Giới thiệu quản lý đau bằng châm cứu đổng thị

Chinese Medical Theory and Tung’s AcupunctureIn Tung’s original book there is no discussion of Chinese medical theory, and in his own teaching, Tung rarely mentioned any theory to his students. There is some controversy in the community of Tung’s Acupuncture practitioners about how much Chinese medical theory should be used to understand, explain, and teach the system.The title of Tung’s original 1973 text gives the first insight into this question. The original book in Chinese was called “Dong Shi Zhen Jiu Zheng Jing Qi Xue Xue; A Study of Tung’s Lineage Acupuncture and Moxibustion – Primary Channel Extra Points.” The term chosen to describe Tung’s points is notably 正經奇穴 Zheng Jing Qi Xue – “Primary Channel Extra Points,” and is a clear reference to his points being located in relation to the channels of regular acupuncture. Certainly, many points in Tung’s system overlap conventional acupuncture points with identical indications (e.g., Huo Chuan 33.04 is located at Zhi Gou SJ6; used in both Tung’s and conventional acupuncture to treat constipation). Likewise, some of Tung’s points are named in relation to either conventional channels or acupuncture points (e.g., Ce San Li 77.22 translates as “next to San Li,” a reference to its location lateral to Zu San Li ST36). It is clear that Tung’s points relate to the channels and conventional acupuncture points, and can therefore be understood in reference to Chinese medical theory. This topic will be explored in much greater depth in the chapters that follow.According to one of Tung’s direct disciples, Dr. WeiChieh Young, every time questions were raised to Tung, he would say, “Observe for yourself, then think about it” (WeiChieh Young, 2008a, p. 269270). This is certainly the reason why the original canon of point indications was broadened or changed over time and that in the course

DR HENRY M CCANN, D A O M , L A C

馬 爾 博 中 醫 博 士

Treatment of Pain with Tung’s Acupuncture – An Introduction

Pain in our Clinics

common reasons for primary care visits in the United States

"  McCarberg BH, Nicholson BD, Todd KH, Palmer T, Penles L The impact of pain on quality of life and the unmet needs of pain management: results from pain sufferers and physicians participating in an Internet survey Am J Ther 2008;15:312-320

acupuncture clinic (40%)

"  Ward-Cook K, Hahn T, ed NCCAOM 2008 Job Task Analysis, Jacksonville:

NCCAOM, 2010

Pain in Chinese Medicine

!  Descriptions of treating pain account for

a significant portion of early medical

literature, such as the Huang Di Nei Jing

!  Pain is associated with stagnation, and in classical literature caused by cold

疼（疒＋冬）

Pain in Chinese Medicine

痛病必瘀

Tong Bing Bi Yu

There must be stasis in painful disorders

不通則痛，通則不痛

Bu Tong Ze Tong, Tong Ze Bu Tong

If there is no free flow there is pain, establish free

flow and there will be no pain

Case Study 1 – Lumbar Pain

travel; patient complained of bilateral lower back pain with pain slightly worse on the left; reduced range of motion with limited left trunk rotation

! Secondary points = Left Wan Shun Yi 22.08, Wan Shun Er 22.09

asked to stand and move; pain also almost completed

abated soon after needles inserted

Zheng Shui 正水穴

! Location: 3 point group; on the horizontal midline of the

posterior proximal phalanx of the 5th (small) finger; one point

on the midline of the finger (over the bone), and then one point each on the ulnar and radial margins of the phalangeal bone  

! Functions: Drains the lower jiao, rectifies water and disperses

swelling 

! Indications: Pyelitis (inflammation of the renal pelvis), cystitis,

urethritis, sour pain of the lumbar region, back pain, aching pain

in the leg bones, injury and pain of the lateral leg 

! Needle: 0.1-0.2" insertion  

! Location: On the ulnar margin of the hand on the junction of the red and white skin, 2.5 cun distal to the wrist joint crease, 0.5 cun proximal to Hou Xi (S.I.-3); and 1.5 cun distal to the wrist joint crease,

1 cun proximal to Wan Shun Yi (22.08); on the Small Intestine channel

! on the Small Intestine channel 

! Functions: Enriches the Kidneys and disinhibits urine, frees the Kidneys and settles pain 

! Indications: Headache, back pain (especially due to Kidney vacuity), fatigue, nephritis, pain and fatigue of the whole body, dizziness (due to Kidney depletion), sciatica, edema of the limbs; epistaxis（Wan Shun

Yi 22.08 only); hip pain (Wan Shun Er 22.09)

! Needle: 0.5-1.0" perpendicular insertion

Wan Shun Yi 腕順一穴 22.08 &

back to Han Dynasty*

to eldest son

of extra points, as well as

14 channel points

Characteristics of Tung’s Acupuncture

! Almost exclusive use of distal (distant) point treatment; points needled mostly contralaterally

6 needles)

techniques, including bleeding

Tung’s Points

original Chinese name and a modern numbering system (e.g., Ling Gu 22.05)

rather “reflex areas” 神經

Point Distribution

Zone Location Number of Points

2 Palm and dorsal hand 11 (22)

4 Upper Arm 17 (9)

5 Plantar aspect of foot 6

VT and DT Ventral and Dorsal Trunk 160+

Zone Characteristics

and get faster symptom relief

and recalcitrant conditions

?

