The Luo-connecting Points

Peter Deadman & Mazin Al-Khafaji

The purpose of this article is to examine those clinical applications of the luo-connecting points of the fourteen channels that relate directly to their luoconnecting status. Of course each of the points discussed has other important actions and indications which do not come under the scope of this article. All the indications mentioned in the discussion of the points are translated from Chinese sources; most are classical indications, whilst a few are modern. Each of the twelve primary channels has a luo-connecting channel which diverges from the primary channel at the luo-connecting point (Lieque LU-7, Pianli L.I.-6, Fenglong ST-40, Gongsun SP-4, Tongli HE-5, Zhizheng SI-7, Feiyang BL-58, Dazhong KID-4, Neiguan P-6, Waiguan SJ-5, Guangming GB-37 and Ligou LIV-5). In addition there are three further luo-connecting points: Jiuwei REN-15 (for the Ren Mai), Chengqiang DU-1 (for the Du Mai) and Dabao SP-21 (the great luo-connecting point of the Spleen). John Pirog in Meridian Style Acupuncture1 has argued persuasively that the luo-connecting channels were probably the oldest and first recognised channels and that their origin lies in the visible network of superficial veins. Thus the Spiritual Pivot2 says "The major meridians cannot be seen. Whether they are replete or not one must use the wrist pulse to know. The vessels which can be seen are all luo", and "Therefore, when needling the luo vessels, one must needle the places where they collect together on the surface, where there may be an accumulation of blood3". Subsequently, the luo-connecting points - in fixed rather than variable locations - became the sites of needling to affect the luo network, and the luo-connecting channels became integrated into the general system of channels. The term 'net' is important, being the literal translation of 'luo'. Perceiving the luo channels as forming a net of broad and fine strands, allows us to understand how they can both spread to connect with their interior-exteriorly related channel, and at the same time spread to a particular region of the body. For example, the luo-connecting channel from Ligou LIV-5 both spreads laterally to connect with the Gall Bladder channel and vertically to reach the genitals. This seemingly minor question of theory is stressed for two main reasons: i. there is no historical Chinese record of the idea that there are two distinct luo-connecting channels - one transverse and one vertical - nor is there any suggestion that the transverse channel links the luo-connecting point of one channel with the yuan-source point of its interiorly-exteriorly related channel; both these seem to be modern ideas proposed by the Vietnamese acupuncturist Nguyen Van Nghi; ii. some concept of the channel system as forming a network of broader, finer and even finer channels is essential to the proposition that there is no part of the body that is not nourished by qi and blood. The actions of the luo-connecting points may be summarised as: i. treating disorders of their interiorly-exteriorly related channel or zangfu. ii. treating disorders in regions reached by the luo-connecting channel. iii. treating psycho-emotional disorders (mostly yin channels). 1. Treating disorders of their interiorly-exteriorly related channel or zangfu The Guide to the Classic of Acupuncture states "the luoconnecting points are located between two channels ... if they are punctured, symptoms of the exteriorly-interiorly related channels can be treated4". In clinical practice, many of these points are used to treat disorders of their interiorly-exteriorly related zangfu or channel. For example Guangming GB-37 treats the eyes which are dominated by the Liver, Fenglong ST-40 treats phlegm deriving from Spleen disharmony etc. 2. Treating disorders in regions reached by the luoconnecting channel As well as spreading to their interiorly-exteriorly coupled channel, the luo-connecting channels mostly have additional pathways. For example the Lung luo-connecting channel spreads through the thenar eminence, and Lieque LU-7 is an important point in the treatment of thumb disorders, the Large Intestine luo-connecting channel ascends to the ears, and Pianli L.I.-6 is especially applicable for the treatment of ear disorders. 3. Treating psycho-emotional disorders Whilst it is true that classical texts include a variety of psycho-emotional indications for many of the acupuncture points, several of the luo-connecting points are particularly important in this respect, for example Fenglong ST-40, Tongli HE-5, Zhizheng SI-7, Dazhong KID-4, Neiguan P-6 and Ligou LIV-5. Lieque LU-7 (Broken Sequence) The name of Lieque LU-7 'Broken Sequence' describes the sudden change of direction of the Lung channel at this point. Indeed such a forking of the channel is also found at other luo-connecting points, for example Fenglong ST-40, Feiyang BL-58 and Dazhong KID-4. In the case of Lieque LU-7 this fork takes it almost as far as the pathway of the Large Intestine channel, emphasising the close affinity of this point to the Lung's paired yang channel. This affinity is further illustrated by the fact that a branch of the Lung primary channel flows from Lieque LU-7 to Shangyang L.I.