Some Acupuncture Points Which Treat Disorders of Blood

ne of the things that strikes the acupuncturist who studies Chinese herbal medicine is the great array of herbs, prescriptions and protocols which treat disorders of blood. By comparison, acupuncture may seem inadequate, and it is sometimes said that there are only three or four acupuncture points which are important in the treatment of blood disorders. A careful examination of the traditional and modern indications of the acupuncture points, traditional commentaries and classical combinations, however, reveals that many acupuncture points are able to nourish blood, dispel blood stasis, clear heat from the blood or stop bleeding. Some of the most important are listed in this article. The indications, discussion and classical combinations for the points given here are concerned only with these actions, and many other important aspects of the use of these points are omitted. TIANFU LU-3

Relevant indications • Nosebleed, spitting blood, coughing blood, wheezing, dyspnoea, cough, asthma.


Discussion According to the Discourse Into the Origins and Development of Medicine "The Lung is the delicate zang, neither heat nor cold is appropriate ... too hot and the fire will melt the metal and the blood will stir". As early as the Spiritual Pivot (Chapter 21: On Hot and Cold Disease) Tianfu LU-3 was indicated for "Severe thirst, internal upsurge, Liver and Lung struggle against each other, blood pours from the mouth and nose". This is a clear reference to the pattern of Liver fire attacking the Lung. Liver fire rushes upwards and scorches the Lung, injuring the blood vessels and giving rise to reckless pouring of blood from the mouth and nose. At the same time there will be coughing, which is characterised in this pattern by bouts of spasmodic coughing with a red face.


Classical combinations • Bleeding from the nose: Tianfu LU-3 and Hegu L.I.-4 (Ode to the 100 Patterns).


CHIZE LU-5 Relevant indications • Spitting blood, coughing blood, nosebleed, vomiting
DISORDERS OF BLOOD by Peter Deadman and Mazin Al-Khafaji blood, Heart pain, Heart agitation. Discussion Chize LU-5 is the water and he-sea point of the Lung channel. Its principal action is to clear all forms of heat (whether shi or xu) from the Lung. Heat in the Lung may injure the blood vessels and give rise to reckless bleeding, characterised by coughing or spitting of blood or nosebleed. The Lung channel originates in the middle jiao. As well as being indicated for heat-induced bleeding from the Lung, due to its secondary action of descending Stomach qi, Chize LU-5 may also be used for vomiting blood. The Song of Points for Miscellaneous Diseases states uncompromisingly: "In cases of vomiting blood the action of Chize LU-5 is without comparison". The Lung and Heart are intimately associated in the upper jiao. Yang Zhao Li says "The Lung and Heart are mutually connected; when there is Lung heat it most easily enters the Heart" and the Spiritual Pivot (Chapter 75) says "If zong qi does not descend, blood will stagnate in the vessels". In the case of Lung heat entering the Heart there will be agitation of the Heart, and in the case of Lung and zong qi deficiency there will be blood stasis giving rise to Heart pain. Classical combinations • Spitting blood, at times hot and at times cold: tonify Chize LU-5 and disperse Yuji LU-10 (A Systematic Classic of Acupuncture and Moxibustion). TAIYUAN LU-9 Relevant indications • Spitting blood, coughing blood, vomiting blood, agitated Heart with Heart pain and choppy pulse, oppression of the chest, manic raving, pulseless syndrome. Discussion According to the Plain Questions "The Lung governs the one hundred vessels", and the Classic of Difficulties (45th Difficulty) states "the vessels gather at Taiyuan LU-9". This concept of the hundred vessels was discussed more fully in The Classic of Categories which stated "The flow of the jingmai (channels and vessels) must follow the qi; the qi is dominated by the Lung, therefore it is the meeting of the hundred vessels". These statements refer to the important relationship between the qi and the blood, ex pressed in the saying "The qi is the commander of the blood", and the statement in The Classic of Categories that "The vessels are the pathways of the blood qi; the movement of the vessels is dependent on qi". In other words, the blood moves through the blood vessels by virtue of the movement of qi, and in the chest and Heart region especially, the circulation of the blood is dependent on the zong qi which is formed from the gu qi and air inhaled by the Lung. Taiyuan LU-9, the Hui-Meeting point of the vessels, is therefore an important point to harmonise the relationship between the zong qi and the blood. When the zong qi is deficient and fails to circulate the blood, it will pool and stagnate in the chest and Heart, giving rise to oppression and fullness, agitation, Heart pain with a choppy pulse, and in severe cases manic raving. Taiyuan LU-9 is further indicated for disorders of the blood vessels in general such as vomiting, spitting or coughing of blood and pulseless syndrome. Classical combinations ¥ Pain of the Lung and Heart: Taiyuan LU-9 and Yuji LU10 (A Systematic Classic of Acupuncture and Moxibustion). ¥ Raving speech: Taiyuan LU-9, Yangxi L.I.-5, Xialian L.I.8 and Kunlun BL-60 (The Great Compendium).

