Acupuncture Management of Acute Conditions: Seven Common Methods I Use in Clinical Practice

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Chinese Medicine Book Club Issue 3092

One issue daily, accompanying the growth of TCM practitioners

IIntroduction: This article discusses the basic principles of acupuncture treatment for acute conditions from a clinical perspective: differentiate syndromes and diseases, clarify diagnoses; grasp timing, emphasize both symptoms and root causes; focus on main symptoms and treat accordingly. The main methods include: clearing heat, stabilizing asthma, relieving pain, dispersing masses, relieving spasms, opening orifices, and stabilizing collapse. (Editor: Yan Qifeng)

Discussion on Acupuncture Management of Acute Conditions

Author: Xu Zong

The characteristic of acute conditions is urgency. The term “acute” has two meanings: one refers to the rapid and fierce onset of the disease; the other refers to the severity and danger of the disease. Therefore, regardless of the internal or external factors involved, as long as these two points are characteristic, any symptoms indicating severe imbalance of Yin and Yang in the body, or even imminent separation of Yin and Yang, can be considered acute conditions.

Acupuncture is one of the main methods in TCM for treating acute conditions and often achieves significant therapeutic effects. An example recorded in the “Tong Xuan Zhi Yao Fu” states, “To treat corpse collapse at Wei Hui, revive with a touch; to treat fetal death at Yin Jiao, use acupuncture and it will fall away.” There is also a wealth of valuable experience accumulated, such as the emergence of the “Sixteen Xie” points primarily for treating acute diseases, as well as methods like “Hui Yang Nine Needles,” “Sun Zhenren’s Thirteen Ghost Points,” and “Initial Stroke Emergency Acupuncture Techniques,” all of which have made great contributions to acute medicine.

So how does acupuncture manage acute conditions? This article shares my personal views on this matter.

1. Basic Principles of Acupuncture Management of Acute Conditions

There are many types of diseases, and the range of acute conditions is vast. The main focus of acupuncture management of acute conditions is to take emergency measures to prevent the progression and worsening of the disease, to gain time for rescue or treatment, and ultimately achieve the goal of cure.

Therefore, the basic principles of acupuncture management of acute conditions in clinical practice are three:

1. Differentiate syndromes and diseases, clarify diagnoses.

Differentiating syndromes is a characteristic of TCM diagnosis, while differentiating diseases is the core of modern medical diagnosis. The combination of the two complements each other, facilitating a clear diagnosis that aids in urgent acupuncture treatment. For example, in cases of syncope, the patient may be unresponsive, with clenched jaws, incontinence, and convulsions. Is it caused by high fever? Or is it due to liver Qi stagnation or phlegm-heat? Is it a case of closure or collapse? Closure should be opened, while collapse must be stabilized; acupuncture treatment varies accordingly, which is the TCM principle of syndrome differentiation.

Modern medicine categorizes syncope due to cerebral hemorrhage and cerebral thrombosis under similar conditions. In treatment, the former requires hemostasis, while the latter needs to invigorate blood circulation. Analyzing these two conditions from a TCM perspective, both can present as closure syndrome or collapse syndrome. Generally, acupuncture treatment involves opening with needles and stabilizing with moxibustion.

Cases of excessive bleeding during acupuncture surgeries remind us that needling can dilate blood vessels and invigorate blood circulation, making it suitable for closure syndrome due to cerebral thrombosis. However, closure syndrome due to cerebral hemorrhage should be used cautiously; otherwise, it may exacerbate the bleeding in the brain, directly threatening the patient’s life and causing irreparable consequences. This illustrates that while syndrome differentiation is crucial in managing acute conditions, disease differentiation should not be overlooked. The accuracy of the diagnosis is key to the success or failure of treatment.

2. Grasp timing, emphasize both symptoms and root causes.

Regarding the relationship between symptoms and root causes, the “Ling Shu: Ben Ben” states: “Carefully observe the severity of the condition; adjust according to intention; those that are simultaneous should be treated together, while those that are severe should be treated separately.” This means that medical personnel should carefully observe the severity and urgency of the patient’s condition and make corresponding treatments.

For mild conditions, both symptoms and root causes can be treated together; for severe and urgent conditions, either the symptoms can be treated alone or the root causes can be treated alone.

In general, for acute conditions, the primary focus is to treat the symptoms first, which is known as “treating the symptoms urgently.” This advocates for an aggressive approach to acute conditions, attacking the evil. However, urgent treatment must grasp the timing, attacking the evil while contending with the righteous, with the premise that the righteous Qi has not declined.

