appreciated as such) to keep a focus on the

imbalanced Official (Zang or Fu) and the

Causative Factor (CF), a concept Worsley
Reflection Four: Yin Tends borrowed from English homeopathy with its
Toward Deficiency/Treating the associated concept of “law of cure”. In doing
Source (The Easy Part); Yang this, there was frequent mention of treating
Tends Toward Excess/On Thorns, the “bodymindspirit”, a New Age concept
Knots, Stains and Obstructions that had entered acupuncture circles, and
especially with a focus on the Spirit which
(The Work)
was privileged as a level of intervention.

In the TCM approach, on the other hand,

THE PROBLEM: the focus was still on the primary ZangFu
pattern, but from a decidedly physical
“Ordinary skills of acupuncture maintain the perspective that gathered data about stools,
physical body […] Some people say chronic urine, breathing, sleep, pain, weakness,
disease cannot be cured. This is speaking etcetera, much more like an internal medical
incorrectly.” practitioner of western medicine with a
similar focus in treating the patient on the
(LS, Scroll One) physical level of organ dysfunction and
disease.

During the course of this on-line project, I Lines were drawn, and those entering the
have come to realize as I shared in the study of AOM to help people deal with
Preface that the “ordinary skills of complaints started to lean much more heavily
acupuncture” include the Ben (root) and in the direction of “8 Principle” acupuncture,
Biao (symptomatic) aspect of routine later referred to as TCM.
acupuncture treatment, and that there has
been much time spent discussing Root versus While TCM played lip service to the classical
Symptomatic treatment, as if the former were notion that Internal ZangFu problems were
more important than the latter, and required caused by disorders of the 7 emotions, it was
higher skills, when they are both in fact part Worlsey’s approach that took this concept
and parcel of good solid acupuncture. the furthest in those days. Each approach was
certain it had the correct way of treating the
Root, and each style, from my perspective,
5 Element and 8 Principle Treatment missed the main point of acupuncture, that
in fact has to do with knowing how to
In both the 5 element and the 8 principle navigate the channels to deal with those
discussions of 25 years ago, each of these thorny, knotted, messy obstacles which
approaches argued that it was treating the present themselves as symptoms, which bind
Root. In Worsley’s “Five Element” our patients in chronic holding patterns and
approach, practitioners were strongly which, once they become chronic, make
dissuaded from using needles to treat escape quite difficult without some hands-on
symptoms (which would make one a “Local” help. And it is especially there, in each of
doctor using local meridian points for these two main style’s lack of education or
symptoms), as it encouraged its students from training in palpation and touch, that
the very beginning, after removing whatever treatment of the meridians (jingluo) got so
basic blocks (which were, interestingly, often seriously shoved into the background.
meridian blockages but not taught or

  1  
Where Worsley himself was a gifted physical
medicine practitioner before learning Maciocia stresses that treatment principles
acupuncture, who resorted at every turn to can be discussed in four distinct yet
physiotherapeutic and osteopathic interrelated ways:
manipulations to clear away these thorny ♦ As Root (Ben) and Manifestations
obstacles and open the way for a Root (Biao): Upright Qi is the Root
acupuncture treatment, the North American relative to Pathogenic Factors which
teachings that derived from his work would are the Manifestation; Root is
have to wait for Fritz Smith’s brilliant “zero- etiologically the root of a disease
balancing” method, developed to fill the gap while the clinical manifestations are
in this 5 element training tradition, to learn the Manifestation; Root is the initial
how to lay on hands to promote “free-flow” condition while Manifestation is the
through the channels and collaterals. later developments of the condition;
Chronic disease is the Root relative
While I grew to be quite impressed by the to Acute disease which is the
sincerity of the education in Worsley’s Five Manifestation. “They are not two
Element style, I became dizzy with the separate entities, but two aspects of a
gyrations such practitioners would go contradiction, like Yin and Yang” (p.
through to avoid inserting a needle in places 312). Maciocia makes the oft-quoted
that were knotted, obstructed, and screaming statement that “[g]enerally speaking,
for relief, and confused and dismayed by the treating the Root only is sufficient to
associated lack of interest in navigation and clear all clinical manifestations in
treatment of the meridians of acupuncture in most cases” …”when the clinical
their classical sense. manifestations are not too severe”(p.
313”. The Root and the
It felt to me as if the Worsley tradition, in Manifestation would be treated
short, was intentionally not embodied, seeing together, an approach he admits is
itself instead operating on some rarified widely used in chronic conditions,
“spirit level”. “when the clinical manifestations are
severe and distressing for the
patient” or when “the clinical
Root and Symptomatic Treatment manifestations themselves are such
that they would perpetuate the
During this period of development of North original problem”p. 314). When the
American acupuncture, the issue of Root manifestations/symptoms are severe,
versus Symptomatic treatment lead usually in acute conditions, he goes
practitioners to galvanize under one or the on, it is often necessary to treat the
other pole, with 5 Element practitioners manifestations first. You are referred
claiming the higher, Root ground and stating to Maciocia’s chapter for the more
that 8 principle/TCM acupuncture was detailed discussion regarding
purely “local doctor” treatment of symptoms. situations where there are more than
one Root, in which case each Root
For a detailed, although decidedly TCM, must be treated; one Root giving rise
internal medical (and therefore herbalized) to several different manifestations,
perspective on Root and Manifestation in where the treatment is still directed
TCM, see Maciocia’s The Foundations of primarily at the Root; and situations
Chinese Medicine, pp. 312-323, which I will where the Root and Manifestation
briefy summarize here. coincide which he states “can only
happen when the clinical