YUJI LU-10 Relevant indications • Coughing blood, vomiting blood, blood in the urine, genital damp itching, impotence with abdominal distention. Discussion Yuji LU-10 is the ying-spring and fire point of the Lung. According to the Classic of Difficulties (68th Difficulty), ying-spring points are indicated for "heat in the body", and Yuji LU-10 is effective to clear heat from both the Lung channel and the Lung zang. When heat, a form of yang excess, enters the blood it may lead to excessive and reckless movement, and hence haemorrhage. Yuji LU-10 is indicated for bleeding disorders affecting all three jiao. Lung heat may injure the vessels of the Lung causing coughing of blood, transmit to the origin of the Lung channel in the Stomach causing vomiting of blood, or transmit to the Heart and thence the Small Intestine and Bladder giving rise to urinary bleeding (which may be accompanied by genital damp itching or impotence). Classical combinations ¥ Vomiting blood: Yuji LU-10, Quze P-3 and Shenmen HE-7 (The Great Compendium of Acupuncture and Moxibustion). ¥ Pain of the penis: Yuji LU-10, Taixi KID-3, Zhongji REN3 and Sanyinjiao SP-6 (The Great Compendium of Acupuncture and Moxibustion).

GUILAI ST-29 Relevant indications • Amenorrhoea, irregular menstruation, uterine blood stasis due to cold. Discussion The name of this point, Guilai ('Return') refers to its ability to restore the menstruation to normal, and its overriding action is to warm the lower jiao, most particularly the uterus in women. The uterus (along with the Stomach and Spleen and the intestines) belongs to that group of the zangfu or extra fu that can suffer from direct attack by exterior pathogenic cold (i.e. without initially giving rise to symptoms and signs of an exterior pattern such as chills and fever, body aches etc.). Injury of the uterus by cold may be due to inadequate clothing or sitting on cold ground, or over-consumption of cold foods and drinks, especially during menstruation or after childbirth. According to the Plain Questions (Chapter 82 'On Regulating the Channels'), "Qi and blood desire warmth and dislike cold; when cold is encountered they coagulate; when warmth is encountered they disperse and flow", whilst the Spiritual Pivot says "The qi and blood of the human body circulate without stopping, in the same way that the stars do in the upper region and the rivers in the lower region. When a cold pathogen comes to reside in the channels as a guest, the blood will coagulate; when the blood coagulates the channels do not move". Pathogenic cold entering the uterus will cause stagnation of qi and coagulation of blood and disrupt the function of the Ren Mai and Chong Mai, giving rise to disorders such as amenorrhoea, irregular menstruation and abdominal masses. Guilai ST-29 is normally treated with warm needling to warm the uterus and drive out pathogenic cold. YINBAI SP-1 Relevant indications • Uterine bleeding, menorrhagia, vomiting blood, nosebleed, heat illness with nosebleed, blood in the urine, blood in the stools. Discussion According to theSupplements to Commentaries "The Spleen gathers the blood; when the Spleen is xu it is unable to unite the blood", whilst the Treatise on Disorders of Blood says "When Spleen yang is xu the blood is not gathered". Yinbai SP-1, the jing-well point of the Spleen channel, is one of the foremost acupuncture points for strengthening the Spleen's function of holding blood. This pattern, which is usually chronic in nature, may manifest as bleeding in any part of the body, but most commonly in the lower jiao, whether as uterine bleeding or as bleeding into the urine or stools. In such cases moxibustion at Yinbai SP1 is frequently employed, and it is particularly helpful to instruct the patient in the daily use of moxibustion at home. The action of Yinbai SP-1 in stopping bleeding, however, is not confined to cases of Spleen deficiency, but may also be applied where shi or xu heat enters the blood level giving rise to reckless bleeding, especially in the upper part of the body (nosebleed, vomiting blood). In these cases, needling is the usual method employed. Classical combinations ¥ Bloody stools: Yinbai SP-1 and Zusanli ST-36 (Gatherings from Outstanding Acupuncturists). ¥ Bloody dysentery: Yinbai SP-1, Tianshu ST-25, Neiting ST-44, Qihai REN-6, Zhaohai KID-6 and Neiguan P-6 (The Great Compendium of Acupuncture and Moxibustion). ¥ Vomiting and nosebleed: Yinbai SP-1, Pishu BL-20, Ganshu BL-18 and Shangwan REN-13 (The Great Compendium of Acupuncture and Moxibustion). ¥ Severe and ceaseless nosebleed: Yinbai SP-1 and Weizhong BL-40 (Classic of Supplementing Life with Acupuncture and Moxibustion). ¥ Hot head and nosebleed: Yinbai SP-1, Feiyang BL-58, Jinggu BL-64, Kunlun BL-60 and Chengshan BL-57 (1000 Ducats).