For example, in cases of severe deficiency of righteous Qi, with the evil Qi rampant, or even when Yin and Yang are on the verge of separation, one cannot ignore the aspect of the body’s exhaustion and life-threatening situation. At this point, the deficiency of righteous Qi has become the main issue, and one must not simply attack the evil but should primarily support the righteous, treating the root cause alone. This requires strong measures to control the further deterioration of the condition to avoid endangering life.

Taking the “closure” and “collapse” examples: if the disease is in the “closure” stage and the “opening” method is not applied in time, waiting until the condition develops to the “collapse” stage to use the “opening” method would be too late. Conversely, if the “collapse” symptoms are not evident but the “stabilizing” method is applied prematurely, it would also be an inappropriate treatment method, which not only fails to control the condition but may also accelerate the deterioration of the disease.

Therefore, urgent treatment of acute conditions must emphasize both symptoms and root causes, grasp timing, and strive for initiative to reverse the situation and turn danger into safety.

3. Focus on main symptoms, treat accordingly.

As the name suggests, acute conditions are “urgent,” and the condition can change rapidly, so there can be no negligence or delay. Close observation of changes in the condition is essential, and based on the characteristics of acute conditions, one must grasp the fundamental main symptoms among the series of syndromes that appear in acute conditions, prescribe points, and apply appropriate stimulation. This requires strong specificity and precision in point selection. Avoid a scattershot approach with a haphazard selection of points. This is known as “when this symptom appears, use this point, and apply this method.”

2. Main Methods of Acupuncture Management of Acute Conditions

In managing acute conditions with acupuncture, the above three principles should be applied based on the specific condition, flexibly utilizing the characteristics of acupuncture. Below are seven methods I commonly use in clinical practice.

1. Clearing Heat Method

This method is based on the principle from the “Nei Jing” that “heat is countered with cold” and “warmth is cleared.” It is mainly used for febrile diseases characterized by excess Yang and insufficient Yin. Such as high fever due to external wind-heat or damp-heat, as well as surgical abscesses.

Points:

Da Zhui (Dazhui), Qu Chi (Quchi), Qu Ze (Quze), Wei Zhong (Weizhong), He Gu (Hegu), Shang Yang (Shangyang), Shao Shang (Shaoshang).

Method:

Use the reducing method with filiform needles or three-edged needles to puncture and draw blood, and the two methods can be combined. If necessary, skin needles can be applied to the back along the Du Mai and the three Yang meridians, or cupping can be added. Bloodletting is used to clear accumulated heat and eliminate evil toxins.

Case 1:

Huang ××, male, 23 years old, consulted on July 12, 1980.

The patient had a fever for one day, accompanied by headache, nasal congestion, yellow phlegm cough, sore throat, bitter mouth, and red urine. Axillary temperature was T39.2℃, throat congestion, tonsils (+ + +). Pulse was floating and rapid, tongue coating was thin, yellow, and greasy. Diagnosed with wind-heat (common cold, tonsillitis). Treatment plan was to dispel wind and clear heat. Points selected were Qu Chi, He Gu, and Shao Shang (all bilateral). The first two points were treated with the reducing method, leaving the needles for 40 minutes, with re-reducing every 10 minutes. The Shao Shang point was punctured with a three-edged needle to draw blood. During the third re-reduction at the He Gu point, the patient felt a reduction in throat pain and no pain when swallowing. After needle removal, the axillary temperature dropped to 37.5℃, throat pain was basically relieved, and tonsils were (+). The patient was advised to return home and decoct Chinese medicine to consolidate the effect.

2. Stabilizing Asthma Method

This method is derived from the “Nei Jing” principle of “suppressing the high” and “sweating out what is on the skin.” It is suitable for symptoms of cough and asthma caused by external wind invasion, loss of lung descent, or new infections triggering latent evil.

Points:

Tian Tu (Tiantu), Dan Zhong (Danzhong), Feng Men (Fengmen), Fei Shu (Feishu), Wai Guan (Waiguan), He Gu (Hegu), Chi Ze (Chize), Kong Zui (Kongzui), Lie Que (Lieque).

Method:

Reducing method with filiform needles. If cold is predominant, moxibustion can be added after needling. If necessary, cupping can be applied to the back Shu points.

Case 2:

Tang ××, female, 4 years old, consulted on February 3, 1982.