  2  
 manifestations are caused by external factors to strengthen upright Qi”(p.
physical trauma, such as in an 317) This can be done by using
accident”(p. 315). Here the dispersing acupuncture techniques,
stagnation of Qi and Blood in the cupping or bleeding. Maciocia
channels leads to pain because the concludes that a strategy commonly
pain is the stagnation of Qi and used for exterior and interior
Blood. conditions, when the body’s upright
♦ When to support Upright Qi, when Qi, its resistance, is low, is to expel
to eliminate pathogenic factors: the pathogenic factors first, then
Maciocia defines upright Qi as the tonify the upright Qi (only when
“body’s resistance to disease” […] there are no more signs of
“used only in relation and in pathogenic factors being fought off
contrast to pathogenic factors” does one tonify upright Qi he states).
(regardless of whether they are While this is a required approach in
external such as wind, cold, damp, acute or urgent cases, it is also
heat, or internal such as interior commonly used “in chronic cases
wind, blood stasis and stagnation of where the symptoms do not have a
Qi, phlegm and fire). An Excess in character of urgency, but are
this circumstance refers to the nevertheless, very distressing and
presence of an exterior or interior painful”(p. 319). This is the case in
pathogenic factor, where the upright chronic visceral and pain disorders,
Qi is still intact enough to fight the and the APM/CCA integrated
pathogenic factors, he clarifies. A approach usually adopts this
Deficiency, on the other hand, refers approach, of focusing on expelling
to a weakness of upright Qi and an the pathogenic factors, but also
absence of a pathogenic factor. simultaneously supports the upright
Finally, a mixed Deficient/Excess Qi for balance. I agree with Maciocia
condition, which he adds is far more that one must be very careful when
frequent clinically than a purely dispersing excess to suggest to
excess condition, refers to a patients not to overdue it with
condition where upright Qi is weak, exercise or activities which may
but pathogenic factors are also aggravate the dispersal and lead to
present. Treatment must therefore undue soreness and fatigue. They
be directed at tonifying or dispersing would do well to rest, and/or
(expelling) or both. meditate to calm the body and mind
♦ When to tonify, when to disperse: and gather resources. If there are
Tonifying upright Qi is only signs of the body fighting something
applicable, Maciocia underscores, in off, a fever, even if low grade, chills,
interior conditions. This can be a feeling that one is coming down
accomplished with acupuncture, with something or just getting over
exercise, diet, Qi Gong, meditation, it, I do not treat their original
rest or herbs, he clarifies. He quotes chronic condition, say chronic
the saying “support upright Qi, to Taiyang Zone pain in the low back
eliminate the pathogenic factors”(p. and buttocks, as this would invite the
316). In exterior conditions it is current EPF to enter more deeply.
almost always sufficient to expel the This is also why physicians counsel
pathogenic factors and the upright patients not to work out during a
Qi will be strengthened, whence the cold or flu, but rather to stay home
saying “eliminate the pathogenic and rest.