-1 Lieque LU-7 is well-known as the principal point on the Lung channel to expel exterior pathogens from the body. It is indicated for the classic signs of an exterior pattern such as chills and fever, headache, aches and pains in the neck, shoulders and back etc. as well as acute oedema of the limbs due to impairment by exterior wind of the Lung's function of regulating the water passages and descending fluids to the Bladder. The vulnerability of the Lung to exterior pathogens is explained in two ways. Firstly the Lung is closely related to the skin, which since the time of the Treatise on Injury by Cold5 has been perceived as one of the main routes of penetration of exterior pathogens into the body. Secondly, the Lung is intimately related to the nose and mouth -the pathways of respiration - and since the Wen Bing (warm diseases) theory of the early 17th century, these also have been understood as a route of penetration of exterior pathogens. This concept of Lung vulnerability is found as early as the Yellow Emperor's Inner Canon. According to both the Spiritual Pivot6 and the Essential Questions7 "Taiyin is the opening, jueyin is the closing and shaoyin is the pivot". The Lung (taiyin) therefore, which communicates so directly with the exterior via respiration, and indirectly through the skin of the whole body, is the 'opening' to the exterior and thus the most vulnerable of the zang to attack by exterior pathogens. The Lung zang is yin and hence by implication interior, whilst its coupled Large Intestine fu is yang, and hence by implication more exterior. When the disease is still at the exterior, it has by definition not yet injured the Lung zang but is at the most superficial, or yang, portion of the Lung system (at the level of the skin and pores), and it is the point of the Lung channel which most closely communicates with the Lung's paired yang Large Intestine channel that is able to expel the pathogen. Once the pathogen has entered more deeply into the Lung, giving rise to cough with phlegm, chest pain etc. it is to other Lung channel points that we look, for example Zhongfu LU-1, Kongzui LU-6 and Chize LU-5. Lieque LU-7 is an important point to treat diseases of the head. It was included by Ma Danyang, the great Jin dynasty physician, among the 'twelve heavenly star points' for one-sided headache and obstruction of phlegm in the upper body. The Ming dynasty author Gao Wu includes Lieque LU-7 among the 'four command points' for 'disorders of the head and nape', and in the Ode Of The Obstructed River, the use of Lieque LU-7 is referred to as one of 'the eight therapeutic methods'. In this description of the application of the eight confluent points of the extraordinary channels to affect specific symptoms and areas of the body, Lieque LU-7 is indicated for "disorders of the head region, rebellion and blockage of phlegm and dry throat". Among other classical indications for Lieque LU-7 we find headache and stiffness of the neck and nape, one-sided headache, lockjaw, deviation of the mouth and eye and toothache. This emphasis on the head region is all the more surprising since the Lung channel ascends no higher than the throat, and it is to the close connection of this point with the Large Intestine channel (which traverses the face and head), as well as to the strong descending nature of the healthy Lung, that we must look to explain this anomaly. The Lung luo-connecting channel follows the Lung channel into the palm and then spreads through the thenar eminence. Lieque LU-7 is consequently the principal proximal point in the treatment of disorders of the thumb joints. For this purpose it is needled distally towards the thumb. Ideally deqi should transmit to the thumb joint although in practice it commonly travels to the index finger. In this case, partially withdrawing the needle and re-directing it more radially towards the thumb will often produce the desired result. For all its other clinical applications, Lieque LU-7 is normally needled proximally towards the chest and head. Lieque LU-7 shares with the other luo-connecting points of the yin channels the ability to treat psycho-emotional disorders, and is indicated for propensity to laughter, frequent yawning and stretching and especially for poor memory. Finally the Great Compendium of Acupuncture and Moxibustion gives specific indications for excess and deficiency of the luo-connecting points. In the case of Lieque LU-7, these are heat of the chest and back, sweating, and sudden oedema of the four limbs (excess), and shivering and cold of the chest and back, diminished qi and shortness of breath (deficiency). Pianli L.I.