Tran on Pain

Dr. Tran Viet-Dzung Tendino-Muscular Meridians May, 2001

Lake Chelan WA, May 2004

The tendino-muscular meridians (TMM) originate at jing well points of principle meridians & travel at a level below the dermis, where muscles, ligaments, tendons & nerves reside. Their function is to protect principle meridians from EPI invasion. The main symptom of EPI invasion of TMM is Bi syndrome, manifested as pain & paresthesia. The Ling Shu connects each TMM with a season & lunar month within each season. Practitioners may notice they’ll have several patients coming in with similar TM complaints at certain times of year. For example, 4 patients in late Spring with plantar fascitis. Reunion points are accumulation points common to the 3 TMM of each season. Disperse reunion points to clear EPI from TMM.

Spring - GB, BL & ST.

3 Yang Foot TMM. Reunion points SI-18, ST-8.

Summer - LI, SI & SJ.

3 Yang Arm TMM. Reunion points ST-8, SI-18.

Autumn - SP, K & LV.

3 Yin Foot TMM. Reunion points CV-2 or 3.

Winter - PC, LU & HT.

3 Yin Arm TMM. Reunion point GB-22.

GB TMM: 1^st month of Spring (approx. March 21 – April 20) Symptoms: 4^th toe pain, contracture, spasm, tightness or paresthesia. Lateral ankle pain or paresthesia. Lateral leg pain or paresthesia. Popliteal crease or lateral knee pain. Lateral thigh pain or paresthesia. Coccygeal pain. Lateral rib pain or spasm. Breast pain. Contra lateral neck pain or spasm, lateral blephera spasm.

GENERAL TX: Analgesic technique: disperse ah shi points by inserting 2 needles facing each other, one on either side of the ah shi point. Needle obliquely into the TM level, which is deeper than dermis level. Locally stimulate needles manually or with electro, until local distention occurs. Electro machine set on continuous mode, high frequency & high intensity (just below patient tolerance) for 5 minutes. Re-adjust as needed every 5 minutes, for a total of 15 minutes. Moxa can also be used to move pain out of affected area. Tonify principle meridian with GB-43 (ying spring point), GB-40 (yuan source point), contra lateral GB-44 (jing well point). SI-18 or ST-8 (reunion points of yang leg MTT.) Always add Yang Ming tonification points LI-4 & ST-36.

EX 1: Hypochondriac pain due to biliary cholic. Use analgesic technique at ah shi points. SJ-6, GB-43, GB-40, SI-18, GB-44. Use GB-34 (xi-cleft point) & LV-6 to regulate LV-GB system. Do not to allow GB-34 to bleed, as loss of Liver blood disrupts connection between LV & GB. LV-14. Moxa BL-18 & 19. LV-13 (influential point for Liver). Treat GB by needling CV-12 (influential for yang organs). CV-5, since this is a lower jiao problem & SJ Mu point brings water to balance K/LV in lower burner. LI-4 & ST-36.

EX 2: Breast pain – especially superficial or with very light palpation. CV-17 & K-25. Both needled towards affected breast. SP-21 (located in 6^th intercostal space, mid-axillary line). GB-22 (located in 5^th intercostal space). Needle ST-15 with electro to K-22. Electro between K-25 & either SP-21 or GB-22. Use analgesic technique (continuous mode, high frequency & high intensity.) SP-21 for general body pain (it is at level of an upper horizontal zone (analogous to Dai Mai at GB-26 level). Pain at top of nipple is associated with LV-GB. Disperse ah-shi point around GB-21. Disperse LV-3, SI-18 and/or ST-8. Tonify GB-43, GB-40, GB-44, LI-4 & ST-36.

EX 3: Lateral blephera spasm. Due to lack of water in muscles of eyelids. Need K water traveling along ShaoYang (SJ & GB) to moisten eye muscles. GB-4, 5 & 6 are near eye & can bring water to it. Tai yang extra point corresponds to water, too. It’s directly on superficial artery near eye. SJ-20 connects to GV-20, where all yang organs meet. GV-20 concentrates water & balances jing. SJ-20 connects to BL-7. GV-20 connects to SI-18 & ST-8. Needle both ST-8 points, pointed toward each other. Add GB-43, GB-40, GB-44, SJ-3 (to tonify SJ as Shao Yang). Tonify LI-4 & ST-36.