  3  
 ♦ Treating the constitution. This meridian therapy claims that treatment of
refers, Maciocia stresses, to the localized areas is unnecessary. Sometimes
“Three Treasures (San Bao)—Essence local, symptomatic treatment may even have
(Jing, prenatal, hereditary Qi and a beneficial effect on the balance of Qi in the
inherited constitution gauged by body as a whole (Japanese Classical
general vitality, symptoms, pulse and Acupuncture: Introduction to Meridian Therapy,
eyes- leading to strong bones and translated by Stephen Brown, Eastland Press,
good mental faculties and memory); Seattle, 1990, p. 152).
Qi (acquired or postnatal Qi, which
can be gauged by symptomatology, Shudo sensei then goes on to summarize the
tongue, pulse); and Shen (the state of two opposite views, with some meridian
mind is “primarily a result of the therapists claiming that root treatment
interaction of Jing and Qi and is also effectively deals with 70-80% of symptoms,
reflected in the eyes”). The heart while others state that “symptomatic
pulse will also be strong but not treatment is necessary because practitioners
overflowing. Constitution can also of meridian therapy lack confidence in the
refer to treating according to the Five effectiveness of root treatment (ibid),” even
Elemental types. Maciocia raises the questioning the line drawn between root and
issue of whether one should treat the symptomatic treatment “on the basis that
constitution in the absence of some practitioners of meridian therapy
clinical manifestations, which he actually spend more time on symptomatic
believes only an experienced treatment (ibid).”
practitioner can ascertain. He
concludes that it is generally better to Shudo sensei concludes that there is a major
treat the constitution toward the end misconception among some conventional
of the course of treatment to acupuncture practitioners in Japan that
“consolidate the results. On the “practitioners of meridian therapy believe
other hand, one must pay attention that root treatment is all that is necessary, but
not to exceed in treating the the truth is that symptomatic treatment is by
constitution and stir up problems no means neglected in meridian therapy
unnecessarily”(p. 323). (ibid).”

Shudo sensei then concludes: “The only real

Japanese and Acupuncture Physical difference between meridian therapy and the
Medicine Perspectives conventional approaches to acupuncture in
Japan is that root treatment is performed to
This issue of Root versus Symptomatic balance the body energetically before the
treatment has also been a major source of specific symptoms are treated ibid).”
debate, at times heated, in the Japanese
Acupuncture field over the last half decade, With that clarified, Shudo sensei’s own
where conventional acupuncture simplified approach to root treatment is
practitioners and meridian therapists argue presented, and consists in the treatment
their views on the subject. In his seminal text, primarily of tonfication points, as well as
master practitioner Shudo Denmei master points on the “mother” meridian, to
summarizes the issues and debates, by first treat the primary yin meridian/organ
stating clearly: “It should be emphasized that deficiency as phase one of treatment, based
both root and symptomatic treatment are on Nan Jing five phase treatment strategies.
necessary and important. No authority on

  4  
Shudo sensei’s approach is consistent with effective fashion: with meridian therapy
the tonification at the ying level of the most reassessing the pulse during the treatment to
deficient yin meridian/organ, and/or check for positive change; KM style
balance of the jing level extraordinary rechecking the hara and other reflexes for
meridians before moving on to treat the this evidence of change during the treatment;
local, symptomatic complaints of the patient, APM looking for expected reactions to the
in APM, which incorporates Shudo sensei’s needling of the first phase of points (sinking
hypothesis that “yin tends toward deficiency, deeply into the point for tonification,
yang tends toward excess” as a central focus spreading out and/or propagating away from
for chronic complex disorders specifically, as the point for dispersal); and TCM rechecking
well as for internal visceral complaints in pulse and tongue the next visit.
general.
But all of these styles and practitioners are in
KM style acupuncture, likewise, begins phase fact also assessing the effectiveness of the
one of treatment by regulating the Yin, treatment as it is being administered,
ventral aspect of the body by needling distal whether consciously or tacitly, by looking for
points often selected based on Nan Jing five more general signs of positive change already
phase theory, to regulate constitutional and enunciated in the first chapter of the Ling
Organ imbalances before moving on to Shu: “Look at the patient’s color. Observe the
treatment of the patient complaint and the eyes. Know how the qi disperses and returns.
yang, dorsal aspect of the body. Each has its own form. Listen to the patient’s
movement or stillness. Know his imbalance
Finally, TCM, which has borne the brunt of and his balance (Ling Shu or The Miraculous
five phase criticisms that it only treats Pivot translated by Wu Jing-Nuan, University
symptoms, also often begins with treatment of Hawai’i Press, 1993, p. 4).
of distal essential points to address the
underlying pattern of disharmony, and then
adds local specific points to address the Vital Signs of Change
patient complaint.
I believe too little is made of these
In selecting distal points for this first, observations of change, some of which I
YinYang regulatory phase of treatment, the learned from practitioners at the Traditional
term the college prefers to “Root treatment”, Acupuncture Institute in Maryland almost
meridian therapy, as well as KM, APM and three decades ago. And I believe there is a
TCM styles of acupuncture as taught at the tendency to privilege assessment by the radial
college, all teach to select from the 5 shu- pulse, which is prone to very subjective
transporting/5 phase elemental points, the interpretation by the acupuncturist, rather
yuan-source points, the luo-connecting points than learning to read the signs of energetic
and the xi-cleft points. Where meridian change in the circulation of Blood and Qi by
therapy and KM style tend to select these observing these changes directly: looking for
distal “command” or essential points based improved facial color, for the shen to return
on Nan Jing five phase theory, APM and a sparkle to the eyes, and listening for more
TCM tend to select these points for their relaxed breathing and more relaxed speech,
functions as jing-well, ying-spring…he-sea looking for a more relaxed demeanor, and
points more consistent with earlier Ling Shu listening, watching for and questioning how
theory. the qi and blood are moving, changing
temperature, releasing constrictions (creases
These four styles also have different ways of across the abdomen, x’s in the back of the
assessing if the treatment is proceeding in an