SANYINJIAO SP-6 Relevant indications • Irregular menstruation, uterine bleeding, uterine bleeding with dizziness, menorrhagia, amenorrhoea, dysmenorrhoea, difficult labour, failure of the lochia to descend, post-partum dizziness, palpitations, blurred vision, insomnia, eczema, urticaria. Discussion Along with Geshu BL-17, Xuehai SP-10 and Diji SP-8, Sanyinjiao SP-6 is considered one of the most important acupuncture points to nourish, harmonise and cool blood and to promote and invigorate its circulation. This action finds its most important application in the treatment of gynaecological disorders, but extends to other disorders where blood disharmony plays an important role such as skin diseases. When Spleen qi or yang is xu there may be: i. inadequate formation of blood (palpitations, blurred vision, amenorrhoea, post-partum dizziness, dizziness associated with uterine bleeding etc.), or ii. failure of the Spleen to hold the blood (uterine bleeding, menorrhagia). By virtue of its ability to tonify the Spleen qi and yang and to strengthen the Spleen's ability to hold the blood, Sanyinjiao SP-6 is an essential point in the treatment of these disorders, especially uterine bleeding and menorrhagia. The further ability of Sanyinjiao SP-6 to regulate the Spleen, Liver and Kidney channels and to treat all disorders of the lower abdomen renders it an important point to treat gynaecological disorders due to blood stasis, Kidney deficiency, phlegm-dampness or Liver stagnation. Classical combinations ¥ Uterine bleeding: Sanyinjiao SP-6, Yinjiao REN-7 and Yangchi SJ-4 (The Lyric of Standard Profundities). ¥ Ceaseless uterine bleeding: Sanyinjiao SP-6, Jiaoxin KID-8, Yingu KID-10 and Taichong LIV-3 (Classic of Supplementing Life with Acupuncture and Moxibustion). ¥ Menorrhagia: Sanyinjiao SP-6, Tongli HE-5 and Xingjian LIV-2 (The Great Compendium of Acupuncture and Moxibustion). ¥ Disordered menstruation: Sanyinjiao SP-6, Zulinqi GB41 and Zhongji REN-3 (The Great Compendium).

