Disease and Condition Overview
Viral Hepatitis is an infectious disease caused by the hepatitis virus. It is known to be extremely contagious, the path of transmission is complex and the incidence rate is high. The clinical symptoms are primarily fatigue, loss of appetite, nausea, vomiting, swollen liver, and damaged liver functions. Some patients may exhibit jaundice and fever. Some patients may have urticaria, joint pain and upper respiratory symptoms. Others have no symptoms but after examination show abnormal liver functions.
Viral hepatitis is differentiated clinically into chronic and acute, also by types, such as A, B, C, D and E.

Pair-point Treatment Combinations

(1) Qimen (LR14), Wenliu (LI7) (Fig 111)
Qimen (LR14): on the chest, directly below the nipple, in the sixth intercostal space, 4 cun lateral to the anterior midline.
Wenliu (LI7): On the radial side of the dorsal surface of the forearm, 5 cun proximal to the wrist crease, on the line connecting Yangxi (LI5) and Quchi (LI11). Flex elbow when locating point.
Qimen (LR14) is the front-mu point of the liver. It disperses and reduces liver and gallbladder. Wenliu (LI7) is the xi-cleft point of the Large Intestine channel. It clears heat and harmonizes and regulates intestine. This pair point combination, one yin one yang, works in synergy to release the exterior and interior and promotes and elevates functions of qi and blood. This treatment is appropriate for all types of acute or chronic hepatitis, liver and gallbladder damp heat or excess heat in yangming.

Needling techniques:
1. Qimen (LR14) oblique insertion to a depth of 0.5 cun.
2. Wenliu (LI7) perpendicular insertion to a depth of 1 cun.

(2) Danshu (BL19), Riyue (GB24) (Fig 110)
Danshu (BL19) is the back-shu point of gallbladder. Riyue (GB24) is the front-mu point of gallbladder. This pair point combination, one anterior and one posterior, one yin and one yang, works to regulate the functions of gallbladder, disperses and reduces liver and gallbladder, opens the luo-connecting channels and stops pain. This treatment is appropriate for all types of acute or chronic hepatitis pain caused by stagnation of the channels and collaterals and jaundice.

Needling techniques:
1. Danshu (BL19) towards spine oblique insertion to a depth of 1 cun.
2. Riyue (GB24) oblique insertion to a depth of 0.5 cun.

(3) Zhiyang (DU9), Y0ngquan (KI1) (Fig 112)
Zhiyang (DU9): on the back, on the posterior midline, in a depression below the spinous process of the seventh thoracic vertebra.
Yongquan (KI1): on the sole, in a depression formed when the foot is planter flexed, at the junction of the anterior third and posterior two-thirds of the line connecting the base of the second and third toes and the heel.
Zhiyang (DU9) unobstructs yang, harmonizes and regulates qi, regulates gallbladder and reduces jaundice. Yongquan (KI1) clears heat and tonifies yin. This pair point combination, one superior and one inferior, clears heat by draining dampness and reduces jaundice. This treatment is appropriate for acute hepatitis accompanied by jaundice.

Needling techniques:
1. Zhiyang (DU9) the point of the needle is directed upwards, oblique insertion to a depth of 1 cun. When needling Zhiyang (DU9) the needling sensation should radiate upwards toward the abdomen.
2. Yongquan (KI1) perpendicular insertion to a depth of 1 cun.

(4) Zhongwan (RN 12), Wangu (SI4) (Fig 113)
Zhongwan (RN12): on the upper abdomen, on the anterior midline, 4 cun superior to the umbilicus.
Wangu (SI4): on the ulnar side of the border of the palm, in depression between the base of the fifth metacarpal bone and the hamate bone, on the junction of the red and white skin.
Zhongwan (RN12) is front-mu point of stomach. It regulates qi of the middle jiao, harmonizes stomach and resolves dampness. Wangu (SI4) disperses the pathogenic qi from the taiyang channel and clears and harmonizes small intestine damp heat. This pair point combination, one dispersing and one clearing, reduces heat and dampness. This treatment is appropriate for acute hepatitis with jaundice.

Needling techniques:
1. Zhongwan (RN 12) perpendicular insertion to a depth of 1 cun.
2. Wangu (SI4) perpendicular insertion to a depth of 0.5 cun.

(5) Zusanli (ST36), Ganshu (BL18) (Fig 22)
Zusanli (ST36) strengthens spleen, harmonizes stomach and tonifies qi and blood. Ganshu (BL18) disperses and reduces liver and gallbladder and opens the luo-connecting channels. This pair point combination, one tonifying and one reducing, one elevating and one lowering, works to disperse liver, harmonizes stomach, strengthens spleen, tonifies qi, promotes blood and removes stagnation. This treatment is appropriate for chronic hepatitis with disharmony of liver and spleen.

Needling techniques:
1. Zusanli (ST36) perpendicular insertion to a depth of 2 cun. The needling sensation must traverse down and felt at the toes.
2. Ganshu (BL18) perpendicular insertion to a depth of 1 cun, using moxa stick for 10 minutes.

(6) Yanglingquan (GB34), Zusanli (ST36) (Fig 114)
Yanglingquan (GB34): on the lateral side of the lower leg, in a depression anterior and inferior to the head of the fibula.
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.
Yanglingquan (GB34), the lower he-sea point of gallbladder, disperses and reduces liver and gallbladder and clears and drains damp heat. Zusanli (ST36) strengthens spleen, harmonizes stomach and tonifies qi and blood. This pair point combination, one tonifying and one reducing, tonifies spleen and disperses liver. This treatment is appropriate for chronic hepatitis with disharmony of liver and spleen.

