Five-Phases Acupuncture

 Akabanis

0.  Introduction

This is a technique invented by Dr. Akabanè (“Red Feather”) who discovered that a source of heat through a sequence of time can give a relative idea of the balance between the left and right external branches of a meridian.

Since all Jing-meridians are bilateral, the akabani test allows to determine the balance of flow of energy between Right and Left.  It is both a diagnostic tool and a treatment.  It can show up as pain or ache in one side, an “off center” feeling, and, most important, after accidents or operations.

1. Technique

The Jing-well point of each meridian is tested for heat sensation with a lighted incense stick.  The stick is either slowly and consistently moving above the point or stays motionless above the point until the patient says “hot” (do not wait above 40 counts for safety reasons).  Alternate the test from left to right (or inversely but in a way that you always remember which count goes with which side) going to each meridian.

The Shao Yin-Kidney Jing-replacement point is on the medial side of the little toe.

The less sensitive side is the deficient side.

2. Treatment

a. Tonify Junction point of the deficient meridian (for example if Lung is 4/8, tonify right LU-7)

Recheck Akabani, if there is still an imbalance:

1. make sure the needle is on right point.

2. Do source point on deficient meridian.

3. Do Back Shu on deficient meridian.

b.  Manaka’s technique : placing any metal on the tonification or luo point of the weaker side will make that side stronger when tested a few minutes later.  This restores the balance and treats the problem.

3.  Notes

Some Five-Elements practitioners claim that paraplegics have responded to akabani treatment.
Pay attention with people presenting peripheral neuropathies, such as diabetes, cancer, HIV positive patients.
When do you decide that there is an imbalance?
6/7 or 6/9, “I take 6/12.”
If the person is affected by the akabani itself, it is only transient.
In case of amputation, choose another other point.

Introduction to Needling Techniques

It is the acupuncturist’s choice whether to use deep or shallow insertion, whether to make the energy come from far away or nearby, but at all times he must maintain total concentration and act as if he were standing on the edge or holding back a tiger.  Su Wen, Chapter 2

0. Introduction

The terms Dispersion and Tonification may be misleading.  

The energy, through the point choice, treatment design, and needle action is reprogrammed and reorganized.

 If the quantity of energy is increased in the Living system, it is by conduction through the needle that may act as a special wave captor or energy injector (using electricity).

The practitioner should be clear of the technique used.  

The energetic systems can actually be modulated in a way to increase their performance.  

This leads to a better use of the energy or better assimilation of the Food and Air energies and thus to an increase of energy.

But the energy may need to be supplemented in other ways.

According to what is needed, within the tonification techniques, appropriate choices must be done.

Dispersing the energy means exactly that.  The energy is dispersed.  But this is not enough.  Where is the energy dispersed from and where does it go to after dispersion are key questions.

As there are a few acupuncture styles, there are a few synonyms for the basic effects triggered by the needle.  The table that follows shows a few of them:

The terms “reducing,” and “sedation” are incorrect by themselves.  If the energy is reduced somewhere, it is only because it is increased somewhere else.  If the energy is sedated, how is that done.

Another aspect of energy manipulation is the understanding of evolution in time and space.  This requires the knowledge of the “Pre-heaven” and “Post-Heaven” configurations as well as of the Pentacoordination.  Knowledge of these concepts may lead to the understanding of transformation, transmutation, symmetries, contraries, and so for.    

In this way, the energy not only can be “tonified” or “dispersed” but it can also be “transformed”.  The notion of transformation of Energy into Matter, and inversely, is well known.  In the case of acupuncture, this notion is the basis of the Evolution of the various energetic substrata to the emergence of Structure and the differentiation into two systems or two poles and the final integration into a full living Set with the apparition of the inter-system relationships.

1. Dispersion

It is called “Sedation” in TAI-Sophia and Worsley’s Five Elements’ Style., in other styles it goes by the name of “Reduction.”

It addresses a condition of "relative excess" and is aimed to release, disperse, move, “de-congeal” or “de-stagnate.”

It has a turning down, quieting, calming and relaxing action.

Dispersion is a manipulation technique done on any point.

It is not to be confused with a dispersion point.