DIJI SP-8 Relevant indications • Irregular menstruation, dysmenorrhoea, abdominal masses in women due to qi and blood stasis. Discussion Diji SP-8 is the xi-cleft point of the Spleen channel. The xi-cleft points are where the qi and blood, which flow relatively superficially along the channels from the jingwell points, gather and plunge more deeply. The xi-cleft points in general are indicated in the treatment of acute conditions and pain, whilst the xi-cleft points of the yin channels have an additional action of treating disorders of blood. The Spleen controls blood and its channel enters the lower abdomen, joining with the Ren Mai at Zhongji REN-3 and Guanyuan REN-4. Diji SP-8 has a specific and important action on resolving blood stasis in the uterus and lower abdomen, being indicated in the treatment of irregular menstruation, abdominal masses in women and dysmenorrhoea due to this pathology. As the xi-cleft point, Diji SP-8 is especially suited to treating acute dysmenorrhoea, for which purpose it is often combined clinically with Hegu L.I.-4. A specific indication for this point mentioned in the Illustrated Classic of Acupuncture Points on the Bronze Man is a hot flowing sensation spreading down the inner thigh to the knee when pressure is applied to abdominal masses in women. Classical combinations • Irregular menstruation: Diji SP-8 and Xuehai SP-10 (Ode of the 100 Symptoms). XUEHAI SP-10 Relevant indications • Irregular menstruation, dysmenorrhoea, amenorrhoea, uterine bleeding, clotted uterine bleeding, sudden uterine bleeding, post-partum qi and blood deficiency, urticaria, eczema, erysipelas, herpes zoster, painful hot sores, ulceration and itching of the scrotum, blood lin. Discussion The name of this point Xuehai SP-10, literally "Sea of Blood", reflects its pre-eminent role in treating various disorders at the blood level. It is generally recognised as having two principal actions: i. invigorating the blood and dispelling stasis, and ii. clearing heat from the blood. These two actions find their expression in its ability to treat a wide range of gynaecological and dermatological disorders due either to blood stasis or heat in the blood. As far as gynaecology is concerned, normal menstruation depends on a number of factors including the smooth circulation of blood. Impairment of blood circulation and consequent stasis may be due to stagnation or deficiency of qi, traumatic injury, haemorrhage, penetration of cold, blood deficiency, heat, chronic disease or emotional factors, and may give rise to many different disorders of menstruation. These include dysmenorrhoea and uterine bleeding characterised by severe fixed pain and the discharge of dark or clotted blood, and amenorrhoea accompanied by pain and distention, a purple coloured tongue and a choppy pulse. By contrast, if heat enters the blood level, most frequently due to internally generated heat from the Liver or Heart, or due to overconsumption of excessively heating foods, then two principal conditions may arise: i. the movement of blood may become reckless and overflow its bounds leading to uterine bleeding, or the heat may dry the blood leading to amenorrhoea. In both cases there will be signs of heat such as a red dry tongue and a rapid pulse. In fact, both the blood cooling and blood invigorating properties of Xuehai SP-10 come together in its ability to treat uterine bleeding. Blood heat is the most commonly seen pattern of uterine bleeding, and as well as cooling blood, treatment must emphasise resolving stasis, since any pathological bleeding may lead to pooling and stagnation of extravasated blood. This is expressed in the Chinese medicine saying "where there is haemorrhage there is stasis" . Some authorities further attribute blood nourishing properties to Xuehai SP-10 and incorporate it into prescriptions for the treatment of blood deficiency. In the light of Xuehai SP-10's pre-eminence in invigorating blood, this action reflects the saying in Chinese medicine "if blood stasis is not transformed, new blood cannot be generated". This refers to situations either where blood deficiency and consequent poor circulation lead to stasis, or where blood stasis prevents the creation of new blood. Both of these patterns are commonly encountered in postpartum blood deficiency. As far as dermatology is concerned, blood disharmony often plays a central role. The main dermatological patterns treated by Xuehai SP-10 are heat in the blood level characterised by red lesions, and blood stasis characterised by purple lesions. Xuehai SP-10 may also be used for the concomitant blood deficiency and stasis seen for example in eczema with thickening of the skin (lichenification) or post-herpetic neuralgia. Xuehai SP-10 may also be used to treat the manifestations of wind in skin diseases, the most important of which is intolerable itching. This illustrates the Chinese medicine saying "to treat wind first treat the blood; once blood moves wind will be dispelled". Although the action of Xuehai SP-10 on invigorating and cooling blood is classically confined to the two principal areas of gynaecology and dermatology, its application may be extended to any disorder in the body with these pathologies. Classical combinations • Irregular menstruation: Xuehai SP-10 and Daimai GB26 (Classic of Supplementing Life with Acupuncture and Moxibustion). DABAO SP-21 Relevant indications • Pain of the whole body, weakness of the four limbs, flaccidity of the limbs. Discussion The name of the point Dabao SP-21 is made up of two characters, 'Da' meaning great, and 'Bao' meaning 'to wrap', or 'to envelop'. According to the Spiritual Pivot "The great luo of the Spleen is known as Dabao ... it spreads in the chest and flanks. When it is shi there is pain of the whole body. When it is xu the hundred joints are flaccid. This channel is like a net embracing the blood of all the luo". A possible explanation of this statement from the Spiritual Pivot is that one of the functions of the luo-connecting channels in general is to assist in the distribution of qi, and more especially blood, to all the tissues of the body via the network of the minute luo-connecting channels. Since the Spleen controls blood, its great luo-connecting channel dominates this function of blood distribution throughout the body. When blood stagnates "there is pain of the