-IBIS-1.5.0-
tx
digestive system
cholelithiasis/biliary colic
acupuncture
patterns and combinations
after assessing the person and palpating, consider these patterns:
Qi Stagnation, Damp-Heat Accumulation
» illustrative combinations:
LI-4 and Lv-3 (-): Four Gates circulate Qi; disperse Stagnation and relieve pain; NEEDLE FIRST WITH ACUTE PAIN; Large Intestine and Liver Yuan Source points
GB-34, TW-6, PC-6, Lv-13, Lv-14, UB-19 and GB-40 for cholecystitis and cholelithiasis; also consider CV-13 with vomiting; CV-12 with severe pain; LI-11 and LI-4 with high fever; UB-25 and St-25 with abdominal distention and constipation; GV-9 and UB-48/53 with jaundice (Liu, p. 415)
UB-19, CV-12, and St-36 for expelling stones in cholelithiasis (Liu, p. 415)
da nang xue and PC-6; also consider: GB-34, St-36, (right) GB-24, and hua tuo jia ji of T8 and T9 for acute cholecystitis, gall stones or round worm in the biliary tract (Shanghai, p. 642; Lee and Cheung, p. 360)
UB-18, UB-20, CV-12, St-21, St-36 and GB-34 for chronic cholelithiasis with no clear symptoms (Qiu and Su, p. 56)
LI-4, Lv-3, St-21 and GB-34 for pain of acute cholelithiasis due to Damp-Heat (Qiu and Su, p. 55)
Lv-14, GB-24, St-19, CV-14, Sp-9, Lv-3 and GB-34 for cholelithiasis due to Damp-Heat with Liver and Gall Bladder Qi Xu (Deficiency) (Qiu and Su, p. 56)
UB-22, UB-23, UB-24, UB-25, CV-13, CV-15, TW-5, St-36, (right) Lv-13 and (right) GB-25 for gallstones (Shanghai, p. 643); also consider UB-19 and CV-12 (Lee and Cheung, p. 361)
UB-18, UB-19, SI-4, GB-34, GB-41 and Lv-2 (strong stimulation) for biliary colic (Lee and Cheung, p. 361; Shanghai, p. 643)
UB-18, UB-19, and pi gen (R) (+): regulate Liver and Gall Bladder; and/or (d. D) one time each week for 4-6 weeks (So, 1987, p. 236)
UB-22, UB-23, UB-24, UB-25, CV-13, CV-15, TW-5, St-36, (right) Lv-13 and (right) GB-25 for gallstones (Shanghai, p. 643)
UB-19, CV-12 and St-36, with strong stimulation, once daily for ten treatments, for cholelithiasis (Lee and Cheung, p. 361)
UB-43/48 and GV-9 (-): resolve jaundice; dissipate Heat and Dampness from the Gall Bladder; strengthen the Spleen to resolve Dampness; UB-43/48: Gall Bladder psychospiritual associated point
St-36, St-37 and St-39: regulate biliary secretion (Finkelstein, p. 20)
» treatment method:
points can be divided into two groups and alternated, e.g. Lv-14 or GB-24, St-19 or CV-14, etc. Apply reducing method as Damp-Heat is still Excessive and circulation of Qi is still uneven. For points on the abdomen reduce by rotating only; for points on the lower limbs use lifting and thrusting. (Rotating method is used mainly to regulate the function of the Zang-Fu organs. Lifting and thrusting is mainly used to eliminate pathogenic factors).
Retain needles for 30-60 minutes and manipulate frequently. (In general there are two methods of retention: quiet retention with little manipulation for chronic diseases, active retention with more manipulation for acute diseases).
