-IBIS-1.7.6-
tx
cardiovascular system
angina pectoris
Acupuncture
patterns and combinations
after assessing the person and palpating, consider these patterns:
Heart Xue Yu (Blood Stasis) and Qi Stagnation; Obstruction by Phlegm and Xue (Blood) Stasis; Liver Yin and Kidney Yin Xu (Deficiency); Heart and Kidney Yang Xu (Deficiency); dysfunction of the Yin Wei Mai (Yin Linking Vessel)
» illustrative combinations:
during angina: PC-4, UB-17 and CV-17 (all -) to stimulate Xue (Blood) circulation, remove Stagnation, and reduce Phlegm (Ross, 1985, p. 128)
between episodes: UB-14, UB-20, UB-23, PC-6, St-36 and Kd-3 (all + or = and D) to strengthen Heart Yang and warm Spleen and Kidney Yang (Ross, 1985, p. 129)
Xu Li ashi (tender) points on left chest, including St-18, upper Kd points, PC-1, together with CV-12, CV-17, PC-6, Ht-7, St-40, St-43; esp. with an overworked person who is flushed above the diaphragm and has a reddened face (Seem, p. 52)
Kd-4 (listed as "Kd-5"), TW-7 and CV-3; St-36, UB-17, Kd-2, CV-12 and St-19; Sp-6, Ht-8, PC-8, Ht-3 and GB-41; PC-1, PC-7, SI-1, UB-60 and UB-42/47 for angina pectoris (Mann, p. 118)
Ht-1, CV-7 and Sp-7 for angina pectoris (Shanghai, p. 229)
PC-5, PC-6 and St-36 for angina pectoris (Shanghai, p. 249-250)
PC-6 and Ht-7 for angina (Finkelstein, p. 33)
UB-15, CV-14, PC-4 and Ht-5 for angina pectoris (Shanghai, p. 178)
PC-6, Sp-4, UB-15, CV-14, St-36 and Sp-6 for heart pain due to Phlegm-Dampness with Xue Yu (Blood Stasis) (Jirui and Wang, p. 52)
CV-13, PC-6 and Sp-4 for cardiac spasm (Shanghai, p. 178);
CV-13 and CV-12: treat nine types of cardiac pain (Ellis, et al, 1988, p. 356)
PC-6 and Sp-4: open the Yin Wei Mai (Yin Linking Vessel) for which heart pain is a symptom of dysfunction
point analysis
» palpate and consider:
UB-14 (-): disperses Yang Shi (Excess) in the Jue Yin (Pericardium and Liver); regulates and tonifies the Heart (especially Qi and Yang); expands and relaxes the chest; resolves Phlegm-Dampness in chest, Pericardium Shu Associated point
UB-15 (+): calms, nourishes and strengthens the Heart; regulates the Xue (Blood) and Qi of the Heart; reinforces the Heart Qi; nourishes and invigorates Heart Xue (Blood); invigorates circulation of the Qi and Xue (Blood) and tonifies Xu (Deficiency); disperses Yang Shi (Excess) in the Heart; transforms Heart Phlegm; relaxes and expands the chest; clears Heart channel; Heart Shu Associated point
UB-17 (=): regulates, nourishes and invigorates the Xue (Blood) (esp. invigorates with D); transforms Xue (Blood) Stasis and disperses Obstruction; enriches Yin; expands the chest and diaphragm; strengthens Xu (Deficient) conditions and increases stamina; Diaphragm Shu Associated point; Hui Reunion and Master point of the Xue (Blood)
UB-20 (+): regulates Spleen Qi and benefits the Ying (Constructive) Qi; enhances Spleen Yang to mobilize Stagnant Qi; tonifies and harmonizes the Xue (Blood); resolves Phlegm; Spleen Shu Associated point
UB-23 (+): tonifies and adjusts the Kidney; strengthens Yang and Qi Hai; nourishes Yin, Xue (Blood) and Kidney Jing (Essence); counterbalances Liver Fire; Kidney Shu Associated point
PC-2 (=): quickens the Xue (Blood); relaxes and opens the chest; regulates and nourishes the Heart; transforms Stagnation; relieves pain
PC-4 (-): pacifies and tranquilizes the Heart; regulates Heart Qi; stops pain; relieves Obstruction in Jue Yin (Pericadium); Pericardium Xi Cleft Accumulation point
PC-5 (-): transforms Phlegm in Heart and chest; regulates and tonifies Heart; pacifies the Shen; stops pain of angina; Pericardium Metal point
PC-6 (-): pacifies the Shen; regulates Heart Qi and Xue (Blood); improves circulation of Xue (Blood) [and] Yin of the Heart thus countering Yang of the Heart (Finkelstein, p. 58); opens the Yin Wei Mai (Yin Linking Vessel) to distribute Qi to the chest and Heart; tranquilizes the Heart; suppresses pain; opens the chest and builds Zhong (Ancestral) Qi in the chest; clears and spreads Qi in Pericardium channel; relieves Liver Qi Stagnation; Pericardium Luo Connecting point; Master point of the Yin Wei Mai (Yin Linking Vessel)