-6 (Veering Passage) As discussed above, the yang Large Intestine channel as a whole may be seen as the outer reflection of its coupled yin Lung channel, and its points (Hegu L.I.-4 most notably) are frequently used to release the exterior portion of the Lung system. The particular application of Pianli L.I.-6 in this respect is in the treatment of oedema, especially when acute. Oedema has various and complex causes. It may be due to internal or external disharmony and may be acute or chronic in nature. However, it predominantly involves disharmony of the Lung, Spleen and Kidneys, the three zang responsible for the movement of fluids. Acute oedema occurs when exterior pathogens lodge in the superficial portion of the body, initially impairing the wei qi and the Lung function of regulating the water passages. Such oedema mostly affects the upper body and face and is accompanied by absence of sweating and difficult urination. Pianli L.I.-6 is the main point on the Large Intestine channel to open and regulate the water passages and thus treat such symptoms as difficult urination, oedema, ascites and borborygmus with oedema. From Pianli L.I.-6 the luo-connecting channel diverges (hence the name 'Veering Passage') and travels to the jaw, one portion entering the teeth and another entering the ear to join the 'zong mai' (where the channels of the Large Intestine, Stomach, Small Intestine, Gall Bladder and Sanjiao gather and collect at the ear). Pianli L.I.-6 is therefore indicated for toothache and swelling of the cheek, which is unsurprising since most distal points of the Large Intestine channel do the same, but also - and more interestingly - for tinnitus and deafness. Interesting because it is principally distal points from the Sanjiao and Gall Bladder channels (for example Zhongzhu SJ-3, Waiguan SJ-5, Zulinqi GB-41, Xiaxi GB-43 etc.) which are selected for ear disorders, especially when shi and due to heat and/or wind. Two prescriptions appear in the Classic of Supplementing Life, one for tinnitus where Pianli L.I.-6 is combined with Yangxi L.I.-5, Shangyang L.I.-1, Luoque BL-8, Wangu SI-4 and Qiangu SI-2, and the other for deafness where it is combined with Qiangu SI-2 and Houxi SI-3. Since both tinnitus and deafness are hard to treat, it is valuable to have alternative treatment strategies to consider. Finally the Great Compendium of Acupuncture and Moxibustion indications for excess and deficiency of Pianli L.I.-6 are tooth decay and deafness (excess) and cold teeth and obstruction of the diaphragm (deficiency). Fenglong ST-40 (Abundant Bulge) Fenglong ST-40 is well-known as the single most important acupuncture point to transform phlegm in the body, whatever its origin. There are various causes for the formation of phlegm, including stagnation of Liver qi which results in stagnant fluids, shi or xu heat which condense body fluids, and disharmony of any or all of the three zang responsible for fluid transformation and transportation (the Lung in the upper jiao, the Spleen in the middle jiao and the Kidneys in the lower jiao). Of all these, Spleen disharmony is clinically the most important, and the Essential Questions8 says "The Spleen is the origin of phlegm" and "When water, grain and body fluids do not flow, they will accumulate and form tanyin [phlegm-fluid]". Furthermore, it is a general treatment principle that the Spleen function should be regulated in the treatment of phlegm of whatever aetiology, to assist in its transformation. Fenglong ST-40 is the point from which the Stomach luo-connecting channel connects with its associated Spleen channel, and has been used traditionally to treat any accumulation of phlegm, especially af fecting the Lung, the Heart and the throat, as well as obstruction by phlegm of the ascent of clear yang to the head. We may speculate why it should be a point of the Stomach channel rather than the Spleen channel which treats phlegm patterns. Firstly, there is a long tradition of Stomach channel points being used to treat phlegm or phlegm-fire obstructing and agitating the Heart and shen (for example Jiexi ST-41 and Chongyang ST-42), and this may in part be explained by the pathway of the Stomach divergent channel to the Heart zang, and the connection made by the Stomach primary channel with the Du Mai (and hence the brain) at Shenting DU-24 and Renzhong DU 26. Secondly, since phlegm is the most stagnant and stubborn of body fluid patterns, it may be that the potentially more dynamic