whole body"; when blood is xu and unable to nourish the tissues, "the hundred joints are flaccid". YINXI HE-6 Relevant indications • Heart pain, unbearable stabbing pain of the Heart, fullness of the chest, palpitations, fright palpitations, sudden turmoil disorder with cardiac pain, nosebleed, vomiting blood. Discussion Yinxi HE-6, the xi-cleft point of the Heart channel (see Diji SP-8 above) is indicated for Heart pain due to blood stasis, and bleeding disorders due to excessive heat agitating the blood. However, in terms of both these actions, Ximen P4, the xi-cleft point of the Pericardium channel, is clinically more important. Acute severe pain from blood stasis which threatens the survival of the Heart zang is therefore primarily treated by using points of the Pericardium channel, the 'protector' of the Heart. This is reflected in the statement in theSpiritual Pivot (Chapter 71) "The Heart is the great master of the five zang and six fu and the residence of the jing shen ... If the Heart is injured, the shen will depart; if the shen departs, the person will die ... therefore the pathogenic qi that attacks the Heart will be diverted to reside in the Pericardium". XINSHU BL-15 Relevant indications • Heart pain, oppression of the chest with restlessness, chest pain extending to the back, palpitations, irregular pulse, poor memory, anxiety, weeping with grief, insomnia, excessive dreaming, absent-mindedness as if in a trance, delayed speech development, coughing blood, vomiting blood, nosebleed, night sweating. Discussion Xinshu BL-15 is the back-shu point of the Heart, where the qi of the Heart emanates from the interior to the body surface, and in common with all the back-shu points (especially those of the yin zang) Xinshu BL-15 has a strong action on regulating and tonifying its corresponding zang at the deepest level. It is used equally to tonify deficiency of Heart blood and to resolve blood stasis. According to the Spiritual Pivot (Chapter 18) "Blood is the qi of the shen", whilst the Plain Questions (Chapter 8) says "The Heart is the monarch from which the shen emanates". Since storage is a yin function, it is primarily the Heart blood and yin that have the function of nourishing the Heart and providing the material basis for the Heart to house the shen. Blood and yin deficiency of the Heart may originate from physical causes such as loss of blood, chronic illness and overwork, or from emotional causes. Fei Bo Xiong (1800-1879) said: "The seven emotions injure the five yin organs selectively but they all affect the Heart", whilst according to the Plain Questions (Chapter 62) "The Heart stores the shen ... when the shen is in excess there is ceaseless laughter, when the shen is insufficient there is sadness". When Heart blood or yin are deficient, the unrooted and unanchored shen loses its harmony and becomes restless and unquiet, resulting in such symptoms as anxiety, poor memory, insomnia and excessive dreaming and weeping with grief. The Heart controls the pulse, and when Heart qi is deficient and is unable to regulate the blood, there may be palpitations or irregular pulse, especially if the Heart blood is also deficient. In the latter case, palpitations will be more likely to be accompanied by anxiety, in contrast to the palpitations caused purely by qi deficiency which are usually unrelated to emotional changes. According to Essential Readings from the Medical Tradition, "That which is stored by the Heart internally is blood, externally it is emitted as sweat; sweat is the fluid of the Heart". For this reason, Xinshu BL-15 is also indicated for night sweating. References to the relationship between the Heart, the blood and its vessels abound in the classics. The Plain Questions says: "All blood pertains to the Heart" (Chapter 10), "The Heart dominates the blood vessels of the entire body" (Chapter 44), and "The Heart stores the qi of the blood vessels" (Chapter 18). The Classic of Categories states "The vessels are the pathways of the blood qi, the movement of the vessels is dependent on qi", whilst in the Spiritual Pivot it says "When the qi of hand shaoyin channel is exhausted, the vessels will not move, thus the blood will not flow; when the blood does not flow the circulation will eventually stop ... and the blood will die". The Methods and Rules of Medicine says "In chest bi, pain in the Heart region is caused by yang deficiency and invasion of cold". In Treatment Planning According to Pattern Categories it says "In chest bi, the yang qi of the chest does not move; after a long time, yin takes the place of yang". The above statements all emphasise the close relationship between the circulation of blood in the chest and the qi and yang of the Heart. When Heart yang is deficient and unable to circulate the blood in the chest and Heart, there may be consequential Heart blood stasis giving rise to pain and oppression of the chest. Xinshu BL-15 is an important point for all kinds of Heart and chest pain, whether due to deficiency, stasis of blood, or stagnation of qi or phlegm. The action of Xinshu BL-15 in treating blood stasis as well as blood deficiency, reflects its ability to treat both xu and shi patterns of the Heart with equal effect. According to a number of classics it is an important point to clear heat from the Heart, both shi and xu, whilst the Illustrated Appendices to the Classic of Categories states "Xinshu BL-15 is indicated for clearing heat of the five zang in combination with the five zang back-shu points". This reflects the application of five phase theory in which the Heart pertains to sovereign fire and plays a role in governing the fire of the whole body. When Heart fire injures the blood vessels of the Lung or Stomach, therefore, there may be coughing or vomiting of blood. Classical combinations ¥ Weeping with grief: Xinshu BL-15, Shenmen HE-7, Jiexi ST-41 and Daling P-7 (Classic of Supplementing Life with Acupuncture and Moxibustion). ¥ Melancholy and trance-like absent-mindedness: Xinshu BL-15, Tianjing SJ-10 and Shendao DU-11 (Classic of Supplementing Life with Acupuncture and Moxibustion ). ¥ Trance-like mental confusion: Xinshu BL-15, Tianjing SJ-10 and Juque REN-14 (The Great Compendium of Acupuncture and Moxibustion). ¥ Mental stupidity and dull-wittedness: Xinshu BL-15, Shenmen HE-7, Shaoshang LU-11 and Yongquan KID-1