The child had a cough that progressed to asthma for nearly a year. Each night, an attack required steroids or bronchodilators for control, with six emergency hospitalizations. Usually, the child had a lot of white phlegm, with normal appetite and bowel movements. Last night, another asthma attack occurred. Pulse was floating, tight, rapid, and slippery, tongue coating was white.

This was a case of wind-cold invasion, leading to loss of lung descent; treatment should disperse wind, scatter cold, regulate the lung, and stabilize asthma. Points selected were Kong Zui, Dan Zhong, Wai Guan, Lie Que, and Fei Shu (all bilateral). Kong Zui and Fei Shu were injected alternately with 2 ml of Houttuynia cordata liquid or placental tissue liquid, while the remaining points were needled and moxibusted for 5 minutes each, treated once a day. After 10 treatments, the child had fewer asthma attacks, and additional points Zu San Li (Zusanli), Qi Hai (Qihai), and Feng Long (Fenglong) were added when not experiencing asthma, along with 2 ml of transfer factor injected at the points, twice a week. After three months of continuous treatment, steroids and other medications were discontinued, and asthma was controlled. Follow-up for over two years showed no asthma attacks.

3. Pain Relief Method

The classic saying goes, “If there is no flow, there is pain; if there is flow, there is no pain.” This method is based on this principle. It is derived from the “Nei Jing” principle of “attack what remains” and “remove what is external.” It is used for various pains in the organs and meridians caused by stagnation of Qi and blood.

Points:

Select the following Shu points based on the location of pain.

Head:

Feng Chi (Fengchi), Tai Yang (Taiyang), He Gu (Hegu), Nei Ting (Neiting), Tai Chong (Taichong).

Face:

Si Bai (Sibai), Di Cang (Dicang), Jia Che (Jia Che), Xia Guan (Xiaguan), Quan Liao (Quanliao), He Gu (Hegu), Nei Ting (Neiting).

Chest:

Dan Zhong (Danzhong), Nei Guan (Neiguan), Kong Zui (Kongzui), Feng Long (Fenglong), Zhi Gu (Zhigu), T1-7 Jia Ji.

For heart angina: Nei Guan, Shen Men (Shenmen), Xie Men (Xiemen), Jue Yin Shu (Jueyinshu), Xin Shu (Xinshu).

Upper Abdomen:

Zhong Wan (Zhongwan), Nei Guan (Neiguan), Zu San Li (Zusanli), T9-12 Jia Ji. For gallbladder colic: Qi Men (Qimen), Ri Yue (Riyue), Dan Shu (Danshu), Yang Ling (Yangling), Qiu Xu (Qiu Xu).

Lower Abdomen:

Qi Hai (Qihai), Guan Yuan (Guanyuan), Tian Shu (Tianshu), Zu San Li (Zusanli), San Yin Jiao (Sanyinjiao), L1-5 Jia Ji. For renal colic: Shen Shu (Shenshu), Jing Men (Jingmen), Yang Ling (Yangling), Shui Dao (Shuidao), Tian Ying (Tianying).

Neck, Shoulder, and Upper Limb:

Tian Zhu (Tianzhu), Feng Chi (Fengchi), Jian Jing (Jianjing), Qu Chi (Quchi), He Gu (Hegu), Tian Zong (Tianzong), Hou Xi (Houxi), Jue Gu (Juegu), Yang Ling (Yangling), C4-T1 Jia Ji.

Lumbar and Lower Limb:

Ren Zhong (Renzhong), Huan Tiao (Huantiao), Yang Ling (Yangling), Wei Zhong (Weizhong), Qiu Xu (Qiu Xu), L2-5 Jia Ji.

Method:

Reducing method with filiform needles. If cold is predominant, add warming moxibustion or cupping; if heat is predominant or there is blood stasis, puncture or skin needle tapping.

Case 3:

Wang ××, female, 52 years old, consulted on June 3, 1983.

The patient had pain in the left upper and lower jaw for a week due to irregular work and rest. The facial pain was electric-like and could be triggered. The patient appeared in pain, supporting her jaw with her hand. Previous dental treatments had not alleviated the pain. Pulse was thin, wiry, rapid, tongue was red with thin coating. Diagnosed with facial pain (trigeminal neuralgia). Treatment plan was to elevate clear Yang and descend turbid Yin, and regulate the facial meridian Qi. Points selected were Xia Guan, He Gu, and Nei Ting (all left). First, Xia Guan was needled, followed by He Gu and Nei Ting. The Qi guiding method was applied three times, and facial pain was reduced. During needle retention, a G6805 machine provided continuous weak stimulation for 20 minutes. After three treatments, facial pain was completely relieved, and it has not recurred since.

