ACU 3 - June 6: Extraordinary Channels and Confluent Point Regulation

Practical Study Advice and Point Recognition Practice

• Picture Books and Point Recognition:

  • The transcript references picture books from ACUE 1 and 2, which are located in the attachment section at the back of the textbook (not included in standard page counts).

  • These pictures contain numbers but do not list point names. They are intended for practicing point recognition.

  • Study Tip: Students should practice on a separate piece of paper rather than writing directly on lecture notes to allow for repetitive, rote practice.

• Anatomical Landmarks for Vertebrae Identification:

  • Thoracic vs. Lumbar/Cervical: An easy way to identify thoracic vertebrae is the presence of attached ribs. This helps in locating specific points like $T_1$ and $T_{12}$, which are essential for the Du channel and the outer bladder channel on the back.

• Clinical Priority of Specific Points:

  • High Priority: Five Shu points ($Jing$-well, $Ying$-spring, $Shu$-stream, $Jing$-river, $He$-sea), $Yuan$-source points, $Luo$-connecting points, $Xi$-cleft points, and Confluent points.

  • Lower Priority: Coalescent points (cross points) are considered lower priority as they are less consistently identified across different sources and used less frequently in general practice.

Theoretical Framework of Eight Extraordinary Channels

• Origins and Constitutional Level:

  • The Ren, Du, and Chong channels all originate in the lower abdomen (specifically tracing back to the Kidneys and Uterus).

  • Because they originate from the Kidneys and are tied to the Pre-heaven Essence, they are used to affect a patient's energy at a deep, constitutional level.

• The Three Key Reservoirs:

  • Ren Mai: The "Sea of Yin."

  • Du Mai: The "Sea of Yang."

  • Chong Mai: The "Sea of Blood," "Sea of the 12 Regular Channels," and "Sea of the Five $Zang$ and Six $Fu$ Organs."

• Paired Regulation by Polarity:

  • Extraordinary channels are grouped in pairs to treat specific body areas:

    • Ren Mai ($Lu\,7$) + Yinqiao Mai ($Kd\,6$): Abdomen, chest, lungs, throat, face.

    • Du Mai ($Si\,3$) + Yangqiao Mai ($Ub\,62$): Back of the legs, back, spine, neck, head, eyes (inner canthus).

    • Chong Mai ($Sp\,4$) + Yinwei Mai ($Pc\,6$): Inner aspect of the legs, abdomen, chest, heart, stomach.

    • Dai Mai ($Gb\,41$) + Yangwei Mai ($Sj\,5$): Outer aspect of the legs, sides of the body (hypochondrium), shoulders, side of the neck.

Selection Methods for Confluent Points

• Method 1: Opening Point Only:

  • Needle only the confluent point of the specific channel (e.g., $Lu\,7$ for Ren Mai) bilaterally.

• Method 2: Opening and Coupled Points Bilaterally:

  • Needle both the opening (confluent) point and its coupled pair (e.g., $Lu\,7$ and $Kd\,6$) on both sides of the body.

  • Total of $4$ needles.

  • Recommended when regulating the extraordinary channel is the primary focus of the entire treatment.

• Method 3: Crossover (One Point Each Side):

  • Needle the opening point on one side and the coupled point on the opposite side.

  • Total of $2$ needles.

  • Clinical Preference: Commonly used in North America for patients with weaker constitutions, children, the elderly, or anxious patients, as it provides effective regulation with less stimulation.

• Method 4: Unilateral (Same Side):

  • Needle both the opening and coupled points on the same side of the body.

  • Total of $2$ needles.

  • Indication: Best for strictly one-sided issues (e.g., unilateral back pain, shoulder pain, or sequelae from a stroke).

• The Principle of Needling Order:

  • To effectively "open" or activate the functions of a channel, one must needle the Opening Point (the confluent point of the target channel) FIRST, followed by the Coupled Point (the confluent point of the paired channel).

  • Example: To treat the Ren Mai, needle $Lu\,7$ then $Kd\,6$. This distinguishes the treatment from a Yinqiao Mai treatment (which would needle $Kd\,6$ then $Lu\,7$).

• Gender-Based Crossover Rule (Method 3):

  • Females: Open on the RIGHT side, couple on the LEFT side.

  • Males: Open on the LEFT side, couple on the RIGHT side.

  • Note: This is a basic clinical guideline, but practitioners should remain flexible based on local symptoms or available points.

The Ren Mai (Conception Vessel)

• Key Statistics & Markers:

  • Opening/Confluent Point: $Lu\,7$ (Lieque).

  • Coupled Point: $Kd\,6$ (Zhaohai).

  • Starting Point: $Ren\,1$ (Huiyin).

  • Luo-Connecting Point: $Ren\,15$ (Jiuwei).

  • Body Areas Influenced: Abdomen, chest, lungs, throat, face.

• Primary Functions:

  • Sea of Yin Channels: Regulates all internal Yin channels. Nourishes Yin and clears empty heat (e.g., menopause, night sweats, anxiety).