(The Great Compendium of Acupuncture and Moxibustion). ¥ Agitated Heart: Xinshu BL-15 and Juque REN-14 (Classic of Supplementing Life with Acupuncture and Moxibustion). ¥ Coughing and spitting blood: Xinshu BL-15, Ganshu BL-18, Quepen ST-12, Juque REN-14 and Jiuwei REN-15 (Classic of Supplementing Life with Acupuncture and Moxibustion).

GESHU BL-17 Relevant indications • All blood diseases, epigastric pain, fullness of the abdomen and flank, pain of the whole body, pain of the skin, flesh and bone, stabbing pain of the Heart, Heart pain on eating, tidal fever, night sweating, spontaneous sweating, steaming bone syndrome, fever without sweating, aversion to cold, mania-depression disorder, coughing blood, vomiting blood, spitting blood, blood in the stool, urticaria, bi of the whole body. Discussion Geshu BL-17 is one of the eight hui-meeting points with a specific action on the blood. Many classics simply state that this point can be used for "all blood diseases". Disorders of blood may be of three main kinds: blood stasis, blood heat and blood deficiency. Impairment of blood circulation and consequent blood stasis may be due to various causes (see Xuehai SP-10 above). The variety of symptoms that blood stasis can give rise to is extensive, but of these the principal one is pain. Shi pain may be due either to stagnation of qi or stasis of blood, as reflected in the famous adage "when there is no movement there is pain". Pain due to blood stasis is characterised by its fixed and stabbing nature. According to Wang Qingren, the Qing dynasty author of Correcting the Errors of Medicine, "whenever there is pain in the abdomen that does not move, it is blood stasis". Tang Rong Chuan in the Treatise on Disorders of Blood said "... When blood stasis is between the jingluo and the zangfu the whole body is in pain ... when it is in the upper jiao ... there is stabbing obstinate pain of the arm, chest and diaphragm ... when it is in the middle jiao there is pain of the abdomen and flanks". As is clear from its indications, Geshu BL-17 is applicable in all these cases. It should be noted, however, that due to its location and its special action on the diaphragm which intersects the upper and middle jiao, its main sphere of action is on these two areas and it is less used for blood stasis in the lower jiao. Geshu BL-17 is also an important point to treat various kinds of fever due to blood stasis. The Treatise on Disorders of Blood states "when blood stasis is at the level of the pores the ying and wei are not harmonised there is fever accompanied by chills ... when it is half-interior half-exterior ... there is alternating chills and fever ... when it is at the level of the muscles and flesh there will be a burning fever ... when it is in the jingluo and zangfu ... there is necessarily steaming bone consumption fever". Geshu BL-17 is also indicated for mania-depression disorder, and according to Wang Qingren in Correcting the Errors of Medicine, "In the pattern of insanity, where there is continual crying and laughing, swearing and singing ... then the qi and blood will coagulate in the brain". An alternative explanation for this manifestation is that blood stasis may both transform to heat and obstruct the blood vessels, preventing nourishment from reaching the Heart. This combination of heat and malnourishment may disturb the shen. Geshu BL-17 is an important point for many kinds of bleeding disorders, primarily due to blood heat or blood stasis. Heat entering the blood level may be due to a number of causes including constitutional heat, exterior pathogenic heat, overconsumption of excessively heating food or drink, or shi or xu heat generated by disharmony of the zangfu. When heat agitates the blood it causes it to move recklessly and burst out of the vessels giving rise to haemorrhage that is usually acute and profuse. Geshu BL17 is able to cool the blood and stop bleeding, primarily from the upper and middle jiao (Lung and Stomach). Another important cause of haemorrhage is blood stasis. When blood is stagnant and does not move it may be forced out of the vessels giving rise to haemorrhage characterised by its intermittent nature, dark purplish colour and presence of clots. At the same time, haemorrhage of any aetiology is itself in an important cause of blood stasis, as blood that is forced out of the vessels easily pools and stagnates. This is reflected in the saying "where there is haemorrhage there is stasis". The close interrelationship between blood heat, blood stasis and haemorrhage is further illustrated by the fact that blood heat may condense and dry the blood giving rise to stasis, as stated in the Treatise on Acute Epidemic Febrile Disease by Wu You Ke (1642) "Because latent stagnant fire evaporates the blood's fluid, the blood simmers and forms stasis". The ability of Geshu BL-17 to nourish blood and yin is clearly overshadowed in the classical indications by its ability to resolve blood stasis and heat. There are three areas, however, that reflect its nourishing and tonifying properties. The first is its ability to treat disorders such as night sweating and steaming bone syndrome due to severe blood and yin xu. The second is the use of Geshu BL-17 with Danshu BL-19 which forms the classical combination of the 'Four Flowers'. The Four Flowers were first mentioned in Secrets of a Frontier Official by Wang Tao (752 AD), who did not specify the points but described rather a complex location method (see below*). The Classic of Supplementing Life with Acupuncture and Moxibustion in the 13th century first defined the Four Flowers as Geshu BL-17 and Danshu BL-19 and said that they dominated blood, being indicated (for treatment by moxibustion) for consumption disorder manifesting as exhaustion with steaming bone syndrome, night sweating cough, asthma, feebleness and emaciation. The third is the special ability of Geshu BL-17 to treat blood deficiency allied to blood stasis. It has long been understood that following haemorrhage, the consequent blood stasis prevents the formation of new blood. This is reflected in the saying: "if blood stasis is not transformed, new blood cannot be generated" and the statement by Tang Rong Chuan "In vomiting blood, nose bleeds and blood in the stool, the blood leaves the channels; any blood that has left the channels is separated and no longer connected with the blood that nourishes the entire body ... this blood is unable to augment with good blood, thus the transformation of new blood is hindered". At the same time, by pooling outside the channels, blood stasis may lead directly to blood deficiency as sufficient blood is no longer available to nourish the body. Thus blood stasis may not only be the cause of, but may be the end result of blood deficiency. The action of Geshu BL-17 on bi syndrome, commonly referred to as wind-damp in Chinese medicine, which affects the whole body reflects its action of regulating blood. Prolonged bi syndrome may give rise either to blood stasis or blood deficiency. The importance of treating the blood in such cases is reflected in the saying "to treat wind first treat the blood; once blood moves wind will be dispelled".
*The method of locating these points described in the Secrets of a Frontier Official (752 AD) is as follows: a piece of string is tied around the neck, with a knot made at the level of Jiuwei REN-15. When the string is allowed to fall down the back, the knot will then lie on the vertebral column at the crossing point of two diagonal lines the end of each of which leads to one of the four points. WEIZHONG BL-40 Relevant indications • Pain and stiffness of the lumbar spine, heaviness of the lumbar region and buttock, nosebleed, clove sore (ding chuang), erysipelas. Discussion An alternative name for Weizhong BL-40, used in a number of classics, is Xuexi (Blood Xi-Cleft). According to theInner Classic taiyang channel is abundant in blood. This not only explains the powerful effect of bleeding Weizhong BL-40 to move blood stasis in acute lumbar sprain, but also its ability to cool the blood in cases of nosebleed and a variety of skin disorders, in which case the point may also be bled. Interestingly, the only other channel abundant in blood according to the Inner Classic is the jueyin channel, and this may help to explain certain similarities between Weizhong BL-40 (the he-sea point of the Bladder taiyang channel) and Quze P-3 (the he-sea point of the Pericardium jueyin channel). Both points are bled to clear heat from the blood level and are used in the treatment of injury by summer-heat, sudden turmoil disorder with heat of the four limbs, ceaseless thirst, vomiting and diarrhoea. Classical combinations ¥ Severe and incessant nosebleed: Weizhong BL-40 and Yinbai SP-1 (1000 Ducats). ¥ Carbuncles on the back: needle Weizhong BL-40 and Jianjing GB-21, and place a slice of garlic on the carbuncle and burn moxa. If there is no pain, then moxa until there is pain; if there is pain, moxa until there is no pain, the more moxa the better (The Great Compendium of Acupuncture and Moxibustion).