In general treatment is applied for two main purposes. In the stage of acute pain, treatment is aimed at eliminating pain. In the longer term, treatment is applied to eliminate stones. Acupuncture can be effective in eliminating the most severe pain at the acute stage, acting remarkably quickly. To be effective, however, the needling method must be suitable. Needle sensation must be stronger than the pain from the disease, and the needles should be strongly stimulated after deqi has been obtained, for half a minute to one minute. Needles are retained for 40 minutes and manipulated intermittently throughout the treatment, except where electroacupuncture is used. Generally electroacupuncture is applied on the points on the chest and abdomen. In China the machine G6805 is most frequently used, set at lowest frequency and on dense-disperse wave. Correctly applied, acupuncture is frequently effective in relieving pain within about five minutes of the needles being inserted.
In general, points on the chest and abdomen are selected on the right side only. Distal points may be selected on the right side or bilaterally.
When needling Lv-14, the point 'lower Qimen' is selected, either alone or in combination with Qimen in its usual location. Lower Qimen is located directly inferior to the nipple on the lower border of the ribs, and is inserted perpendicularly.
Subcutaneous buried needles can be used for a few hours or even 1-2 days.
When needling GB-24 the needle should slant downwards along the rectus muscle. In needling Jiaji the acupuncture sensation should radiate to the front.
In the stage following acute pain, i.e. the stage described above, stones are most easily expelled.
After needling these points the patient may have a distending or contracting sensation in the abdomen. These sensations are positive signs for expelling stones showing that needling has effectively stimulated the biliary duct.
After withdrawing the needles the patient may have a distending sensation in the area of the gall bladder. This is also a positive sign for expelling stones. If the pain stops suddenly and is followed by a comfortable sensation, the stones have been expelled. The patient should be told to examine their stools.
During the course of treatment in the stone-eliminating stage, two conditions may rapidly occur. Firstly the sudden onset of acute colic pain in the right upper abdomen and secondly jaundice. This means that stones have moved and blocked the biliary duct, either because they have moved from the gall bladder to the duct, or because they have changed position within the duct. If this occurs one should either continue the treatment, or remove the needles and needle Sp-6 and Lv-3 bilaterally. The effect of these points is to relieve spasm of the biliary duct and allow the position of the stones to change. If the stone remains obstructed for longer than 4 hours despite treatment, this indicates acupuncture is ineffective and alternative methods should be considered.
If after or during needling patients experience a distending or contracting sensation in the abdomen or hypochondrium this is a good indication that stones will be expelled, especially if followed by a sensation of comfort in these areas.
Prognosis:
The prognosis for effective elimination of stones depends on two main factors, first the size and type of stones and secondly their location.
1) Smaller stones in the gall bladder itself may be eliminated in healthy patients. Stones larger than 1 cm in diameter will be difficult.
2) Larger stones may be eliminated from the biliary duct-up to 1.5 cm in diameter. If, before treatment begins, the patient is experiencing acute colic pain from stones in the duct this is itself a positive sign.
3) Sand-like or gravel-like stones in both the gall bladder itself and the biliary duct are relatively easy to expel, but difficult to expel completely. For elimination of stones, treatment should be given dally. Evacuation of sand-like stones may begin after 3 treatments, but even with continued treatment some will remain. Clinical symptoms and signs may be however be relieved with excretion of part of the stones and allow the patient to live and eat normally. Larger solid stones in the biliary duct or gall bladder will take longer to excrete-up to 15 treatments - but if the treatment is effective it is more likely that all stones will be evacuated.
4) Stones remaining after surgery may be effectively eliminated with acupuncture.
Statistics are not reliably available for analyzing the results of treatment, but preliminary research indicates that the rate for eliminating stones, of both types, is:
Effective in 70% of patients but not all stones eliminated.
Complete elimination of stones, effective rate 40%.
