. Researchers from Heilongjiang University of Chinese Medicine and Henan University of Chinese Medicine investigated the effects of acupuncture on perimenopausal syndrome as it relates to metabolism, reproductive endocrinology, and the immune system. Clinical and laboratory findings reveal important biochemical benefits induced by acupuncture and electroacupuncture.

Onset of perimenopause may occur years prior to menopause. It may occur in the 40s, 30s, or earlier and is related to a decrease in estrogen production by the ovaries. Perimenopause typically lasts approximately four years. Indications of perimenopause include hot flashes, fatigue, increased premenstrual syndrome (PMS), irregular menstrual cycles, insomnia, vaginal dryness, decreased libido, mood swings, anxiety, and breast tenderness. Conventional treatments include hormone replacement therapy, antidepressants, and vaginal lubricants.

The researchers note that a reduction of serum estradiol in perimenopausal women leads to changes in the hypothalamic-pituitary-ovarian (HPOA) axis thereby causing pathologies. Citing several investigations in their meta-analysis, the researchers note that acupuncture regulates the HPOA and levels of serum estradiol, follicle stimulating hormone (FSH), and luteinizing hormone (LH). Additionally, they document the clinical success of acupuncture for the treatment of hot flashes.

The meta-analysis covered a large body of research. Jin et al. compared acupuncture with Premarin oral intake. Premarin is a brand name for conjugated estrogens. The acupuncture group received the administration of Back-Shu acupoints. The acupuncture group demonstrated superior patient outcomes over the group taking oral conjugated estrogens.

Shang et al. document that Yuan-Primary and Back-Shu acupoints are effective for the regulation of estradiol, FSH and LH in perimenopausal women. Qin et al. conclude that electroacupuncture applied to acupoint SP6 (Sanyinjiao) effectively modulates reproductive endocrine system functions in perimenopausal women. Li et al. measured significant beneficial increases of estradiol levels in perimenopausal women after the application of either of two acupuncture point prescriptions.

Prescription #1 was:
Guanyuan (CV4)
Sanyinjiao (SP6)

Prescription # 2 was:
Neiguan (PC6)
Zusanli (ST36)

Human clinical trials are augmented by laboratory research. Chen et al. conducted an experiment entitled “Effects of electroacupuncture on the expression of estrogen receptor protein and mRNA in rat brain.” Electroacupuncture increased estradiol levels while downregulating other factors thereby normalizing “the function of hypothalamic-pituitary-ovarian axis.” The work of Yao et al. confirms that electroacupuncture can increase estradiol levels and expression of prolactin releasing peptide in the medulla oblongata. The researchers cited several other studies demonstrating that acupuncture increases estradiol levels by transforming androgen into estrogen and by “promoting aromatase activity and mRNA expression in adipose and liver tissues.”

The above findings are but a few covered by the researchers. They examined the regulatory effects of acupuncture on the immune and neuroendocrine systems plus the regulatory effects of acupuncture on metabolism. This broad body of research confirms acupuncture’s ability to regulate bodily systems.

The researchers conclude that acupuncture is effective in the treatment of perimenopause “by improving clinical symptoms such as menstrual disorders, hot flashes, sweating, insomnia, and mood disorders.” They add that acupuncture benefits perimenopausal women by:

• increasing estrogen levels
• decreasing levels of FSH and LH
• increasing estrogen receptor protein expression
• inhibiting GnRH
• transforming androgen into estrogen

Immunity system benefits of acupuncture include increasing E-selectin and L-selectin and also by regulating immune cell estrogen receptor expression. Neuroendocrine benefits of acupuncture include:

• increasing dopamine and GABA
• decreasing aspartate and glutamate
• free radical regulation via nitric oxide and superoxide dismutase
• blood lipid regulation
• oxidative stress suppression
• bone metabolism regulation of alkaline phosphatase and DPD

The researchers note that the goal of their study was to investigate and summarize the mechanisms by which acupuncture affects perimenopausal women. They document clinical benefits and important biological regulatory effects induced by acupuncture and electroacupuncture. Given the large body of supportive research, the investigators recommend a multicenter study to further evaluate the effects of acupuncture on perimenopause.

