1996年第4回世界鍼灸学会連合会学術大会 (ニューヨーク大会)

4. HA.

The symptoms are joint redening and swelling with heat feeling, fever, thirsty, relieved by cold. The tongue is red and dry, the coating is yellow and the pulse is rapid. The treatment methods are cleaning away the heat, dredging the collaterals, shallow needling without needle retention (reducing). The points selected are Dazhui (GV 14) and Quchi (LI 11) (heat-removing cool-producing needling).

Ｇｒｏｕｐ　２
The endogenous include:
1. DQB.

The symptoms are worsened by overworking. The patients present thin and weak constitution, dim complexion, pale lips and hands, dyspnea, dislike to speaking, dizziness, spontaneous perspiration. The tongue is pale and delicate, the coating is thin and the pulse is thready, weak, deep and small. The treatment methods are supplimenting the qi, nourishing the blood, needling or moxibusting(reinforcing). The points selected are Qihai( CV 6 ) and Zusanli (ST 36).

2. BS.

The symptoms are stabbing pains. The tongue is purblish with attack, history of injury, etc.

In inspection, deformity, swellings, edema, etc should be observed, and tenderness, cold, heat, etc should be diagnosed by pulse-feeling and palpation. In addition, tongue-inspecting, abdomen-palpating, and pulse-taking are of importance as well. According to the differentiation of the Eight Syndromes, namely yin and yang, exterior and interior, cold and heat, deficient and excessive syndromes, tongue-inspecting is used to differentiate the viscera, channels and collaterals, qi and blood(qi and blood deficiency and blood stasis), stagnation of phlegm, etc. According to the reactions of the Mu point, abdomen-palpating is used to diagnose the conditions of the viscera. According to the six pulses, namely superficial, deep, slow, rapid, weak, substantive pulse, pulse-taking is used to select needling manipulations, and through the pulse at six locations of Cun, Guan and Chi, to diagnose the abnormality of the viscera and channels.
According to the above diagnostic items, the authors determined which disease each patient had and which channel the disease belonged to.
For instance, if a patient has an ice-cool feeling and tenderness in the left lateral Xiyan( Extra 32) (Tupi). The tongue is dark and damp, and the pulse is slow. The disease may be diagnosed as DA with BS belonging to the Stomach Channel. The treatment method should be warming the channels, dispelling the cold, dredging the channels, promoting Qi flow and blood circulation. Needle retention and moxibustion could obtain better results.

Ｔｈｅ　ｔｈｅｒａｐｅｕｔｉｃ　ｏｒｄｅｒ　ｉｎｃｌｕｄｅｄ：
Step 1.

Abdomen-palpating should be made to observe the reactions of the Mu point, and then this method and the Five Shu points of hand and foot should be used for the treatment because they can improve the conditions of abdomen, such as tenderness, scleroma, abdominal distension, depression, cold and heat feeling, etc.

Step 2.

Insert the needle into Zhongwan( CV 12 ), the Mu point of the Stomach Channel as the lateral Xiyan ( Extra 32 ) belongs to the Stomach Channel, retain the needle and add moxibustion after the improvement of the pains, tenderness and cold feeling, Retain the needle in Zusanli ( ST 36 ) for 20 or more minutes as to dredge channels better.

Step 3.

The patient is told to take a prone position. Then, Weishu ( BL 21 ), the Shu point of the Stomach Channel, is punctured after the pain location is affirmed. The knee is once more flexed to the confirmed angle. At that time, the significant improvement of the pains can be confirmed in comparison with the pre-needling. In case of tenderness and seleroma in Yingu ( KI 10 ) of the medial knee fossa due to severe cold, Shenshu( BL 23 ) should be punctured and moxibusted. Moreover, acupuncture of Xuehai ( SP 10 ) and Geshu ( BL 17 ) functions to promote the qi flow and blood circulation and thus produce better results.

Cａｓｅ　１． ( CA, DA and BS )

male and 25 years old, was a staff member and made the first visit on January 25,1996.
He complained of the pains in the right anterior medial and lateral knee after being tripped by a skis. One week after his knee injury, the pains were exacerbated and his walking became difficult. He received tap and blockade in a hospital but the pains were still too severe to put the foot on the ground and to go down on his knee and sit. The pains became worse at night.
Finding in the First Visit. In recent years, his body weight increased by 8 kg, his stature was medium and became slightly fat. In feeling the knee, ice-cold could be felt, and edema could be found near the right Liangqu ( ST 34 ). The tongue was dark-red, the coating was white and a little thick with fissures and the pulse was irregular. Obvious tenderness was found in Qimen ( LR 14 ), Zhongwan ( CV 12 ) and Zhangmen ( LR 13 ) in the abdomen and the medial and lateral Xiyan ( Extra 32 ), Liangqiu ( ST 34 ) and Yingu ( KI 10 ) in the knee.
Since they belong to the Stomach and Spleen Channels in the anterior medial and lateral knee, the pains were diagnosed as gonarthragia due to the accumulation of the blood stasis caused by CA and DA of the Stomach and Spleen channels. Therefore, it was treated by warning and dredging the channels, dispelling the cold and promoting diuresis, qi flow and blood circulation.
Taichong( LR 3 ), Taibai (SP 3 ) and Zusanli ( ST 36 ) were needled with reducing, reinforcing and reducing method, respectively as to remove the abdominal reactions. Then, Zhongwan( CV 12 ), the Mu point of the stomach, and Zhangmen( LR 13 ), the Mu point of the spleen, were needled as to remove the pains and tenderness in the knee, the needles were retained in Yinlingquan( SP 9 ) and Sanyinjiao( SP 6 ) with diuretic function, and Zhangmen ( LR 13 ) and Zhongwan( CV 12 ) were moxibusted as to warm the knee. Finally, the patient was told to take a prone position and flex the knee, and the pains were examined. When the knee was flexed to 90°, the pains reappeared. As the tenderness still existed in Yingu( KI 10 ), Weishu ( BL 21 ), Pishu ( BL 20 ) and Shenshu ( BL 23 ) were needled. After that, the extension and flex ion of the knee became easy and the pains disappeared.
After treatment, the patient could make his successful walking. He was cured after 8 sessions with the same method. The one-year follow-up showed no recurrence.