The classical texts on Acupuncture have discordant opinion regarding the technique.

In the Five Elements Style, the technique is as follow:

Insertion of  15^o against the meridian flow.  Counterclockwise rotation of 90^o.  Needle remains in for about 15 to 20' and is removed slowly.  If the Qi is still grasping, leave the needle longer.  There should not be any pulling during removal.

The point is left open.

2. Tonification

It strengthens, supplement, stimulates, increases, tones, “energizes” and “pump up the volume.”

Tonification can be used on any point, including Dispersion point.

In the Five Elements Style, the technique is as follow:

Quick Insertion, 15 degrees in the direction of the channel flow, quick 45 degrees clockwise rotation and quick removal.  The point is sealed right after to avoid Qi loss.

3. Where is the truth?

The two techniques seen above are those used in a specific style.  Actually they strangely resemble the general needle techniques used with young children.

A wide variety of techniques do exist, and the texts contradict one another as to which one is which.

The effect of needling seems to depend on limited sets of parameters;

Insertion
Transmission of the needle sensation
Number of points used
Choice of points used
Withdrawal
 Patient’s feeling
Practitioner’s feeling.

Each of these sections would require a chapter by itself.

Finally, a synoptic table may add to the general “feeling” of what the needle manipulation should be:

This is only a contemporary opinion among others.

Transfers

0.  General

Transfers are typical Five Phases treatments.  They require the knowledge of the five Shu points in their Element aspects.

It is a technique widely used in Japanese Five Phases acupuncture as well as in Five Elements Worsley acupuncture.

According to the Classics, movements along the Ko cycle never occur among the Yang Meridians.  For example, Spleen  energy can transfer to Kidney but Stomach energy does not transfer to Bladder.

This could be true at the strict Five Phase concept but if the Five Phase model is expended to its relationship to the Stems, this does not seem to apply, nor does it apply in the Energetics understanding of the Five Phases.

When a treatment is being designed according to this technique, a few things have to be kept in mind:

Least action
Avoid Arm Shao Yin (Heart)
Apply the Sheng cycle as last step, so that you avoid any unpredictable over-control from the K'o cycle (See example Two).
When choosing points, think about the body logistic

1.  Example One

1.1. Picture: Excess Heart, Deficient Master of the Heart

1.2. Resolution

Put your finger on deficiency:

Where is the problem: MH
Where is the Energy coming from?:  

 2.  Example Two 

2.1. Picture:   Excess Liver, Deficient Large Intestine 

2.2. Resolution:

A third possibility exists.  It involves a K'o cycle, which should be avoided.

3.  Example Three

3.1 Picture:  Excess Small Intestine, Deficit Bladder

3.2. Resolution:

4.  Example Four 

4.1 Picture: excess Gallbladder, Deficient Bladder 

4.2 Resolutions 

The third possibility is longer.  A few other possibilities exist.  In case of multiple possibilities, a few thinks should be taken in account.  First is the logistic of needling.  Which needling combination is the easiest?  Then, which combination is the most beneficial?  Would a junction be better because it harmonizes the two officials in an Element or would a Mother/Child relationship benefit from being consolidated? 

5. Additional Examples

5.1 Example One

Always take action on the deficiency when transferring.  Take action by using the point on the liver, draining energy from the Kidneys to the Liver.  Since Water generates Wood, then the point on the Liver has to be a Water point.  This category of points are called tonification points. 

Remember the law of least action: “one point, one needle.” 

5.2. Example Two

1. Use the K'o cycle.  The energy on its own does not move “energy.”   With the K'o cycle, treatment can be used to move energy.  In this example, use a “grand-mother” child point (in this case LR-1). 

2. Use the Shen cycle; Liver ---> Heart ---> Spleen.

First insert a needle on the Fire point of Spleen or SP-2 (destination point than on Wood point of the Heart or HT-9 (carrier point). 

Always begin with a destination point.

