TCM Book Club Issue 919
Daily updates to accompany the growth of TCM practitioners
Author/ Zhang Qiaowen
Editor/Wali ⊙ Proofreader/Zheng Xiancheng
IIntroduction： The treatment plan for patients is entirely based on meridian diagnosis, combined with individual symptom presentations and the theory of qi transformation. Relying solely on experience points or special effect points for treatment may lead to ineffective and slow results. Therefore, meridian diagnosis and a reasonable interpretation of meridian changes are key to achieving excellent clinical outcomes.
Meridian Diagnosis is the Guide in Clinical Practice
As a Canadian exchange student, I have been studying meridian medicine under Professor Wang Juyi in Beijing for five years, gradually gaining a comprehensive understanding of his theories. This includes meridian theory (meridian qi transformation), meridian diagnosis, differentiation of meridians, selection of meridians, understanding of acupoints, selection of acupoints, needling techniques, and various meridian adjustment methods (such as acupuncture, moxibustion, manual therapy, cupping, etc.). Here, I will focus on meridian diagnosis.
All Five Diagnostic Methods Must Be Employed
Like many students who mistakenly believe that meridian palpation is the main content of meridian diagnosis, I initially thought it was the only diagnostic method. However, over time, I gradually realized that meridian palpation is just one of five diagnostic treatment methods.
Observation
Observation is a crucial part of meridian diagnosis. It is often used to diagnose blood stasis manifested in superficial meridians. For example, patients with back pain often show signs near the Weizhong (BL40) point, and bloodletting therapy can yield immediate results. Observation is not limited to superficial blood vessels; it also includes other aspects, such as examining the wrinkles on the face of a patient with facial paralysis to understand the severity and progression of the condition.
Observation is also frequently applied to various skin disease patients to assess the state of deficiency or excess. For instance, a 31-year-old female patient had a boil in the right groin. Through meridian diagnosis, Wang Juyi found a noticeable nodule at the Ligu (LR5) point of the right foot’s jueyin liver meridian, which corresponded exactly to her lesion. Upon careful examination of the boil’s appearance, it was found to be pale red, swollen, and without pus, leading to a diagnosis of yin boil.
Initially, Professor Wang intended to use Xingshu (LI4) to clear heat, but considering the patient had a yin boil without obvious heat swelling, pain, or itching, and the patient’s pulse was also weak, he chose Taichong (LR3) to tonify qi and promote healing of the sore; Ququan (LR8) adjusted the qi mechanism of the meridian. I was surprised to see that after needling, the size of the boil actually shrank.
Palpation
Professor Wang frequently uses palpation in clinical practice, as changes in the softness of the abdominal wall and abnormal pulsations of the abdominal aorta can provide excellent clinical guidance. The aforementioned boil patient also had her Qimen (LR14) point palpated, which was found to be abnormally sensitive, indicating that her condition involved the liver meridian. Subsequent meridian diagnosis results confirmed that the jueyin meridian indeed showed changes. Thus, palpation is very important.
Touching
Touching is a method of discovering diseases by sensing the skin’s moisture and temperature. For example, a patient presented with headaches due to hypertension, and initially, the differentiation of deficiency and excess was not very clear (seemingly excess), but Professor Wang discovered through touching that the patient’s feet were cold, leading to a diagnosis of deficiency; subsequently, he selected the relevant meridian’s source points for treatment, achieving effective results.
Pulse Diagnosis
Pulse diagnosis is a method of discerning deficiency and excess by palpating the arterial pulsations at superficial body parts, not limited to the usual cun, guan, and chi pulses. For patients with dizziness due to hypertension, Professor Wang often first palpates the temporal artery to determine the state of qi and blood circulation in the brain and assess deficiency or excess. If it is an excess condition, the pulse here is often large, and local acupoints (such as Fengchi (GB20)) would not be selected for treatment.