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BL TMM: 2^nd month of Spring (approx. April 21 – May 20) Symptoms: Pain in 5^th toe that may radiate into heel. Plantar fascitis. Pain at approx. Bl-61. Lateral ankle pain. Popliteal knee pain, contracture, inflammation or hardness. Gluteal pain. Spinal pain, especially at GV-4. Feels like they are “broken in half.” Leans backwards to walk. Reduced range of motion rotating L or R. Shoulder or axilla pain. Posterior neck tightness. Skull or periorbital eye pain. Upper blephera inflammation or spasm.

GENERAL TX: Analgesic technique at ah shi points. Tonify principle meridian with BL-66 (ying spring point), BL-64 (yuan source point), and BL-67 (jing well point). LI-4 & ST-36. Disperse SI-18 and/or ST-8.

EX 1: Plantar fascitis. Find ah shi point near center of heel. Needle directly into it, all the way to bone. DO NOT HESITATE OR VACILLATE. Just do it with clear intention. Find another ah-shi point around BL-61. Use analgesic technique with electro between these two points. Tonify BL-67, BL-66, BL-64, LI-4 & ST-36. Disperse SI-18. Can use moxa to tonify.

EX 2: Spinal pain. Patient may feel as if they are breaking in half. Tendency is to lean backwards when they walk. Ah shi points using electro & analgesic technique. SI-3, BL-62. Oblique insertion of jiaji points at GV-4. GV-4, BL-23, BL-52. Tonify principle meridian with BL-66, BL-64 & BL-67. Tonify ST-36 & LI-4. Disperse SI-18.

EX 3: Posterior neck pain, skull pain, occipital headache or periorbital pain. Needle GV-1 & GV-16 (end points of longitudinal luo meridian). Curious point in center of posterior neck at level of cervical vertebrae 4, 1 cun lateral to the spine is empirical for neck pain. Angle towards BL-10. BL-10, GB-20 & SJ-16 are Window of the Sky points, which close when too much energy rises into head. They must be opened in order to maintain communication between upper & lower body. BL-10 treats K, GB-20 brings K water to LV. BL-7, connects Tai Yang (a water point) to brain via connection to GV-20. BL-2 accelerates water transport to brain. Tonify BL-66, BL-64 & BL-67, LI-4 & ST-36. Disperse SI-18.

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ST TMM: 3^rd month of Spring (approx. May 21 – June 20) Symptoms: Pain, tightness or cramps in 2^nd toe. Antero-lateral ankle pain. Tight anterior tibialis muscle. Pain or tightness around GB-34 or ST-32. Hip pain at GB-30. Inflammation of femoral triangle that ascends to external genitalia or to CV-2 - CV-3 area. Tightening or clenching of abdomen. Pain at CV-12. Pain or spasm of lower jaw. Facial paralysis. Spasm of lower blephera.

GENERALTX: Analgesic technique at ah shi points. Tonify principle meridian with ST-44, ST-41 & ST-45. Disperse ST-8. Point it towards opposite ST-8. Tonify LI-4 & ST-36.

EX 1: Facial paralysis. This usually occurs when patient is tired & their wei qi is weak. Riding in a car or sleeping near an open window can result in facial paralysis. Due to WC or heat EPI. Determine which eye is affected & whether or not it is held open or closed. Have patient close both eyes. If upper eyelid is affected, patient won’t be able to close affected eye. If lower eyelid is affected, patient won’t be able to open affected eye. If GB TMM, strabismus occurs toward affected side. If contracture caused by WC EPI, mouth deviates toward affected side, & eye will remain open. For example, if L side affected by cold, L eye will remain open & mouth will deviate toward L. Thread L ST-6 towards ST-4. Contra laterally, thread ST-4 towards ST-6. Tonify ST-41, the Qing of the ST meridian, to bring heat to area to fight cold invasion. If blephera spasm is caused by heat, affected eye can’t open because heat expansion is pushing it closed. Heat will also push mouth to opposite side. So, if, L side affected by heat, L eye remains closed & mouth deviates to R. Thread L ST-4 towards ST-6, & R ST-6 towards ST-4. Tonify ST-44, ying spring point, to cool heat. LI-4, LI-11, ST-36 & GV-14. All yang meridians cross GV-14 & those meridians bring water to create wei qi, which must circulate to be effective. To circulate wei qi in face, bilaterally needle CV-22, CV-23, ST-5 & ST-9.

