Root Treatment Strategies II – Cross & Mixed Yang (Yoshio Manaka)

Cross Strategy (Chong Mai + Dai Mai)

Core Idea

• Combination of two Extraordinary Vessels (EVs):
  • Chong Mai (opening/luo: \text{SP4} \rightarrow \text{PC6})
  • Dai Mai (opening/luo: \text{GB41} \rightarrow \text{TW5})
• Nick-named “Cross” because the two EV pairs intersect at the umbilical level, influencing both vertical (Chong) and horizontal (Dai) axes of Qi/Blood circulation.
• Devised by Yoshio Manaka as part of his Root Treatment Strategies II.

Major Actions / Clinical Rationale

• Harmonises longitudinal (core) and transverse (belt) Qi flows.
• Strongly moves Blood → primary choice for patterns with Blood stasis or Blood deficiency (especially involving SP & LV).
• Regulates connection between upper & lower body; left–right imbalances; internal–external dynamics.

Typical Signs & Symptoms

• Gynaecological disorders (menses, fertility, fibroids, endometriosis).
• Digestive complaints – particularly intestinal: IBS, chronic constipation, Crohn-like presentations.
• Sciatica (esp. L-sided), hip & low-back pain.
• Liver pathology: hepatitis, LV Qi or LV Blood issues.
• Shoulder pain, frozen shoulder.
• Head/Ears/Eyes/Nose/Throat complaints, predominantly left-sided.
• Any condition with demonstrable or suspected Blood stasis.

Diagnostic Reflex Zones

• MUST palpate both pressure–pain AND tension; ≥ 1 of the following should be positive:
  • Right subcostal region (LV/GB area).
  • Left ASIS (anterior-superior iliac spine).
  • Left ST25–ST27 line (periumbilical).
• Always palpate the relevant Mu points for the EVs to confirm pattern.

Primary Needle Prescription

• Needles retained 10–30 min.
• No change in reflex? → re-check: point location, polarity, needling direction, or the diagnosis itself. Persistence may = poor prognosis.

Back-Shu Reinforcement

• Select 2 points with the greatest pressure, pain, or tightness (always include BL18 because of LV–Blood link):
  • \text{BL18 (T9)} – Liver (ALWAYS)
  • \text{BL19 (T10)} – Gall Bladder
  • \text{BL20 (T11)} – Spleen
  • \text{BL22 (L1)} – Triple Warmer
• Retain ≤ 10 min.
• Optional moxa:
  • 3–5 Okyu to base of needle, or
  • 1–3 Chinetsukyu, or
  • 1–3 Ibuki cones at each needle.
• Caution: No perpendicular needling above BL25 (risk of pneumothorax).

Mixed Yang Strategy (Du Mai + Dai Mai)

Core Idea

• Addresses “mixed” Yang disorders—conditions involving simultaneous vertical (Du) & horizontal (Dai) Yang channel dysfunction.
• Especially useful for whiplash, post-traumatic spinal/hip problems, and complex axial misalignments.

Vessel Pairing

• Du Mai: opening/luo \text{SI3} \rightarrow \text{BL62}
• Dai Mai: opening/luo \text{GB41} \rightarrow \text{TW5}
• Four-needle chord (bilateral) → 4 polarities create strong Yang resonance.

Key Clinical Presentations

• Musculo-skeletal
  • Arthritis of spine or hips; sacro-iliac pain; tail-bone injuries.
  • Restricted neck rotation, flexion, extension; occipital headaches.
  • Shoulder/neck tension (esp. GB/SI trajectory).
  • Hip pain; sensation of cold or pain in low back.
• Neurological
  • Neuralgia along Du or GB channels.
  • Dizziness, speech disorders secondary to cervical involvement.
• Systemic
  • Chronic fatigue when rooted in structural Yang disharmony.

Diagnostic Reflex Zones

• At least 1 positive finding from each category:
  1. ASIS (ant. hip crest) – Dai reflex.
  2. \text{GB24} – front-Mu of GB.
  3. Periumbilical area: ST25/ST26; KD11.
  4. Posterior: Dai line (L2), PSIS, \text{SI9–10}, bilateral sides of cervical spine.
• Confirm with Mu points of both EVs when unclear.

Primary Needle Prescription

• Needles inserted bilaterally (total = 8 needles) and retained 10–30 min.
• If reflex zones persist → re-evaluate technique or diagnosis; persistent findings may indicate guarded prognosis.

Back-Shu Reinforcement

• Choose 2 reactive points.
  • \text{BL19 (T10)} – GB Shu.
  • \text{BL22 (L1)} – TW Shu.
  • \text{BL27 (1st Liao)} – SI Shu.
  • \text{BL28 (2nd Liao)} – BL Shu.
• Retain ≤ 10 min.
• Moxa options identical to Cross protocol; again no perpendicular needling above BL25.

Comparative / Integrative Notes

• Blood vs. Yang Emphasis: Cross targets Blood (SP/LV) stagnation; Mixed Yang focuses on Yang channel integrity & axial realignment.
• Laterality: Cross treatment is asymmetrical (R SP4/PC6, L GB41/TW5) reflecting observed left-right presentations. Mixed Yang uses bilateral symmetry to correct whiplash-type torsions.
• Reflex Resolution Rule: In both strategies, disappearance or softening of abdominal/hip/cervical reflexes is the gold-standard indicator of correct root treatment.
• Integration with Previous Lectures: Mirrors Manaka’s principle of pairing EVs by complementary polarity to shift deep constitutional patterns rather than merely relieving symptoms.
• Ethical/Practical Implication: Careful palpation and strict needling depth respect patient safety (no perpendicular insertion near thoracic cavity); need to inform patients about prognosis if reflexes stubbornly persist.