5.3. Example Three 

“Grand mother” point on Spleen or  Wood point SP-1
Junction point on Liver: LR-5

5.4. Example Four

Wood point on Heart HT- 9

Metal point on Liver LR- 4

Fire point on Lungs LU-10

5.5. Example Five 

1) Metal point on Bladder Bl-67

Earth point on Colon LI-11
Fire point on Stomach St- 41
Wood point on TH  TH-3

2) Junction point on Bladder Bl-58

Earth point on Kidney Ki-3
Wood point on Spleen Sp-1
Junction point on Liver  Lr-5

6.  Needles Insertion (quotes from 5-E teachers)

Insert all the needles, from the site of Deficiency to the site of Excess in the direction of the flow, first on left side than on right side
Once they are all in, tonify the needle on the Deficiency which is the first needle inserted, than remove that needle than remove the rest of the needles, in the reverse order of insertion.
“Know what a point-action does to the entire kingdom.”
In the case of transfer; check the pulse once all needles are in, than check the pulse after tonification, than after the removal of all needles. 

Body Points with Command Points

“Non-Command Points With Command Points.”

0. Introduction 

Once the “backbones” of Five Elements acupuncture (i.e. command points, treatment blocks) become familiar, you can begin to venture into the “Craft” of it by incorporating within the same treatment the use of both non-command points with command points.  This means creating a general movement towards harmony (command point) and focusing one of the benefit of this in a local area (non-command point) while still staying within the C.F.  

It implies refinement of the diagnosis, for example by incorporation of Eight Parameters.

1. Categories 

1.0. Rule of Action

The action on the “non-command” point has to be the same as on the command point.

I.e. Tonify both points or disperse both points. Do Not tonify one and disperse the other (Daniel, J.). 

1.1 Points Used for their “Spirits” 

When working on a meridian, a body point can be used according to its Spiritual aspect. 

i.e.; When working on Arm Shao Yang; SI-11, “Heavenly Ancestor.” 

1.2. Local Effect (pain) 

In the presence of a local phenomenon, it is absolutely necessary to identify its nature.

Pain due to an excess: heat, sharp pain, “don't touch”, worsening with movement, sharp.
Pain due to deficiency: decreases when pressure or/and heat, cold, stiff, aches, dull, heavy.

Example One:  When patient has a “Sorting problem” and  a shoulder pain, SI-10.

“The shoulder blade area can accumulate a lot of stuff.” 

a) Case of Deficiency:

Ton. SI-3 : General focus; treatment of disharmony.
Ton.  SI-10: Local focus; focus on one of the benefits of a) to the shoulder.

 This is really the refinement of the technique.

b) Case of Excess:

Sedate GB-38
Sedate GB-21

c) Notes: -  "The Energy goes from GB-21 to GB-22 through the shoulder" (Daniel, J.)

"The body does not lie; there is pain when excess and ache when deficiency" (Daniel, J.)

Example 2:  A woman in her early thirties has painful periods with heavy clotting and mood problems.

All tendencies are towards heaviness and density.
The problem is in the Three Lower Yin.
Very dense, depleted; stagnation, congealed blood.

Disperse Sp-6 and consider using a lower CV point (there is Yin Deficiency in lower abdomen).

2.  Various Notes

2.1. Tables of Confluence 

This table, found in most acupuncture books, gives a list of point called “confluent points” or “crossing points.”  These points are at the intersection of two or more meridians and allow a wide action, through appropriate technique.  They are convenient since through one needle you affect several meridians, instead of using several needles.

For example, in Case Two (see above), CV-3 or CV-4 command all three yin and are command points.

Using SP-6 and CV-3 or CV-4 is a great and elegant combination, with replicating effects. 

2.2. Qualities on pulses 

Within Five Elements Acupuncture, the pulse reading is about quantities.  Each of the six pulses is assigned a value.

One of the therapeutic action consists in regulating these quantities, aiming towards leveling them and bringing them towards a non-excess\non-deficient status.  

Besides this quantitative reading, a qualitative reading, or the perception of an abnormal pulse, without a specific name to this reading is called a Quality.  For example, an unusual Spleen reading will be called “quality on the Spleen,” no matter the actual nature of the quality. 

Ultimately, the pulse reading is brought to a status of smooth, even, neither excess nor deficient, without “abnormal” qualities.