  5  
neck, compressed wrinkles in areas of spinal • APM use of classical Chinese bi-
stenosis, release of muscular holding syndrome and modern trigger point
patterns). These things can all be seen, and dry needling techniques, pre-
those observing will concur on the changes acupuncture palpation, pacing and
noted far more consistently, I would submit, leading ones therapeutic comments
than those checking the pulse. and silences to prod change (based
on Ericksonian hypnotherapy and
Finally, if one makes positive change in the NLP techniques), and prodding of
pulse the sole arbiter of therapeutic change, the “bodily felt-sense” (Gendlin), as
the classical rules of assessment have been well as education of the patient
ignored, which call for assessing in as many about their holding patterns and
fashions as possible, to glean as much armoring (Reich, Keleman);
information as one can, until this • TCM use of stationary and moving
information is able to be assessed tacitly, cupping, guasha, indirect
which I believe is the case with all senior moxibustion, tui na, Qi Gong and
practitioners. And no practitioner taking the Daoyin exercises.
pulse during the treatment is failing to also
take in changes in complexion, tone of voice,
breathing patterns etcetera, all of which will Treating Excess: Surface Manifestations
influence how they interpret the pulse. and the Patient-Complaint

It might be interesting to devise a research In excess disorders the jingluo, the soma,
study to see if assessing therapeutic change and especially the cutaneous regions (zones)
without taking the pulse by some and tendinomuscular meridians need to be
practitioners coincides with therapeutic pulse dispersed as the primary strategy. In APM,
changes assessed in that way by others. YinYang regulatory treatment at the ying
level in such cases simply consists in
That being the case, Shudo Denmei makes a supporting the yin paired meridian’s primary
point that is a truism in APM, KM and TCM Zang (supporting the Kidneys for Taiyang
style practices as well: “When it comes to Zone, Liver for Shaoyang Zone and Spleen
symptomatic treatment, there is practically for Yangming Zone) and completing the
no limit to the variety of approaches and circuit for zone excesses, or needling the 4
techniques that can be employed. gates or distal jing-well and other tender
Symptomatic treatment is an area in which points for tendinomuscular excess to clear
every practitioner can display his own talent the jingluo and promote smooth flow of
and unique skills. Each of us must spend a Blood and Qi.
lifetime developing our own treatment style
(Shudo, ibid, p. 153).” In deficiency conditions the ZangFu are the
main target of treatment, but the French
This would certainly be true in the three acupuncture strategies that lie at the
main styles taught at the Tri-State College of foundation of APM treat these visceral
Acupuncture, where local treatment of the disorders and diseases through the
patient complaint are varied indeed: extraordinary vessels as well, which are
activated when the organism is confronted
• KM style use of various needling with the strain of chronic disease or
techniques and depths, moxibustion, dysfunction. Here a jing level treatment of
patchi-patchi, ion chains and diode the extraordinary vessels is done first, and
rings, sotai, etcetera; then a ying level treatment of paired yin