quality of the yang channel has been considered more effective to move and transform it. As far as phlegm obstructing the Lung and Heart is concerned, Fenglong ST-40 treats any kind of phlegm accumulation in the Lung (cough, wheezing, asthma, fullness and pain of the chest) and Heart (mania-depression disorder, mad laughter, likes to ascend to high places and sing, seeing ghosts, indolence etc.). The Stomach luo-connecting channel from Fenglong ST-40 joins with all the yang channels in the head region and then travels internally to terminate at the throat. If phlegm-damp obstructs the head, it may impair the ascent of clear yang to the head and sensory orifices, giving rise to dizziness and headache characterised by a heavy and clouded sensation. In the throat region, if stagnant qi impairs the ability of the Lung and Stomach to descend the fluids, phlegm is formed and combines with the stagnant qi to obstruct the throat, giving rise to plumstone qi (globus hystericus). Finally the Great Compendium of Acupuncture and Moxibustion indications for excess and deficiency of Fenglong ST-40 are mania-depression disorder (excess), and lack of control of the legs and withering of the lower legs (deficiency). Gongsun SP-4 (Grandfather Grandson) One explanation of the name 'Grandfather Grandson' refers to the status of Gongsun SP-4 as the luo-connecting point of the Spleen channel (the grandfather) which links with the Stomach channel (the grandson). Certainly one of the main actions of this point is to harmonise the relationship between this interiorly-exteriorly coupled zang and fu. The Stomach and Spleen, which together comprise the middle jiao, are intimately related and their functions and nature complement each other. The 'rotting and ripening' of food and drink in the Stomach, the first stage of the digestive process, is governed by the Spleen; the Stomach descends whilst the Spleen ascends; the Stomach dominates the upper abdomen and the Spleen the lower abdomen; the Spleen abhors dampness whilst the Stomach abhors dryness. The Spleen luo-connecting channel from Gongsun SP-4 not only connects with the Stomach channel, but with the Stomach and intestines themselves. It is ideally suited, therefore, to harmonise the relationship between the Spleen and Stomach, and is indicated for vomiting, cold in the Stomach, no desire to eat and oesophageal constriction on the one hand, and borborygmus, diarrhoea, dysenteric disorder, tenesmus etc. on the other. It is also indicated for sudden turmoil disorder - the sudden and acute onset of simultaneous diarrhoea, vomiting and abdominal discomfort or pain. This disease is associated with eating unclean food, or with attack of cold, summer heat, dampness or epidemic qi. The second principal action of Gongsun SP-4 is the treatment of abdominal pain. The area of pain it best resolves is disputed in various classical sources, some saying above the umbilicus, some below, and some emphasising the umbilical region itself. Considering the close relationship of this point to the Stomach, Spleen and intestines and the pathways of the Spleen channel and the Chong Mai (of which this is the confluent point) both of which ascend the entire abdominal region, we can conclude that it is important in the treatment of pain anywhere in the abdomen. In common with several other luo-connecting points, Gongsun SP-4 has a pronounced effect on emotional disorders. The Spleen channel connects with the Heart, and when phlegm and dampness accumulate and transform into phlegm-heat, it may be carried upwards to obstruct the Heart and agitate the shen giving rise to mania-depression disorder, manic raving, insomnia, restlessness and epilepsy. Alternatively, if Spleen qi is deficient, the source of blood will be weak and the Heart and shen will lack nourishment resulting in insomnia and restlessness. Unusually for a Spleen channel point, Gongsun SP-4 is also indicated for Gall Bladder deficiency and much sighing, referring to the pattern of Gall Bladder and Heart qi deficiency. Finally the Great Compendium of Acupuncture and Moxibustionindications for excess and deficiency of Gongsun SP-4 are cutting pain of the intestines (excess), and drum distention (deficiency). Tongli HE-5 (Penetrating the Interior) From Tongli HE-5, the luo-connecting channel penetrates deeply into the Heart zang, strengthening the relationship between the channel and its related zang, and this is reflected in the name 'Penetrating the Interior'. This close relationship with the Heart zang renders Tongli HE-5 able to treat both emotional and physical Heart disorders. Tongli HE-5 shares with most of the other luo-connecting points of the yin channels the ability to treat psycho-emotional disorders, but as the luo-connecting point of the Heart zang it