David, age 55, a mechanical-engineer by profession is an old and close friend of mine. Our friendship began some 10 years ago when he called upon me to treat his nine year old daughter. She had been hospitalised for a severe stomach ache of unknown aetiology, from which she had been suffering intermittently for a long time. I treated her with acupuncture and ever since then she has remained healthy. Another outcome of that treatment was the friendship of our two families and my appointment as their family doctor from that day on. On several occasions during the past ten years I also treated David himself. He suffered from rather acute pressure behind both his eyes, and was diagnosed as having glaucoma. Before becoming acquainted with Chinese medicine David had taken conventional medication for this problem. This medication had had some symptomatic benefit, but the problem only seemed to worsen in the long run. When I started to treat David for his glaucoma it was clear to me that a Liver imbalance was the main pattern of disharmony. David had a wiry strong quality on his Liver pulse and a somewhat soggy floating quality to his Lung pulse. He also had a thin red tongue, with a pointed redder tip. Both his inner eyelids were very red, and his sclera gave the impression of being bloodshot. Given the above clinical picture, one would probably be surprised not to find any personality characteristics reflecting Liver qi stagnation. David, however, is hardly ever angry, nervous or depressed. On the contrary, he is a sworn optimist and an energetic and cheerful man. He is a red haired, freckled faced man of middle build, very intelligent and learned. David is a great expert in wines, and is very fond of the gastronomic arts, especially French cuisine. Oh, yes, and he develops occasional cancerous skin growths, resembling small warts, mainly on his face and head. These are removed when necessary by surgery. These growths usually appear after exposure to direct sunlight, which David cannot tolerate anyway. Configuring and weighing all these findings, I made up my mind that the primary imbalance in my friend's case was a heated Liver. Liver yang was ascending to his eyes, reddening his sclera and the flesh inside his eyelids and
basis without paying. One way or another, when David came to my clinic again five years later (which is a few months ago), I had a sense that the current incident could have been avoided had I treated him more thoroughly last time. This time David presented himself with hoarseness of voice to the degree that he could barely be heard at all. This had already been going on for a few weeks, getting worse all the time. A visit to an ear, nose and throat specialist a few days earlier, had established a diagnosis of two small tumours on the vocal cords. This was confirmed later by another examination, which was followed by an appointment for surgery. At that time David called me, whispering the whole story hoarsely through the phone, asking for my advice. The next day, when David came to see me, he revealed the following story. Approximately one month ago he caught a severe cold with sore throat, cough and fever. This seemed to be a little stubborn and since he had to travel abroad to the USA, he took a course of antibiotics following the advice of his general practitioner. In the USA his condition worsened, and upon returning to Israel he had already lost his voice. Examining David I took note of the following facts: Besides being hoarse to the degree almost of muteness, David was constantly trying to clear his throat, coughing up sputum and making strange noises while doing so. He felt as if something was stuck inside his throat, which he was unable to swallow or spit out. He felt constantly as if he had the 'flu, i.e. weak, tired and perspiring very easily. He also had a dull ache inside his left ear. His pulse felt much the same as I remembered from the past, only the quality of the Lung pulse was harder on the most superficial level, and soggier on the deeper level. The Liver pulse remained wiry. His tongue also had not changed significantly, except that it now had a yellowish, filmy, damp coating. The points Zhongfu LU-1 and Qimen LIV-14 on the right side were both quite tender. Being familiar with David's energetic imbalances from the past, I took into account the possibility of 'plumstone qi' pathology as the core problem here1. Plumstone qi is a pattern in which people have a sensation of something stuck in their throat. This pathology is, in most cases, attributed to Liver qi stagnation affecting the throat, through which the internal pathway of the Liver channel ascends to the eyes and head. Stagnation (mostly of heat or yang qi) in this region, combined with accumulation of phlegm, may give rise to plumstone qi. In David's case, the combination of excess Liver yang-qi ascending through the throat, plus an external attack of wind and damp, caused the formation of these two small tumours in the vocal cord canal. His preexisting Lung qi deficiency was a contributing factor to this pathology, since the internal pathway of the Lung channel ascends to the throat (before descending to the Lung organ), and the vocal cords resonate according to the relative strength and amplitude of Lung qi2. Taking antibiotics in this case, for what was probably only a viral infection, had its own role in lowering the body resistance mechanism - the wei qi. Wei qi is an important component of Lung qi, and depressing it in this way caused another insult to the Lung qi, thus contributing to building up the stagnation in the vocal canal. Summary of clinical manifestations ¥ Severe hoarseness, almost with inability to speak at all. ¥ Weakness and tiredness, as if having the 'flu. ¥ A plumstone sensation in the throat. ¥ Constantly trying to clear his throat. ¥ A damp and phlegmy cough. ¥ A dull ache inside the left ear. ¥ A strong wiry Liver pulse, and a soggy, superficially harder, floating Lung pulse. ¥ A thin red tongue, a little redder on its tip, with a filmy, wet, yellowish coating. ¥ Tender right side Liver and Lung front-mu points. ¥ A history of glaucoma caused by a Liver qi pathology, which had been resolved by acupuncture some five years ago. ¥ Occasional small cancerous skin warts on the upper parts of the body, mainly aggravated by direct exposure to the sun.