Point Location Needling

Indication Results

Acupuncture

Black box: causal chains are unknown

A model is required which links acupuncture points and their effects in a reliable, rational,

and reproducible way

“Heaven, Earth and Humanity [are] in Harmony”

天地人和 Tiān Dì Rén Hé

According to Chinese philosophy man is a microcosm or hologram of the natural world with structural and functional characteristics corresponding to those of its immediate environment and nature, as well as to those of the universe

On a smaller scale, analogous rules of correspondence can be observed within the human organism: parts of the body can be viewed as microsystems or holograms representing the whole Likewise, channels and tissues have various correspondences This provides us with a reliable tool for point selection

G UIDING P RINCIPLE : C ORRESPONDENCE Humans and Nature are in Harmony

!  天地人和 Tiān Dì Rén Hé

natural world

(TaijiQuanxi太極全息）

" Quan Xi = Microsystem/Hologram Yang L 周易与中医学 [The Zhou Changes and Chinese Medicine] Beijing:

Beijing Science Technology Publishing House, 1999

Humanity and the Universe

!  “A human body is the image of Heaven and Earth”

! 人身應天地

!  “A human body is a small Heaven and Earth”

! 人身小天地

" Zhang Jie Bin (in the Lei Jing)

!  “Yin and Yang are the Dao of Heaven and Earth”

! 陰陽者天地之道也

" Yin Yang Ying Xiang Da Lun (Su Wen Ch 5)

Rules of Diagnosis and Treatment

!  Holographic Correspondence

! Identifying diseased locations of the body to choose treatment location

! Identify diseased channels to choose treatment channels

! Identify diseased Zang-Fu and tissues to choose point location and needling methods

FOR MORE INFORMATION ON THESE CORRESPONDENCES PLEASE SEE:

McCann H, Ross H-G Practical Atlas of Tung’s Acupuncture Munich: Müller and Steinicke20, 2018

Shubs J The foundations of channel theory Journal of Chinese Medicine 100 Oct 2012:53-61

Young WC Lectures on Tung’s Acupuncture: Therapeutics Rowland Heights, CA: American Chinese Medical Culture Center, 2008

Wang M 董氏奇穴精要整理 Shenyang: Liaoning Science and Technology Publishing House, 2011

Holographic Correspondence

! Large Taiji Holograms

! Body mapped out onto large regions of the body

! Limb to limb, trunk to limb

! Elbow and knee are pivot points

" Originally described in philosophical, martial arts & Dao Yin / Qigong writings

! Small Taiji Holograms

! Body mapped out onto small structure, such as long bones

! Ear, hand or scalp acupuncture are examples of this mapping

Tung’s Correspondence of arm and Leg

[Large Taiji]

Tung’s Korrespondenz Arm – Bein [Großes Taiji]

Tung’s Correspondence of the extremities

[Large Taiji]

Tung’s Korrespondenz der Extremitäten

[Großes Taiji]

Large Taiji:

Correspondence between head, trunk and extremities

Knee-navel-elbow level

Genital area

Großes Taiji:

Abbildung von Kopf und Rumpf auf Extremitäten

Small Taiji

of ECIWO theory in early 1970s (prior to publication of any material on Tung’s acupuncture correspondences)

such as Korean hand acupuncture by Tae Woo Yoo

microsystems (全息), and all long bones can be microsystems

"  Zhang YQ ECIWO and Its Applications to Medicine Jinan: Shandong Science and Technology Press, 1991

Small Taiji - Kleines Taiji

Zhang YQ ECIWO and Its Applications to Medicine Jinan: Shandong Science and Technology Press, 1991

Small Taiji – Long Bones Kleines Taiji – Röhrenknochen

McCann H, Ross H-G Practical Atlas of Tung’s Acupuncture Munich: Mü̈ller and Steinicke, 2018

Small Taiji – Palm Diagnosis

Small Taiji – Palm Diagnosis Channel Correspondence - same Name Channels Korrespondenz von Leibahnen gleicher Namen

! Lv ↔ Pc

! Bl ↔ Dü

! Ni ↔ He

! Le ↔ Pe

Wu Zang Bie Tong 五臟別通:


