Acupuncture v herbalism

[michael]

Exactly what i was getting at in my last post Paddy! Your rationalisation of CV21 makes perfect sense, but was it originally used with ANY rationale behind it? We accept that a point works, and because of our training we can make sense of why, but from what I can tell it wasn't always described or thought of in such depth. Maybe it was only recently that people started to look individually at these points in combos.
Someone with a more in depth knowledge of the history of all this would help here.

The way some of the classics set out point combinations is very similar to the way formulas are transmitted classically- a simple collection of signs and symptoms, then what to use. The Shang Han Lun and the Golden cabinet are set out like many classical point formula books; for sweating, dizziness, and great heat that does not recede, use... bla bla insert points or herbs.

I'm just curious (and I don't mean to sound condescending ) Paddy, on what basis do you select your points? Do you use classical formula, or point function according to five phase/shu theory? Reading your posts I am just a little confused? To use the current example, if someone had food stagnation, would you use CV21 and ST36, or would you substitute or add SP3? Just curious

[Dale]

I agree with Michael on this, and feel that it extends to many modern day texts also.
Most (engilish translations of) chinese books that I have read on acupuncture offer little, if any, explaination of why certain points work or why certain points are chosen. A modern example of this can be seen in the book Chinese Acupuncture and Moxibustion** which describes CV 21 as being used for:
" Indications: Pain in the chest, cough, asthma"
and ST 36 for:
"Indications: Gastric pain, vomiting hiccup, abdominal distension, borborygmus, diarrhea, dysentry, constipation, mastitis, enteritis, aching of the knee joint and leg, beriberi, edema, cough, asthma, emaciation due to general deficiency, indigestion, apoplexy, hemiplegia, dizziness, insomnia, mania."

This book offers no rationale and suggests to me that it is taking a more traditional view of acupuncture and describing the points uses in terms of how they move Qi and Blood.

We can theorise till the cows come home about why the Chinese don't tend to offer rationale for their point selections in their literature but that will get us nowhere. I personally welcome the modern herbal type descriptions of acupoint functions as long as it is all thought about thoroughly.
As Michael was describing CV 21 may well be indicated for Food Stagnation, but we don't know if this is the case in all instances or only when an appropriate point combination is used.
Deadman seems to base the point functions on classical formulae, which is logical, but do the points work in isolation the same as they do in a formula? Herbs don't, so why should acupoints?

I personally feel that, as CV 21 is not listed in the classic texts as being able to treat Food Stagnation on it's own then it's inclusion in the combination with ST 36 is most likely due to it's ability to alleviate pain in the chest. The symptoms of Food Stagnation include chest pain or discomfort, so ST 36 treats the majority of the symptoms and CV21 helps by relieving the chest pain.

I think that it is important to consider why the points work from both a traditional Qi and Blood moving view as well as how this relates to the more modern 8 methods type approach... we are, after all, practising holistic medicine, it should theoretically all make sense!


Respectfully,
Dale Elsdon

Cheng, X. (1987) Chinese Acupuncture and Moxibustion. Foreign Languages Press, Beijing.

[paddy]

Nothing much to add, except that I think that these sorts of enquiries are absolutely necessary if we are to have any sort of a clue about what we're doing.

To answer Michaels question, I've never used CV21 for food stagnation, I was just trying to figure out how it may be effective when combined with St36 for those symptoms. I guess I may use it if there was some imbalance between the Lungs and Stomach stopping the Stomach qi descending and a lot of upper body tension. As the Spleen makes the qi rise I don't think CV21 would have the same effect in combination with Sp3 even though it's similar to St36 in a 5 phase context. The point is that I don't think they work in isolation so ascribing functions to individual points seems problematic.
I tend to base my point selection around channel connections, and movements through the 5 phases.

