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Acupuncture Balance Method

Bruce Ferguson DVM, MS

Holistic Veterinary Carewww.naturalvet.org

Prelude

I am about to share with you ideaswhich I have put into practice toachieve excellent clinical results

Why did I choose to explore novel pointlocation and combinations?

Why didn’t I just practice what I wastaught?

Prelude I am fortunate to have studied with

numerous TCVM experts There are 4 in particular who I would like

to honour for inspiring me to investigate

acupuncture point use and location Dr. Are Thoreson Dr. Richard Tan Dr. Keija Zhang Dr. Jan Still

Prelude

Richard Tan, a human acupuncturist, isfamous for his “Revolutionary Acupuncture” which achieves rapid clinical results

His system has 3 major subsystems, butdepends upon Anatomic Imagery

Anatomic Imagery acupuncture utilizes bothmirror imagery and microsystems

Both are based upon Anatomical Tissue

Similarity

Prelude

Both are based upon Anatomical TissueSimilarity

We would all agree that the front and rear

distal quadruped leg and foot are much moresimilar than the human hand and foot

Viewing the symmetry and tissue similarity,novel acupuncture point locations andcoupling automatically arise

Prelude

The leader of TCVM in China for more than30 years, and Dr. Xie’s mentor, Dr. KeijaZhang was an amazing inspiration

When I was “on the search” for all speciesLIV 3 after Are’s inspiration, I asked Dr.Zhang where he placed LIV 3 in the dog

Dr. Zhang laughed at me as if I was a foolishchild, then, with a grin, asked me where I

thought LIV 3 was on a horse!

Prelude

Dr. Zhang explained that EVERYTHING thatmakes LIV 3, Tai Chong, exist, is HUMAN andnot found in the same way in quadrupeds!

Thus, LIV 3 exists ONLY as a human point Although we may still search for and use

clinically acupuncture points which resemblehuman points such as LIV 3

Conclusion?

Lighten up about point names and locations

Prelude

Finally, Dr. Jan Still inspired me with a fewsimple words about 6 years ago that havechanged my practice forever

Jan said that each day of clinical practice, forat least one patient, try using a protocol thatyou have not previously used

In other words, do miniature “experiments” or clinical case studies to expand your

treatment regimen

Fei Boxiong

費伯雄

1800-1870 “There exist no miraculous

methods in the world, only

plain ones and theperfection of the plain

is miraculous”

AP reduces crying in infants with infantile colic:a randomised, controlled, blind clinical study

Landgren K, Kvorning N, Hallström I. Acupunct Med. 2010 Oct 1

OBJECTIVE: To investigate whether AP reduces the duration and

intensity of crying in infants withcolic Patients and methods 90 otherwise

healthy infants, 2-8 weeks old, withinfantile colic were randomised in

this controlled blind study

81 completed a structured programmeconsisting of six visits during 3 weeks to an

AP clinic in Sweden Parents blinded to the allocation of their

children met a blinded nurse The infant was subsequently given to another

nurse in a separate room, who handled all

infants similarly except that infants allocatedto receive AP were given minimal,standardised AP for 2 s in LI04

RESULTS: There was a difference (p=0.034)

favouring the AP group in the time which passedfrom inclusion until the infant no longer met thecriteria for colic

The duration of fussing was lower in the AP groupthe first (74 vs 129 min; p=0.029) and second week(71 vs 102 min; p=0.047) as well as the duration ofcolicky crying in the second intervention week (9 vs13 min; p=0.046) was lower in the AP group

The total duration of fussing, crying and colickycrying (TC) was lower in the AP group during the first(193 vs 225 min; p=0.025) and the secondintervention week (164 vs 188 min; p=0.016)

The relative difference from baseline throughout the

intervention weeks showed differences betweengroups for fussing in the first week (22 vs 6 min;p=0.028), for colicky crying in the second week (92vs 73 min; p=0.041) and for TC in the second week

(44 vs 29 min; p=0.024), demonstrating favourtowards the AP group

CONCLUSIONS: Minimal AP shortened the durationand reduced the intensity of crying in infants withcolic

Further research using different AP points, needletechniques and intervals between treatments isrequired