Differential diagnosis for the 3 yang leg TMM is blephera spasm. Lateral spasm or strabismus = GB. Upper eyelid = BL. Lower eyelid = ST.

LI TMM: 1^st month of Summer (approx. June 21 – July 20) Symptoms: pain, contracture or paresthesia at LI-1, possibly radiating towards LI-5. Pain along dorsi-lateral aspect of forearm. Lateral epicondylitis. Frozen shoulder - patient cannot touch their opposite shoulder across front of their body. Contra lateral dislocation of jaw or TMJ. Contra lateral maxillary arthritis. Contra lateral migraine with pain at ST-8, across forehead, or wraps front & sides of head like a scarf. Migraine pain may extend to contra lateral neck.

GENERAL TX: Analgesic technique at ah shi points. Tonify LI-1, LI-4, LI-11 & ST-36. Disperse ST-8 (most likely) or SI-18. Point ST-8 towards opposite ST-8. Add SJ-5 & GB-41.

EX 1: Lateral epicondylitis (tennis elbow). Needle an elbow ah shi point toward hand. Find another ah shi point around LI-10.This ah shi point is almost always directly on tendon, ligament or bone. Needle this ah shi point toward elbow ah shi point. Electro with analgesic technique (continuous mode, high frequency & high intensity). Tonify LI-11, LI-4, ST-36 & LI-1. Disperse ST-8 needled towards contra lateral ST-8. SJ-5 (to release the exterior). Wei guan is outer gate, or external barrier. Add GB-41 (Master of Yang Wei Mai.)

EX 2: Frozen shoulder. This condition can be due to either LI principle meridian blockage or LI TMM. Generally, if it’s acute, it’s LI TMM. Chronic cases are usually a blockage in principle LI meridian. A quick test is to vigorously needle contra lateral LI-1. Then have them reach across their body to touch their opposite shoulder. If needling LI-1 helped that movement, it’s TMM. Disperse ah shi points using analgesic technique with electro. Tonify LI-11, LI-4, LI-1, ST-36, GB-41 & SJ-5. Disperse ST-8 toward opposite ST-8. If needling LI-1 did not improve movement, it’s principle LI meridian. Needle ST-37 ipsilaterally with deep, strong stimulation.

EX 3: Maxillary arthritis. Can affect upper or lower maxilla. If upper maxilla, contra lateral LI-4 & ST-7. Add ST-41, ST-44, ST-36 & LI-1. Disperse ST-8 toward opposite ST-8. Add SJ-5 & GB-41. If lower maxilla, use contra lateral ST-6 instead of ST-7.

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SI TMM: 2^nd month of Summer (approx. July 21 – Aug. 20) Symptoms: Pain in 5^th finger that radiates to lateral wrist or medial epicondyle. Pain at SI-8. Pain in axilla or shoulder. Female patients cannot reach behind their back to remove their bra. Posterior neck pain or inflammation. Otalgia, tinnitus, or buzzing in ear. Migraine with neck & shoulder pain & ringing in ears. Maxillary pain.

GENERAL TX: Analgesic technique at ah shi points. Tonify SI-3, SI-4, SI-1, ST-36 & LI-4. Disperse ST-8 toward opposite ST-8. SJ-5 & GB-41.

EX 1: Ear pain. Can be otalgia, tinnitus or buzzing in ear. Find a zone about a finger’s width above ear. Insert 2 needles. SJ-17, slightly inferior to where we learned it… Tran’s location is right behind ear lobe. Should be tender to touch. Deep insertion, pointed toward inner ear. SI-19 (in front of tragus). SJ-21 & GB-2. Tonify SI-3, SI-4, SI-1, LI-4 & ST-36. Disperse ST-8 toward contra lateral ST-8. SJ-5 & GB-41.

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SJ TMM: 3^rd month of Summer (approx. Aug. 21 – Sept. 20) Symptoms: Pain in 4^th finger that may radiate to wrist at SJ-4. Synovial cyst around SJ-3. Shoulder pain – patient cannot touch top of their head or behind their neck when their elbow is out to affected side. Lateral neck pain. Pain in front of the ear. Tongue retraction or migraine with tongue retraction.