Ht-1 (-): nourishes Heart Yin; clears Heart Empty Heat; facilitates Qi flow; relaxes the chest; helps deficient lactation; frees the channels and invigorates the collateral vessels; Heart Entry point
Ht-4 (-): pacifies the Shen; regulates the Heart and Mind; invigorates and removes Obstructions from the channel; Heart Metal point
Ht-5 (=): regulates Heart Qi; pacifies the Shen; tonifies Heart Qi; clears Heart Fire and Xu (Deficiency) Heat; Heart Luo Connecting point
Ht-7 (-): pacifies the Shen; calms the Heart; nourishes Heart Xue (Blood); removes Qi Stagnation in the Heart; regulates and tonifies the Heart, esp. Heart Qi; relieves pain, esp. lateral costal pain; Heart Yuan Source, Earth and Dispersion point
Ht-8 (=): pacifies the Shen; regulates Heart; treats Heart Shi (Excess) patterns; clears Heart Fire and Empty Heat, clears Heart Phlegm Fire; Heart Fire and Horary point
TW-10 (-): pacifies the Shen and Heart; regulates Qi circulation of the Triple Warmer; dissolves Phlegm; expands and relaxes the chest; Triple Warmer He Sea Upper Uniting, Dispersion and Earth point
TW-6 (-): revives the sensory organs from unconsciousness; transforms Phlegm; facilitates Qi flow and spreads the Qi; regulates the Triple Warmer and the Zang-Fu organs; expands and relaxes the chest; frees the channels and invigorates the collateral vessels; disperses Obstruction; relieves pain; Triple Warmer Fire and Horary point
shi xuan (bleed): use during episode to subdue Internal Wind; revive consciousness; clear the Heart Orifices
Xu Li (=): palpate circumference of left breast, i.e., encircling the heart, usually starting ca. St-18 or proceeding counterclockwise from the axilla, ca. PC-1; shallowly needle ashi (tender) points to calm the Shen, ease anxiety, and release Obstruction and/or Stagnation in this microchannel, the extra Luo Vessel of the Stomach (see Seem, p. 52)
Kd-24 (=): resurrects the Spirit (Worsley); pacifies the Shen; opens and releases the chest; clears Heat; reverses Rebellious Qi; tonifies the Kidney
CV-17 (=): calms emotions; regulates and smooths Qi circulation in the Upper Warmer; reinforces the Zhong (Ancestral) Qi; expands the chest; transforms Phlegm; Pericardium Mu Alarm point; Hui Reunion point of the Qi
CV-14 (=): clears the Heart and stabilizes the Shen; regulates and invigorates the Qi; expands and clears the chest; disperses congested Phlegm in the chest and diaphragm; reverses adverse flow of Qi; acts on the nervous system and brain through the solar plexus and releases tension throughout whole body (Finkelstein, p. 90); Heart Mu Alarm point; Heart Qi enters the Ren Mai (Conception Vessel) here (Finkelstein, p. 90)
CV-13 (=): calms the Heart and Shen; invigorates the Qi; clears Heat of Heart and Stomach and relieves fullness in chest and epigastric region
CV-11 (=): moves and strengthens the Spleen; dissipates Dampness and disperses Accumulation; loosens the Center; esp. when angina accompanied by sensation of Qi rising upward in the body
CV-7 (-): warms and supplements Kidney Yang; clears Obstruction from the Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel); regulates the Xue (Blood); Lower Warmer Mu Alarm point
St-36 (+): regulates and strengthens Qi and Xue (Blood); disperses Stagnation in the Upper Warmer, esp. cracks Xue Yu (Blood Stasis) in the chest; builds Heart Yang; nourishes Kidney, Liver and Spleen; tonifies Kidney Yin; Stomach He Sea Lower Uniting and Earth point
St-40 (-): clears and calms the Shen; relieves chest congestion; strengthens the Spleen, harmonizes the Stomach, and opens up the Middle Warmer; transforms and eliminates Phlegm; strengthens Kidney Yin and drains Liver Yang; invigorates the channels; Stomach Luo Connecting point
Sp-7 (=): regulates Qi and Xue (Blood); strengthens the Spleen; frees the channels and invigorates the collateral vessels
Sp-1 (+): pacifies the Shen; clears the Heart and Brain; stimulates the flow of Xue (Blood); regulates the Xue (Blood); Spleen Jing Well and Wood point