Circadian Cycle of Qi

Intestine

LungLiver

Stomach

Bladder

Triple

Heater

Pericardium

Kidney

Bladder Small

Intestine

Spleen

Taiyin

Yangming

Shaoyang

Jueyin

Taiyang

Shaoyin

Yangming

Taiyin

Shaoyin

Taiyang

Jueyin

Shaoyang

3:00 am

5:00 am1:00 am

11:00 pm

9:00 pm

11:00 am

9:00 am

7:00 am

7:00 pm

5:00 pm

3:00 pm

1:00 pm

Richard Tan’s Balance Method

Biographical and publications information maybe found at www.drtanshow.com

Dr. Tan’s Balance Techniques are based upon

the I Ching (Ba Gau/Eight Trigrams and 64Hexagrams) and Taoism

I will omit his philosophical development ofthe Balance Method and focus on the clinicalapplications

Minimal needle Distal point-only

Obtains clinical results very rapidly Easy to use in the clinic

Effective in the treatment of a widerange of both internal and externalchannel blockages and imbalances

An Acupuncturist’s

Acupuncture

There is an extensive history of variousacupuncture techniques usedthroughout the world

Most “modern” acupuncture taught inTCM and TCVM training programs is

“herbal” acupuncture

“Herbal” Acupuncture

In “herbal” acupuncture, both individualacupuncture points and pointcombinations are used as “herbal”

singles and formulas For example

Hou San Li , ST 36 is roughly equivalent toRen Shen , Panax ginseng

Tai Xi , KI 3 is roughly equivalent to Shu Di

Huang , Cooked Rehmannia

Further, the patient is usually diagnosedby a combination of 8 Principles Yin/Yang, Hot/Cold, Excess/Deficient,

Internal/External Fundamental Substances

Qi, Blood and Body Fluids

And Zang-Fu Organ Kidney, Heart, Spleen, Stomach, etc.

Thus a dog with lethargy, loose stools,weak pulse, and pale, moist tonguemight be diagnosed with Spleen Qi Deficiency

And treated with the herbal formula Si Jun Zi Tang , Four Gentlemen Decoction

And acupunctured at such points as BL 20, BL 21, CV 12, and ST 36

Examples of Herbal

Acupuncture

Golden Needle Wang Le-Ting: A 20th

Century Master’s Approach to Acupuncture

Yu Hui-chan and Han Fu-ru

Blue Poppy Press, 2001

Boulder, CO, USA

ISBN 0-936185-78-3

“Old Ten Needles” Shang Wan (CV 13), Zhong Wan (CV 12),

Xia Wan (CV 10), Qi Hai (CV 6), Tian Shu

(ST 25 bilateral), Nei Guan (PC 6 bilateral)and Zu San Li (ST 36 bilateral)

Based upon Li Dong-yuan’s Pi Wei Lun

(Treatise on the Spleen and Stomach)Bu Zhong Yi Qi Tang (Supplement theCenter and Boost the Qi Decoction)

Acupuncture

An “acupuncturist’s acupuncture” is focusedon adjusting the Qi in the Jing-Luo Channelsand Collaterals, commonly after making a

channel diagnosis Essentially the acupuncturist wants the

patient to “point” to the problem which is

then rectified by various acupuncture pointapplications based upon “Balance” andmicrosystems techniques

Acupuncture

The effect of “an acupuncturist’sacupuncture” is described in Chinese as

Li , Stand

Gan , Under Jian , See

Ying , Shadow

This implies that the effect of such treatmentshould be as rapid as seeing one’s shadowwhen standing in the sunshine

Microsystems Acupuncture

Include but not limited to Auriculotherapy

Scalp acupuncture

Facial acupuncture Nose acupuncture

Tongue acupuncture

Korean hand-needling

Foot acupuncture

E t P i t

Extra Points or

Microsystems Acupuncture ?

E t P i t

Extra Points or

Microsystems Acupuncture ?

