-IBIS-1.5.0-
tx
digestive system
peptic ulcer disease
acupuncture

patterns and combinations

after assessing the person and palpating, consider these patterns:
Spleen Qi and/or Yang Xu (Deficiency) with invasion of Cold (Han Stagnation); Stomach invaded by Cold; Stomach Xu (Deficient) and Cold; Liver Invading Stomach (Liver and Stomach Disharmony); Jeh Stagnation (fever pain); Qi Stagnation; Liver Qi Stagnation; Stomach Xue Yu (Blood Stasis); Spleen and Kidney Qi Xu (Deficiency); Spleen Distressed by Dampness; Stomach Fire Blazing; Stomach Yin Xu (Deficiency); Liver Yin Xu (Deficiency)

» therapeutic notes:
• Dr. So estimates that, using acupuncture alone according to his protocol, mild cases of stomach ulcer will require 30 treatments, while severe cases will require 60 treatments.
• see also "hypochlorhydria", "hyperchlorhydria", "food sensitivities", etc.

» remarks:
Acupuncture is suitable for the early stages of this condition (i.e., when there is acute abdominal pain), and for simple perforated ulcer (the perforation is small and the general health and strength of the patient is good).
During treatment, the patient should lie down.
If, after acupuncture treatment, the patient becomes relaxed and intestinal noises are restored, such evidence indicates that acupuncture is working. If, on the other hand, after 6-12 hours there is no improvement or the condition worsens, other methods (including surgery) should be also considered.
The physician must be careful to distinguish this condition from pancreatitis, appendicitis and cholecystitis.
(Finkelstein)

» illustrative combinations:
• ca. St-38 with Sp-4 or Sp-9, unilaterally: palpate reflex zone across abdomen between the levels of St-25 and the sternum for tender and/or painful points, note them; reaction around St-21 on the left indicates a gastric ulcer; reaction around St-21 on the right indicates a duodenal ulcer; palpate for tender or painful point along the Stomach channel in the region of St-38 on the same side as the reactive St-21, apply pressure to see if the previously reactive St-21 reflex point has released, if so, needle that point on the relevant side; also palpate Sp-4 and Sp-9 on the affected side, needle whichever is most reactive to palpation to rectify the underlying Spleen/Stomach imbalance (Matsumoto)
• LI-10, CV-12 and St-36 for "ulcer" (Shanghai, p. 232)
• St-21, CV-12, St-36 and LI-10 for stomach ulcers (Shanghai, p. 180)
• stomach ulcer: (1) needle LI-11 and PC-6; (2) needle Sp-10, St-36, Sp-4 and St-44; needle UB-21, until stimulus obtained, then apply indirect moxa with ginger or an instrument; (4) needle CV-12 and CV-10 with light stimulus, then apply indirect moxa until erythematous; (5) needle "most tender place" to obtain a mild stimulus then lightly apply indirect moxa of moderate temperature with an instrument. Follow this protocol daily for treatment of stomach ulcer. Further, if patient has no fever, and only then, apply five cones of direct moxa, red bean size, to Sp-10 once every five days. If no recovery is evident alternate direct moxa between Sp-10 and LI-11 every five days and apply five cones of direct moxa to GB-34A. "This will be very effective" (So, 1987, p. 210-211)
• Sp-4, St-44 and St-36 (- and bleed); also, divide the following points into two groups and alternate daily: UB-11, UB-17, UB-18 and St-34 for gastric ulcer; add PC-7 for duodenal ulcer; add CV-4 and TW-10 for black stools (McWilliams, et al, Lesson 31, p. 89)
• CV-12, St-36, Lv-13 and St-25 (add PC-6 for vomiting) for gastritis, peptic ulcer (Lee and Cheung, p. 254)
• CV-13, CV-12, St-21, St-25, St-36 and the point of the pain (strong stimulation and 30-60 minutes retention) for acute perforation of gastric and duodenal ulcer (Shanghai, p. 641)