In related research, Tan et al. concluded that acupuncture combined with Chinese herbal medicine is effective in the relief of insomnia due to perimenopause. The researchers combined administration of the herbal formula Zi Shen Tiao Gan Tang with acupuncture. The total effective rate of the combined therapy increased significantly over using acupuncture as a standalone therapy. Acupuncture achieved a total effective rate of 74.60% but the combined therapy achieved a 96.83% total effective rate.

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Qin ZY, Ling H, Xia XH, Meng L, Wu ZJ. Effects of electroacupuncture of Sanyinjiao (SP 6) on genito- endocrine in patients with perimenopausal syndrome. Zhen Ci Yan Jiu, 2007, 32(4): 255-259.

Li, Rui-li, Jin-ying Fu, Ying-ying Deng, Wen-juan Shen, Hong-li Ma, Wei Li, and Xiao-ke Wu. "Review of acupuncture treatment for perimenopausal syndrome." Journal of Acupuncture and Tuina Science 2, no. 13 (2015): 129-133.

Chen BY. Acupuncture normalizes dysfunction of hypothalamic-pituitary-ovarian axis. Acupunct Electrother Res, 1997, 22(2): 97-108.

Zhao H, Tian ZZ, Chen BY. Electroacupuncture stimulates hypothalamic aromatization. Brain Res, 2005, 1037(1-2): 164-170.

Cheng K, Tian SL. Effects of preventive- electroacupuncture of “Guanyuan” (CV 4) and “Sanyinjiao” (SP 6) on hypothalamus-pituitary-ovary axis in ovariectomized rats. Zhen Ci Yan Jiu, 2012, 37(1): 15-19.

Hu L, Wang HL, Gao XZ, Shen XM, Jin R, Zhu QC, He ZB. Comparison of regulative effects of electro- acupuncture at “Guanyuan” (CV 4) and “Sanyinjiao” (SP 6) on sex hormones and hypothalamic β-endorphin in perimenopausal model rats. Zhongguo Zhen Jiu, 2004.

Jin H, Liu TT, Wang R. Clinical observation on acupuncture at the five-zangshu for treatment of perimenopausal syndrome. Zhongguo Zhen Jiu, 2007, 27(8): 572-574.

Shang YJ, Bhang Y, Kong LL, Wang YY, Wang DS, Li J. Clinical observation on combination of source point and Back-Shu point for treatment of perimenopausal syndrome. Zhongguo Zhen Jiu, 2009, 29(6): 444-448.

Qin ZY, Ling H, Xia XH, Meng L, Wu ZJ. Effects of electroacupuncture of Sanyinjiao (SP 6) on genito- endocrine in patients with perimenopausal syndrome. Zhen Ci Yan Jiu, 2007, 32(4): 255-259.

Li Y, Xia Y, Liu SM, Ju ZY, Shi XL, Chen MG, Cheng L, He JS. Effect of electroacupuncture on serum sex hormones in patients with perimenopausal syndrome. Shanghai Zhenjiu Zazhi, 2010, 29(4): 199-201.

Chen BY, Cheng LH, Gao H, Ji SZ. Effects of electroacupuncture on the expression of estrogen receptor protein and mRNA in rat brain. Shengli Xuebao, 1998, 50(5): 495-500.

Yao X, Wang XQ, Ma SL, Chen BY. Electroacupuncture stimulates the expression of prolactin-releasing peptide (PrRP) in the medulla oblongata of ovariectomized rats. Neurosci Lett, 2006, 411(3): 243-248.

Tan KP, Yao X, Li XW. Observation on clinical effect of acupuncture plus Zi Shen Tiao Gan Decoction for perimenopausal insomnia. J Acupunct Tuina Sci, 2015, 13 (1): 49-53.



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