Non-”Classical” Acupuncture

Modern TCM textbooks are based uponclassics written by erudite scholars

Much of the rich history of regional TCM

herbal and acupuncture therapy hasbeen lost

Occasionally we are able to see into thetactics of such non-classicalacupuncture

Non-”Classical” Acupuncture

Master Tong’s Acupuncture An Ancient Alternative Style in Modern Acupuncture Practice

Miriam Lee, Blue Poppy Press, 2002

Family Style of Acupuncture

Very few points per treatment Generally uses contralateral and

asymmetrical needling

Can We Rationally Organize

Acupuncture Point Function?

Humans create interpretations or “models” of natural systems in order to

Organize seemingly disparate data

For example, Master Tong’s Acupunctureconsists of seemingly endless lists of novelpoints, each with a plethora of functions

Test hypotheses

Generate novel uses of current knowledge

Acupuncture Point Function?

Richard Tan believes that there is ahidden “code” in the Ba Gua andCircadian Clock which allows us

immediate, rational access toacupuncture point functions

Let’s examine his “model” or BalanceSystems/Techniques/Methods

Overview of Dr. Tan’s “1,2,3” Step 1: Diagnose which acupuncture channel or

channels is/are involved Step 2: Choose a Balance Technique

Local Balance for well-localized dysfunction

Global Balance for functional disorders or broadpain

Step: Choose Points to Treat

Mirror

Ba Gua

“Special Points”: 4 Magic, 8 Magic, 12 Magic

Point Location It is important to palpate ahshi or tender

points when locating distal points for

treatment The textbook descriptions of point

locations are intended to help you “getclose” to the actual point, which is thenfound by palpation

Importance of Sensitive Points Zhongguo Zhen Jiu. 2011 Feb;31(2):134-8. [Return of Qibo: on hypothesis of sensitization

state of acupoints]. [Article in Chinese] Chen RX, Kang MF, Chen MR. Affiliated Hospital of Jiangxi College of TCM, Nanchang 330006, China. chenrixin123@yahoo.com.cn

To discuss the hypothesis of the sensitization state of acupoints based on the original definition and the

localization method of acupoint from Internal Classicas well as the clinical evidence of heat-sensitivemoxibustion

Acupoints are different in the states, named restingand sensitization

The acupoints of sensitization state are the reactive

sites of disease on the body surface, also the bestsites for acupuncture and moxibustion treatment

Importance of Sensitive Points The acupoints are the specific sensitive sites on the body

surface relevant with diseases with the best therapeutic effects Hence, the acupoints of sensitization state are of dynamic

variability

In clinical application, only the two-step location method,preliminary and accurate localizations (sensitive probinglocalization) from Internal Classic can localize the acupointsprecisely, rather than one-step location method such as

proportional measurement or body surface landmarklocalization.

The nature and property of acupoints are different based on thefunctional state, not just on the fixed locations

Importance of Sensitive Points Zhen Ci Yan Jiu. 2010 Aug;35(4):311-4. [Paying attention to the heat thermal sensitivity of

moxibustion is the key for raising the curative effect]. [Article in Chinese] Chen RX, ChenMR, Kang MF, Chi ZH, Zhang B. Department of Acu-moxibustion and Rehabilitation, the

Affiliated Hospital of Jiangxi College of Chinese Medicine, Nanchang 330006, China.chenrixin123@yahoo.com.cn

When moxibustion is applied to a certain acupoint in

the patient, a regional heat sensitive reaction may befound

In the present paper, the authors expound its

conception and appearing regularities, its relationshipwith the "arrival of qi" of Chinese medicine, and itsclinical application in guiding acupoint selection and

heat-stimulation quantity

Importance of Sensitive Points Heat sensitive reaction during moxibustion

("heat sensitive moxibustion") is frequentlyseen in people undergoing pathological

conditions and correlates highly with thediseases

It characterizes in dynamic changes in the

location along with the state of the disordersand in being not always to coincide with thestandard meridian acupoint location

Importance of Sensitive Points The heat sensitive phenomenon of moxibustion is

one of the manifestations in theactivated functional activities of meridian of Chinesemedicine just like the arrival of the qi

caused by acupuncture stimulation It is also a sign of activation of the human

endogenous functional regulative system Therefore,

thinking highly of the heat sensitive reaction of moxibustion is the key point for raising the curativeeffect in clinical practice