• Sp-4, St-36, PC-6 and St-44 for bleeding of upper digestive tract (Shanghai, p. 289);
• Kd-4 (listed as "Kd-5") and Lu-9 for gastric ulcer due to acid-base imbalance (Mann, p. 104)
• Sp-4, PC-6 and St-34: increase secretion of gastric fluids (Finkelstein, p. 26)
• Lv-8 and GB-40 for gastric ulcer due to hepatic disturbance (Mann, p. 104)
• PC-6, CV-12, CV-13, CV-10, St-25 and St-36 for gastric ulcer of "abdominal type" (Mann, p. 104)
• CV-12, St-36, PC-6, Sp-4, UB-20 and UB-21 for peptic ulcer due to Yang Xu (Deficiency) leading to Cold in Spleen and Stomach (Jirui and Wang, p. 83)
• PC-6 and St-36 (also consider CV-12, UB-21, hua tuo jia ji of T8 through T12, CV-14, St-40, Sp-6, Lv-3, CV-11, Sp-4, UB-20, UB-17, CV-4, St-43, PC-6 and Sp-9) for gastric pain (Lee and Cheung, p. 254)
• CV-12, CV-13 and St-36 for pain of Cold accumulation in the gastric region (Lee and Cheung, p. 254)
• St-21, PC-6 and St-34 for nervous dysfunction of the Stomach (Shanghai, p. 180)
• St-36 and LI-10: regulate gastro-intestinal peristalsis (Finkelstein, p. 20)
• LI-4, St-36 and Sp-6: increase acidity of the stomach and increases enzyme activity (Finkelstein, p. 20)
• Sp-4 and PC-6: unite and regulate the Yin Wei Mai (Yin Linking Vessel) and Chong Mai (Penetrating Vessel); open Qi and Xue (Blood) of the Middle Warmer; treat symptom complex of Heart, chest and Stomach; tone up constitutional deficiency due to heredity (Finkelstein, p. 26)
• PC-6 and Sp-6: nourish Yin; clear Fire; and strengthen the Heart to activate the Xue (Blood) circulation (Finkelstein, p. 59)
• St-44 and St-36: has a "wondrous effect" on diseases of the abdomen (Ellis, et al, 1988, p. 138)


point analysis

»
therapeutic notes:
• Method: Select 2-3 points each session. Use moderate to strong stimulation, retaining needles 20-30 minutes. Treat once every 4-6 hours. (Ambrose)
• moxa can be essential or contraindicated depending upon the etiology and presentation

» palpate and consider:
• UB-11 (-): dispels Cold and resolves Shi (Excess) Heat; connects the Du Mai (Governing Vessel) to the Shu Associated points; distributes Bladder Qi and Jing-Ye (Yin) to all the dorsal Shu points, thus cooling them (Finkelstein, p. 38); facilitates Xue (Blood) flow; Sea of Xue (Blood) upper entry point
• UB-17 (- and/or D): tonifies the Qi; regulates and invigorates the Xue (Blood) (esp. invigorates with D); transforms Xue Yu (Blood Stasis) and disperses Obstruction; enriches Yin; generates Fluids; strengthens Xu (Deficient) conditions and increases stamina; harmonizes Stomach Qi; esp. with Stomach Xue Yu (Blood Stasis); Diaphragm Shu Associated point; Hui Reunion and Master point of the Xue (Blood)
UB-18 (-): pacifies the Shen; drains the Liver and clears Liver Fire; cools Damp-Heat; moves Stagnant Qi; strengthens Xu (Deficiency) conditions; nourishes and regulates the Xue (Blood); nourishes Liver Yin; facilitates generation of fluids; increases gall bladder secretions; harmonizes the Stomach and benefits the Qi; treats atrophy syndrome stomach diseases and duodenal ulcer; Liver Shu Associated point
• UB-19 (-): regulates the Qi and calms the emotions; cools and drains Heat from the Liver and Gall Bladder; calms and harmonizes the Stomach; Gall Bladder Shu Associated point
UB-20 (+ and/or D): regulates Spleen Qi; tonifies the Spleen and Stomach to facilitate digestive transportation and transformation; benefits the Ying (Constructive) Qi; enhances Spleen Yang to mobilize Stagnant Qi; harmonizes the Xue (Blood); warms the Middle Warmer (D); raises Middle Qi; drains Heat Shi (Excess) from the Middle Warmer; dispels Cold and relieves pain; Spleen Shu Associated point