Kd-3 (+): tonifies the Kidney, Yuan (Original) Qi, Xue (Blood) and Jing (Essence); pacifies Xu (Deficiency) Fire; nourishes and enriches Kidney Yin, supplies Liver Yin, and tonifies Yin of the entire body; tonifies Kidney Yang; regulates the Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel); Kidney Yuan Source and Earth point
Kd-2 (+): nourishes Yin; tonifies Kidney (especially Yang) and Jing (Essence); regulates the Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel); strengthens Yin Qiao Mai (Yin Motility Vessel); Kidney Fire point
tu yin (d. D): seven cones of direct moxa, one-half rice grain size
footnotes
Ballegaard S, Karpatschoff B, Holck JA, Meyer CN, Trojaborg W. Acupuncture in angina pectoris: do psycho-social and neurophysiological factors relate to the effect? Acupunct Electrother Res. 1995 Apr-Jul;20(2):101-116.
Abstract: We studied the effect of acupuncture in 49 patients with angina pectoris with focus on its relationship to psycho-social factors and changes in skin temperature, pain thresholds, and pain tolerance thresholds. No significant influence from patient expectation, social stress (strain) or profiles of the Minnesota Multiphasic Personality Inventory (MMPI) was found (all p > 0.1). Acupuncture slightly increased exercise tolerance (median 7%), the difference in Systolic Blood Pressure-Heart Rate Product between rest and maximal exercise (delta PRP) (median 3%), and the time to onset of pain (median 10%); decreased nitroglycerin consumption (median 58%) and anginal attack rate (median 38%). Improvement in exercise tolerance was significantly correlated to an improvement in delta PRP (correlation coefficient = 0.7; p < 0.0001) but not to time of myocardial ischemia (correlation coefficient = 0.1; p = 0.1). Compared with 28 patients with a less pronounced anti-anginal effect, the 21 patients with a pronounced effect had a significant increase in local skin temperature, but had no significant change in distant skin temperature and pain thresholds. It is concluded that acupuncture, due to hemodynamic alterations, might have a specific effect on angina pectoris in addition to drug treatments.
Ballegaard S, Meyer CN, Trojaborg W. Acupuncture in angina pectoris: does acupuncture have a specific effect? J Intern Med. 1991 Apr;229(4):357-362.
Ballegaard S, Johannessen A, Karpatschof B, Nyboe J. Addition of acupuncture and self-care education in the treatment of patients with severe angina pectoris may be cost beneficial: an open, prospective study.
J Altern Complement Med. 1999 Oct;5(5):405-413.
Abstract: OBJECTIVES: A cost-benefit analysis of acupuncture and self-care education in the treatment of patients with angina pectoris. DESIGN: An open prospective study on an unselected group of patients. For comparison of risk three control groups were used: (1) published data concerning medical and invasive treatments; (2) an age- and sex matched group obtained from a randomly selected Danish population of 14,000 people; and (3) the 211 patients in this group with angina pectoris symptoms. SETTING: The treatment was carried out on a outpatient basis in a private research clinic. SUBJECTS: 105 patients with angina pectoris, 73 candidates for invasive treatment, and 32 for whom this was rejected. INTERVENTIONS: Acupuncture and self-care education was added to the pharmaceutical treatment. OUTCOME MEASURES: Healthcare expenses, a satisfactory medical status defined as New York Heart Association (NYHA) classification 0-I and/or no use of antianginal medication, and risk measured as cardiac death or myocardial infarction. RESULTS: The estimated cost savings during 5 years were $32,000 (U.S.) per patient, mainly due to a 90% reduction in hospitalization and 70% reduction in needed surgery. Compared to 8% before treatment, 53% of the patients achieved a life without limitations (NYHA 0-I) 1 year after treatment, as did 69% after 5 years. No increased risk for myocardial infarction or cardiac death was observed. CONCLUSIONS: The addition of acupuncture and self-care education was found to be cost beneficial in patients with advanced angina pectoris. The results invite further testing in a randomized controlled trial.