Point Location In this system, acupuncture points are 3-

dimensional

Generally the Balance Method works bestwhen needle are inserted to a depth whichallows the needles to “stand up” on theirown

Richard Tan’s Balance Method Point Location

In deciding where to look for possibleappropriate points, use either the

“Anatomical Image” of the limbs “Mirror”

Digits correspond on hands and feet

Carpus corresponds to the tarsus Elbow to the knee

Shoulder to the hip

Anatomic Tissue Similarity

Why does the Nan Jing tell us “needleskin deep to treat skin diseases, needlemuscle deep to treat muscle diseases,

needle into the tendons and ligamentsto treat tendons and ligaments, and

needle bone deep to treat the bones”?

Needles/Technique Needle until De Qi response is elicited

De Qi sensation delivers a powerful signal

to the patient’s channel system This is very important in making the distal

point approach both efficacious and rapid

Sensation should be somewhere between “can’t feel it” and “let me out of here!”

Treatment Time and Frequency

Rapid improvement in pain, numbness andrange of motion

Needle retention should be 45 min-1 hr Re-treat before clinical signs fully reappear

This allows the clinician to “stay ahead” ofthe condition with continued and additivereduction in clinical signs

5 Core Systems of Balance

Method #1- Anatomical Image System

#2- Bie Jing or Branching ChannelSystem

#3- The Interior/Exterior Relationship #4- The Chinese Clock: Opposite

System #5- The Chinese Clock: Neighbor

System

The Unspoken 6th System

I tend to call it channel clearing

May be a form of microsystemsacupuncture

Especially useful on quadrupeds inimaged on the distal carpel/tarsal,

metacarpel/metatarsal and phalangealarea

The Unspoken 6th System Usually my first choice in treatment

May be “coupled” with system 1

Thus, treating TH 3 on the Shaoyangchannel may simultaneously treatshoulder (TH) and coxofemoral (GB)

Qi/Blood Stagnation

#1- Anatomical Image System Employs the Chinese concept of

channel-based anatomical zones andimagery

This system always treats points thatare located on the correspondingchannel

Treats on the opposite, diagonal side ofthe patient’s body

#1- Anatomical Image System For this system you must remember the

Chinese channel names and locations! Taiyang =Small Intestine and Bladder

Shaoyang =Triple Burner and Gallbladder Yangming =Large Intestine and Stomach

Taiyin =Lung and Spleen

Shaoyin =Heart and Kidney

Jueyin =Pericardium and Liver

The Limbs all “Mirror” one

another Toes and fingers mirror each other

E.g. right front lateral 5th finger (SI TaiYang channel) is treated by left lateral 5th

toe (BL Tai Yang channel) Tarsi mirror the carpi

Right foot medial ankle injury (SP Tai Yin channel) may be treated by left medialcarpus (LU Tai Yin channel)

The Limbs all “Mirror” one

another Stifles mirror the elbows

Left antero-lateral knee injury (STYangming channel) may be treated byright antero-lateral elbow (LI Yangming channel)

Hips mirror the shoulders

Left lateral shoulder injury (TH Shaoyang channel) may be treated by right lateralhip (GB Shaoyang channel)

The Axial Body is “Imaged” “Image”

The hand and foot “images” the head

The carpus and tarsus “images” the

neck Elbow and knee “images” the central

abdomen

Shoulder and hip “images” the lowerabdomen and genitals

The Axial Body is “Imaged” Chest Pain may be thought to be

traversed by the CV, KID, LIV Channels

CV is balanced by GV

KID is balanced by HT

LIV is balanced by PC

An Image of the chest on the forearmthus places the most effective PC pointat the level of PC 6!

#1- Anatomical Image

System: Example 17.5 year old Corgi

cross Carpel flexion inhibition

Pain in dorsolateral

carpus

Which channel?

Which correspondingchannel to treat?

Roughly which point totreat?

#1- Anatomical Image

System: Example A 53 year old

male complains oflower back pain

ChannelsInvolved?

BalancingChannels?

Area Imaged?

What Points?