A summary of his pathology in diagrammatic form is shown in Illustration 2. The treatment plan In my experience, even diseases that have already formed organic changes, such as tumours, cysts, warts and the like, and that are of a relatively short duration, may respond favourably to acupuncture. I told David so and suggested that we commence right away with the treatment. My plan was to work from the outside in. I wanted to get rid of the symptoms of the exterior pathogen as quickly as possible,
and only then concentrate my efforts on re-establishing a proper circulation in the throat. The points prescription for the first phase was therefore as follows: ¥ Hegu L.I.-4, Quchi L.I.-11 and Dazhui DU-14 to clear external pathogenic wind and damp from the face and head regions, to facilitate qi flow and to promote sweating. ¥ • Fengfu DU-16, Fengmen BL-12 and Feiyang BL-58. This combination was used in conjunction with the previous one, in order to strengthen the action of dispelling wind systemically. The addition of Feiyang BL-58 has the effect of lowering excessive upward movement of yang qi.
The patient lay prone during this treatment procedure, and all the needles were manipulated by dispersing method. I used a strong thrust directly to the appropriate depth, followed by relatively quick, gentle withdrawals of a few millimetres at a time to the superficial level, and then repeated the manoeuvre several times. After some ten minutes the needles on the back were substituted with cupping for fifteen more minutes to conclude the treatment. This precise treatment was carried out twice, in two consecutive daily sessions, after which all the 'flu symptoms were virtually gone. David felt much stronger on the third day and his optimism was restored. The next phase of the treatment was aimed directly at the hoarseness and the tumours. For this I formulated the following combinations: ¥ Yuji LU-10, Futu L.I.-18 and Taixi KID-3. Yuji LU-10 is indicated especially for hoarseness, loss of voice and obstructions in the throat. It is the fire point of the Lung channel and has the ability to cool heat obstruction along the pathway of this channel. Futu L.I.-18 was combined with Yuji LU-10 as a local point belonging to the Lung's interiorly-exteriorly coupled Large Intestine channel. This
point is capable of transforming phlegm in the throat, and of facilitating the flow of Lung qi. Among its indications are hoarseness and "sounds in the throat like a duck"3. (These duck-like sounds were quite descriptive of the queer sounds David had been making while trying to clear his voice). Taixi KID-3 was chosen for its role as a major tonifying point, being able to assist both in subduing Liver yang, as well as in grasping Lung qi and facilitating its flow. Besides that it has a specific indication for clearing throat blockages. The first two points were reduced whilst Taixi KID-3 was mildly reinforced. The reinforcing here was achieved by needling the point and gently manoeuvring the needle until a slight radiating sensation started to propagate upward to the medial calf. Futu L.I.-18 was needled as follows: after needle sensation was obtained, reducing manipulaton was applied, and then the needle was redirected in a different direction and reduced again. After being reduced in several directions in this way, it was then redirected medially towards the laryngeal prominence on both sides. • Ligou LIV-5 and Tiantu REN-22. Ligou LIV-5 is the luoconnecting point of the Liver channel, and among other tasks it deals specifically with the phenomenon of plumstone qi4, spreading Liver qi and facilitating its flow through the channel. Tiantu REN-22 is indicated for diseases of the vocal cords. It transforms phlegm and facilitates the flow of Lung qi in the throat. These two points together enhance qi flow in both of the channels involved, while exerting a strong effect on the diseased area. Ligou LIV-5 was manipulated by reducing method, producing a qi sensation which radiated upwards along the tibia. Tiantu REN-22 was punctured obliquely until the qi sensation spread through the entire throat, and ascended to reach both ears. These two combinations