  6  
meridians to any yang zones affected is
executed, to regulate yinyang circuits at the “As for that which is termed tri (level)
same time as removing chronic muscle insertion for promotion of grain qi (ie; the
channel obstructions by addressing ashi and correct qi), one first inserts the needle
trigger points. shallowly, barely penetrating the skin to drive
out yang evil. Next one needles to drive out
It is in this sense that APM focuses on the yin evil [inserting the needle] slightly deeper
need to disperse excess in the three Yang to penetrate the skin and flesh but not
Zones (the cutaneous regions) or the penetrating the parting of the flesh. Finally,
tendinomuscular (muscle) channels, thereby one needles still deeper, penetrating the
fortifying the body’s defenses/upright Qi. parting of the flesh to promote the
emergence of the grain qi (p. 279).”
This is also why APM focuses on addressing
up-regulation/hyper-reactivity in the “The so-called arrival of the grain qi implies
extraordinary vessels, especially, chong, du, that supplementation has replenished (the
dai and ren, which are called into play, channel) and drainage has evacuated (the
according to certain French acupuncture channel). Thus one may know that the grain
understandings, when the body is perpetually qi has been attained (p. 305).”
attacked, to protect the ZangFu against this
steady onslaught. “Once the evil qi has been removed, despite
a failure to regulate yin and yang, the disease
The point is, that excess conditions must be will display signs of improvement. This is
dispersed. I believe it is a mistake to treat the why it is said that supplementation is sure to
constitution alone in the presence of excess replenish, while drainage is sure to evacuate,
in the zones and/or muscle channels and luo and that although the disease may not appear
vessels, as this excess will block Qi and Blood to have diminished following acupuncture, it
and the ensuing stagnation and constraint will have indeed been mollified (p. 306).”
will create a vicious cycle of pathogenic
activity that will generate more excess. Here is It takes a tough kind of compassion, and
where lifestyle counseling, especially focus, to disperse Excess and evacuate evils in
regarding getting proper rest, sleep and stress patients with chronic conditions, where the
reducing activities like Yoga, meditation, Tai excess is laden with pain, suffering, and even
Qi and Qi Gong can be so critical. Tui-Na at times abuse. The going can get rough at
and massage, moving cupping and GuaSha times. But the result, freeing patients from
are also a vital part of treatment of excess, to some of this excess, from holding patterns
keep the body supple and functioning that have been constricting or suffocating
optimally. If Excess in the jingluo is left them, is worth the effort for practitioner and
unaddressed, this will lead to stagnation of patient alike.
Blood, constrained Qi, Phlegm and Fire, the
internal pathogenic factors. These, too, must To focus on the constitution alone, then, to
be dispersed. attempt to gently tonify patients with Excess
conditions with acupuncture is, and here I
This focus on dispersing Excess as a primary agree totally with TCM and Maciocia, an
strategy is clear from the LingShu and later error. This could be done if the patients were
texts that develop this notion in the classic addressing the excesses in another somatic,
discussion of “tri-level” needling. Here is physical practice, like Rolfing for example.
Huang-fu Mi’s version in the Jia Yi Jing or But somewhere the Excess has to be
Systematic Classic of Acupuncture & dispersed, or these Exesses will build up and
Moxibustion (Blue Poppy, 1993): lead, potentially, to what yoga refers to as a

  7  
Kundalini experience where the Excess symptomology as part of the internal branch
remains trapped in the patient’s nervous of the 12 regular meridians, I found
system. This can lead in extreme cases to Chamfrault and Van Nghi’s earlier
never-ending nervous system agitation. categorization in L’energetique humaine
more useful than Van Nghi’s later French-
Vietnamese one based on the Vietnamese
Beyond Root and Symptomatic Trung Y Hoc, in his Pathogenie et pathologie
Treatment energetique en medecine traditionnnelle
chinoise.
After much reflection on how North
Americans tend to ascribe more significance In the earlier text, Chamfrault and Van Nghi
to Root, than to Symptomatic treatment, I organized the teaching of the jingluo filter by
discussed this issue with Kiiko Matsumoto, category of meridian, and therefore category
who was rather surprised at how one might of point strategy, to be utilized in formulating
think a tree might have only roots or a comprehensive treatment plan based on
branches and still be a tree! This lead to a jingluo pattern identification. This
decision at the college to refer instead to: categorization was broken down into Ying,
“YinYang regulation, using the essential Jing and Wei as follows.
points (distal command and local Mu and
Shu) to treat primary Organ or
Constitutional patterns; and Treatment of Ying & Ying Level Treatment
the Patient-Complaint, using reactive points,
which focuses on the complaint, and its signs The Ying level is comprised of the 12 regular
and symptoms as manifested by the patient. meridians, and internal branches (parallel to
This reformulation underscores the fact that the 12 divergent meridians) which function
one must address the patient’s complaint if as a circuit as presented in the previous
one wishes to practice patient-centered care, Reflection. Here, one identifies the regular
as this part of the treatment focuses on the meridian that is most affected, and its circuit,
patient’s experience and story of illness and and utilizes the source, or ying and shu, or
distress, not ours. This reformulation also tonfication or other essential command
hopefully puts to rest the fantasy, point on the Yin meridians, and the luo,
pronounced by those who profess to have the dispersal, xi-cleft, or other essential command
deep secrets, that one can treat chronic point on the paired yang meridian. The yang
complex disorders by “root” treatment alone, meridians are primarily used to address the
a fantasy that has lead far too many symptomatic presentation, while the yin
practitioners to clinical failure after failure. meridians address the underlying regular
meridian dysfunction. If one has already
made a TCM ZangFu pattern diagnosis, say
in preparation for an herbal
Treating the Patient-Complaint and
recommendation, one can just select the
Holding Patterns
corresponding regular meridian and its
associated circuit to develop a jingluo
As I reorganized the curriculum of the treatment plan.
Quebec Institute of Acupuncture into a more
workable model that integrated in TCM When the internal associated organ and
ZangFu pattern identification (the “ZangFu bowel are affected, resulting in internal
diagnostic filter”) in the second year, and visceral symptomology, one can add the local
after a thorough grounding in jingluo pattern
identification in Year I, that viewed visceral