#2- Bie Jing or Branching

Channel System Uses another set of relationships

between the channels according toenergetic levels

Unlike System #1, the same nameenergetic channel is not the one used

for treatment Instead, treat according to Bie Jing

Channel System Bie Jing

Taiyang and Taiyin treat one another

Jueyin and Yangming treat one another

Shaoyang and Shaoyin treat one another

As in system #1, hand channels treat

foot channels and foot channels treathand channels

Channel System Examples of this system include

Hand Taiyin (LU) treats foot Taiyang (BL)

Hand Taiyang (SI) treats foot Taiyin (SP)

Hand Shaoyin (HT) treats foot Shaoyang (GB) Foot Shaoyin (KID) treats hand Shaoyang (TH)

Foot Yangming (ST) treats Hand Jueyin (PC)

Foot Jueyin (LIV) treats hand Yangming (LI)

Channel System In system #2, both contralateral and

ipsilateral treatment may be used

Depends upon location of strong ahshi

Thus a Shaoyin (HT) carpel flexion painmay be treated by an ahshi point found

on the foot Shaoyang (GB) channel E.g. GB 40, Qiuxu

abdomen

The Axial Body is “Imaged” Urinary Bladder Pain may be thought to

be traversed by the CV, KID, STChannels

CV is balanced by GV KID is balanced by TH

ST is balanced by PC An Image of the lower abdomen on the

forearm thus places the most effectiveTH point at TH 10-11!

Channel System: Summary Uses Yang channels to treat Yin

channels

Uses hand channels to treat foot

channels, and vice versa If the disharmony is unilateral, Bie Jing

treats the selected point on the sidethat elicits the most ahshi sensitivity

Channel System: Example 10 year old

shepherd cross Left lateral stifle

pain and stiffness

Which channel?

Which channel to

treat? Roughly which

point?

Channel System: Example 35 year old male

with lumbar strain

What channel?

What Balancingchannel?

What point?

#3- The Interior/Exterior

Relationship Utilizes Zang-Fu organ pairs taught in

all TCVM classes Lung/Large Intestine

Kidney/Bladder Liver/Gallbladder

Heart/Small Intestine

Pericardium/Triple Heater Spleen/Stomach

Relationship Also good for internal medical disorders

To treat many types of abdominal pain

Remember that the thorax and

abdomen are “imaged” on the front andrear legs

“Image” technique for chest

and abdomen The carpus and tarsus “images” the

The elbow and knee “images” the

central abdomen The shoulder and hip “images” the

lower abdomen and genitals

abdomen

Relationship: Summary Treats the contralateral side

Arms treat arms, legs treat legs

Treats Yin channels for Yang and Yang

channels for Yin

Treats the Zang-Fu paired channel

The Interior/Exterior

Relationship: Example 35 year old male

with epicondylitis

What channel?

What Balancingchannel?

What point?

#4- The Chinese Clock:

Opposite System The affected channel is treated by using the

channel directly opposite on the clockdiagram

HT/GB (Shaoyin/Shaoyang )

SI/LIV

BL/LU (Taiyang/Taiyin )

KID/LI PC/ST (Jueyin/Yangming )

Opposite System The affected channel is treated by using

the channel directly opposite on theclock diagram

Note the highlights above are the same asBie Jing System #2!

As with System #2, you may treatipsilaterally or contralaterally

3:00 am

5:00 am1:00 am

Intestine

LungLiver

Stomach

Bladder

Triple

Heater

Pericardium

Kidney

Bladder Small

Intestine

Spleen

Taiyin

Yangming

Shaoyang

Jueyin

Taiyang

Shaoyin

Yangming

Taiyin

Shaoyin

Taiyang

Jueyin

Shaoyang

11:00 pm

9:00 pm

11:00 am

9:00 am

7:00 am

7:00 pm

5:00 pm

3:00 pm

1:00 pm

Opposite System Effective for the treatment of any kind

of blockage related to the channel

External or Internal

For example, scapular pain on the SIchannel may be treated by needling

distal hindlimb LIV channel ahshi points

Opposite System: Summary Based on the Chinese circadian clock

Treats Yang channels for Yin channeldisharmonies and Yin channels for Yang channel disharmonies

Treat hand channels for foot problems andvice-versa

Depending upon palpation and ahshi findings,uses either ipsilateral or contralateral side fortreatments

N i hb S t

Neighbor System Use the Chinese circadian clock to find

neighbors of the same polarity LI/ST (Yangming/Yangming )

SP/HT SI/BL (Taiyang/Taiyang )

KID/PC

TH/GB (Shaoyang/Shaoyang ) LIV/LU

N i hb S t

Neighbor System The affected channel is treated by using

the neighbor channel of the samepolarity on the clock diagram

Note the highlights above are the same as#1- Anatomical Image System!