In clinical practice, I encountered an asymptomatic hypertensive patient. When palpating the pulse, I found this patient had premature beats, which also corresponded with the abnormal findings in the shaoyin meridian during meridian examination. Therefore, Professor Wang selected Shenmen (HT7) and Shaohai (HT3) as main points to adjust the patient’s cardiac conduction system. When the patient returned for a follow-up, the premature beats had disappeared.
Palpation of Meridian Flow
Meridian palpation can be considered the core content of meridian diagnosis, primarily guiding diagnosis and treatment by understanding the physiological and pathological states of the body’s meridians.
Professor Wang believes that meridians lie between the flesh and exist in the gaps of tissues; moreover, meridians are composed of surrounding structures, and the physiological metabolic processes of meridians occur in these tissue gaps. However, I truly unraveled the confusion regarding this theory a year later while performing meridian palpation at my father’s clinic. I still vividly remember the enlightening feeling when my thumb palpated along the muscle gaps, clearly sensing the knowledge imparted by my teacher. Subsequently, I reviewed anatomy books, which helped solidify the theory of meridians existing in tissue gaps in my understanding.
Diagnosis Must Correlate with Symptoms
Once the above methods are understood, the next step is to comprehend the significance of the changes in the meridians. First, it is essential to identify the patient’s main symptoms; once the main symptoms are confirmed, the associated meridian abnormalities can be understood and recognized. In other words, it is crucial to connect the symptom patterns with the abnormal meridians, discovering which abnormal meridians can correlate with the symptom patterns. Related treatments should never deviate from the main symptoms, nor should one fall into the trap of treating all abnormal meridians.
If the changes in the meridians and symptoms can be directly correlated, it becomes the easiest to understand. A few years ago, I diagnosed a person’s meridians and found a hard nodule deep in the Taiyin lung meridian of the left hand, while the right side had none. Upon inquiry, I learned that he had a history of left lung lobe pneumonia as a child. This unexpected finding convinced me that one must first examine the meridians to understand the patient’s constitution.
By analyzing some patients’ symptom patterns, one can deduce which meridian is affected, and this inference can also be confirmed through meridian diagnosis. For example, I once treated a patient with temporal migraines, as the pain was along the pathway of the shaoyang meridian, it was natural to think it was a shaoyang issue. During meridian diagnosis, I found a nodule at the Diji (SP8) point on the right side, further confirming my hypothesis. After treating the shaoyang meridian five times, the patient’s symptoms significantly improved.
In other cases, when the symptom pattern is not very clear, the more I inquire about the medical history, the more confused I become; however, when I performed meridian diagnosis, it became clear. A female patient, due to menopause, had a flushed face and dark spots on her cheeks, and had previously taken kidney tonics prescribed by a TCM practitioner with no effect. I found many abnormalities in her shaoyang and jueyin meridians. She also exhibited many excess signs, such as dry eyes, burning sensations, irritability, and redness in both cheeks. Therefore, I decided to use the outer guan (SJ5) and Zuliqiao (GB41) points to clear the shaoyang fire, and the treatment indeed yielded results. Meridian diagnosis has now become a helpful tool in my diagnosis and treatment.
Diagnosis and Accurate Interpretation Ensure Efficacy
Due to some successful treatment cases, I began to gain confidence in treating shaoyang meridian disorders. However, I soon realized that my understanding was still at a very elementary stage. The following three cases are follow-ups of Professor Wang’s treatment cases; although they all superficially belong to shaoyang headache, guided by meridian diagnosis and theory, the diagnosis and treatment for each case were different.
Case 1
A 59-year-old female patient complained of throbbing pain on the left temple for over 40 years. The patient often experienced headaches in the afternoon after napping, accompanied by nausea and vomiting. I immediately thought of using shaoyang meridian points for treatment.