UB-21 (+ and D): harmonizes the Stomach; regulates the Stomach Qi; strengthens the Spleen; warms and reinforces the Middle Warmer (D); benefits the Zhong (Ancestral) Qi and cultivates Yuan (Original) Qi; dissolves and eliminates Stagnation and Obstructions; descends Rebellious Qi; Stomach Shu Associated point
• LI-11 (-): clears Heat; regulates and harmonizes Qi and Ying; cools and harmonizes the Xue (Blood); tonifies Metal to cool inflammatory processes and restrain Wood, esp. the Liver; harmonizes the Stomach and regulates the Intestines; Large Intestine Upper He Sea Uniting, Earth and Tonification point; Master point of Heat in the body (Finkelstein, p. 9)
LI-10 (-): lowers nervous excitement; promotes the circulation of Qi and Xue (Blood); tonifies Qi and Xue (Blood) (Maciocia, p. 378); harmonizes the Stomach and soothes the Intestines; tonifies Yang Ming (Stomach and Large Intestine) and the internal duct of the Triple Warmer (Finkelstein, p. 8)
• LI-4 (-): reduces fever; pacifies the Shen; regulates Qi and Xue (Blood); tonifies Metal to cool inflammatory processes and restrain Wood, esp. the Liver; relaxes Stomach spasms; relaxes pylorus and inhibits peristalsis; elevates Clear Qi and descends Turbid Qi; clears Toxins; sedates pain; Large Intestine Yuan Source and Entry point
PC-6 (+): clears Heat; pacifies the Shen and tranquilizes the Heart; regulates the Qi; harmonizes and spreads the Qi in the Upper and Middle Warmers; regulates Liver Qi and relieves Liver Qi Stagnation; harmonizes the Stomach; descends Rebellious Qi to resolve nausea, reduce eructations, and stop vomiting; opens the Yin Wei Mai (Yin Linking Vessel) to distribute Qi to the Stomach, chest and Heart; regulates the Chong Mai (Penetrating Vessel); relieves pain; Pericardium Luo Connecting point; Master point of the Yin Wei Mai (Yin Linking Vessel); Couple point of the Chong Mai (Penetrating Vessel)
PC-7 (-): pacifies the Shen and stabilizes the emotions; clears Fire of Heart and Pericardium; harmonizes the Stomach; dissipates Heat from the Ying (nutrient system) and Xue (Blood); treats gastritis and duodenal ulcers; Pericardium Yuan Source, Earth and Dispersion point; historically used as the Heart Source point (Maciocia, p. 436)
• TW-6 (-): clears Fire and drains Heat, esp. Stomach Heat; facilitates Qi flow and spreads the Qi; regulates the Triple Warmer and the Zang-Fu organs; frees the channels and invigorates the collateral vessels; disperses Obstruction; relieves pain; Triple Warmer Fire and Horary point
• Ht-6 (-): pacifies the Shen; nourishes Heart Yin; helps check Yang hyperactivity (EAMSS, p. 227); clears Xu (Deficiency) Heat, esp. from Heart; clears Fire from the Heart; Heart Xi Cleft Accumulation point
Kd-19 (=): harmonizes the Stomach; strengthens the Spleen; regulates the Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel); facilitates Qi flow, esp. in the abdomen; Jiao Hui Intersecting point of the Chong Mai (Penetrating Vessel) and Foot Xiao Yin (Kidney) channel
• Lv-14 (-): spreads and moves Liver Qi to regulate circulation of Qi; soothes and promotes function of the Liver; helps transformation and transportation function of the Spleen; strengthens the Spleen and Stomach; invigorates flow of Xue (Blood) and removes Xue Yu (Blood Stasis); Liver Mu Alarm point
Lv-13 (-): spreads and promotes smooth flow of Liver Qi; invigorates the Stomach and Spleen; benefits the Qi; harmonizes Liver and Spleen; disperses Cold-Damp; regulates circulation of Qi and Xue (Blood); quickens the Xue (Blood) and disperses Xue Yu (Blood Stasis); Spleen Mu Alarm point; Hui Reunion point of the five Zang (Yin viscera)
• Lv-11 (-): facilitates the flow of Qi and Xue (Blood); regulates the Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel); esp. with Stomach Xue Yu (Blood Stasis)