  • Uterus and Menstruation: Essential for reproductive health in women (puberty, fertility, pregnancy, childbirth). It transforms Kidney Essence into $Tian\,Gui$ (menstrual blood/fertility essence).

  • Life Cycles: Regulates the $7$-year cycle in women and $8$-year cycle in men.

  • Qi Movement: Promotes descending of Lung Qi and the Kidney's function of receiving Qi (treats asthma/shortness of breath).

  • Fluid Metabolism: Regulates the San Jiao (Triple Energizer) to transport and excrete fluids (treats edema/urinary disorders).

  • Membranes ($Gao$) and Fat Tissue ($Huang$): $Ren\,6$ is considered the "Source Point of the Membranes."

  • Male Genital System: Equivalent to the uterus in men, influencing the prostate and seminal fluid production.

The Du Mai (Governing Vessel)

• Key Statistics & Markers:

  • Opening/Confluent Point: $Si\,3$ (Houxi).

  • Coupled Point: $Ub\,62$ (Shenmai).

  • Starting Point: $Du\,1$ (Changqiang).

  • Luo-Connecting Point: $Du\,1$ (starts there and spreads on the back).

  • Body Areas Influenced: Spine, back, back of neck, head, brain.

• Primary Functions:

  • Sea of Yang Channels: Tonifies Kidney Yang and the "Gate of Life" ($Ming\,Men$) fire to warm the body and internal organs.

  • The Spine and Brain: Strengthens the back and nourishes the brain/marrow. Marrow is sourced from Kidney Essence and fills the brain ($Sea\,of\,Marrow$).

  • The Mind ($Shen$): Connects to the Heart, Brain, and Kidney. Used for mental-emotional disorders (depression, anxiety, lifting the spirit via $Du\,20$).

  • Wind (Interior and Exterior): Expels exterior wind (fever, stiff neck) and extinguishes interior wind (tremors, dizziness, stroke sequelae).

  • Lifting Function: Lifts sinking Kidney Qi (treats organ prolapse, excessive menstrual bleeding, or urinary incontinence).

  • Male Reproductive Health: Essential for the warming and mobility of sperm; relates to erectile function.

The Chong Mai (Penetrating Vessel)

• Key Statistics & Markers:

  • Opening/Confluent Point: $Sp\,4$ (Gongsun).

  • Coupled Point: $Pc\,6$ (Neiguan).

  • Starting Point: $Ren\,1$ (or lower abdomen/uterus).

  • Body Areas Influenced: Abdomen, uterus, chest, heart, stomach, inner leg, big toe.

• Primary Functions:

  • Sea of Blood: Controls the blood of the uterus and the regular 12 channels. Regulates the menstrual cycle (menses is a form of $Tian\,Gui$ derived from Essence and Blood).

  • Connection of Pre-Heaven and Post-Heaven: Connects the Kidney ($Pre-Heaven$) with the Stomach/Spleen ($Post-Heaven$) at $St\,30$ ($Qi\,Street$).

  • Rebellious Qi and Internal Urgency: A special pathology characterized by anxiety, restlessness, and a sensation of Qi rushing upward from the abdomen to the chest or throat ("Running Piglet" Qi).

  • Blood and the Heart: Influences heart rhythm and blood flow. It connects the Heart and Uterus via the "Uterine Vessels" ($Bao\,Mai$). This explains why emotional stress/Heart issues can cause menstrual irregularities.

  • Circulation to the Feet: Sends Qi and Blood to the lower limbs. Pathology manifests as cold feet, numbness, or "Restless Leg Syndrome."

  • Ancestral Muscle ($Zong\,Jin$): Runs through the rectus abdominis; deficiency results in slackness, uterine prolapse, or atrophy of the legs.

Questions & Discussion

• Q: When is the practicum midterm and quiz?

  • A: The midterm is scheduled for July $11$, Quiz $2$ is July $25$, and the Final Exam is August $8$. These dates are subject to progress but are the current plan to ensure students have ample practice before the final.

• Q: Which side do you needle first for Method 3 (Crossover)?

  • A: You always needle the Opening (Confluent) Point of the channel you are treating first. For a female, this is on the right side. For a male, it is on the left side. The Coupled Point is needled second on the opposite side.

• Q: Can we use moxa on $Du\,20$?

  • A: Practically, $Du\,20$ is often considered contraindicated for moxa due to the presence of hair and fire hazard. However, some books and devices allow for protected moxibustion. For safety and exams, follow the caution that hair-bearing areas should generally not receive direct moxa.

• Q: Why use the extraordinary channels instead of the regular 12?

  • A: While regular channels affect the Qi and Blood of their specific meridians, the extraordinary channels act as a reservoir. For Ren, Du, and Chong, using the confluent points is often more powerful for constitutional, deep-seated, or chronic issues than using a regular coalescent point (which may have only local effects).