As with System #1, you should treat

contralaterally

3:00 am

5:00 am1:00 am

Intestine

LungLiver

Stomach

Bladder

Triple

Heater

Pericardium

Kidney

Bladder Small

Intestine

Spleen

Taiyin

Yangming

Shaoyang

Jueyin

Taiyang

Shaoyin

Yangming

Taiyin

Shaoyin

Taiyang

Jueyin

Shaoyang

11:00 pm

9:00 pm

11:00 am

9:00 am

7:00 am

7:00 pm

5:00 pm

3:00 pm

1:00 pm

N i hb S t

Neighbor System Very effective for the treatment of

localized channel-related pain and/orblockages

Used when the channels and pointspalpated give a positive ahshi response

For example, left LU 5 pain may

coincide with right LIV 8 ahshi which isthen used for treatment

N i hb S t S

Neighbor System: Summary Uses the same polarity neighbor to

diagnose and treat

Treats hand channels with foot

channels and vice-versa Treats contralateral blockages

N i hb S t E l

Neighbor System: Example 2 year old Mastiff

with hip and elbowdysplasias

Which channel(s)?

Which channels totreat?

Roughly whichpoints?

Neighbor System: Example

Neighbor System: Example 54 year old male

with bilateralshoulder bursitisfrom too much

hugging

Which channel(s)?

Which channels totreat?

Roughly which

points?

3 Steps to use All Systems

3 Steps to use All Systems Make a diagnosis by anatomic channel

systems What channel(s) cross the area of

disharmony?

Choose a Balancing channel Using one of the 5 systems

Choose the ahshi point from step 2 Using either “mirror” or “image”

Summary Treatment Table

Summary Treatment TableChannel

Pathology

System 1

Contralateral

System 2

Treat Ipsi-or

Contralateral

System 3

Contralateral

System 4

Treat Ipsi-or

Contralateral

System 5

Contralateral

LU SP BL LI BL LIV

LI ST LIV LU KID ST

ST LI PC SP PC LI

SP LU SI ST TH HTHT KI GB SI GB SP

SI BL SP HT LIV BL

Summary Treatment Table

Summary Treatment TableChannel

Pathology

System 1

Contralateral

System 2

Treat Ipsi-or

Contralateral

System 3

Contralateral

System 4

Treat Ipsi-or

Contralateral

System 5

Contralateral

BL SI LU KID LU SI

KID HT TH BL LI PC

PC LIV ST TH ST KID

TH GB KI PC SP GBGB TH HT LIV HT TH

LIV PC LI GB SI LU

Global Balance

Global Balance Global Balance is used when there is

multi-system or functional disease ornon-localized pain and includes:

Dynamic Balance Yin-Yang Energetic

Static Balance Yin-Yang

Ba Gua

Global Balance: Dynamic

TH 3 LU 9

SP 3 GB 41

Global Balance: Endocrineincluding depression due to hormone imbalances

SP 4GB 34GB 41

Global Balance

Yin Yang

Global Balance

Yin Yang

8 Magic Points

LU 7, PC 6 LI 4, TH 5

LIV 8, SP 9ST 36, GB 34

Global Balance: 12 Magic Points

LI 4SJ 3SI 3

PC 9HT 9LU 11

ST 36GB 34BL 40

LIV 4 or 5KID 7SP 6

Global Balance: Quick and

Dirty for Low Back Pain

LI 4.5LI 3.5SJ 3.5SI 4

Lu 5-6 ah shiHT 3-3.5

KID 2KID 4KID 7

GB 41BL 65

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