  8  
front-Mu and/or back-Shu points to address This palpation of the target or symptomatic
the ZangFu directly. area has been a hallmark of the meridian
approach I have practiced for three decades,
A] Ying-Level Local Treatment of Patient- and was most elegantly and simply stated by
Complaint Dr. Ni in her clinical text, when she stressed
that any local point on a meridian may be
The main difference in this jingluo approach, used to treat local symptoms in the area of
from TCM acupuncture treatment, is that that point. For those who palpate distally and
points are selected based on their dynamic locally, to assess the state of excess and
effect on the circulation of Qi (what the early deficiency of the “beginning and ends” of the
French authors referred to as the ‘energetics’ meridians, a rich array of circuit palpation
of the points) rather than based on supposed and treatment is readily available that is
indications, and that local points are selected always patient-centered, because it starts by
from the meridians in the area of the assessing that area of the body-person (shenti)
complaint, by palpating for obstruction and that brings the patient to our office and
excess. Thus one might palpate and find affords us the privileged opportunity to
tightness and constriction over the lungs in a witness and support their efforts at change.
patient suffering from chronic obstructive
pulmonary disease (COPD) in the following I have started with this discussion of local
configurations, with the local obstruction treatment of the patient’s complaint in
guiding the distal YinYang regulatory visceral disorders of the ZangFu to stress that
treatment as well: in such cases, the local “symptomatic”
treatment addresses the ying level of the
• Tight Tender Points (TTPS, not to regular meridians based on the classical
be confused with Trigger Points or notion of assessing and treating the
TrPs) in the area of the Taiyin beginnings and ends of the meridians, not
union, Lu 1-2 and Sp 20 (beginning trigger points in the muscle channels.
of hand taiyin lung and end of foot
taiyin spleen), indicating a Taiyin In such ying level visceral disorders, one may
dysfunction; add treatment of the 8 extraordinary vessels
• The above TTPs, with exquisite with their distal opening points, a
tenderness at ST 14-16 and LI 17, characteristic of Van Nghi style French
indicating a taiyin/yangming meridian acupuncture, but also of Manaka
dysfunction; style Japanese style treatment, where ion-
• TTPs at Lu 1 and Liv 14, indicating a pumping cords are attached to the distal
blockage in the circulation of Qi opening points instead of needles.
from foot jueyin liver to hand taiyin
lung OR in Metal and Wood (Metal I list common local ying and jing level points
controls Wood); of union for addressing the patient-complaint
• TTPs at Lu 1-2 and Kidney 23-27, in my earlier Acupuncture Imaging, p. 26, and
indicating a hand taiyin lung and especially in chapter 7, on “bodymind-
foot shaoyin kidney dysfunction energetic palpation”, pp. 66-78, as well as in
(disorder of Metal and Water/ the drawings of the greater meridian units in
Mother and Child); my earlier BodyMind Energetics, chapter 2.
• TTPs at CV 18-17 and CV 23 with
plumpit Qi, indicating a dysfunction Main union points that I routinely observe,
of Wood and Water/ Liver and assess and release are:
Kidney/ Mother and Child.

