Disease and Condition Overview
Angina Pectoris is characterized by sudden squeezing pain at the left upper check, in front of the heart area accompanied by palpitation, tightness in the chest, shortness of breath. It is most common clinical manifestation of coronary heart disease. In Chinese medicine, it is often caused by deficiency of normal, healthy qi, resulting in external pathogenic qi invading the chest, blocking the yang in the chest; or repressed emotions led to qi and blood stagnation； or improper diet, causing the accumulation of phlegm and turbid, cold yin, qi and blood stagnation, phlegmand turbid blocking the heart collateral. Or because of prolonged period of exhaustion, kidney deficiency in an old age, leading to loss of blood and weakened heart yang, resulting in malnourishment of the heart, causing pain. Location of the disease is at the heart, also related to liver, spleen, and kidney. The fundamental etiology is the irregulation of heart qi and blood and blockage of the heart channel.
The main etiology of coronary heart disease is the coronary artery limits of blood flow to the heart, causing lack of oxygen to the heart muscles. Exhaustion, extreme emotions, over indulgence in food, exposed to cold, and raining weather are instigating factors.
Pair-point Treatment Combinations
(1) Shanzhong (RN17), Neiguan (PC6) (Fig 46)
Shanzhong (RN17) is the fr0nt-mu point of the pericardium. Neiguan (PC6) is the Luo-connecting point of the hand-jueyin channel. This pair point combination, working in synergy, soothes the chest, harmonizes and regulates qi, opens the luo-connecting channels and stops pain. Appropriate for treating all types of coronary heart disease/angina pectoris.
Needling techniques:
1. Shanzhong (RN17) towards inferior oblique insertion 0.5 cun, or Hegu needling technique.
2. Neiguan (PC6) perpendicular insertion 1 cun.
(2) Xinshu (BL15), Neiguan (PC6) (Fig 83)
Xinshu (BL15) disperses and opens heart collateral, regulates qi and blood. Neiguan (PC6) soothes the chest, harmonizes and regulates qi, quiets the heart and calms the mind. This pair point combination, primary and secondary working in conjunction, nourishes and strengthens the heart, harmonizes and regulates qi and relieves pain. Appropriate for all causes of coronary heart disease/angina pectoris.
Needling techniques:
1. Xinshu (BL15) obliquely towards the direction of the spine perpendicular insertion 1 cun.
2. Neiguan (PC6) perpendicular insertion 1 cun.
2. Manipulation with even method for 10-30 minutes.
(3) Xinshu (BL15), Tongli (HT5) (Fig 85)
Xinshu (BL15): on the back, below the spinous process of the fifth thoracic vertebra (T5), 1.5 cun lateral to the posterior midline.
Tongli (HT5): on the palmer side of the forearm, on the radial side of the tendon of the flexor carpi ulnaris, 1 cun proximal to the wrist crease.
Xinshu (BL15) is the back-shu point of the heart channel. Tongli (HT5) is Luo-connecting point of the hand-shaoyin, This pair point combination, one superior and one inferior, work in synergy, regulate heart opens the luo-connecting channels, calms shen and stops pain. Appropriate for all causes of coronary heart disease.
Needling techniques:
1. Xinshu (BL15) obliquely towards the direction of the spine perpendicular insertion 1 cun.
2. Tongli (HT5) perpendicular insertion 0.5 cun.
(4) Xinshu (BL15), Juque (RN14) (Fig 82)
Juque (RN14) is the front-mu point of the heart. Xinshu (BL15) is the baek-shu point of the heart channel. This pair point combination, one anterior and one posterior, one yin and one yang, disperses and opens heart collateral, strengthen heart stabilizing shen, regulate qi and blood. Appropriate for all causes of coronary heart disease.
Needling techniques:
1. Xinshu (BL15) obliquely towards the direction of the spine perpendicular insertion 1 cun.
2. Juque (RN14) perpendicular insertion 0.5 cun.
(5) Shanzhong (RN 17), Juque (RN14) (Fig 86)
Shanzhong (RN17): on the chest, on the anterior midline, on the level of the fourth intercostal space, at the midpoint of the line connecting both nipples.
Juque (RN14): on the upper abdomen, on the anterior midline, 6 cun superior to the umbilicus.
Shanzhong (RN17) is the qi hui-meeting point, front-mu point of the pericardium. It soothes the chest, harmonizes and regulates qi. Juque (RN14) is the front-mu point of the heart, clears heart, and stablizes shen. This pair point combination, work in synergy, unobstructs heart collateral, harmonize and regulate qi invigorates blood, removes stagnation and stops pain. Appropriate for qi and blood stagnation type of coronary heart disease.
Needling techniques:
1. Shanzhong (RN17) towards inferior oblique insertion 0.5-1 cun or Hegu needling technique.
2. Juque (RN14) perpendicular insertion 0.5 cun.
(6) Zhongwan (RN12), Daling (PC7) (Fig 87)
Zhongwan (RN12): on the upper abdomen, on the anterior midline, 4 cun superior to the umbilicus.