St-21 (- or =): harmonizes the Spleen and Stomach; regulates Center Qi and promotes flow of Qi; strengthens the Spleen; promotes the transportation and transformation of Grain and Liquids by the Spleen and Stomach; dispels Middle Warmer Heat; stimulates descending of Stomach Qi; relieves pain; very useful for testing as a reflex point with palpation (left St-21 tender with gastric ulcer; right St-21 tender with duodenal ulcer), but needling usually contraindicated, esp. with active ulcer, as patient very likely to be aggravated and may vomit blood (Matsumoto)
St-25 (=): supports Earth and harmonizes the Center, esp. the Stomach; regulates the Stomach and Spleen; regulates and facilitates the functioning of the Intestines; regulates Qi, esp. Ying (Constructive) Qi and Wei (Protective) Qi (Finkelstein, p. 15); tonifies Ying (Constructive) Qi and thus neutralizes Shi (Excess) Heat; transforms Dampness; ascends the Clear and descends the Turbid; Large Intestine Mu Alarm point; according to Sun Tzu Miao, this point contains a storehouse of Qi and should not be dispersed (Finkelstein, p. 15)
local ashi (tender) points (+ and/or D): clear Shi (Excess); facilitate flow of Qi and Xue (Blood); disperse Stagnation and Obstruction; warm Cold (D)
CV-13 (+, - and/or D ): calms the Heart and Shen; invigorates the Qi; clears Heat of Heart and Stomach and relieves fullness in the chest and epigastric region; harmonizes the Spleen and Stomach; opens upper Stomach Qi; strengthens the Spleen and dissipates Dampness; warms the Spleen and Stomach to disperse Cold (D); Jiao Hui Intersecting point of the Hand Tai Yang (Small Intestine) and Foot Yang Ming (Stomach) channels on the Ren Mai (Conception Vessel)
CV-12 (+ and/or D): regulates the Stomach Qi and harmonizes the Stomach; strengthens and calms the Spleen; transforms Dampness; increases peristalsis of the stomach and jejunum, esp. upper section; transforms Rebellious Qi; clears Stomach Fire and Heat; benefits and soothes the Qi; warms and tonifies the Middle Warmer, Stomach and Intestines; facilitates ascension of the Clear and descension of the Turbid; Stomach and Middle Warmer Mu Alarm point; Hui Reunion point of the Fu (Yang organs)
• CV-10 (+ and/or D): strengthens the Spleen and regulates the Stomach; stimulates descending of Stomach Qi; clears Stagnancy in Middle Warmer; special point of the Lower Warmer which directs Qi, distilled by the Spleen and Stomach, to the Kidney for further purification as Ying and Wei Qi (Finkelstein, p. 88); Jiao Hui Intersecting point of the Foot Tai Yang (Spleen) channel and the Ren Mai (Conception Vessel)
CV-6 (D on ginger): warms and strengthens the Lower and Middle Warmers (D); strengthens and moves the Qi, esp. in the Lower Warmer; reduces Fire of Liver and Gall Bladder; captures the Xue (Blood) and stops bleeding (+); regulates Qi of Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel); tonifies the Kidney; regulates and tonifies Yuan (Original) Qi; regulates Water Pathways and dispels Dampness; Dan Tien (Elixir of Long Life), with CV-5
• CV-4 (+): pacifies the Shen; grounds the Shen when there is Empty-Heat (Maciocia, p. 207); regulates the Qi and benefits Yuan (Original) Qi; nourishes Xue (Blood) and Yin; tonifies the Middle Warmer and strengthens the Spleen; warms the Kidney Yang (D); regulates and reinforces the Qi of the Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel); separates the Clear and the Turbid; dispels Cold-Damp; strengthens the function of astringing the Dai Mai (Girdle Vessel) and restraining the Xue (Blood); nourishes the Kidney and strengthens the Kidney Qi; Small Intestine Mu Alarm point
