Editor's introduction Dr. Zhou Yu Yan is well known for the simple yet remarkable technique discussed in this article. Many patients and practitioners have been astonished by the dramatic and rapid relief of pain and limitation of movement that can be achieved using the crossing method of point selection. Introduction The crux of acupuncture treatment is the selection of points and needling technique. Chapter 7 of the Ling Shu discusses many different needling methods, for example Jiu Ci,the nine needling methods, which are used to treat nine different kinds of disease, Shi Er Ci, the twelve needling methods, which are used to treat disorders of the twelve regular channels, and Wu Ci, the five needling methods, which are applied to treat disorders relating to the five zang. Some of these methods are still applied in the clinic, and in 1982, based on these traditional methods, I developed the crossing method of needling which not only resolves the problem that occurs when local points cannot be needled, for example in the case of acute sprain, but also obtains excellent results. Origin and Name In Chapter 7 of the Ling Shu the needling methods of Jiu Ci, Shi Er Ci, and Wu Ci discuss the principles of selecting points from the local area, selecting points along the course of the channels, and selecting points from the distal area. Of these, the principle of selecting points from the local area is most frequently applied. Clinically, however, some disorders cannot be treated with local points, or in some cases patients need to move the affected limb during treatment, and in these cases local points are not suitable. The Su Wen states that "An experienced acupuncturist is able to lead yang from yin and lead yin from yang; to treat a disease on the left side with points on the right side and treat a disease on the right side with points from the left side", and the Ling Shu states "Select points from the lower part of the body for a disease in the upper part of the body and select points from the upper part of the body for a disease in the lower part of the body". Based on these statements, and the needling methods of Jiu Ci and Miao Ci in Chapter 7 of the Ling Shu, both of which are methods of selecting points from the left side to treat disease on the right side and vice
versa, I created a method named The Crossing Method of Selecting Points from the Corresponding Meridians of Hand or Foot Which Have the Same Names as the Affected Meridians, more simply called The Crossing Method. Indications
1. Disorders when local points cannot be needled. In such cases, the local area is swollen and the disorder is in the superficial portion of the body, for example swelling and pain of the joints in Bi syndrome.
2. Disorders in which the affected limb should be moved during the treatment, for example local sprain, contusion and injury of the tendons. In such cases, the patients are usually asked to perform voluntary or passive exercises to promote circulation of the qi and remove obstruction from the channels, so as to improve the therapeutic effect. If local points were punctured, these movements would certainly bend the needle or cause the needle to become stuck.
Point selection i. The principle of selecting points in the crossing method is that the 'corresponding area' to the affected area should first be determined. The rule of the corresponding area is: ¥ the shoulder corresponds to the hip and vice versa ¥ the elbow corresponds to the knee and vice versa ¥ the wrist corresponds to the ankle and vice versa ¥ the palm corresponds to the sole and vice versa ¥ the fingers correspond to the toes and vice versa Specific points are then selected according to the following principles: ¥ select points from yin channels if the disorder is on the medial aspect, and select points from the yang channels if the disorder is on the lateral aspect ¥ select points on the right side of the body to treat disorders on the left and vice-versa • observe the order of "Yangming1 channel runs along the anterior side of the lateral aspect of the limb2, shaoyang channel runs along the middle of the lateral aspect, taiyang channel runs along the posterior side of the lateral aspect, taiyin channel runs along the anterior side of the medial aspect, jueyin channel runs along the middle of the medial aspect and shaoyin channel runs along the posterior side of the medial aspect". In other words, select points from the
arm yangming channel to treat the leg yangming channel and vice versa, the arm shaoyang channel to treat the leg shaoyang channel and vice versa, etc. For example, for a disorder affecting Jianyu LI-15 on the right shoulder, Biguan ST-31 on the left hip is selected; for disorder around Qiuxu GB-40 on the left ankle, Yangchi SJ-4 on the right wrist is selected. ¥ if the disorder covers several channels, the points are selected from all the corresponding channels; however, it is better to "select few but excellent points". ¥ selecting the correct channel takes priority over point selection, as is emphasised in the ancient saying "rather change points than select the wrong channel". ¥ the patient should move the affected limb whilst the needles are being manipulated. This is because the combination of needling and movement may regulate qi and blood so as to provide immediate relief of pain.