SHUIQUAN KID-5 Relevant indications • Amenorrhoea, irregular menstruation, dysmenorrhoea, delayed menstruation with epigastric pain on onset of menstruation, prolapse of the uterus. Discussion Shuiquan KID-5is the xi-cleft point of the Kidney channel (see Diji SP-8 above). The Plain Questions (Chapter 1) states: "At the age of fourteen, the Kidney qi of the female is strong, the reproductive function matures, the Ren Mai flows and the Chong Mai fills, the menses come according to their times, and she can bear offspring". Normal development of the uterus and the Ren and Chong Mai, therefore, depend on healthy functioning of the Kidneys. At the same time, harmonious menstruation depends on adequate formation of blood in the body, especially the Liver blood which flows to the Ren and Chong Mai to form menstrual blood. The close relationship between the Kidneys and Liver blood was emphasised inMaster Zhang's Medical Encyclopaedia which said "When the jing is not discharged it will return to the Liver and transform into clear blood", whilst the Kidneys themselves play an important role in the formation of blood, stated unequivocally in the Bing Ji Sha Zhuan "The source of blood is the Kidney". If the Kidneys are deficient, then the function of the Ren and Chong Mai will be disturbed and the formation of blood inadequate. Shuiquan KID-5, the xi-cleft point of the Kidney channel and thus able to treat disorders of blood, regulates the qi and blood in the Kidney, Ren and Chong channels. It is indicated for a variety of menstrual disorders such as amenorrhoea, irregular menstruation, dysmenorrhoea and delayed menstruation, whether characterised by deficiency (of blood or qi) or excess (stasis of blood). Classical combinations ¥ Amenorrhoea with much oppression and pain in the lower Heart (upper epigastrium): Shuiquan KID-5 and Zhaohai KID-6 (1000 Ducats). ¥ Irregular menstruation: Shuiquan KID-5 and Tianshu ST-25 (Ode to the 100 Patterns).

JIAOXIN KID-8 Relevant indications • Uterine bleeding, irregular menstruation, dysmenorrhoea, amenorrhoea, uterine prolapse. Discussion Jiaoxin KID-8 is the xi-cleft point of the Yin Qiao Mai on the Kidney channel. The xi-cleft points of the yin channels have a special action of treating disorders of blood, especially resolving blood stasis, clearing heat from the blood and stopping bleeding. Although the Yin Qiao Mai does not enter the uterus, like all the extraordinary channels, it has a close relationship with the Kidneys and originates at Zhaohai KID-6. Jiaoxin KID-8 is indicated in a variety of menstrual disorders, and most especially uterine bleeding. According to the Classic of the Central Viscera by the great Han dynasty doctor Hua Tuo, the Kidneys serve the purpose of "wrapping the blood" in women. If the Kidneys are injured by excessively early sexual activity, sexual overindulgence, multiple pregnancies etc, then either the Kidney yin or Kidney yang may become deficient leading to infirmity of the Ren and Chong Mai and hence uterine bleeding. Jiaoxin KID-8 is predominantly indicated in xu patterns of uterine bleeding, particularly in cases of Kidney deficiency, but its status as a xi-cleft point and its secondary action of draining damp-heat renders it suitable in the treatment of uterine bleeding due to blood stasis, reckless movement of hot blood and damp-heat. Classical combinations ¥ Ceaseless uterine bleeding: Jiaoxin KID-8, Yingu KID10, Taichong LIV-3 and Sanyinjiao SP-6 (Classic of Supplementing Life with Acupuncture and Moxibustion). ¥ Diminished qi uterine bleeding: Jiaoxin KID-8 and Heyang BL-55 (Ode to the 100 Patterns).

SIMAN KID-14 Relevant indications • Abdominal distention, oedema of the abdomen, diarrhoea, constipation, masses below the umbilicus, painful masses, cutting pain below the umbilicus, irregular menstruation, uterine bleeding, blood stasis in the uterus, acute pain due to blood stasis. Discussion The name of this point, Siman KID-14, is translated as 'Four Fullnesses'. Although there are different interpretations of the meaning of this name, one opinion is that it refers to four kinds of stagnation: qi, water, food and blood. There are clear indications that reflect each of these conditions, for example abdominal distention for qi, abdominal oedema for water, diarrhoea or constipation for food, but overwhelmingly the indications reflect the presence of blood stasis, for example painful abdominal masses, cutting pain below the umbilicus, blood stasis in the uterus etc. XIMEN P-4 Relevant indications • Chest pain, Heart pain, Heart pain with vomiting, vomiting blood, coughing blood, nosebleed, furuncle and carbuncle, agitated Heart, insomnia, melancholy and fear, fear of strangers, weakness of the shen qi. Discussion Ximen P-4 is the xi-cleft point of the Pericardium channel (see Diji SP-8 above). Through its dual actions of invigorating blood and moderating acute conditions, Ximen P-4 is strongly indicated for stagnation of blood in the chest and Heart, giving rise to pain. Its important role in the treatment of Heart pain was both emphasised in the classics and is borne out by modern clinical practice and research. By virtue of its ability to clear heat from the blood and stop bleeding, Ximen P-4 is also indicated for hot reckless bleeding in the upper jiao giving rise to nosebleed, and vomiting or coughing of blood. The second principal group of indications for Ximen P4 includes a variety of mental and emotional disorders such as agitation of the Heart, insomnia, melancholy and fear, fear of strangers and epilepsy. The relationship between Ximen P-4 and emotional disorders is expressed through its effect on the blood and the Heart qi. The Heart rules the blood and houses the shen, and there is therefore a reciprocal relationship between blood and disturbance of the shen. On the one hand when the blood is stagnant and does not flow freely, essential nourishment will not reach the Heart and the shen may be disrupted. On the other hand, emotional disturbance may lead to stagnation of blood. The Spiritual Pivot in the chapter 'On Original Causes of the 100 Diseases' states: "Internally a person may be injured by worry and anger; when this occurs the qi will rush upwards; when the qi rushes thus the six shu (points) will not move, the warm qi will not circulate and internally the blood will coagulate and not scatter". By resolving stasis of blood Ximen P-4 therefore is able to restore emotional harmony. Blood stasis in the Heart most commonly occurs as a result of deficiency of Heart qi and yang. These patterns frequently give rise to feelings of fear, melancholy and gloominess, typically seen in patients after a myocardial infarct (the shock of which may further injure the Heart qi). Ximen P-4 is able to regulate the Heart qi, as well as the blood, and is classically indicated for weakness of the shen qi. Finally there may be symptoms of mental and emotional agitation, as well as haemorrhage, when heat enters the ying or blood levels during febrile disease and rises to disturb the spirit. Thus the Treatise on Warm Febrile Diseases stated: "When the ying system is invaded by heat, the blood is consumed, the shen is disturbed and there is insomnia". Ximen P-4 is able to calm the shen in such cases by clearing heat from the ying and blood levels. Classical combinations ¥ Heart pain: Ximen P-4, Quze P-3 and Daling P-7 (1000 Ducats). ¥ Heart pain with dry heaves and agitation and fullness: Ximen P-4 and Jiquan HE-1 (Classic of Supplementing Life with Acupuncture and Moxibustion). ¥ Coughing blood: Ximen P-4 and Daling P-7 (A Systematic Classic of Acupuncture and Moxibustion). ¥ Fear of people, insufficiency of shen qi: Ximen P-4 and Dazhong KID-4 (1000 Ducats).