• Sp-10 (- and/or +): clears Heat and Summer-Heat; harmonizes and tonifies Ying (Constructive) Qi; regulates and invigorates the Xue (Blood); cools Heat in the Xue (Blood); nourishes Xue (Blood) Dryness; "Sea of Blood"
Sp-9 (= and/or +): regulates and tonifies the Spleen (especially Yang); regulates the Stomach (especially Yin); warms and moves the Middle Warmer; reestablishes harmony between Spleen and Stomach (Matsumoto); regulates the Water Pathways; transforms Damp Stagnation, esp. through promotion of diuresis; preferred to Sp-4 if more reactive to palpation, according to K. Matsumoto, who recommends an oblique insertion in a lateral superior direction superficial to the tibia; Spleen He Sea Uniting and Water point
• Sp-6 (+): pacifies the Shen; nourishes Yin, esp. of the Spleen, Liver and Kidney; clears Fire due to Xu (Deficiency); strengthens the Spleen; tonifies Qi and nourishes the Xue (Blood); transforms Xue Yu (Blood Stasis); aids transportation and transformation to improve digestion and nourishment; frees Qi Stagnation; spreads Liver Qi and suppresses Liver Heat; warms the Middle and Lower Warmers; tonifies the Kidney; regulates the Bladder and transforms Dampness; Jiao Hui Intersecting point of the three Foot Yin channels
Sp-4 (=, + and/or D): pacifies the Shen; clears Heat; moves, adjusts and strengthens the Spleen and Middle Warmer; dispels Cold from the abdomen and relieves pain (D) - note: better than Sp-3 for pain (Finkelstein, p. 26); harmonizes the Chong Mai (Penetrating Vessel) and circulation of Qi in the Middle Warmer; regulates and stabilizes the Stomach; reestablishes harmony between Stomach and Spleen (Matsumoto); invigorates the Xue (Blood) and regulates the Sea of Xue (Blood); regulates the Yin Wei Mai (Yin Linking Vessel); disperses Qi Stagnation and Xue Yu (Blood Stasis), esp. in the Middle Warmer; transforms Dampness; tonifies Yuan (Original) Qi; descends the Turbid; preferred to Sp-9 if more reactive to palpation, according to K. Matsumoto, who recommends a location one thumb-width proximal to the base of the first metatarsal and an oblique insertion directed medially under the bone; Spleen Luo Connecting point; Master point of Chong Mai (Penetrating Vessel); Couple point of the Yin Wei Mai (Yin Linking Vessel)
• Sp-3 (+): regulates the Qi dynamic; clears Heat; regulates and strengthens the Spleen (especially Qi and Yang); regulates the Stomach (especially Yin and Qi); harmonizes the Middle Warmer; promotes transporting function; transforms and expels Dampness; influences the pancreas (Worsley, 1975, p. B-20); regulates Large Intestine, Middle and Lower Warmers; dispels hemorrhoids; Spleen Yuan Source, Earth and Horary point
St-34 (+ or -): pacifies the Stomach; clears Heat from the Stomach; dispels Stagnation and accumulation of the Yang Ming (Stomach and Large Intestine); Stomach Xi Cleft Accumulation point
St-36 (-, + and/or D): calms the Shen; dispels Cold; facilitates the Lung and regulates Wei (Protective) Qi so as to resist External invasion; disperses noxious Yang and brings down high fever; dispels and eliminates Dampness; regulates and strengthens Qi and Xue (Blood); regulates the Stomach and strengthens the Spleen (+); removes Cold of Stomach and abdomen (D); disperses Stomach Fire (-); regulates and replenishes the Middle Warmer; regulates Ying (Constructive) Qi; spreads Liver Qi and benefits the Gall Bladder; nourishes Kidney, Liver and Spleen; tonifies Kidney Yin; clears Heat from the Yang organs and drains Shi (Excess) from the Yang channels, esp. chronic cases with Heat; regulates ascension of the Clear and descension of the Turbid (-), esp. by the Intestines; frees the channels and invigorates the collateral vessels; Stomach He Sea Lower Uniting, Earth and Horary point; Sea of Nourishment point