Needling method Reducing method is the main needling technique applied in the crossing method. This is because the clinical indications of the crossing method are those patterns where stagnation of qi and blood results in obstruction of the channels and collaterals, and reducing method is chosen to activate blood and remove obstruction from the channels. Even method may be applied if the patient has a weak body condition or is elderly. The depth of needling is determined according to the area where the treatment is given and the intensity of needling sensation required. Electroacupuncture may be used according to the clinical situation, and local moxibustion can be added at the affected area if the treatment is given within 24 hours of the onset of the injury. Case Examples Case 1 Male 23 years Chief complaint: sprain of the left hip due to a bicycle accident, resulting in limitation of movement at the hip. The patient had previously received treatment in the massage department. Examination: a marked tenderness at Huantiao GB-30 with slight localised swelling. Diagnosis: injury of the tendons and channels resulting in stagnation of qi and blood. Principle of treatment: relax the tendons and activate blood circulation. Points: Jianliao SJ-14 at the right shoulder, plus local cupping in the affected area. Result of treatment: after treatment the pain disappeared and normal movement was restored. The patient was able to go home without assistance. The next day the patient returned and said that he was fully recovered. Examination showed that both the local tenderness and the swelling had disappeared. Case 2 Female 36 years Chief complaint: swelling and pain on the dorsum of the right foot for 3 weeks after being trodden on, with limitation of movement and worsening of pain with weight bearing. Examination: tenderness was found at Jiexi ST-41, Qiuxu GB-40 and in the area above the ankle. Diagnosis: injury of the tendons resulting in stagnation of qi and blood. Principle of treatment: relax the tendons, activate blood circulation and remove obstruction from the channels. Points: left Yangxi LI-5, Yangchi SJ-4 and Zhigou SJ-6; local moxibustion was applied to the affected area. Results of treatment: after treatment, pain and movement were greatly improved and the patient could walk normally. Only one treatment was required and at a one-month follow-up, the patient reported no problems. Discussion of the mechanism of the crossing method The crossing method is based on channel theory and the principles of point selection and needling technique. The channels and collaterals are pathways along which the qi and blood of the human body circulate. They connect to the zangfu interiorly and extend over the body exteriorly, forming a network and linking all the tissues and organs of the body into an organic whole. Although the channels of the hand are distributed in the upper part of the body, and the channels of the foot traverse the lower part of the body, the channels of hand and foot which have the same names connect with and co-ordinate with each other. For example: ¥ taiyin channels of hand and foot connect at Zhongfu LU-1. ¥ shaoyin channels of hand and foot connect in the heart. ¥ taiyang channels of hand and foot connect at Jingming BL-1. ¥ • yangming channels of hand and foot connect at Yingxiang
LI-20 . Meanwhile, the right and left branches of the twelve regular channels all communicate with the Ren and Du channels. For example: ¥ the right and left branches of foot yangming (Stomach) channel communicate at Renzhong DU-26, Shenting DU-24 and Dazhui DU-14. ¥ the right and left branches of foot shaoyin (Kidney) channel communicate at Shanzhong Ren-17, Guanyuan Ren-4 and Chengqiang DU-1.
Since channel qi can flow freely through these connecting and communicating points, the crossing method, like a 'remote controller', can treat disorders on the left side of the body by stimulating points of the right side, or treat disorders of the right side by stimulating points of the left side, or treat disorders of the hand by needling points of the foot, or treat disorders of the foot by needling points of the hand. Clinical discussion I once analysed the treatment of 92 cases of sprain. Of these,
67 cases were treated with the crossing method and 25 cases with local points. In the crossing method group, 62 cases were cured, 4 cases were improved and 1 case failed, the total effective rate being 98.5%. In the local points group, 8 cases were cured 15 cases were improved and 2 cases failed, the total effective rate being 92%. By comparing the therapeutic results of the two groups, the crossing method was shown to work better than treatment by local points. Since the crossing method is simple and convenient, easy to learn and quickly achieves a satisfactory therapeutic effect, it is welcomed by patients. Notes
1. Yangming channel = Large Intestine and Stomach channels; shaoyang channel = Sanjiao and Gall Bladder channels; taiyang channel = Small Intestine and Bladder channels; taiyin channel = Lung and Spleen channels; jueyin channel = Pericardium and Liver channels; shaoyin channel = Heart and Kidney channels.
2. Assuming the patient is standing with the arms by the side rather than in the anatomical position.
Dr Zhou Yu Yan is Director of Acupuncture Department of Nanjing Municipal Hospital of Traditional Chinese Medicine. Ding Xiao Hongis a Lecturer at Nanjing University of Traditional Chinese Medicine.