  9  
 • TH 22-23 and GB 1-3 as well as the organs, are at risk. Treatment here is directed
extra point “taiyang” for Shaoyang toward stimulation of key points to address
lateral head pain, dizziness, vertigo, dysfunction in the chong, dai, ren and du
headache, migraines; vessels (Sp 4, GB 41, Lu 7, SI 3), with their
• TH 15 and GB 21 for Shaoyang paired vessels’ key points (Per 6, TH 5, Kid 6
upper back, trapezius, supraspinatus and Bl 62).
pain and dysfunction;
• TH 16 and GB 20, as well as the Local points from the extraordinary vessels
extra point “anmian” for involved can also be selected to address
Shaoyang/Jueyin tinnitus, visceral or somatic symptomology that
temperature problems including constitute the patient’s complaint, distress
excess sweating and hot flashes, and and suffering. While APM has specific stress
neck pain; patterns (the Four Patterns of
• Bl 1 (not needled) and SI 18 for Fatigue/Visceral Agitation presented in
Taiyang facial pain, trigeminal Reflection II) to address common chronic
neuralgia and sinusitis signs and adrenal patterns of our day, APM is
symptoms, which has come to predicated upon a solid grounding in jingluo
include Bl 2 and ST 2 where tender theory and treatment, and I frequently resort
in the same area of facial pain and to treatment of an extraordinary vessel or
sinus symptoms; vessels on their own, with little or no
• Bl 11 and SI 9-14 for rotator cuff treatment at the ying level.
disorders and shoulder pain and
dysfunction; This is common for me in addressing
• ST 2 and LI 20 for Yangming facial gynecological and reproductive problems,
pain and sinus symptoms; where I treat distal opening points for chong,
• ST 3-4 and LI 19 for trigeminal dai and ren, but also address excess and
neuralgia; deficiency along the local points of these
• LU 1-2 and SP 20 for Taiyin chest meridians, so GB 26-28 (dai), Kid 11-15 and
pain, respiratory disorders, shoulder ST 30-26 (chong) and CV 2-4 (ren). I also
pain and dysfunction; often treat a series of local HJJ points in
• Kid 27 and HT 1 (HT 1 replaced by spine disorders, with the infinity opening
subclavius trigger point near ST 13) point treatment for ren and du: Lu 7/Kid 6;
for Shaoyin Thoracic Outlet-like SI 3/Bl 62, as a du mai treatment (HJJ and
signs and symptoms of neck pain adjacent BL meridian points, as well as the
and arm repetitive strain signs and muscle channel multifidi, being seen as part
symptoms; and parcel of du mai).
• Liv 14 and Per 1-2 for Jueyin chest
pain, panic disorder, shoulder pain I felt the need early in my teaching career to
and dysfunction, respiratory focus heavily on teaching the extraordinary
problems. vessels when English language texts did not
exist and Chamfrault and Van Nghi’s texts
were the main resources. When these texts
B] Jing-Level Local and Distal Treatment went out of print, there was still Royston
Low’s book on the secondary vessels, which
The Jing level is comprised of the 8 then went out of print as well, and Felix
extraordinary vessels, which function outside Mann’s early text on the meridians of
of the 12 main meridians but kick in when acupuncture, which recently went out of
disorders are complex or chronic and two or print but appears to be circulating in an
more regular meridians, and their associated unofficial on-line version, has also

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disappeared. Since Mann recanted all of his correlate to, and perhaps more manageable
earlier books based on classical theory, form of such complex emotionally laden
support for training in the secondary vessels problems.
and extraordinary vessels was scanty indeed.
In its simplest version, one merely palpates
And then Dr. Ni published her brilliant along a muscle channel and performs wei
Navigating the Channels, which we use as the level oblique shallow needling (a needling
main authoritative text at the college for approach known as Bao Ci), to point after
jingluo clinical pattern differentiation and point in the symptomatic area as well as
treatment. distally on the channel involved (jing-well
and other tender ashi points), and this is
That said, any serious student of a jingluo done in APM most frequently on the Yang
approach should study Maciocia’s book on tendinomuscular meridians. One can also
the channels carefully and repeatedly, as it is incorporate trigger point dry needling based
full of clinically useful and classically on referral patterns, an extremely pragmatic
informed information, even if an awkward addition to classical muscle channel
text to use in the clinic itself. His study of the treatment, and these muscle channels can be
extraordinary vessels alone contains treated by region as well, with points from all
everything Chamfrault and Van Nghi wrote, three Yang or Yin meridians of the arm or leg
is consistent with Felix Mann’s early text on depending on region affected. Distally, one
the jingluo, and with Ni’s text. His treatment can treat the jing-well point as the furthest
of the extraordinary vessels fills 10 chapters point from the symptomatic area, the jing-
and over 270 pages, and is a book unto itself river point if the problem has become
that I highly recommend. chronic and rheumatic affecting the joints,
the luo-connecting point if its target area is
C] Wei Level Muscle Channel Local within the symptomatic region, or excess
Treatment reactive points on palpation along the same
channels.
Finally, APM focuses on W ei level treatment
in all myofascial and many musculoskeletal While release through a special “sparrow-
Bi syndromes where the treatment is pecking” needling technique is my preferred
comprised of the 12 tendinomuscular way to release active local trigger points,
meridians (muscle channels) and the 15 especially if acute, or if newly inflamed in a
primary luo vessels, which are activated chronic condition, which I lay out in my A
according to classical theory to protect the New American Acupuncture: Acupuncture
regular meridians and the skeletal system Osteopathy, I also often simply use rapid
from external attack, injury, repetitive strain lifting and thrusting to deep muscle ashi
and wear and tear, thus diverting the brunt points if sparrow-pecking does not lead to
of the attack to the larger muscle channels rapid fasciculation and release, which can be
and superficial cutaneous regions (Zones), the case in chronic pain where the fascia has
which occupy the broadest area and thus become fibrotic, in women right before or
serve best to offer this protection. In chronic during menstruation when their cou li layer
emotional disorders, affecting the internal is congested and full of damp Sha, or in
meridian/organ complex, the muscle patients with very low Blood Pressure or with
channels and cutaneous regions often serve Low Thyroid conditions.
as a shock absorber to take on the bulk of the
trauma, thus creating physical symptoms and While some practitioners who have trained
myofascial holding patterns, which Wilhelm with me might make almost exclusive use of
Reich referred to as “Character Armor” as a my APM Trigger Point Dry Needling