is especially suitable for this purpose and is wide-ranging in its effect. According to the Ode to the Jade Dragon "Tongli HE-5 treats a frightenable Heart". The action of Tongli HE-5 on calming the shen, however, is somewhat different from that of Shenmen HE-7, the other major shen regulating point of the Heart channel. Tongli HE-5 almost entirely focuses on the emotional aspect of the shen, compared with the wider action of Shenmen HE-7 which includes disturbances of sleep and memory. According to Fei Bo Xiong9 "The seven emotions injure the five yin organs selectively but they all affect the Heart". Tongli HE-5 is classically indicated for many different emotional manifestations, not only fright and agitation which are traditionally associated with disharmony of the shen, but fear, vexation, anger, sadness and depression which are usually considered to injure, or result from injury to, other zangfu. The great doctor Hua Tuo said of the relationship between the Heart and fear "excessive thought gives rise to apprehension, and apprehension injures the Heart; an injured Heart gives rise to loss of spirit, and loss of spirit gives rise to fright and fear10". As for regulating the Heart zang, Tongli HE-5 plays an important role in the treatment of palpitations, fright palpitations, pounding of the Heart and disorders of Heart rhythm. As far as the different kinds of palpitations are concerned, simple palpitations is a general term, fright palpitations denotes palpitations that are either triggered by or accompanied by feelings of fright, and pounding of the Heart - the most serious kind - denotes palpitations which may be felt as high up as the heart itself, or as low as the umbilicus (the termination point of the Heart sinew channel). The rhythmical beating of the Heart is a manifestation of the Heart qi, and although palpitations may accompany any pattern of the Heart zang, as disorders of Heart rhythm and function they always involve the Heart qi. After penetrating the Heart, the luo-connecting channel ascends to the root of the tongue, which according to a saying of Chinese medicine is "the sprouting forth of the Heart". For this reason, Tongli HE-5 is the primary point to treat loss of voice and stiffness of the tongue which affects the speech, usually resulting from mental disorders or the sequelae of windstroke. It is also indicated for the treatment of stuttering. After entering the root of the tongue, the Heart luo-connecting channel then ascends to the eye, which explains the ability of Tongli HE-5 to treat eye pain. From Tongli HE-5, the luo-connecting channel spreads to the Heart's interiorly-exteriorly coupled Small Intestine channel. Tongli HE-5 is indicated for (and included in a number of classical combinations for) head wind, headache and dizziness, all of which may be accompanied by eye pain. This symptomatology reflects disharmony of both coupled channels. The Small Intestine taiyang channel is paired with the Bladder taiyang channel according to six channel theory. This linkage has traditionally been used to explain the relationship between Heart disharmony and urinary disorders, and in the case of Tongli HE-5 its ability to treat enuresis due to accumulation of heat in the Bladder. Finally the Great Compendium of Acupuncture and Moxibustion indications for excess and deficiency of Tongli HE-5 are fullness and distention of the chest and diaphragm radiating to the lateral costal region (excess) and inability to speak (deficiency). Zhizheng SI-7 (Branch of the Upright) From Zhizheng SI-7, the Small Intestine luo-connecting channel connects with the Heart channel. This is reflected in its name 'Branch of the Upright', the 'upright' being the Heart channel, almost implying that Zhizheng SI-7 belongs to the Heart channel. As a result of its influence on the Heart, Zhizheng SI-7 has a pronounced effect on regulating and calming the shen and is indicated for mania-depression disorder, fear and fright, and sadness and anxiety. The Methods of Acupuncture and Moxibustion from the Golden Mirror of Medicine, more specifically recommends Zhizheng SI-7 for depression and knotting of all the seven emotions. The Great Compendium of Acupuncture and Moxibustion indications for excess and deficiency of Zhizheng SI-7 are slackness of the joints and inability to move the elbow (excess) and warts (deficiency). Feiyang BL-58 (Soaring Upwards) An examination of the modern application of Feiyang BL-58, compared with its traditional indications, reveals a significant disparity. Clinically it is most commonly used nowadays for disorders of the lower limb and lumbar pain and particularly for sciatic pain which is located either along the course of both the Bladder and Gall Bladder channels, or between these two channels. Its traditional