Case 4:

Luo ××, male, 9 years old, consulted on September 13, 1968.

The child had severe pain in the right rib area for half an hour and was brought in for emergency treatment. After injection of atropine, there was no relief, and a consultation was requested. At that time, the child was holding his ribs with both hands, curled up and rolling in pain, sweating profusely, and had cold extremities. The parents reported that the child had vomited a roundworm the night before. Examination revealed numerous worm spots on the child’s face and eyes, pulse was tight and wiry, tongue was dark with thin coating, diagnosed with roundworm collapse (gallbladder roundworm causing gallbladder colic). Urgently selected Yang Ling Quan to drain, combined with the “Dragon and Tiger Fighting” technique. After 10 minutes, the right rib pain decreased, and the child stopped rolling, could lie on his back, and sweating reduced. However, after stopping needling, the pain returned, so needling was continued for about an hour until the pain alleviated, and the child immediately fell asleep. Subsequently, the child took an anthelmintic and expelled nearly 30 roundworms.

Case 5:

Shen ××, male, 52 years old, consulted on May 8, 1981.

The patient presented with hematuria for two days and received gentamicin injections in the school clinic, suddenly experiencing severe pain in the right lumbar region, radiating to the lower abdomen, groin, and thigh, unable to walk, and thus came to the new medical department. Examination revealed significant percussion pain in the renal area; right kidney Shu point was tender; pulse was tight and choppy, tongue coating was thin. Diagnosed with lumbar pain (right urinary tract stone? renal colic). Points selected were right kidney Shu and Yang Ling, applying the “Dragon and Tiger Fighting” technique for 3 minutes, pain decreased, and after 10 minutes, pain alleviated. The patient then went to the injection room for intramuscular injection. Subsequent abdominal X-ray confirmed the patient had a stone in the upper ureter.

Case 6:

Zhang ×, female, 60 years old, consulted on September 8, 1969.

The patient suddenly experienced lumbar pain, unable to bend or twist for half a day. After using atropine and demerol, there was no relief, and she was brought to the acupuncture department. The patient lay on her back, appearing in pain. During the examination, any slight movement of the lower limbs and lumbar region caused her to cry out in pain. The L3 spinous process was slightly deviated to the left, with significant tenderness and local muscle guarding. Pulse was wiry, tongue coating was thin and white. Diagnosed with lumbar sprain (acute lumbar strain). Urgently needled Ren Zhong, applying the “Dragon and Tiger Fighting” technique for 2 minutes, then asked the patient to walk and move her waist. This was done five times, and the patient’s lumbar pain was completely relieved, allowing her to walk out of the clinic.

4. Dispersing Masses Method

This method is derived from the “Nei Jing” principle of “what is congealed should be dispersed” and “what is suppressed should be dispersed.” It is mainly used for blood stasis or damp-heat obstruction, leading to intestinal accumulation symptoms, such as intestinal abscess, constipation, and diarrhea.

Points:

Tian Shu (Tianshu), Da Chang Shu (Dachangshu), Shang Ju Xu (Shangjuxu), Zu San Li (Zusanli), He Gu (Hegu), Ge Shu (Geshu), Xue Hai (Xuehai).

Method:

Reducing method with filiform needles or combined acupuncture. If there is significant stasis and heat, three-edged needles can be used for puncturing, and cupping can be applied.

Case 7:

Zhan ××, male, 50 years old, consulted on April 18, 1983.

The patient had right lower abdominal pain and fever for two days, accompanied by bitter mouth, yellow urine, and dry stools. He had a history of appendicitis, which improved with acupuncture. Examination revealed tenderness in the right lower abdomen, rebound tenderness, T38.1℃, blood test: total white blood cell count 11,000, neutrophils 78%, lymphocytes 22%. Pulse was slippery and rapid, tongue coating was yellow and greasy. Diagnosed with intestinal abscess (acute exacerbation of chronic appendicitis). Points selected were Tian Shu, Da Chang Shu, Shang Ju Xu, He Gu, and Qu Chi (all right), applying the reducing method, and during needle retention, a G6805 machine provided strong stimulation for 40 minutes to 1 hour. Treated once a day for three days, with all symptoms alleviated and blood tests returning to normal.

5. Relieving Spasms Method

This method is derived from the “Nei Jing” principle of “calming what is startled” and “relaxing what is urgent.” It is used for symptoms of convulsions caused by excessive liver fire, phlegm obstruction, or high fever leading to liver wind.