Qualities are usually found when repression of emotions occurs.  When emotions are repressed deeply and for a long time, there is exhaustion and a deep hidden pulse.  The body than becomes a repository of emotions.  At this point, the prognosis gets very nasty; i.e over 10 years, there is stagnation and congealed blood, perfect for the apparition of a tumor. 

One of the methods to remove a “quality” is to use the Yuan-source point corresponding to the meridian affected.

Aggressive Energy

0.  Introduction

Porker list about thirty or more forms of energies (Qi).  

Woodwerth wrote an article on the nature of A.E. in one of the M.A.S.

Aggressive Energy is the denomination of a special status of the energy.  It manifests as a state of agitation. 

1.  Description 

It utilizes the K'o cycle to advance itself:

Symptoms across K'o (CSOE, Qualities)
Mostly will reside in the Yin organs, because they are the Zhang (storing of the Spirit of the Element).

It is a toxic and polluted energy.   It comes from different sources.  See it as impure energy coming from diet, environment, Mind or Spirit such as substance abuses, "abuses," severe emotional trauma, . . .
It is erosive in nature, and attacks the Yin officials (the storehouses, even if spiritual resources - shen, ideation, corporal soul, will, non-corporal soul).  Yin organs are solid masses of Blood which have no mean of expelling AE, while Yang organs are hollow and able to expel the AE by themselves.  

Some ancient texts mention the attack of Demons that is not to remind some of the concepts of Aggressive Energy (see Appendix). 

Certain disease as MS, AIDS and other progressive diseases lead to AEs, check every three or four treatments.  Play safe, especially in early practice. 

After AE treatment, work on the CF immediately.  
It is treated by and tested at the same time by the Yin back Shu points:
The insertion is superficial (1 fan) and test needles are used at the same time.

2.  Diagnosis/Treatment 

2.1. Introduction:

The Treatment is a confirmation of the diagnosis.  In early practice, the treatment is actually done no matter the diagnosis as AE may be to subtle to be identified.  Later on, specific symptoms across the Ko cycle, both in pulse reading and Color, Sound, Odor and Emotions become more evident. 

2.2.  Treatment:

The placebo needles allow differentiating the Histamine response from an AE response.

Five needles should be used because the skin is different in the various areas used, thus its reaction may be different.

The Histamine response is usually bright red with sometimes blotch following the “grain” of the tissue, and may persist for a long time. 

Only experience will provide insight on placebo and AE differences. 

3.  Various 

According to some opinions, the Heart Shu should be needled last.

AE does not necessarily appear on both sides.

Through the treatment, heat rises through the body (when person's torso is upward).

Some people may be too weak to have all AE drained at the same time.  Some practitioners would then subdivided this treatment by Jiao.   

“According to Worsley, draining the Zhang automatically drains the Fu, should AE be present in them.” Julia Measures.

Treatment Patterns

0. Introduction 

There are specific pulse pictures that necessitate immediate attention.  They refer to specific disorders and may sometime be overlooked.  Only a quantitative reading allows this type of reading.

1.  Patterns “Classes”

In Pattern One and Two, there is either a deficiency in the Yin-Zang with an excess in the Yang-Fu or inversely.  
In Pattern One; the Yang energy, which is to moves, accumulates.
Pattern Two; the Yin  energy, which is to store, is depleted.
In both cases, there is a Inside/Outside split.

In Cases Three, Four and Five, the patterns reflect a disharmony between the three Jiao. 

In Cases Six and Seven, there is either a general deficiency or a general excess. 

Note:  All these patterns reflect serious conditions.  Would you treat this prior to any other protocol?

1.  Pattern One

1.1. Patient Presentation

Accumulation of structive Energy.
Tremendous heavy body, lethargy.
Use of stimulants (caffeine, cocaine,...) because no active energy.
Feeling of exhaustion, inability to carry on.

1.2. "Non-acupuncture" treatment

Get the person more active; the person does have energy.

1.3. Acupuncture treatment

Junction points:  SI-7, TH-5, GB-37, Bl-58, LI-6, St-60.

Q: Asides the CF, which point might be more effective?

A: “Outer Frontier Gate” because the Triple Heater is the Minister of Balance and Harmony, and takes care of every body.