Branching Connections of the Five Zang

(as opposed to Yin-Yin or Yang-Yang as described already)

(Entering the Gate of Medicine – Ming Dynasty); derived also from Su Wen Chapter 6

McCann H, Ross H-G Practical Atlas of Tung’s Acupuncture Munich: Müller and Steinicke, 2018

Young WC Lectures on Tung’s Acupuncture: Therapeutics Rowland Heights, CA: American Chinese Medical Culture Center, 2008

Wang M 董氏奇穴精要整理 Shenyang: Liaoning Science and Technology Publishing House, 2011

太陽為開 Taiyang is the open 陽明為闔 Yangming is the close 少陽為樞 Shaoyang is the pivot

太陰為開 Taiyin is the open 厥陰為闔 Jueyin is the close 少陰為樞 Shaoyin is the pivot Yin Yang Li He Lun (SW6)

陰陽離合論

Channel Correspondence -

Wu Zang Bie Tong 五臟別通

! Bl ↔ Lu

! SJ ↔ Ni

! Di ↔ Le

Clock Channel Correspondence

Tissue Correspondence

From Guan Zhen 官針 (Ling Shu 7)

! 一曰半刺，半刺者，淺內而疾發針，無針傷肉，如拔毛狀，以取皮氣，

此肺之應也。

! The first is called one-half piercing (ban ci) For one-half needling, shallowly insert, then quickly withdraw the needle without injuring the flesh It is like plucking a fine hair and is used to treat the skin qi It is in resonance with the lungs

! 二曰豹文刺，豹文刺者，左右前後針之，中脈為故，以取經絡之血者，此心 之應也。

! The second is called the leopard's spots piercing (bao wen ci) Leopard's spots piercing involves piercing in left and right, front and back [to the diseased location] This strikes the vessels, and is used to remove blood from the channels and network vessels It is in resonance with the heart

Tissue Correspondence

Acupuncture Points

Diseased Regions Diseased Tissues

Holographic Correspondence Correspondence Tissue / Zang

Diseased

Channel Correspondence

Potentially effective Areas, Channels, and Points

Therapeutic Point(s)

Inspection Palpation

Acupuncture Points

Needle Rules and Methods

ipsilateral

! Also called Hui Ma 回馬

Technique 動氣針法

McCann H, Ross H-G Practical Atlas of Tung’s Acupuncture Munich: Müller and Steinicke, 2012

Li GZ 台灣董氏針灸倒馬針刺療法 [Taiwan’s Tung Lineage Dao Ma Needle Therapy] Taipei: Zhi Yuan Bookstore, 1999

Wang M 董氏奇穴精要整理 Shenyang: Liaoning Science and Technology Publishing House, 2011

needles [i.e., the superior acupuncturist], from the yin they pull the yang and from they yang they pull the yin With the right they treat the left and with the left they treat the right.”

vol I, p.120

Distant Point Needling

How do we treat pain?

不通則痛，通則不痛

Bù Tōng Zé Tòng, Tōng Zé Bú Tòng

If there is no free flow there is pain, establish free flow and there will be no pain

Needling and Movement

disease is engendered in the vessels Treat it with cauterization [moxa] and piercing.”

" The physical body is not damaged or overtaxed Mind/emotions leads

to diseases in the circulation of Ying/Wei Mind-intent leads and the

Qi follows (意到氣到)

" 形樂志苦，病生於脈，治之以灸刺

as well, disease is engendered in the flesh Treat it with needles and stones.”

" The ‘body is joyful’ means no laboring or physical movement leading

to stagnation

" 形樂志樂，病生於肉，治之以鍼石

Needling and Movement

!  “When the physical body suffers while the mind is joyful, disease is engendered in the sinews Treat it with ironing and pulling.”

" Here there is injury to the muscles and connective tissue (sinews 筋) The circulation of Qi and Blood in the channels and vessels is not yet systematically damaged Ironing is the application of poultices or other topical application of hot medicinal substances (e.g., herb packs), and pulling is movement therapy such as Dao Yin (導引) or Dao Yin / Dong Qi needle technique

" 形苦志樂，病生於筋，治之以熨引

! Su Wen 24 (Blood, Qi, Body, Mind 血氣形志); translations based on Unschuld, 2011

Case Study 2 – Lumbar Pain

!  80 year old with severe lumbar pain She has a history of kidney cancer (treated by nephrectomy 1 year ago), and a diagnosis of osteoporosis and spinal stenosis She is very stiff and has difficulty walking upright Hands are cold on palpation and the Kidney region is very pale Pulse is deep and weak