Needling techniques:
1. Yanglingquan (GB34) towards Yinlingquan (SP9) direction penetration needling to a depth of 2 cun.
2. Zusanli (ST36) perpendicular insertion to a depth of 2 cun, the needling sensation must traverse down and felt at the toes.

(7) Pishu (BL20), Weishu (BL21) (Fig 23)
Spleen governs transformation and transportation while stomach governs the ascending and descending of nutrients. These two points are the back-shu points of spleen and stomach. This pair point combination, one elevating and one lowering, strengthens spleen and harmonizes stomach. This treatment is appropriate for chronic hepatitis caused by spleen and stomach deficiency and middle qi deficiency.

Needling techniques:
1. Pishu (BL20), Weishu (BL21) both points perpendicular insertion to a depth of 1 cun, manipulate using "dao qi" method, or use warm needle moxa.
2. After needling, apply moxibustion for 15 minutes.

(8) Zhigou (SJ6), Yanglingquan (GB34) (Fig 105)
Zhigou (SJ6) clears and harmonizes Sanjiao (upper, middle and lower jiao) while Yanglingquan (GB34) disperses and reduces liver and gallbladder. This pair point combination, one superior and one inferior, located on the same channel, has great effects on the qi of that channel, resolves shaoyang and disperses and removes blockage. This treatment is appropriate for chronic hepatitis accompanied by rib pain.

Needling techniques:
1. In sitting position or in prone position, perpendicular insertion or upwards oblique insertion Zhigou (SJ6) to a depth of 1 cun.
2. Yanglingquan (GB34) towards Yinlingquan (SP9) direction penetration needling to a depth of 2 cun, manipulate for 5 minutes.

(9) Waiguan (SJ5), Yangfu (GB38) (Fig 108)
Waiguan (SJ5) disperses and reduces pathogenic heat in Sanjiao (upper, middle and lower jiao). Yangfu (GB38) disperses liver and resolves blockage. This point in this combination, both located on the same channel, echo and couple the effects of each other. In combination they have great effects on the qi of that channel, disperse and reduce liver and gallbladder, resolve shaoyang, disperse cold and reduce heat. This treatment is appropriate for chronic hepatitis accompanied by rib distension and pain.

Needling techniques:
1. Waiguan (SJ5) towards Neiguan (PC6) direction penetration needling to a depth of 1 cun.
2. Yangfu (GB38) perpendicular insertion to a depth of 1 cun.

(10) Xiawan (RN10), Xiangu (ST43) (Fig 115)
Xiawan (RN10): on the upper abdomen, on the anterior midline, 2 cun superior to the umbilicus.
Xiangu (ST43): on the dorsum of the foot, in the depression distal to the junction of the second and third metatarsal bones.
Xiawan (RN10) harmonizes stomach, regulates intestine, facilitates qi and removes blockage. Xiangu (ST43) drains dampness, reduces swelling, opens the luo-connecting channels and stops pain. This pair point combination, one superior and one inferior, regulates and harmonizes stomach and intestine, facilitates qi, removes blockage, invigorates the luo-connecting channels and stops pain. This treatment is appropriate for chronic hepatitis accompanied by poor appetite, indigestion, and abdominal distension, etc.

Needling techniques:
1. Xiawan (RN10) perpendicular insertion to a depth of 1 cun.
2. Xiangu (ST43) perpendicular insertion to a depth of 0.5 cun.
3. After needling, apply moxa using moxa stick for 10-20 minutes.

(11) Qimen (LR14), Zhongwan (RN12) (Fig 116)
Qimen (LR14): on the chest, directly below the nipple, in the sixth intercostal space, 4 cun lateral to the anterior midline.
Zhongwan (RN12): on the upper abdomen, on the anterior midline, 4 cun superior to the umbilicus.
Qimen (LR14) is the front-mu point of liver. Zhongwan (RN12) is the front-mu point of stomach. This pair point combination, working in synergy, soothes the liver and regulates qi, strengthens spleen, harmonizes stomach, and reduces and removes stagnation and blockage. This treatment is appropriate for chronic hepatitis accompanied by swollen liver and spleen.

Needling techniques:
1. Qimen (LR14) oblique insertion to a depth of 0.5 cun.
2. Zhongwan (RN12) perpendicular insertion to a depth of 1 cun.
3. After needling, apply moxa using moxa stick for 10-20 minutes.

Commentaries
Acupuncture has definite effects in treating viral hepatitis.
In fact, Qimen (LR14), Wenliu (LI7) and Danshu (BL19), Riyue (GB24), these two pair-point combinations are appropriate for both acute and chronic hepatitis. Qimen (LR14), Wenliu (LI7) is used to treat liver and gallbladder damp heat or yangming heat syndrome. The latter pair of Danshu (BL19), Riyue (GB24) IS often used to treat stagnation of the channels and collaterals accompanied by pain and jaundice.

For acute hepatitis with apparent jaundice, select Zhiyang (DU9), Yongquan (KI1), or Zhongwan (RN12), Wangu (SI4).

Chronic hepatitis is not only related to liver and gallbladder, it is also closely associated to the functions of spleen and stomach. In treating this set of diseases, most often use moxibustion. For liver spleen disharmony, select Zusanli (ST36), Ganshu (BL18). For liver and stomach disharmony, select Yanglingquan (GB34), Zusanli (ST36). For spleen and stomach deficiency and middle qi deficiency, select Pishu (BL20), Weishu (BL21). In addition, one should select points according to clinical symptoms: if accompanied by rib pain, select Zhigou (SJ6), Yanglingquan (GB34), if accompanied by rib distension, select Waiguan (SJ5), Yangfu (GB38), if accompanied by poor appetite, indigestion and abdominal distension, etc. select Xiawan (RN10), Xiangu (ST43), if accompanied by enlarged liver spleen, select Qimen (LR14), Zhongwan (RN 12).