Ballegaard S, Norrelund S, Smith DF. Cost-benefit of combined use of acupuncture, Shiatsu and lifestyle adjustment for treatment of patients with severe angina pectoris. Acupunct Electrother Res. 1996 Jul-Dec;21(3-4):187-197.
Liu Y, Wang T, Zhang J. Treatment of angina pectoris with medicinal plaster fixed at acupoints--a report of 54 cases. J Tradit Chin Med. 1998 Mar;18(1):12-14.
Chao DM, Shen LL, Tjen-A-Looi S, Pitsillides KF, Li P, Longhurst JC. Naloxone reverses inhibitory effect of electroacupuncture on sympathetic cardiovascular reflex responses. Am J Physiol. 1999 Jun;276(6 Pt 2):H2127-2134.
Cheng TO. Acupuncture for relief of angina. Circulation. 1998 Nov 24;98(21):2357-2358.
Cheng TO. Acupuncture treatment for angina. Cardiology. 1998 Oct;90(2):152.
Colquhoun DM. Electrical neurostimulation for angina pectoris. Acupuncture and TENS--where east meets west. Med J Aust. 1993 Apr 5;158(7):440-442.
Gao C, Meng J, Fu W, Song L. [Effect of electroacupuncture on myocardial oxygen metabolism and pH of coronary sinus blood during experimental angina pectoris]. Chen Tzu Yen Chiu. 1992;17(1):28-32. [Article in Chinese]
Kraemer ES, Cardoso M de F, Yamamura Y. Acupuncture in angina pectoris. J Intern Med. 1991 Apr;229(4):383.
Richter A, Herlitz J, Hjalmarson A. Effect of acupuncture in patients with angina pectoris. Eur Heart J. 1991 Feb;12(2):175-178.
Abstract: Twenty-one patients with stable effort angina pectoris were randomized in a crossover study to 4 weeks traditional Chinese acupuncture or placebo tablet treatment. The patients had at least five anginal attacks per week in spite of intensive treatment. Acupuncture was given three times per week at main points Neiguan (Pericardium 6), Tongli (Heart 5), Xinshu (Urinary Bladder 15), Pishu (Urinary Bladder 20) and Zusanli (Stomach 36). Previous antianginal treatment remained unchanged during the whole study. During the acupuncture period, the number of anginal attacks per week was reduced from 10.6 to 6.1 compared with placebo (P less than 0.01). Accordingly, the performance before onset of pain during exercise test increased from 82 W to 94 W (P less than 0.05). However, maximal performance did not increase after acupuncture. Intensity of pain at maximal workload decreased from 1.4 to 0.8 (scale 0-4, P less than 0.01). Further, ST-segment depressions at maximal comparable load decreased from 1.03 to 0.71 mm after acupuncture (P less than 0.01). A life quality questionnaire confirmed improved feeling of well-being. Thus, acupuncture showed an additional beneficial effect in patients with severe, intensively treated angina pectoris.
Zhou XQ, Liu JX. [Metrological analysis for efficacy of acupuncture on angina pectoris]. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih. 1993 Apr;13(4):212-214, 196. [Article in Chinese]
Abstract: Acupuncture (Acupoints: Neiguan P6, Shenmen H7, Shaohai H3 or auriculo-points: Heart, Shenmen) was administrated once or 7 times in a week on 40 patients with stable type of angina pectoris. The effect was assessed quantitatively or semi-quantitatively according to the extent, area, frequency, duration of attack, the time of attack during exercise, and the vanishing of suffering after exercise. Just after one performance of acupuncture, 15 patients' angina pectoris were significantly alleviated (P < 0.001) both in degree and area. After 7 times of acupuncture 10 patients' angina pectoris were not only significantly alleviated both in extent and area, but also in frequency and duration of attack. 15 patients were randomized to an acupuncture, non-acupuncture or acupuncture at non-acupoints (ANA) in a single blind design. The time from the beginning of exercise to the anginal attack in active acupuncture group was longer than that in non-acupuncture or ANA group (P < 0.01), but they were similar (P > 0.05) in both non-acupuncture group and ANA group. The time from the end of exercise to the disappearance of angina pectoris in acupuncture group was shorter than that in the other two groups (P < 0.05).