were used together in each treatment, in the order of the listing of the points. They were used over a span of four weeks, three sessions per week. During the course of the first week I also had to address the problem affecting David's left ear. This was done by puncturing Tinghui GB-2 locally, and Xiaxi GB-43 distally, both on the left side only. The needles at these two points were manipulated and withdrawn immediately. Two treatments were sufficient to resolve the ear problem. Starting from the fifth treatment David's voice disorder started to clear up. There were ups and downs during the treatment process, but with a clear tendency towards improvement. David was instructed not to eat damp-producing foods such as dairy products, fruit, excessively sweet or salty food and so on. He was also asked not to strain his voice, and to speak as little as possible. After the four weeks of treatment, David's voice was 90% restored to normal. There were times when his voice seemed completely clear, but at other times, especially when he was tired or upset, he got hoarse again. His pulse at this stage was less wiry at the Liver position, and less soggy at the Lung position. At this stage I decided to try to harmonise the pulse more completely for the sake of David's health in the future.
Occasionally, when I confront stubborn pulse patterns such as this one in my practice, I resort to a five-phase needling technique which I find immensely helpful to correct pulse abnormalities5. With this technique, one must define which are the excessive and deficient phases, and their relation to each other according to the generating and controlling cycles, or to the superficial flow of qi through the twelve channels. In David's case, as mentioned previously, the wood phase was in excess, while the Lung metal phase was deficient. This pattern could be perceived in two ways. Firstly according to the controlling cycle, the metal phase was insulted by the excessive wood, and was thus unable to exert its controlling effect. Secondly, according to the flow of energy through the twelve channels, the qi of the Liver channel which was in excess was unable to pass freely into the Lung channel, which succeeds it in the cycle. In order to correct this imbalance I reduced Zhongfeng LIV-4 (the metal point of the Liver channel), and then Guangming GB-37 (the luo-connecting point of its coupled channel). This was done in order to open the hinge for the excessive wood energy to flow into the metal phase. Right after that I punctured both Shaoshang LU-11 (the wood point of the Lung metal channel), and Taiyuan LU-9 (the yuan-source point of the Lung channel). To complete the procedure, Qimen LIV-14 (the exit point of the Liver channel) was reduced only on the right side, while Zhongfu LU-1 (the entry point of the Lung channel) was supplemented, also only on the right side. The reader may recall that these two points, the front-mu points of both channels respectively, were found to be tender when David came for the first treatment. This was the reason why I chose to treat them only on the right side. This new prescription had a dramatic effect both on David's pulse quality, as well as on his disease. After three treatments over a period of nine days, David's pulse was in excellent equilibrium, and the remnants of his hoarseness were gone completely. A month or so later David found time to go again to the ear, nose and throat specialist, complying with my request. Neither of the small tumours could be found at this time.
1. Journal of Chinese Medicine No.14, p.17 The Differentiation of Syndromes According to the Zang Fu - The Liver.
2. Journal of Chinese Medicine No.31, p.17 A Discussion on the Relationship Between the Lungs and the Liver.
3. All the points' actions were drawn from these sources: i. Acupuncture
-A Comprehensive Text, by the Shanghai College of Traditional Medicine, Eastland Press 1985; ii. Acupuncture Points Images and Functions by Arnie Lade, Eastland Press 1992.
4. Journal of Chinese MedicineNo.19, p. 18 The Actions of the Acupuncture Points.
5. Wu Wei P'ing, Taipei, personal communications.
Shmuel Halevi is an acupuncturist working in Israel.