DADUN LIV-1 Relevant indications • Irregular menstruation, ceaseless uterine bleeding, menorrhagia, metrorrhagia, bloody urine, nosebleed. Discussion Dadun LIV-1 is the jing-well point of the Liver channel which encircles the genitals and enters the lower abdomen. Through its action of regulating qi in the lower jiao Dadun LIV-1 is also indicated for a variety of disorders of both urination and menstruation. As far as menstrual disorders are concerned, the Liver stores the blood, and if Liver qi stagnation transforms to heat and enters the blood, it will give rise to agitation and turbulence manifesting in such disorders as irregular menstruation, ceaseless uterine bleeding, menorrhagia or metrorrhagia. The Great Compendium of Acupuncture and Moxibustion says "urine red like blood, moxa Dadun LIV-1 and Guanyuan REN-4". The important action of Dadun LIV1 on stopping excessive bleeding from the uterus therefore extends to urinary bleeding, and according to Sun Si Miao, even to nosebleed, which is frequently due to upsurging heat of the Liver. QUQUAN LIV-8 Relevant indications • Abdominal masses in women due to blood stasis, infertility due to blood stasis, amenorrhoea, lower abdominal swelling, pain of the abdomen and flank, umbilical pain. Discussion The Liver stores the blood and its qi is responsible for the smooth flow of menstruation. When Liver qi stagnates, then menstrual blood may also stagnate. Ququan LIV-8 is indicated in various classical sources for blood stasis in the uterus giving rise to infertility, abdominal masses and amenorrhoea. One specific indication found in a number of sources is the presence of abdominal masses which, when pressed, induce a warm sensation which radiates down the thigh as far as the knee. Ququan LIV-8 is an important point to clear damp-heat from the lower jiao. Clinically the combination of damp-heat and blood stasis is frequently encountered in gynaecological disorders, and the action of Ququan LIV-8 on both these pathogenic factors renders it particularly suited to treating such dual disharmony. DAZHUI DU-14 Relevant indications • Nosebleed. Discussion After ascending to the vertex, the Du Mai descends through the midline of the nose. Dazhui DU-14 is indicated for nosebleed which does not stop, an indication that mirrors the folk practice of placing a key or other piece of cold metal, or a cold sponge, at the back of the neck to stop nosebleed. Classical combinations • Nosebleed: moxa Dazhui DU-14 and Yamen DU-15 (Secrets of the Master of Cinnabar Creek). YINJIAO REN-7 Relevant indications • Uterine bleeding, irregular menstruation, amenorrhoea, leucorrhoea, infertility, ceaseless flow of lochia after childbirth. Discussion Yinjiao REN-7, literally 'Yin Meeting' is a meeting point of the Ren Mai, Chong Mai and Kidney channels, the three channels that have the strongest relationship with the uterus. The Ren Mai, known as the 'Sea of the Yin Channels' and the Chong Mai, known as the 'Sea of Blood' both originate in the uterus. Their maturation depends on the flourishing of the Kidneys, thus the Plain Questions states: "At the age of fourteen, the Kidney-qi of the female is strong, the reproductive function matures, the Ren Mai flows and the Chong Mai fills, the menses come according to their times, and she can bear offspring". Disorders of menstruation may be shi or xu, due to cold or heat, exterior pathogens or interior disharmony. Due to the close relationship of Yinjiao REN-7 to the uterus, however, it may be selected to treat such disorders as uterine bleeding, irregular menstruation, amenorrhoea, lochiorrhagia and infertility due to any aetiology. References Among the numerous sources consulted for the material presented in this article, we would especially like to mention:

1. The Practice of Chinese Medicine by Giovanni Maciocia, Churchill Livingstone, 1994.

2. Master Hua's Classic of the Central Viscera: Excerpts from a Translation of Hua Tuo's Zhong Zang Jing, by Bob Flaws, American Journal of Acupuncture, Vol. 22, No. 2, 1994.

The material presented in this article is taken from the forthcoming textbook A Manual of Acupuncture.