• St-37 (-): drains Shi (Excess) from the upper region of body, esp. acute Heat; rectifies the Spleen and harmonizes the Stomach; regulates the Intestines, esp. the Large Intestine; cools Heat and resolves Dampness; Large Intestine He Sea Lower Uniting point; Exit point of Sea of Xue (Blood)
St-44 (-): cools and drains Stomach Heat; reduces pain; harmonizes the Stomach; regulates Rebellious Qi; stops pain, esp. abdominal pain with fever; Stomach Water point
St-45 (-): pacifies the Shen, esp. to relieve accompanying insomnia; facilitates flow of Qi; clears and disperses Heat from the upper body and Yang Ming (Stomach and Large Intestine) channels, esp. Stomach Heat; sedates pain; treats peptic ulcer of purely gastric type (Mann, p. 104); Stomach Jing Well, Metal and Dispersion point
• GB-34 (-): soothes, regulates and subdues Yang of the Liver and Gall Bladder; clears Dampness and cools Heat; facilitates and harmonizes the Liver; tonifies the Spleen; eliminates Phlegm-Fire in the Stomach; alleviates pain; Gall Bladder He Sea Uniting and Earth point; Hui Reunion point of Jin (sinews and tendons)
• GB-41 (-): removes Fire; harmonizes and regulates the Liver and Gall Bladder; removes Stagnancy of Liver Qi; clears and regulates the Dai Mai (Girdle Vessel); clears Wetness (Damp Spleen) by draining into Dai Mai (Girdle Vessel), thereby increasing Spleen Qi and Xue (Blood) production, improving digestion, and warming the extremities; dispels Damp-Heat; Gall Bladder Wood and Horary point; Master point of the Dai Mai (Girdle Vessel); Couple point of the Yang Wei Mai (Yang Linking Vessel)
• Lv-8 (- and/or +): drains Liver Fire; nourishes Liver Xue (Blood) and Yin; Liver Water and Tonification point
Lv-3 (-): pacifies the Shen; "relieves anger and mellows spirits of those who are frustrated and jealous" (Finkelstein, p. 73); clears and harmonizes the Liver and Gall Bladder; promotes smooth flow of Qi and Xue (Blood); spreads and eliminates Liver Qi Stagnation; cools and drains Heat and Fire from the Liver and Gall Bladder; subdues Liver Yang; suppresses Rebellious Qi to stop vomiting; calms the Stomach and expands the chest; tonifies Liver Xue (Blood); opens the channels and relaxes spasms; sedates pain; Liver Yuan Source and Earth point; Independent Associated point for spasms
• Lv-2 (-): calms the Shen and eases the Mind; disperses Stagnant Qi and drains and clears Fire of the Liver and Gall Bladder; subdues Yang Shi (Excess); soothes and loosens the Liver to release Liver Qi and remove Qi Depression; cools the Xue (Blood); influences the pancreas (Worsley, 1975, p. B-20); relaxes cramps; Liver Fire and Dispersion point
• Kd-7 (+): clears Heat and nourishes Yin; strengthens the Spleen and rids Dampness; tonifies Yuan (Original) Qi; strengthens and enriches the Kidney; tonifies the Liver via the mother/child relationship; disperses Stagnation; Kidney Metal and Tonification point
Kd-3 (+): tonifies the Kidney, Yuan (Original) Qi, Xue (Blood) and Jing (Essence); nourishes and enriches Kidney Yin, supplies Liver Yin, and tonifies Yin of the entire body; warms Cold; cools and descends Heat; pacifies Xu (Deficiency) Fire; influences the pancreas (Worsley, 1975, p. B-20); regulates the Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel); esp. with Stomach Yin Xu (Deficiency); Kidney Yuan Source and Earth point
ear: stomach and/or duodenum, abdomen, shen men, sympathetic, lung, spleen, dermis/subcortex


footnotes

Reprinted from The Foundations of Chinese Medicine, Maciocia, Giovanni, 1989, by permission of the publisher Churchill Livingstone, a division of Elsevier Limited.