GENERAL TX: Analgesic technique at ah shi points. Tonify SJ-3, SJ-4, SJ-1, SJ-5, GB-41, LI-4 & ST-36. Disperse ST-8 toward contra lateral ST-8.

EX 1: Synovial cyst. Find ah shi points around SJ-3 & SJ-5. Needle as close to the cyst as possible, unless patient is pre-surgery for cyst. Analgesic technique using electro (continuous mode, high frequency & high intensity). Add LI-4, ST-36, SJ-1. Disperse ST-8 toward contra lateral ST-8.

EX 2: Tongue retraction. SJ-17, CV-23 angled toward tongue. Contra lateral SJ-3, SJ-4, SJ-1 & ST-8. LI-4 & ST-36 – especially if there is atrophy of the tongue due to prolonged retraction.

Differential diagnosis for 3 yang arm TMM is frozen shoulder or migraine pattern. Inability to reach across body to touch opposite shoulder, migraine that travels across forehead or wraps around like a scarf = LI. Inability to reach behind the back (females can’t remove their bra by reaching behind their back), migraine with ear-ringing, neck & shoulder involvement = SI. Inability to touch top of head or back of neck with elbow extended laterally, migraine in front of ear only or with tongue retraction = SJ.

SP TMM: 1^st month of Autumn (approx. Sept. 21 – Oct. 20) Symptoms: Pain in medial aspect of large toe. Hallux valgus syndrome. Medial malleolus pain. Medial knee pain. Women with medial knee pain frequently have hardening around SP-9. Medial thigh pain. Pain in femoral triangle. Pelvic pain that may radiate into external genitalia or to back. Umbilical pain. Patients may also exhibit hypochondriac, thoracic, or spinal pain. Chest fullness due to asthma phlegm.

GENERAL TX: Analgesic technique at ah shi points. Tonify SP-2, SP-3, SP-1, LI-4 & ST-36. Disperse CV-2 or CV-3 zone (reunion points).

EX 1: Hallux valgus syndrome. Needle SP-2 ah shi point toward joint. Needle SP-3 ah shi point towards joint. Analgesic technique with electro. LV-3 angled toward large toe. ST-42 needled where you feel dorsalis pedis artery pulsing. Dr. Tran uses ST-42 for any type of foot problem.

EX 2: Medial knee pain. The Ling Shu says to use BL-62 (Master of Yang Qiao Mai) for men with medial knee pain, & K-6 for women with medial knee pain. As always, find ah shi points around SP-9, use analgesic technique with electro. Then tonify principle meridian & Yang Ming (SP-2, SP-3, SP-1, and LI-4 & ST-36). Disperse reunion point(s) CV-2 and/or CV-3. If a patient has had knee surgery, don’t needle directly into the scar, but surround it with needles angled toward scar.

EX 3: Umbilical pain. K-16 & ST-25 are transit points for wei qi. Needle K-16 deeply, angled toward peritoneum, since it rules peritoneum. It brings wei qi from deep inside body, to surface. Moxa ST-25 to circulate wei qi brought forward by K-16. The ancient texts also use SJ-6 & GB-34 (don’t let it bleed!). Tonify SP-2, SP-3, SP-1, LI-4 & ST-36. Disperse CV-2 and/or CV-3.

EX 4: Thoracic or spinal pain. Yang energy stuck in the chest = fullness. CV-17 re-establishes balance in chest by bringing water from SJ & fire from PC. PC-6 opens chest. CV-22, K-27, SP-2, SP-3, SP-1, LI-4 & ST-36. Disperse CV2 and/or CV-3. If pain radiates to spine, SI-3 & BL-62 open Du Mai. Can also use GV-26. Can bleed it or use a quick, in & out insertion, angled toward base of nose. TCM theory explains loss of consciousness as disconnection between 7 orifices (2 eyes, 2 ears, 2 nostrils & mouth). GV-26 re-establishes connection, because it is located at center of 7 orifices. Tonify SP-2, SP-3, SP-1, LI-4, ST-36 & disperse CV-2 and/or CV-3.