Case Discussion. In our opinion, the pains from the blood stasis produced by traumatic injures appears gradually. Generally, injuries belong to trauma and are not related directly to the visceral functions, and good results could be obtained by oppositing and contra lateral needlings. However, injuries in some difficult cases may be related to the visceral functions. The dark-red tongue belongs to blood stasis, the fissures belong to water stagnation and the white coating belongs to the hypofunction of the stomach and intestines. So, the treatment by Shu and Mu points could improve the visceral functions and thus cure the disease rapidly.

Ｃａｓｅ　２　( DA and HA )

female and 59 years, was a cooker and made her first visit on March 12, 1996.
She complained of pains, swellings and heat feeling in her anterior medial knee. Four-five years before, she had had the pains in the knee as the spring came. Some therapies, such as wet dressing, analgesic, hot-spring and other therapies, failed to cure the pains. However, the pains disappeared during season exchange. The last attack began in the first ten days of March, 1996.
The findings in the first visit included slight obesity, red complexion, and herpes in her lips. She had frequent micturition, thirsty, and much drinking due to her diabetes and cystography and itching in her gastrochemius muscle. The tongue was reddish, the coating was yellow and the pulse was rapid.
Since there was tenderness in the right Qimen( LR 14) in the abdomen and the site was located near Ququan ( SI 13 ) of the Liver Channel and the medial Xiyan ( Extra 32 ) of the Spleen channel, the disease was diagnosed as DA and HA of the Liver and Spleen Channels. It was treated with cleaning away the heat, promoting diuresis and dredging the channels but without needle retention and moxibustion.
This method ( contacted needles used in Xingjian ( LR 12 ) and Dadu ( SP 2 ) ) could improve the abdominal conditions. Qimen ( LR 14 ), the Mu point of the spleen, were horizontally punctured with heat-cleaning-away cool producing needling as to alleviate the heat feeling and pains of the knee. Then, Sanyinjiao ( SP 6 ) was punctured to promote diuresis and Hegu ( LI 4 ) was punctured to clean away the heat. The flex ion limit of the knee was observed with the patient in a prone position. After the horizontal puncture of Ganshu ( BL 18 ) and Pishu ( BL 20), the patient was told to flex the knee once more as to confirm the improvement of the knee conditions. Finally, Dazhui ( GV 14 ) and Quchi ( LI 11 ) functioning to clean away the heat were punctured. After treatment, the heat disappeared and the walking became successful.
The second visit was made on March 14, 1996. The knee was cured, the itching in the gastrocnemius muscle and the herpes in her lips became improved. The times of nocturia decreased from 3 to 0. The follow-up to now shows no recurrence.

Case Discussion.

The attack of patient's disease used to occur in the spring, which may be imputed to WA of the liver. However, WA had disappeared in the first visit and the disease was becoming from cold and damp to damp and heat. The patient was sensitive to the inroads of wet-evils because of her profession. All of the red tongue, yellow coating and rapid pulse were the manifestations of heat syndrome. Therefore, the treatment of the patient by cleaning away the heat and promoting diuresis could improve the symptoms.

ＤＩＳＣＵＳＳＩＯＮ

This method was used to treat 600 cases of gonarthrosis ( 186 males and 414 females : age range : 10-87 years and average : 12 years ). The times of treatment ranged 1 - 61 and averaged 12 . The results were cured in 71 %, improved in 27% and ineffective in 2%.
In view of composite types separated, the rates of syndromes-differentiating types arranged in the following order : cold in 53%, blood stasis in 47%, damp in 32%, deficiency of both qi and blood in 28% and heat in 21%. In view of composite types, they arranged in the following order : cold and blood stasis in 22%, cold and damp in 11%, damp and heat in 7%, cold and damp and blood stasis in 4%.
In view of the channels including composite types, the rates arranged in the following order : Kidney Channel in 63%, Spleen Channel in 52%, Stomach Channel in 49%, Liver Channel in 41%, Urinary Bladder Channel in 14%, Gallbladder Channel in 3% and Tri-jiao Channel in 1%.
Selecting points via Shu and Mu acupoints has an advantage in confirming the therapeutic effects immediately after the insertion of needle, that is, in inquiring about the patient's changes in tenderness and pains during acupuncture and making the corresponding or aiming-at treatment at the same time. Besides, the swelling and edema could be remarkably improved after treatment.
Shu and Mu acupoints are commonly used to treat not only the diseases of the viscera but also ones of the tissues and organs related to the viscera with quite good results. At the same time, that is also an application of the theory that Shu and Mu acupoints could produce therapeutic effects on the diseases related to the channels. This is the results of the regulation of the visceral functions and the related-tissues-organs diseases by Shu and Mu acupoints. Eight years ago, we began to use Shu and Mu acupoints in the treatment of gonarthrosis and obtained satisfactory results in the treatment of the diseases of other motion organs.
The advantage of acupuncture medicine lies in comprehensively grasping the etiology and pathology and keeping prevention and treatment consistent. It was believed that it is the medicine that can make contributions to mankind health, not rigidly adhering to the local but taking aim-at-whole as a therapeutic means. It will benefit more and more people in the future.