Chapter 4
Acupuncture Points

Acupuncture Points for Treatment of Shen Disorders

Practitioners of acupuncture are already familiar with the principle points indicated for shen disorders as a result of their basic training in the field as well as information gleaned from a variety of published reports. In addition, within a short time of developing a practice, acupuncturists may come to prefer using certain points based on both theoretical considerations (the meridian affected, the indications for the point, etc.) and prior experience. There are quite a few such points, so the purpose of this chapter will be to examine some aspects of their utilization in China in order to give further insights to practitioners. In modern Chinese reports, treatment of shen is frequently described as treatment of the mind, or even of the brain, but this should not distract from the meaning of shen as spirit, described in Chapter One. Points used for one condition, which might be deemed a spirit disorder, might also be used for another condition, one attributed to a physical brain disorder. Even though the treatments might be the same, it is not necessarily the case that the two disorders have the same underlying basis.

Some acupuncture points were named for their effect on shen disorders, such as shenmen (HT-7), shenting (GV-24), shentang (BL-24), shendao (GV-11), shenzhu (GV-12), benshen (GB-13), and sishensong (M-HN-1). So, these are often included today as part of a treatment based on traditional indications for the points.

In this chapter, following a description of methodology for the source documents (which are Chinese medical journals except one Japanese medical journal reporting on a Chinese source), the acupuncture points of primary interest are laid out in tables. Because of the large number of points mentioned, the reader might easily be overwhelmed by this presentation. Therefore, as a summary to this chapter, 34 key points are laid out in Table 5, grouped according to the meridians.

Researchers at the Zhejiang Academy of Traditional Chinese Medicine undertook an extensive review of traditional medical literature and determined the acupuncture points most consistently relied on to treat disorders of the mind and brain (1). That is, they searched for points (called, in their English translation, "intelligence points") that were repeatedly mentioned in the traditional literature for certain disorders, such as dementia, poor memory, and loss of consciousness.

The authors said that they "read up all the literature on acupuncture before the Ming Dynasty and most of the relevant literature of the Ming and Qing Dynasties, and collected together 29 intelligence points." For each of the major medical texts consulted, the authors present a listing of the points mentioned that are relevant to treating mental conditions. For example, in the Huang Di Ming Tang Jing, the points listed are tianfu (LU-3), lieque (LU-7), neiguan (PC-6), ximen (PC-4), yongquan (KI-1), and youmen (KI-21). They then determined the frequency of mention of the points among all the texts in relation to treating certain conditions (see Table 1), yielding a total of 17 points mentioned in more than one text.

In addition to individual point recommendations, a few acupuncture formulas listed in texts were examined. Frequency of reliance on individual points within the numerous formulas yields a somewhat different result than examining points specifically indicated for mind-brain disorders, since formulas are constructed with main and secondary points as well as adjunctive points. In the prescriptions, the main points mentioned (5 times or more) were shenmen (HT-7), xinshu (BL-15), baihui (GV-20), and lieque (LU-7). Two adjunctive points were mentioned at least 3 times: zusanli (ST-36) and houxi (SI-3).

The International Acupuncture Training Centers and other organizations in China, such as the Academy of Traditional Chinese Medicine, compiled an acupuncture text: Chinese Acupuncture and Moxibustion (2), published in 1987. In the section on zangfu syndromes, there is a series of descriptions for symptoms that are often associated with shen disorders, such as insomnia, poor memory, heart palpitations, manic-depressive disorders, epilepsy, and melancholia. The acupuncture points, which were presented in groups as main points to be selected from, are presented in Table 2.

Shogo Ishino, at the Oriental Medicine Research Center of the Kitasato Institute in Japan, reported on acupuncture treatment for senile psychic disorders (3). As a main source text, he relied on the book Highly Valuable Commentaries on Acupuncture and Moxibustion: Grand System of Medical Classics on Acupuncture and Moxibustion, an encyclopedic collection published in China in 1978. The points mentioned in that text are listed in Table 3.

A Western textbook, A Manual of Acupuncture (4), presents summations of uses of the acupuncture points. It includes an index of symptoms and diseases with the list of indicated points. Table 4 presents the points mentioned in this index for mind-brain disorders (some indications were combined in preparing the table). In a few cases, particularly epilepsy and mania, there were so many points listed in the index that there would be no benefit derived from examining the collection, so a subdivision (e.g., childhood epilepsy from fright) is presented when available.

The commonly mentioned points in the first four tables yields Table 5, which presents the main acupuncture points utilized in treatment of mind-brain disorders. Two "extra points," sishencong (M-HN-1) and yintang (M-HN-3), have become popularized in recent years for treatment of mental disorders though these points received relatively little mention in the literature reviews; they are included in the table to more completely reflect current practice.

While there are only a few points for each of the channels represented, it is evident that there is much emphasis on treating the back (along the spinal column) and head to address mind and brain disorders. A large number of points along the bladder channel and the governing vessel are mentioned in the literature, even if most of those points are suggested only once or twice. The governing vessel continues along the spine over the top of the head, where baihui (GV-20) and sishencong (four points surrounding GV-20) are utilized. This vessel continues over to the face where the extra point yintang is located (between the eye brows) to the end of the channel at renzhong (GV-26). Needling points along the spinal column and on the head, including fengchi (GB-20), may provide a relatively direct means (proximate treatment) of stimulating the central nervous system and affecting the brain.