indications, however, show a much wider application, characterised by excess in the upper region, sometimes with accompanying deficiency below - a pattern which may explain the name of this point, 'Soaring Upwards' as well as its alternative name 'Flying Yang'. From Feiyang BL-58 the luo-connecting channel meets with the Kidney channel, strengthening the relationship between these coupled channels. When the Kidneys are deficient there may be deficiency below manifesting as lumbar pain, coldness of the lower part of the body, inability to stand and weakness of the legs. At the same time there may be excessive yang rising up the coupled Bladder channel to the head and manifesting as dizziness, headache, pain of the neck and occiput, heat in the head and nosebleed. The Great Compendium of Acupuncture and Moxibustion indications for excess and deficiency of Feiyang BL-58 are rhinitis with obstruction and pain of the head and back (excess) and rhinitis with nosebleed (deficiency). Dazhong KID-4 (Great Bell) In common with many of the luo-connecting points Dazhong KID-4 has a strong action on the emotions. It is indicated for propensity to anger, fright, fear and unhappiness, desire to close the door and remain at home, palpitations, agitation, dementia, mental retardation and somnolence. According to the Spiritual Pivot "Deficiency of qi in the Kidney Channel of foot shaoyin may give rise to susceptibility to fear." When the Kidney qi is not animated, the zhi is deficient and a person easily suffers from fear and lack of confidence, which may be so severe that they withdraw and are unwilling or unable to leave the safety of their home. When congenital jing is deficient, or jing is consumed in old age, there may be a susceptibility to fearfulness, poor mental function or development, and a decline of mental faculties. Susceptibility to fear may be due to i. deficiency of the Kidneys, especially Kidney jing, ii. feebleness and deficiency of qi and blood which fail to nourish and support the shen, iii. deficiency of the Liver and Gall Bladder. Dazhong KID-4 is not only an essential point in the treatment of fear due to Kidney deficiency, but because of the close relationship of the Kidneys to fear, it plays an important role in the treatment of any of these patterns. The Kidney luo-connecting channel rises from Dazhong KID-4 to the lumbar spine, accentuating the close relationship of the Kidneys to this region, and this point is therefore indicated for stiffness and pain of the lumbar region. Finally the Great Compendium of Acupuncture and Moxibustion indications for excess and deficiency of Dazhong KID-4 are retention of urine (excess), and lumbar pain (deficiency). Neiguan P-6 (Inner Pass) The Pericardium is the 'wrapping' of the Heart which stores the shen, and the Pericardium luo-connecting channel links Neiguan P-6 directly with the Heart. The action of Neiguan P-6 on regulating the Heart zang and calming the shen emphasises its dual effect on both the physical and emotional aspects of the Heart. It is an important point in the treatment of Heart pain, palpitations and pounding of the Heart, and disorders of Heart rate and rhythm, and one of the main acupuncture points for regulating and calming the shen and treating a wide range of emotional disorders whatever the underlying pattern. It is therefore indicated for insomnia, epilepsy, mania, poor memory, fright, sadness, fear and apprehension. The Great Compendium of Acupuncture and Moxibustion indications for excess and deficiency of Neiguan P-6 are sudden Heart pain (excess), and stiffness (and pain) of the head (and neck) (deficiency). Waiguan SJ-5 (Outer Pass) From Waiguan SJ-5, the Sanjiao luo-connecting channel rises to converge with the Pericardium channel in the chest. Although this strengthens the Sanjiao-Pericardium relationship, with the exception of oppression and tightness of the chest there are no specific indications of this linkage found in the major classics. In clinical practice, however, the points Neiguan P-6 and Waiguan SJ-5 are often joined by through-needling for pain of the chest which radiates to the back. Waiguan SJ-5 is indicated for numbness, heaviness and pain of the elbow, and this action on the elbow region is emphasised in the Great Compendium of Acupuncture and Moxibustion which gives specific indications for excess and deficiency of the luo-connecting points. In the case of Waiguan SJ-5, these are contraction of the elbow (excess), and flaccidity of the elbow (deficiency). Guangming GB-37 (Bright Light) The Liver opens into the eyes, and the Liver channel (as well as the Gall Bladder and Gall Bladder divergent channels) connects with the eye. Because of the close relationship of many eye diseases to the Liver, Guangming GB-37, the luoconnecting