Note:  The choice of points to use rests upon the duration and state of the condition:
Has it been going on for a long time?  
Is it getting worse/better on its own?
Is it slowly/quickly getting better/worse?

The Art of Questioning:

Getting the Quality, Speed, Duration and Direction of symptoms

2.  Pattern Two.

2.1. Patient Presentation

/

2.2. "Non-acupuncture" treatment

/

2.3. Acupuncture treatment

Junctions points: Ht-5, Ki-4, GB-5, MH-6, Sp-4, Lu-7  OR Sp-21 (Ton.)

“Inner Frontier Gate” is the best choice, all other parameters neglected.

2.4. Note

If, with this pattern, you think the CF is Fire and tonify MH-6:

According to the Five Elements Style, treating the CF leads to a change in all pulses.  The first case may indicate that the CF is not Fire (except if blocks prevent movement . . .).  The second case may indicate that Fire is the CF.

3.  Pattern Three

3.0. Analysis

Upper Jiao problem.  To have more consistent data:

check the three Jiao.
check the tongue (should have a red tip).

3.1. Patient Presentation

Insomnia, shortness of breath, confusion.

4.  Pattern Four

See Pattern Three

5.  Pattern Five

5.1. Patient Presentation

Stuckness (Liver sooths the flow of Qi): frustration, irritability, anger, hopelessness, gloomy feeling(future).
Over pensiveness, followed by tightness and heaviness of the body.
Stagnation and congealed forces (the “energetic tumor” already exists).

Notes:

Liver and Spleen are the two “bloodiest” officials; they are already very dense.
The Middle Jiao is about transformation and changes.

- Example 1.  Presentation:

a. Pulse

b) Stuckness and Over pensiveness   

c)  CF:  Metal

6. Pattern Six

All pulses are deficient.  If the deficiency is deep (i.e. minus two (-2)), this generally points to a CV/GV block.  The Energy does not circulate at all.  

6.1. Patient Presentation

The patient may present lethargy, stuckness, stagnation of fluids (edema).

6.2. Treatment

CV/GV block treatment: CV-1, CV-24, GV-28, GV-1.  The points are needled successively and in this order.  The needle is inserted in the direction of the next point.

7. Pattern Seven

All pulses are excess.  This is a rare presentation in our society.  It may reflect a temporary modification due to drugs or drug withdrawal.  In case of drugs, it generally hides a sever deficiency.  Treatment aiming towards dispersion should be monitored carefully as the patient may actually be already totally deficient.

Four Needle Technique

0.  Introduction

The Four Needles Technique (4NT) is used by Japanese schools as well as the Worsley’s lineage schools.

1.  Operating Principle

When normal Sheng transfers do not work
The Energy in a meridian needs to be dispersed but does not respond to simple dispersion technique.  In this case, the 4NT is used, it is basically a “You will move now” Technique.

• It emphasizes both the Shen and the K'o cycles, and the mechanisms of its actions: Two points for Tonification and Two points for Dispersion

• One element of the 4NT is supplying (thus making sure the mother is healthy before using it for the child.  
   

It is a Tonification of Shen

i.e.  Before supplying a Deficient Fire, make sure there is enough Wood.

The other element of the 4NT is controlling or draining.  It is a deficiency of the K'o.
Use the Draining first (it takes more time) than do the Supplying.  You can do the supplying while the sedating needles are still in.

2.  Illustration

2.1. Picture:  Excess Liver, Deficient Heart.

2.2  Resolution:

2.2.1. Transfer:

HT-9 Ton.   ===> if no effect than 2.2.2.

2.2.2. Sedation:

LR-2 Disp.   ===> if no effect than 2.2.3.

2.2.3. 4NT (1) : Tonification 4NT

a) Dispersion: KI-10 Disp. than HT-3 Disp.

       Drain Water within Water (general supply) than Water within Fire.

b) Ton.  : LR-1 Ton.  than LU-1 Ton.

             Bring Wood within Wood than Wood within Fire.

                  ===> if no effect than 2.2.4.

2.2.4.  4NT (2) : Dispersion 4NT

a) Dispersion: LR-2 Disp. than MH-8 Disp.