During meridian diagnosis, Professor Wang found abnormal responses in the jueyin and shaoyang meridians of the patient’s hands and feet. He believed that throbbing pain often involves the jueyin meridian, as the hand jueyin meridian “is the main pulse for those who are ill.” Therefore, he needled the left Daling (PC7), Neiguan (PC6), Taichong (LR3), Ligu (LR5), and Hanyan (ST5) points. After two treatments, her headaches did not recur.
Professor Wang pointed out that the mechanism of this headache was primarily due to the deficiency of jueyin meridian qi, which also affected the shaoyang meridian. The source points of the jueyin meridian can enhance and promote the original qi of the jueyin meridian. Since the jueyin and shaoyang meridians are interrelated, stimulating the original qi of the jueyin meridian can also promote the movement of the original qi of the shaoyang meridian.
Case 2
A 29-year-old female patient complained of right-sided temporal migraines for over 20 years, characterized by throbbing pain that worsened with cold or fatigue. I thought Professor Wang would choose shaoyang meridian points as the main treatment.
However, aside from local tenderness in the temporal region, Professor Wang’s meridian palpation only revealed abnormal changes at the distal ends of the jueyin meridian pathway, while there were no abnormalities along the distal pathway of the shaoyang meridian. Ultimately, he selected bilateral Quze (PC3), Ququan (LR8), Taichong (LR3), right Fengchi (GB20), Hanyan (ST5), and Xuanli (GB8) points for acupuncture treatment. After several treatments, the patient’s headaches significantly improved.
He believed that the patient’s issue was due to the jueyin meridian being affected by cold, which in turn impaired the “dispersing and pivoting” function of the interrelated meridians, resulting in shaoyang headaches. The he-sea points of the jueyin meridian could improve the qi movement of this meridian, thus achieving the effect of dispelling cold.
Case 3
A 34-year-old female patient complained of headaches on the top of her head and both temples for 6 years, accompanied by nausea and vomiting, and constipation, relying solely on oral laxative tea for relief. I immediately thought it was due to jueyin and shaoyang meridian disorders. After collecting more detailed medical history, I found that the headache location was actually in the forehead, governed by the yangming meridian, specifically presenting as a pressure pain.
During meridian diagnosis, Professor Wang found a soft abnormality from the Xiaojuxu (ST39) to the Zusanli (ST36) along the meridian pathway, and the fontanelle also showed soft abnormal changes, which was the main area of her headache. The constipation reflected a disorder of the yangming meridian.
Thus, he concluded that the patient’s headache was due to the dysfunction of the taiyin and yangming meridians, as the taiyin meridian’s qi could not rise, and the yangming meridian’s qi could not descend, leading to the failure of clear qi to rise and turbid qi to descend. The dysfunction of the taiyin spleen meridian impaired the transformation of fluids, causing water and fluids to accumulate and generate phlegm, which obstructed the qi mechanism, resulting in yangming headaches and vomiting.
It can be said that the root of the headache lies in the taiyin and yangming meridians. Moreover, these two meridians also affected the normal physiological functions of the shaoyang meridian and its ability to disperse, leading to the occurrence of temporal pain.
Professor Wang needled the fontanelle point to elevate clear qi, needled Jianli (ST25) and Fenglong (ST40) points to strengthen the spleen and resolve phlegm, and needled Xiaojuxu (ST39) to regulate the large intestine’s conduction function and adjust the yangming meridian.
Through the above treatments, the patient only occasionally experienced mild headaches and did not vomit again. Throughout the treatment process, there was no concentrated treatment of her temporal pain, but this pain improved significantly as the yangming headache improved.
The treatment plans for these three patients were entirely based on meridian diagnosis, combined with their individual symptom presentations and the theory of qi transformation. If one were to rely solely on experience points or special effect points for their treatment, it is highly likely that quick and effective results would not be achieved.Therefore, meridian diagnosis and a reasonable interpretation of meridian changes are key to achieving excellent clinical outcomes.【Published by TCM Book Club (WeChat ID: zhongyishuyou)】
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