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K TMM: 2^nd month of Autumn (approx. Oct. 21 – Nov. 20) Symptoms: Pain at K-1 or plantar aspect of 5^th toe. Ling Shu describes K-1 at that location. Anterior plantar pain or contracture. Medial ankle pain around K-3. Popliteal pain around K-10. Differentiate between K & BL knee pain by testing reunion points for tenderness. If K, CV-2 area will be tender. If BL, SI-18 area will be tender. Medial thigh pain. Pelvic pain or pain radiating into external genitalia. Lower abdominal “heaviness” & lumbar pain causing patient to hunch forward when they walk. Para spinals ascending to occiput feel tight or painful. K TMM connects to BL TMM as both TMMs ascend the posterior aspect of the body. BL TMM travels along the spine & K TMM travels along para spinals. Differentiate via reunion point reactivity & treat accordingly.

GENERAL TX: Analgesic technique at ah shi points. Tonify K-3, K-7 K-1, LI-4 & ST-36. Don’t allow K-3 to bleed – can result in tachycardia. Disperse CV-2 and/or CV-3.

By now, we should have an idea of how to treat painful areas. Several TMMs have common symptoms (knee pain, back pain, lower abdominal pain, genital pain, etc.) Differential diagnoses & reunion point reactivity provide clarity. Use appropriate tonification of principle meridians involved & disperse proper TMM reunion points. Always remember to tonify Yang Ming.

A few interesting asides Dr.Tran discussed regarding Kidney Yin Xu….

EX 1: Tonification of Kidney Yin. CV-4 or CV-5 angled towards CV-4, K-7, CV-3, SP-6. Secondary tonification of K yang by using GV-4. Generally, to reduce xu heat, use earth points.

EX 2: Kidney stones and wei qi. Kidney yin xu can result in LV fire flare up. Internal LV heat can create internal wind – like leaves burning, which swirl around as they burn. Internal fire evaporates water, leaving only mineral crystals behind. CV-5 (SJ MU point) balances water level to reduce internal LV heat. CV-5 also dilates ureters to allow kidney stones to pass. CV-5 is where wei qi is formed. K water is heated by ministerial fire of LV. The resulting steam circulates throughout body as Yang energy, protecting against EPIs. It is Yang energy originating from Yin source (K & LV).

EX 3: Bone marrow dryness/xu. Again, LV heat & wind can flare up when K yin is xu. CV-5 (as discussed above) threaded toward CV-4. GB-16 brings water to head (located in line with center of eye, 1 cun posterior to anterior hairline). Tonify with perpendicular insertion. GB-39 (palpate from lateral malleolus superiorly along fibula. Where fibula “disappears”, you’ll feel tibial crest. Trace a line anteriorly from there, until you are between tibia & fibula). Needle deeply. K-7, LI-16, GV-20 & GV-15 needled obliquely toward each other. ST-36 & an extra point 3 cun distal & 1 cun lateral to ST-36. Dr. Tran calls this point ST-40. LI-4 & SP-3. Do NOT use moxa on these points, since marrow is already dry.

EX 4: Headache and vertigo. Differential diagnosis: K xu & LV shi = emptiness in lower jiao & fullness in upper jiao. Heavy head = vertigo or vertex headache. HT & SP xu =emptiness below & above. Empty head = vertigo. SP & ST xu = phlegm rises to head & gets stuck there. Shi Phlegm = vertigo. BL-10 (K), GB-20 (LV) & SJ-16 (window of the sky points). GV-16, GV-20, BL-7, GB-16 & BL-2 (angled toward Tai Yang extra point) bring water. LU-7 angled toward LI-4, SI-3 & LI-11 circulate ying energy, GB-34 (don’t let it bleed!) & LV-3 stifle wood (LV) fire with earth points. BL-17 & SP-10 circulate blood to push out wind.

CV-12 & Tran’s ST- 40 remove phlegm. Add appropriate primary channel tonification points & reunion points for the channel involved in your diagnosis (K, LV, HT, SP or ST). Tonify Yang Ming with LI-4 & ST-36.

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LV TMM: 3^rd month of Autumn (approx. Nov. 21 – Dec. 20) Symptoms: Pain or contracture at LV-1. Ankle pain around LV-4. Pain or contracture at adductor tubercle or around LV-8. Internal or external genital pain. Vaginal itching in females. Contracture (cold) or lengthening (heat) of penis in males, preventing erection that is TM in nature. Differentiate from impotence, which is K yang xu. Pain between CV-2 & pubic symphysis.