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technique for local excess ashi points, I two or more regular meridians and
discriminate much more than that, and their associated organs; OR just treat
reserve such a technique for actual myofascial the extraordinary vessel involved as
trigger points, and rarely when I am treating the main root treatment;
ying level regular meridian or jing level • The 3 Zones (Taiyang, Shaoyang,
extraordinary vessel local areas of the specific Yangming): when a chronic
patient-complaint. I also incorporate trigger myofascial or musculoskeletal pain
point release into full-scale jingluo and dysfunction condition is
acupuncture treatments for any complex or involved, especially when it is
chronic disorder, based on my approach to comprised of symptomatic areas at
the three Yang Zones as outlined in chart multiple sits within a zone and
form and in clinical protocols in Acupuncture especially if there are regular
Physical Medicine. meridian concomitants, treat and
entire zone with its APM protocol,
What characterizes APM style above all else is selecting wei, ying and jing level
its focus on careful palpation not only strategies to address the complex
distally, but locally along extraordinary vessel, disorder from several angles;
regular meridian, and tendinomuscular • One hypothesis: Yang tends toward
meridian and luo vessel pathways for areas of excess (so select the yang regular
excess and deficiency to be needled to relieve meridians to address local visceral
symptoms, remove obstructions, and symptomology (such as TH 23 and
promote the flow of Qi and Blood. GB 1 for migraine headache and TH
16 and 17 and GB 20 for tinnitus;
Acupuncture PHYSICAL medicine is thus and the yang muscle and/or luo
aptly named, to underscore a style akin to channels for bi syndrome and
AOM bodywork, where laying on of hands is repetitive strain or injury); Yin tends
central and critical to clinical success. toward deficiency: tonify the most
deficient yin regular meridian
The Jingluo Filter at a Glance (derived from Shudo Denmei’s
simplified meridian therapy
Based on this way of categorizing the jingluo protocol);
filter, jingluo pattern identification and APM • Combine and sequence needle
treatment planning consists of the following selection and stimulation based on
elements: the 8 conditions: select points from
the foot and the hand meridians,
• The 3 circuits (of the 12 regular and from the right and the left, and
meridians): select the circuit based from the front and the back, and
on the primary Yin regular meridian from Yin and Yang meridians, to
involved, and treat its corresponding regulate Yin and Yang.
paired Yang meridians, thus treating •
at least 2 out of 3 meridians in a 8 Conditions of Point Sequencing
circuit;
• The 3 levels (ying, jing, wei ): to the The 8 conditions figure into jingluo
above regular meridian/circuit treatment planning at the point where one
treatment, add the corresponding decides how to combine the selected
extraordinary vessel treatment of key treatment strategies in terms of location
distal and local points, if the disorder where each point is needled. Following the
is complex or chronic and involves basic principle of treating on the diagonal to

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regulate Yin and Yang meridians, most Maciocia presents numerous treatment
common in the treatment of two paired strategies for treatment based on the 8
extraordinary meridians (SP 4 on one side, condition method of point sequencing in his
and Per 6 on the opposite side, for example, The Channels of Acupuncture, Chapters 8-10,
thus regulating right and left and upper and pp. 107-177, and especially in chapter 11, pp.
lower with just two needles), I treat the distal 177-215.
ying meridian points in the same fashion: if
doing the 4 gates, I needle Liver 3 on one
side, and LI 4 on the other (thus regulating
upper and lower, right and left and yin and Summing Up
yang with just two, or at most four needles).
When multiple distal points are selected (say As I routinely tell students, a way to
ST 36, 37 and 39 as lower he-sea points, remember that one can treat from all three
and/or as distal points of chong mai, I just jingluo levels (jing, ying and wei) is to
needle each point where most tender, or imagine each level being done with different
arrange them, perhaps ST 36 and 37 on one therapies and no acupuncture:
side, and ST 39 on the other, based on the
number and location of the other needles so • The jing level, by the patient her or
as to avoid unnecessary bilateral treatment. himself, in daily prescribed Qi Gong
practice;
In brief, based on the 8 conditions, I • The ying level, with herbal remedies
alternate between distal leg/foot, and distal taken daily;
arm/hand points on the diagonal, and • The wei level, with tui na in the
complete my distal points to regulate Yin and office, and self-administered moxa at
Yang meridians, from the extraordinary home by the patient.
vessels and regular meridians, and then add
local mu or shu points if the viscera are All three levels can also be treated only with
involved, as well as local points on these acupuncture, something Acupuncture
meridians to address local symptoms, and Physical Medicine does routinely.
finally distal and local wei level excess yang
points to disperse muscle channel excess and
clear the obstructions.

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