Points:

Si Guan (Siguang), Ren Zhong (Renzhong), Bai Hui (Baihui), Yang Ling (Yangling), Zhi Yang (Zhiyang), Jin Suo (Jinsuo).

Method:

Reducing method with filiform needles or puncturing to draw blood.

Case 8:

Zhang ××, male, 16 years old, consulted on July 17, 1970.

The patient was diagnosed with severe “Japanese encephalitis” and was admitted to the infectious disease department on July 6, 1970. After aggressive rescue, he was transferred to the acupuncture department on the 17th. Upon arrival, the patient was in a confused state, with clenched jaws, convulsions in the left upper and lower limbs, and spastic paralysis in the right upper and lower limbs, with a twisted trunk, unable to lie flat, and difficulty swallowing, being fed through a gastric tube. Pulse was thin and rapid, tongue was red, and coating was peeling. Diagnosed with summer heat (recovery phase of Japanese encephalitis). Points selected were Si Guan, Bai Hui, Ren Zhong, and Yang Ling as the main points, supplemented with Lian Quan (Lianquan), Shao Shang, and Qu Chi, using the reducing method, treating 3-5 points at a time, once daily, with needle retention while applying a G6805 machine for intermittent waves for 20-30 minutes. After 25 treatments, all symptoms resolved, and the patient was discharged fully recovered.

6. Opening Orifices Method

This method is based on the “Nei Jing” principle that “when the evil prevails, the deficiency should be addressed.” It is suitable for certain critical conditions arising from acute febrile diseases or mental disturbances, or due to evil obstruction causing syncope or mania.

Points:

Nei Guan (Neiguan), Bai Hui (Baihui), Yong Quan (Yongquan), Shi Xuan (Shixuan), Ren Zhong (Renzhong), Xian Gu (Xiangu), Lao Gong (Laogong).

Method:

Reducing method with filiform needles or puncturing to draw blood; some may use warming moxibustion at Bai Hui.

Case 9:

Li ××, male, 18 years old, consulted on March 14, 1975.

The patient was diagnosed with liver fire stagnation due to excessive work and heavy drinking, leading to disturbance of the heart spirit, resulting in manic symptoms. He had previously taken a hibernation drug at a local psychiatric hospital for a month, but the condition was not controlled. Upon consultation, the patient had a red face and eyes, loud voice, was restless, incoherent, even cursing, had red urine, no bowel movement for a week, insomnia, and a bitter foul mouth. Pulse was rapid and full, tongue was red, and coating was thick yellow with black. Diagnosed with mania (manic-type schizophrenia). Points selected were Bai Hui, Nei Guan, Yong Quan, Lao Gong, and Xian Gu, with strong reducing treatment. Shi Xuan was punctured to draw blood, and skin needles were used for strong tapping on the back along the Du Mai and three Yang areas. Treated once daily, while also taking Da Cheng Qi Decoction and Qing Xin Niu Huang Pill. After half a month of treatment, the condition was basically controlled, and the patient felt guilty for cursing the doctor. Continued treatment with acupuncture and herbal medicine for two months led to recovery.

7. Stabilizing Collapse Method

This method is derived from the “Nei Jing” principles of “lifting what is down,” “supplementing what is deficient,” and “warming what is lost,” specifically used for conditions of sudden loss of righteous Qi. This often occurs when the evil is strong and injures the righteous, leading to critical symptoms on the verge of Yin and Yang separation.

Points:

Guan Yuan (Guanyuan), Shen Que (Shenque), Bai Hui (Baihui).

Method:

Heavy moxibustion is used, employing large direct moxibustion, regardless of the number of cones, until the pulse returns and the breath stabilizes. Bai Hui can be treated with suspended moxibustion.

Case 10:

Li ××, male, 9 years old, consulted on March 16, 1965.

The child was hospitalized due to damp-heat (otitis media). Due to limited medical conditions at the time, the condition worsened, leading to purulent meningitis. The child suddenly became comatose, sweating profusely, with incontinence, respiratory and cardiac arrest, in a clinical near-death state. Urgently selected Guan Yuan for large direct moxibustion. Direct moxibustion was applied for 10 cones, and the child exhibited weak breathing and pulse. Subsequently, the pulse gradually strengthened, breathing became orderly, and consciousness gradually returned, ultimately extending the child’s life by three days.

Acupuncture Management of Acute Conditions: Seven Common Methods I Use in Clinical Practice

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