Case Study 2 – Lumbar Pain

!  Dx: Kidney vacuity cold with blood stasis

!  Tx: Shui Tong 1010.19 threaded to Shui Jin 1010.20, Wan Shun Yi 22.08, Wan Shun Er 22.09, Ren Huang 77.21 (i.e., San Yin Jiao SP-6)

!  Rx: Du Huo Ji Sheng Tang

" Du Huo 9g, Xi Xin 3g, Fang Feng 9g, Qin Jiao 9g, Sang Ji Sheng 12g, Du Zhong 12g, Dang Gui 12g, Chuan Xiong 6g, Sheng Di 12g, Bai Shao 12g, Fu Ling 12g, Huai Niu Xi 12g, Dang Shen 12g, Gui Zhi 9g, Zhi Gan Cao 6g; 5:1 granular concentrated dosed 4g b.i.d

Shui Tong 水通穴 1010.19 & Shui Jin 水金穴 1010.20

! Location: 0.4 cun inferior to the corner of the mouth (Shui Ting),

and 0.4 cun obliquely medial (and a little inferior) to Shui Tong

! Functions: Benefits the Kidneys, secures the Root, warms the

channels and frees the network vessels

! Indications: Low back pain, acute lumbar sprain, rheumatism,

vertigo, dizziness, fatigue, dyspnea, asthma

! Needle: Oblique needling from medial to lateral to connect Shui

Tong 1010.19 and Shui Jin 1010.20

!  “For Fixed Painful Obstruction that does not leave, with long term Cold that has no end, choose San Li (ST36)” LS19

! 

不榮則痛

Bù Róng Zé Tòng

“If there is no nourishment, there is pain”

Ling Gu 靈骨穴 22.05

! Location: On the dorsum of the hand, at the junction of the first and second metacarpal bones, on the Large Intestine channel  

! Functions: Frees the channels and quickens the network vessels, clears and regulates Lung qi, frees and descends the Stomach and intestines, frees the qi and disperses stasis 

! Indications: Migraine, low back pain, sciatica, facial paralysis, hemiplegia, tinnitus, deafness, menstrual disorders (irregular, scanty, profuse, absent), polyuria, incontinence, foot pain, intestinal pain, difficult labor, angina pectoris, emphysema, pneumonia 

! Needle: 0.5-2.0" perpendicular insertion; can be needled through to the thenar eminence (Hand Taiyin Channel) 

! Notes: Contraindicated in pregnancy

Ling Gu 靈骨穴 22.05

Metacarpal Three Needles 掌三針

stands for ‘metacarpal’ 掌骨)

menses, dysmenorrhea, pneumonia, sciatica, lumbar pain, pediatric asthma, high fever, headache, nasal pain, trigeminal neuralgia; all chronic diseases, unusual diseases, all diseases of Qi stagnation or that lead to stagnation of the

Qi

Wu Hu 五虎穴 11.27

! Location: 5 point group; evenly distributed on the radial side of the proximal phalanx of the thumb at the border between the palmar and dorsal surfaces of the thumb (on the junction of the red and white skin) 

! Functions: Opens the channels and quickens the network vessels, disperses swelling and stops pain 

! Indications: Rheumatoid arthritis, osteoarthritis, osteoporosis, acute injury; pain of hands, fingers, feet, toes, heels Specific indications:

#1- pain of fingers palm, #3- toe pain, #4- dorsal foot pain, instep pain, #5- heel pain; #2- assistant to form Dao Ma with #1 or #3 

! Needle: 0.1-0.2" insertion

! Note: Can be combined with Ling Gu 22.05 and Da Bai 22.04 to treat bony swelling

Wu Hu 五虎穴 11.27 Shou Jie 手解穴 22.10

! Location: On the palm, between the 4th and 5th metacarpals, 0.5 cun proximal to the distal transverse crease; on the Heart channel Overlaps with Shao Fu HT-8  

! Functions: Regulates and harmonizes the qi and blood, courses the channels and quickens the network vessels, settles and tranquilizes, quiets the spirit 

! Indications: Iatrogenic effects of acupuncture treatment (e.g., dizziness

or pain/numbness), severe trauma, intense pain (from disordered movement of Qi and Blood), sciatica, lumbar pain, trigeminal neuralgia, pain of the entire body, post-surgical pain, food poisoning, ingestion of toxic herbs, severe and acute pain from gastroenteritis, use as acupuncture anesthesia for tooth extraction or uterine surgeries (experience of Taiwanese authors)

Shou Jie 手解穴 22.10

! Needle: 0.3-0.5" perpendicular insertion; retain needle for

3 to 5 minutes to treat iatrogenic effects of acupuncture (if effect was caused by one specific needle, apply needle on opposite side of the body); for severe trauma or generalized

Shou Jie 手解穴 22.10