point of the Gall Bladder channel (as its name 'Bright Light' suggests) is therefore the principal distal point on the Gall Bladder channel for the treatment of a wide range of eye disorders, including pain, redness, itching, long and short sightedness and night blindness. The Great Compendium of Acupuncture and Moxibustion indications for excess and deficiency of Guangming GB-37 are heat sensation of the lower leg, knee pain, numbness of the body and propensity to grind the teeth (excess), and wei of the legs with difficulty in standing after sitting (deficiency). Ligou LIV-5 (Woodworm Canal) According to the Spiritual Pivot11 "The Liver governs the tendons", whilst the Essential Questions12 says "The genitals are the gathering place of the tendons". The Liver primary and sinew channels encircle the genitals, and from Ligou LIV-5 the luo-connecting channel ascends to the genitals. Ligou LIV-5 is therefore a major point for treating diseases of this area and is indicated for itching, swelling and pain of the genitals and sudden pain and swelling of the testicles due to both Liver qi stagnation and damp-heat in the Liver channel. Ligou LIV-5 is also indicated for incessant erection (priapism). The Liver belongs to wood and spring, which manifest the energy of growth, spreading and ascending, and is entrusted with ministerial (ming men) fire which has its source in the Kidneys. Normal erection is dependent both on the flourishing of the Kidneys and harmony of the Liver. Incessant erection may arise either in the springtime of adolescence, when the Kidney jing becomes abundant and the Liver is exuberant, in which case it may be embarrassing but is not considered abnormal, or when pathological flaring of Liver fire agitates and inflames the penis. Ligou LIV-5 is one of the few points especially indicated for this condition. In common with many of the luo-connecting points, especially of the yin channels, Ligou LIV-5 treats a variety of psycho-emotional disorders including depression, fright palpitations and fear and fright, these latter indications reflecting the statement in the Spiritual Pivot13 "when Liver qi is xu there is fear". The Liver channel ascends to the throat and according to a number of classics, including the Great Compendium of Acupuncture and Moxibustion, Ligou LIV-5 is indicated for " . . . worried oppression, stuffiness in the throat as if [obstructed by] a polyp". This refers to what is more commonly known in Chinese medicine as plumstone qi (globus hystericus), a sensation of physical obstruction in the throat that fluctuates according to a person's mood. Plumstone qi is most commonly due to stagnation of Liver qi and accumulation of phlegm. It is worth noting that Ligou LIV-5 is in fact the only point of the Liver channel with any significant psycho-emotional disorders among its classical indications. Taichong LIV-3, for example, which is much used in modern clinical practice to treat depression, irritability, anger etc. only has insomnia and tendency to fearfulness. Finally the Great Compendium of Acupuncture and Moxibustion indications for excess and deficiency of Ligou LIV-5 are persistent erection (excess), and sudden itching of the genitals (deficiency). Dabao SP-21 (Great Wrapping) The name of the point Dabao SP-21 is made up of two characters, 'Da' meaning great, and 'Bao' meaning 'to wrap', or 'to envelop'. According to the Spiritual Pivot"14 "The great luo of the Spleen is known as Dabao; it emerges at three cun below the axilla spreading in the chest and lateral costal region. When it is shi there is pain of the whole body. When it is xu the hundred joints are flaccid. This channel embraces the blood of all the luo (channels)". A possible explanation of this statement from the Spiritual Pivot is that one of the functions of the luo-connecting channels in general is to assist in the distribution of qi, and more especially blood, to all the tissues of the body via the network of the minute luo-connecting channels. Since the Spleen controls blood, its great luo-connecting channel dominates this function of blood distribution throughout the body. When blood stagnates "there is pain of the whole body"; when blood is xu and unable to nourish the tissues, "the hundred joints are flaccid". Jiuwei REN-15 (Turtledove Tail) Jiuwei REN-15 is conventionally listed as the luo-connecting point of the Ren Mai, from where the qi of this channel disperses and spreads down over the abdomen. In fact, historically there has been some discussion as to whether Huiyin REN-1, rather than Jiuwei REN-15, is the luoconnecting point of the Ren Mai. The Spiritual Pivot15 refers to the luo-connecting point of the Ren Mai as Weiyi, an alternative name for Jiuwei REN-15, and gives symptoms of excess (pain of the skin of the abdomen) and