Points on the arms and legs may well function via different mechanisms than those associated with the spine and head, though it has been suggested that the effects may still be mediated by stimulating regions of the brain, such as affecting the amygdaloid nucleus when neiguan (PC-6) is needled (5, 6). There is a collection of points listed in Table 5 that are located in the interval from the wrist to the elbow, including three pericardium points, two heart points, two large-intestine points, and the main lung point, lieque (LU-7); this grouping extends to the hand with two more pericardium points. Another hand point, hegu (LI-4) is frequently used as an adjunctive point in many modern treatment protocols for these mind-brain disorders. Similarly, there is a group of points on the lower leg, including two kidney points, three stomach points, and two spleen points, and continuing to the foot with the liver points and one more kidney point, yongquan (KI-1). These groupings of points may reflect an ability to stimulate release of certain neural transmitter substances by applying needles or moxibustion to specific peripheral regions of the body. The wrists, hands, ankles, and feet are richly endowed with nerves that transmit fine details as required for hand utilization and mobility (especially over uneven terrain). Of the points listed in Table 5, very few points (e.g., two conception-vessel points on the abdomen and tianfu (LU-3) on the upper arm) seem to diverge from the pattern of treating the spinal column and head or treating the distal portions of the limbs.

Table 1: Frequency of mention of an acupuncture point for the listed condition in the comprehensive collection of traditional texts examined by the researchers in Zhejiang (1). The points are listed according to total number of references, in descending order (23 references for baihui for two disorders to only 2 references for dazhong for one disorder).

Table 2: Main points listed for treatment of specified disorders in Chinese Acupuncture and Moxibustion.

Table 3: Points listed in Highly Valuable Commentaries on Acupuncture and Moxibustion for selected disorders. The points in the text were differentiated according to whether the treatment should be acupuncture or moxibustion or both, but this distinction is not presented here.

Table 4: Points listed for each of the specified disorders in the index to A Manual of Acupuncture. Chinese point names (pinyin) are not included due to large number of points listed.

Table 5: Summary of 34 main points relied on for mind and brain disorders. The indications presented here are from A Manual of Acupuncture, selecting only those conditions associated with mind and brain disorders. To be listed in the table, the point had to be mentioned frequently in the literature cited above (1-4) and/or in the medical reports (described in Chapter 5), and indicated for several types of mind and brain disorder. taichong (LV-3) was added to reflect modern applications of the point now often used in place of xingjian (LV-2); similarly fengchi (GB-20) was added to this table because of the high frequency of its use in modern practice. Some of the points, such as sanyinjiao (SP-9) and zusanli (ST-36) are mainly added for tonification therapy, rather than being chosen for specific effects on mind and brain disorders. Other adjunctive points sometimes employed in formulas, such as the hand points hegu (LI-4) and houxi (SI-3), are not included in the table because they have few indications for mind and brain disorders and are not mentioned in the traditional literature in that context, though they are used in modern practice.

References

1. Chen Yongcan and Yang Meiling, Literature research on screening of the nucleus acupoints for treating of intellectual disturbances, Journal of Traditional Chinese Medicine 1999; 19(2): 83-88.
2. Cheng Xinnong (chief editor), Chinese Acupuncture and Moxibustion, 1987 Foreign Languages Press, Beijing.
3. Shogo Ishino, Treatment of senile psychic disorders with acupuncture and moxibustion, International Journal of Oriental Medicine, 1999; 24(3): 149-154.
4. Deadman P and Mazin AK, A Manual of Acupuncture, 1998 Journal of Chinese Medicine Publications, East Sussex, England.
5. Lai Zhongfang, Effect of electro-acupuncture of neiguan on spontaneous discharges of single unit in amygdaloid nucleus in rabbits, Journal of Traditional Chinese Medicine 1989; 9(2): 144-150.
6. Lai Zhongfang, Role of amygdaloid nucleus in the correlation between the heart and acupoint neiguan in rabbits, Journal of Traditional Chinese Medicine 1991; 11 (2): 128-138.
7. Gu Shizhe, et al., Four acupuncture methods for treating mental disorders, Journal of Traditional Chinese Medicine 2001; 21(3): 207-210.

APPENDIX: General Methods of Acupuncture Treatment for Mental Disorders

At the Beijing University of Traditional Chinese Medicine, a group of acupuncturists described the basic approach to mental disorders by dividing the treatment strategies into four categories (7). One of these is psychological intervention, mainly talking over an appropriate view of life situations; this can be accompanied by acupuncture points used to calm the mind. Another method was treating the root and manifestation (ben and biao) aspects of internal disharmonies relying on body points, particularly those meeting points as the shu, yuan, luo, he, and xi points. A third type involved enhancement of the zangfu functions, and regulating the ascending and descending qi; among the recommended points were taichong (LV-3) and neiguan (PC-6) that are commonly selected for mental disorders. The most specific therapy, though, was use of points mainly on the head, with particular attention to the Governing Vessel points (from GV-14 through GV-24), sishenshong (M-HN-1), and the Gallbladder Vessel points shuaigu (GB-8) and tianchong (GB-9). These methods, and some of the sample points suggested for treatment, are outlined in the table below.

Table 6: Four Acupuncture Methods for Mental Disorders.