The aim of a) is to drain the Liver, it has nothing to do with the Heart, thus we first Disp. Liver than sed. Pericardium (not Heart by principle).  It is a cumulated drainage of Qi from Liver to Fire, kind of aggravating the deficiency before pushing Wood through Fire in Fire.

b) Ton..   :  LU-8 Ton. than LR-4 Ton.

3.  Modified 4NT (Jack Daniel)

3.1. Picture   :  Deficient Pericardium, normal Wood.

3.2. Resolution:  The modified 4NT:

3.2.1. Ton.. : LR-9 Ton. than MH-9 Ton.

3.2.2. Sed. : none since no Excess on Wood.

Law of Husband - Wife

0.  Introduction

It can only be identified through the pulse!

1.  Definition

The pulses on the Right, compared to the Left, are greater in both quantity and quality and in total and taken as a whole.

If the pulse of the Husband is weaker than the one of the Wife, there is a Husband-Wife imbalance.  

It represents a separation of YinYang in the body (but it is not an akabani imbalance).

It is not a common symptom but it is generally very serious (cancer, tumor, melanoma, total exhaustion, and so forth).

2.  Pathognomic signs

Pulses.
Sense of deep struggle, resignation, despair.
Feeling of being “split apart.”
Loss of unification; relationship, sexuality, career, ...
Chronic Illness.
“Issues of dominations” as in “being bullied” by someone.
“Am I gonna make it?”
May presents rapid deterioration of the BodyMindSpirit.
Stuck treatments.

3.  Reflection

Deep left Pulse:

Shao Yin Heart          “Supreme Controller”
Jue Yin Liver           “General of the Army”
Shao Yin Kidney “Generator or Will”

You are dealing with a serious condition; the treatment is about wrestling with the Energy.  The intent has to be firm and strong.

4. Note

If you treated a H/W, bring the patient back the next day as well as the few following days to build up the Husband (if CF is on it) or the Wife (if CF is on it).  H/W is the most damaging of all blocks because it indicates that Nature has given up.  Everybody dies from AE or HW (for HW, three months maximum then death without warning).

5.  Treatment

5.1. Overview

Transfer the Energy from Right to Left, even at the expense of the Right.  It is about creating movement from the left, and some Deficiency on the Right might even be helpful.

5.1.1. Standard procedure (see fig. 1)

4 combination by transfer and stimulation
2 source points stimulation (Ht-7 and SI- 4)

5.1.2. Alternative procedure 1

Sedate source point on wife, leave needles in until points loosen.
Reapply st. proc., leaving sedation needles in.

5.1.3. Alternative procedure 2

Tonify Associated Effects Points (Back Shu) on wife.

5.1.4. Alternate procedure 3

Use Spirit Barrier points (see ..)

5.1.5. Alternate procedure 4

Apply the 4 needles technique (see fig 2 and 3)

5.2. Specific (variation of overview)

5.2.1.: Transfers:

Metal to Water          : KI-7, BL-67
Metal to Wood           : LI-4
Earth to Water          : KI-3

5.2.2.: Sources:

Ton. Husband sources    : KI-3, BL-64, GB-40, LR-3
Disp. Wife sources              : LU-9, LI-4, ST-42, SP-3

5.2.3.: AEPs:

Ton. Husband            : BL-19, BL-23, BL-15 (?)
Disp. Wife                      : BL-13, BL-21, BL-25

5.2.4.: Source on Ht: Ton. (Put back King/Queen on throne)

5.2.5.: Long-chain Transfers:

SI-3, GB-43, BL-67; HT-9, LR-8, KI-7, LU-9, SP-2.
Pericardium and Triple Heater.

(5.2.6.: “Minimal action”: KI-7, BL-67)

6. “Chronic” imbalance

If the condition comes back after a few days:

The patient is terminally ill
The patient came back too late
The patient is not changing his/her life-style

7.  Digression

Yin, Structive; Yang, Active.

A Husband/Wife is not a Yin/yang split necessarily.

Yin/Yang split: Tongue: no coat, glossy

                     Pulse : all Yin Excess, all Yang Deficient.