deficiency (itching). Later classics, including both the Systematic Classic of Acupuncture and Moxibustion and the Great Compendium of Acupuncture and Moxibustion refer to the luo-connecting point of the Ren Mai as Pingyi, an alternative name for Huiyin REN-1, and ascribe these symptoms of excess and deficiency to this point. Huiyin REN-1, rather than Jiuwei REN-15, as the luo-connecting point of the Ren Mai would reflect a neat symmetry with Chengqiang DU-1 as the luoconnecting point of the Du Mai. Chengqiang DU-1 (Long Strong) Chengqiang DU-1 is the luo-connecting point of the Du Mai, from where the qi ascends bilaterally along the sides of the spine to the nape of the neck and spreads over the occiput. At the scapular region it connects with the Bladder channel and threads through the spine. As well as lumbar and sacral pain, Changqiang DU-1 is indicated for heavi ness of the head. The Spiritual Pivot16 gives specific indications for disorders of the Du luo-connecting channel. If it is shi there is stiffness of the spine, and if xu there is heaviness of the head and shaking of the head. The Method of Combining the Yuan-Source and Luo-Connecting Points in Clinical Practice The combination of the yuan-source and luo-connecting points in clinical practice is known as the "host and guest combination". According to this theory, the yuan-source point of the first or primarily affected channel is combined with the luo-connecting point of its interiorly-exteriorly coupled channel. An examination of many classical point combinations shows that this method seems to have been little used (or at least recorded) through the centuries. It does, however, reflect some interesting combinations of points, for example: ¥ Hegu L.I.-4 and Lieque LU-7: this combination is frequently used when exterior pathogenic wind invades the exterior of the body. Hegu L.I.-4 is able to expel the pathogen whilst Lieque LU-7 both assists in expelling the pathogen and restores the descending and disseminating functions of the Lung. ¥ Taiyuan LU-9 and Pianli L.I.-6: as discussed above, Pianli L.I.-6 is an important point to open and regulate the water passages and is indicated when pathogenic wind disrupts the function of the Lung resulting in acute oedema, especially of the upper part of the body, accompanied by absence of sweating and difficult urination. Since the root of this pattern is Lung deficiency, its combination with Taiyuan LU-9 is able to treat both the root and branch of this disorder. ¥ Taibai SP-3 and Fenglong ST-40: deficiency of the Spleen is the root cause of the formation of excessive phlegm. Taibai SP-3 is an important point to tonify the Spleen, whilst Fenglong ST-40 is the primary point on the body to resolve phlegm. ¥ Shenmen HE-7 and Zhizheng SI-7: Shenmen HE-7 is the primary point on the Heart channel to calm and regulate the shen, whilst Zhizheng SI-7 also has a strong action on treating psycho-emotional disorders. ¥ Taixi KID-3 and Feiyang BL-58: Taixi KID-3 is the primary point on the Kidney channel to benefit Kidney yin below, whilst Feiyang BL-58 (Soaring Upwards) lowers excessive yang, which, not rooted and secured by deficient yin, rushes upwards to the head. ¥ Taichong LIV-3 and Guangming GB-37: the Liver "opens into the eyes" and deficiency of Liver blood or yin, or blazing up of Liver fire or Liver yang may all give rise to eye disorders. Taichong LIV-3 is the primary point on the Liver channel to regulate these disharmonies of the Liver zang, whilst Guangming GB-37 (Bright Light) is an important point to benefit the eyes. Notes 1. The Practical Application of Meridian Style Acupuncture by John E. Pirog, Pacific View Press. 2. Ling Shu Chapter 10. 3. Both from The Practical Application of Meridian Style Acupuncture by John E. Pirog, Pacific View Press. 4. Quoted in Chinese Acupuncture and Moxibustion, Foreign Languages Press, Beijing. 5. Shang Han Lun by Zhang Zhongjing. 6. Ling Shu Chapter 10. 7. Su Wen Chapter 6. 8. Su Wen Chapter 74. 9. Fei Bo Xiong(1800-1879) in Fei Bo Xiong et. al. 1985 Medical Collection From Four Families from Meng He (Meng He Si Jia Yi Ji), Jiangsu Science Publishing House, p.40. Quoted in Maciocia, G. The Practice of Chinese Medicine, Churchill Livingstone, p. 211. 10. Master Hua's Classic of the Central Viscera by Hua Tuo, a translation of the Zong Zang Jing by Yang Shou-zhong, Blue Poppy Press, 1993. 11. Ling Shu Chapter 78. 12. Su Wen Chapter 45. 13. Ling Shu Chapter 8. 14. Ling Shu Chapter 10. 15. Ling Shu Chapter 10. 16. Ling Shu Chapter 10. The material in this article is taken from the forthcoming A Manual of Acupuncture, a major textbook on the actions and indications of the acupuncture points, due for publication in the summer of 1997.

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