Daling (PC7): at midpoint of the transverse wrist crease, between the tendons of m. palmaris longus and m. flexor carpi radialis.
Zhongwan (RN12) is the fu hui-meeting point and also the front-mu point of the stomach, tonifies stomach and benefits qi. Daling (PC7) is the yuan-source point of hand-jueyin channel, clears ying, cools blood, calms shen and stops pain. This pair point combination, working in synergy, regulates the ascending and descending of qi, invigorates blood, strengthens heart and stops pain. Appropriate for eoronary heart disease caused by qi and blood stagnation or dampness and phlegm.
Needling techniques:
1. Zhongwan (RN12) perpendicular insertion 1 cun.
2. Daling (PC7) perpendicular insertion 0.5 cun.
(7) Neiguan (PC6), Zusanli (ST36) (Fig 88)
Neiguan (PC6): on the palmer side of the forearm, on the line connecting Daling (PC7) and Quze (PC3), 2 cun superior to the wrist crease, between the tendons of m. palmaris longus and m. flexor carpi radialis.
Zusanli (ST36): on the anteriolateral side of the lower leg, 3 cun inferior to Dubi (ST35), one finger breadth (middle finger) lateral to the anterior crest of the tibia.
Neiguan (PC6) is the Luo-connecting point of the pericardium channel, regulate qi in upper jiao sooth the chest; Zusanli ( ST36) is the lower he-sea point of the stomach channel, disperses, harmonizes and regulate middle jiao by reversing the rising. This pair point combination, one elevates while the other lowers, one superior and one inferior, soothes the chest harmomzes stomach, harmonizes and regulates qi, calms shen and stops pain. Appropriate for coronary heart disease caused by unsmooth flowing of qi, and qi deficiency.
Needling techniques:
1. Neiguan (PC6) perpendicular insertion 1 cun.
2. Zusanli (ST36) perpendicular insertion 2 cun.
(8) Shanzhong (RNI7), Qihai (RN6) (Fig 89)
Danzhong (RN 17): on the chest, on the anterior midline, on the level of the fourth intercostal space, at the midpoint of the line connecting both nipples.
Qihai (RN6): on the lower abdomen, on the anterior midline, 1.5 cun inferior to the umbilicus.
Shanzhong (RN17) is qi hui-meeting point, soothes the chest harmonize and regulates qi, disperses stagnation and stops pain. Qihai (RN6) regulates, tonifies lower jiao and original kidney essence. This pair point combination, one superior and one inferior, one tonifies while one reduces, one open while the other closes, tonifies kidney benefits qi, soothes the chest and stops pain. Appropriate for coronary heart disease accompanied by slowed heart beat.
Needling techniques:
1. Shanzhong (RN17) towards inferior direction oblique insertion 0.5 cun, or Hegu needling technique.
2. Qihai (RN6) perpendicular insertion 1 cun.
(9) Daling (PC7), Neiguan (PC6) (Fig 90)
Daling (PC7): at midpoint of the transverse wrist crease, between the tendons of m. palmaris longus and m. flexor carpi radialis.
Neiguan (PC6): on the palmer side of the forearm, on the line connecting Daling (PC7) and Quze (PC3), 2 cun superior to the wrist crease, between the tendons of m. palmaris longus and m. flexor carpi radialis.
Daling (PC7), Neiguan (PC6) is the yuan-source point and luo-connecting point of hand-jueyin channel. This pair point combination, working in synergy, invigorates blood unobstructs channels, harmonizes and regulates qi, stops pain, quiets the heart and calms the mind. Appropriate for attacks of coronary heart disease.
Needling techniques:
1. Daling (PC7) perpendicular insertion 0.5 cun.
2. Neiguan (PC6) perpendicular insertion 1 cun.
Commentaries
Acupuncture treatment in relieving the symptoms of angina pectoris, myocardial infarction and arrhythmia has definite results.
Many pair-points are effective in treating coronary heart disease, such as Shanzhong (RN17) and Neiguan (PC6), Xinshu (BL15) and Neiguan (PC6), Xinshu (BL15) and Tongli (HT5), Xinshu (BL15) and Juque (RN14).
Most types of coronary heart disease are qi and blood stagnation which may select Shanzhong (RN17) and Juque (RN14), or Zhongwan (RN12) and Daling (PC7).
As for coronary heart disease caused by sluggish qi, middle qi deficiency, select Neiguan (PC6) and Zusanli (ST36).
In cases of coronary heart disease accompanied by slowed heart beat, select Shanzhong (RN17) and Qihai (RN6). In acute attack of coronary heart disease, select Daling (PC7) and Neiguan (PC6) with less stimulation when needling.
During remission, continued acupuncture treatment, will reduce the chance of recurring episodes of angina peetoris. Meanwhile, it is also important to focus on reducing other risk factors as well.