(Finkelstein)
point analysis
» palpate and consider:
UB-18 (-): benefits the Liver and Gall Bladder; cools Damp-Heat; moves stagnant Qi; clears Liver Fire and Heat; relieves backache; Liver Shu Associated point
UB-19 (-): cools and drains Heat from the Liver and Gall Bladder; transforms Damp-Heat; regulates Gall Bladder; moves Stagnant Liver Qi; relieves backache; Gall Bladder Shu Associated point
UB-43/48 (-): dissipates Heat and Dampness from the Gall Bladder; strengthens the Spleen; regulates the Stomach; Gall Bladder psychospiritual associated point
UB-22 (=): regulates San Jiao (Triple Warmer) and the transforming function of Qi; eliminates Dampness; expels stones; Triple Warmer Shu Associated point
pi gen (R) (d. D): fourteen cones of direct moxa, yellow bean size (So, 1987, p. 235); disperses Stagnation of Qi and Xue (Blood)
GV-9 (-): regulates the Qi functions; transforms Damp-Heat; clears Liver Fire and Heat; regulates the Liver and Gall Bladder
hua tuo jia ji of T8 and T9 (-): promote local circulation of Qi and Xue (Blood); relieve backache
LI-11 (-): clears Heat and eliminates Dampness; regulates and harmonizes Xue (Blood) and Qi; drains Fire; cools Xue (Blood); frees the channels; Large Intestine Earth and Tonification point
LI-4 (-): regulates Qi and Xue (Blood); dissipates pathogenic Heat; reduces fever; sedates pain; frees the channels; clears Toxins; Large Intestine Yuan Source point
PC-4 (-): relieves obstruction in Jue Yin; Pericardium Xi Cleft Accumulation point
Lv-14 (esp. R) (+): relieves colic; eases Liver and Gall Bladder; eliminates fullness and distension; promotes smooth flow of Liver Qi; Liver Mu Alarm point
Lv-13 (=): promotes smooth flow of Liver Qi; invigorates the Stomach and Spleen; harmonizes Liver and Spleen; transforms Damp-Heat; Spleen Mu Alarm point
CV-14 (-): dispels fullness in chest; regulates and invigorates the Qi; stops vomiting; Heart Mu Alarm point
St-19 (-): harmonizes Stomach; invigorates Qi flow; quells vomiting; reduces pain
St-21 (-): pacifies and descends Stomach Qi
GB-24 (-): regulates Liver and Stomach; invigorates the Gall Bladder; spreads Liver Qi and transforms Damp-Heat; relieves hypochondriac pain; expels gallstones; Gall Bladder Mu Alarm point
GB-34 (-): benefits Liver and Gall Bladder; alleviates pain; tonifies Spleen; clears and cools Dampness and Heat; Gall Bladder He Sea Uniting and Earth point
dan nang (-): regulates the Gall Bladder; transforms Damp-Heat (especially Gall Bladder); expels gallbladder stones
St-36 (+): strengthens and harmonizes digestion; eliminates Damp-Heat; stops vomiting; clears Heat from the Yang organs; Stomach Earth and Horary point
Sp-9 (-): transforms Damp Stagnation, esp. through promotion of diuresis; dispels Damp-Heat; Spleen Water point
Sp-6 (-): eliminates Damp-Heat; spreads the Liver Qi; Jiao Hui Intersecting point of the three Foot Yin channels
GB-41 (-): removes Fire; removes stagnancy of Liver Qi; spreads and drains Liver and Gall Bladder; clears and regulates Dai Mai (Girdle Vessel); dispels Damp-Heat; clears Wetness (Damp Spleen) by draining into Dai Mai (Girdle Vessel); Gall Bladder Wood and Horary point; Master point of the Dai Mai (Girdle Vessel)
Lv-3 (-): promotes smooth flow of Qi and Xue (Blood); soothes the Liver; dispels fullness; stops pain; Liver Yuan Source, Shu Stream and Earth point
ear: sympathetic, shen men, gall bladder (right ear), pancreas, (left ear), liver, sympathetic, shen men, dermis/subcortex. Method: Each time use 2-3 points in rotation. Retain needles for 20-30 minutes, using strong stimulation during the painful episode.
footnotes