GENERAL TX: Ah shi points using analgesic technique. Tonify LV-8, LV-3 & LV-1. Dr. Tran needles LV-1 where 3 hairs sprout on large toe. The hairs, like little plants, need water to grow. He considers this location jing well point of Liver. For hairless patients, use traditional location at base of nail. Disperse CV-2 and/or CV-3. Don’t forget ST-36 & LI-4.

EX 1: Vaginal itching or dryness. There is a longitudinal luo meridian between LV-5 & CV-2 or CV-3. If this meridian is empty because of Liver blood xu or stagnant Liver qi in another area, vaginal itching results. Disperse ah shi points & CV-2 /CV-3. Tonify LV-5, LV-8, LV-3, LV-1, ST-36 & LI-4. Add GB-37 (Luo point connecting GB to LV.) For dryness, CV-7 has a branch to bring water to uterus. This branch is why Dr. Tran prefers CV-7 to CV-5 as SJ MU point.

EX 2: TM penile flaccidity. Always good to tonify K-3 (don’t let it bleed!), K-7 & K-1 when LV is involved. If heat prevents erection, disperse LV-5, CV-2. Tonify CV-3 (BL Mu point) to cool heat in genitals. Adds water to wood.) GB-34 (don’t let it bleed!), LV-8, LV-3, LV-1, ST-36 & LI-4.

Differential diagnosis for 3 leg yin TMM is radiation of lower abdominal pain. Radiation to umbilicus, thorax or ribs = SP. Radiation into buttocks, lower lumbar or para spinals = K. No radiation from pelvic region = LV.

PC TMM: 1^st month of Winter (approx. Dec. 21 – Jan. 20) Symptoms: External or internal origin. If external origin, patient exhibits precordial and/or hypochondriac pain. Precordial pain mimics angina, & is worse after eating. Cardiac tests are normal. If internal origin, patient exhibits contracture of internal thoracic area. Stagnation in chest causes supraclavicular compression syndrome, cardiac pain, dyspnea, gastric reflux or hiatal hernia.

GENERAL TX: Analgesic technique at ah shi points. Tonify PC-7, PC-9, LI-4 & ST-36. Disperse GB-22.

EX 1: Precordial pain. The He Li pathway, called Great Luo of the stomach, is an empty channel that runs from stomach to diaphragm, through lungs & heart & descends to ST-18. Spleen hypo function resulting in damp or food accumulation backs up primary channel & eventually into the He Li pathway. This rising energy is yang. It ascends toward yang fire of heart. Yang plus yang = cardiac pain, angina, palpitations or tachycardia. Sure does sound like a MI. BE SURE it is not!!! If you have correctly diagnosed TMM of PC, needle ah shi points around K-25 & K-22. Angle needles toward each other. ST-15 & GB-22 angled towards painful area. Electro between K-25 ah shi point & GB-22. Second electro between ST-15 & K-22 ah shi point. Continuous mode, high frequency & intensity for 20 minutes, adjusting as needed every 5 minutes. CV-12 descends energy from digestive back-up. CV-17 brings water from SJ & fire from PC to balance yin/yang in chest. PC-6 opens chest via longitudinal luo. ST-18 (end of He Li pathway). Disperse ST-45. Tonify PC-7, PC-9, LI-4 & ST-36, SP-3 & SP-9 (To balance the treatment of ST with SP points).

EX 2: Thoracic pain due to internal origin. Thoracic contracture, gastric reflux, hiatal hernia, etc. CV-17, PC-6. CV-13 for gastric reflux. K-20 & K-21 are Chong Mai points bringing (deep) K fire to (surface) CV-13 area. Needle superficially. Disperse GB-22. Tonify PC-7, PC-9, LI-4 & ST-36.

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LU TMM: 2^nd month of Winter (approx. Jan. 21 – Feb. 20) Symptoms: Pain or contracture at LU-11, LU-9 or LU-5. Supraclavicular compression syndrome. Hypochondriac pain, dyspnea, depression.

GENERAL TX: Analgesic technique at ah shi points. Tonify LU-9, LU-11, CV-17, PC-6 & ST-12. Disperse GB-22.