[Sue Cochrane]

This is a query to Carole who said acupuncture was an elite practice and herbalism itinerant. I was wondering what your source is? In Charlotte Furth's book The Flourishing Yin she basically argued the opposite - acupuncture was often practised by women and people who did massage (ie. lower status in imperial China) and the literati educated upper class developed and practised herbs. I have come across a discussion of 2 traditions in herbalism ( and met the reality in China) of itinerant peasant herbalists and the intellectuals like Zhang Zhong-Jing and Li Shi-Zhen. I remember well sitting in a back alley of Chengdu as my landlady consulted a barely literate farmer who had brought fresh herbs into the city that morning and consulted by sitting at a distance, not touching the patient and then bundling up some fresh herbs(complete with soil clinging to them) and sending her away. My landlady got severe diarrhoea from her herbs and saw this as a successful treatment - she belonged to the 'detoxing liver' school of Sandra Cabot!!

Can I declare myself a dedicated herbalist in this forum?!
regards
Sue

[Carole Rogers]

My source is Prof. Unschuld's lecture series in Sydney several years ago. He is a classical scholar of Chinese with a special interest in Chinese medicine - especially herbs. He translated one of the earliest texts to mention herbal practise in China - the name of which escapes me but I am sure Warren Cochran would know. It described the methods of attracting a village crowd to come to listen to the 'sales pitch' of the visiting herbalist - all rather like the snake oil salesmen of the old West. This is not to say that in later years herbalism did not attract very well educated scholars as you mention.

Unschuld also discussed the development of acupuncture among the literati and how it was practised among family and friends. Again this is not to say that it was not subsequently taken up by the general population and eventually, early last century, offered on street corners in Hong Kong and elsewhere. It was so debased that acupuncture in China was banned under the rule of the Kuomintang. Mao would have got rid of all Chinese medicine - both herbs and acupuncture in his efforts to modernise China, but the acute shortage of western trained medical staff forced him to introduce and utilise the Bare Foot Doctors and necessity was turned into a virtue by the spin doctors.

Tension still exists in China between Western and Chinese medicine - something that visitors are unlikely to see displayed openly. My source for that information is some high level government officials in China - as well as very confidential talks with Presidents of Chinese TCM universities. Rivalry exists in all walks of life - it is not just a phenomena of western society.

I think being dedicated to herbs and/or acupuncture is great - and should be encouraged. Sadly there often seems to be some sort of 'one-up-man-ship' between these two areas of Chinese medicine and this is self defeating if we want to present a united front to the rest of the world. Acupuncture would be poorer without Chinese herbs and Chinese herbs would be poorer without acupuncture. Let's support each other.

[yinyangthang]

Just getting back to the St21 st36 debate regarding food stagnation; I've always found that in texts like Deadman, the actions of the points are more helpful than the indication/combination sections. if we are going to talk about acupuncture being more about the state of qi and xue, then the actions will provide us with that information.

St 21 harmonizes the middle jiao and transforms stasis, so obviously it treats food stagnation by itself. But what is the underlying cause of the food stasis? Maybe we've just had Xmas lunch and over-indulged - st21 may be enough. But if it due to Sp/St xu, then St21 will not be enough as it doesn't tonify the earth. st 36 is a good choice as it tonifies the earth while also harmonizing the stomach. sp3 could work too, but maybe isn't as good a choice as it pertains more to the zang than the fu. If we were to add a spleen point, sp4 may be better, due to it being a luo pt.

This is very similar to how a herbal formula is developed, and is still using an understanding of the points from an energetic point of view. Even classical herbal prescriptions are not set in stone, and are adapted to the individual patient; herbs are added due to their actions and energies (hot/cold, flavour, direction, channel, etc), and formulas can be adjusted by using targeting herbs to lead the other more general herbs to act upon a certain area (eg. jie geng leads other herbs to the lung). How is that different to combining GB34 with different points to move liver qi in different areas (eg gb34 with ren 6 to move qi in lower jiao, with ren12 to promote qi flow in stomach)?

Sure, 5 element acupuncture and CHM are coming from different angles, but they are not antagonists. (Lonny S jarrett is an example of a 5 element acupuncturist who is willing to delve into the energetics of herbs).

As an acupuncturist who has only recently found an interest in herbs, I've found that my original view of CHM as almost allopathic to be severely uninformed. I've also found that it has enhanced my differential diagnosis skills, which has, in turn, improved my acupuncture treatments.