EX 1: Dyspnea and asthma. Lungs are summit, kidneys are root. An intimate relationship exists between lung & kidney. During inhalation, qi enters lungs & descends to kidneys. Breathing pattern should be inhale, pause, exhale. Pause allows qi distribution to spleen, liver & heart. Dyspnea results when pathway between lungs & kidney is blocked, shortened or disrupted. Asthmatics cannot descend qi (air) to kidneys. Cortisone origin is adrenals - helps qi descend. Moxa BL-13 & BL-23. LU-1, LU-9, LU-11, K-3 & K-7 (K point combo acts like cortisone.) CV-17, PC-6, LI-4 & ST-36. Disperse GB-22.

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HT TMM: 3^rd month of Winter (approx. Feb. 21 – Mar. 20) Symptoms: External origin shows pain & contracture around HT-9, HT-7 or HT-3. Cardiac pain. Internal origin shows Fu Liang syndrome, an epigastric tumor superior to umbilicus. Sadness or mental disorders.

GENERAL TX: Analgesic technique at ah shi points. Tonify HT-9, HT-7, ST-36 & LI-4. Disperse GB-22.

EX 1: Fu Liang/umbilical tumor. Yin type = fixed, cold, patient wants to be alone. Yang type = accumulation, heat, moves around, hot palms, mental disturbances, patient wants to talk & have company. Too much fire destroys Po, leading to sadness. LU-9 preserves metal. HT-6 (xi-cleft), CV-17, HT-7, Yin Tang, SP-1 for anxiety, GB-20 for insomnia. ST-34 needled toward stomach. Mobilize ministerial fire with BL-13, BL-14, BL-15, BL-42, BL-43 & BL-44. Tonify LI-4 & ST-36, LV-13, CV-12, BL-20, BL-21, SP-3, SP-6 & Tran’s ST-40.

Differential diagnosis for 3 arm yin TMM is axillary & thoracic pain radiation. Axillary, thoracic & hypochondriac pain = PC. Axillary, thoracic & supraclavicular compression syndrome = LU. Axillary, thoracic & pain or tumor superior to umbilicus = HT.

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A few more gems from Dr. Tran…………

EX 1: All-over body pain. Use SP-21 if articulations are generally painful. Ah shi points with analgesic technique. Disperse all reunion points - ST-8, SI-18, GB-22, CV-2 or CV-3 area. Tonify 12 tonification points, 12 source points, 6 yuan yang & 6 yuan yin points, jing well points of most affected TMM (along which channels do you find the majority of ah shi points?) General anti-spasm point is GV-8.

EX 2: Over-thinking & SP xu. Thinking without deciding upon an action prevents LV movement. So either think & act, or don’t think. Bloating = blockage of follow-through. ST yang qi normally descends, but rebels if SP function is blocked (belching, nausea, etc). Humidity (damp) accumulates & alters tongue. Scallops result due to SP lack of holding (maintaining) form. LV heat plus damp accumulation = fog obscuring clarity. Put out fire with GB-16 (shao yang), HT-7 & CV-14 (HT Mu). If fire not controlled, it affects HT & ying qi (qi of the blood). ST-36 to build qi. Tran’s ST-40 for phlegm - longitudinal luo goes to GV-20 (longitudinal luo of ST). Transverse luo goes to SP-3 (source point). At SP-3 level is SJ connection to ST-44. Wei qi metabolizes humidity. Increase wei qi circulation to decrease bloating, prevent phlegm buildup, etc. CV-5 builds wei qi.

ST-30, LV-13, LV-14 & CV-12 circulate wei qi.

EX 3: Dysmennorhea/Menopause. Chong Mai (PC-6 & SP-4) brings heat (generally, yin meridians bring heat) & Tai Yang brings water (yang meridians bring water). 3 leg yin meridians cross at CV-2 & ascend to CV-3 (BL Mu point). CV-3 brings water to the uterus, so is natural cleansing area in females, to prevent pelvic infections. Ba liao points are Tai Yang, so are secondary cleansing areas. BL-31 goes to uterus & then to contra lateral BL-31. Deeply needle contra lateral BL-31 for dysmenorrhea. Menopausal women may have decreased size of sacral foramen. Needle won’t penetrate the decreased opening. If you can’t deeply insert needle, don’t bother needling this point in menopausal women.