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04/06/2013.

Climacteric syndrome acupuncture prescription

Composition: Fengchi (GB 20), Guanyuan (CV 4), Qihai (CV 6), Zhongwan (CV 12), Shenshu (BL 23), Hegu (LI 4), Zusanli (ST 36), Qugu (CV 2), Yintang (EX- HN 3) and Jiaoxin (KI 8). For liver-kidney yin-deficiency, Taixi (KI 3), Ganshu (BL 18) and Baihui (GV20) are added; for heart-kidney disharmony, Xinshu (BL15), Tongli (HT 5) and Zhishi (BL 52) are added; for spleen-kidney yang-deficiency, Pishu ( BL 20 ),  Yin-lingquan (SP 9) and Sanyinjiao (SP 6) are added; for yindeficiency and liver-hyperfunction, Zhaohai (KI 6), Tai-chong (LR 3) and Daling (PC 7) are added.

Source: Newly-Edited Chinese Acupuncture and Moxibustion edited by Qiu Peiran and Chen Hanping.

Action: Nourishing liver and kidney, and regulating yin and yang.

Elucidation: Climacteric syndrome means a syndrome in women at certain ages (generally 45 - 55 years old) chiefly manifested by menstrual disorder, hectic fever, vexation, agitation and irritability. Chinese medicine holds that when menstruation is to be ceased, kidney-qi increasingly declined; thoroughfare and conception vessels gradually become empty; kidney-yin and kidney-yang inbalance,  consequently,  the  viscera  dysfunction.  It presents with kidney-yin deficiency, or yin-essence insufficiency, or yin-deficiency and yang-hyperactivity or spleen-kidney yang-deficiency.  The disease is mainly caused by the disharmony between kidney-yin and kidney-yang. In this prescription, Guanyuan (CV 4) and Qihai (CV 6), two points on conception vessel in the lower abdomen, together with Qugu (CV 2) can regulate the qi in the thoroughfare and conception vessels and enrich primary-qi. Zhongwan (CV 12), the Front-Mu point of stomach, and Zusanli (ST 36), the He-Sea-point of spleen meridian, have the effect to nourish and regulate the spleen and stomach. Shenshu (BL 23), the Back-Shu point of kidney, and Jiaoxin (KI 8), the Shu-Stream-point of kidney meridian, are effective to regulate and invigorate kidney. Hegu (LI 4), the Yuan-Source-point of large intestine meridian of hand yangming, is clinically effective against many diseases; together with Fengchi (GB 20), an acupoint of gallbladder meridian of foot shaoyang on the head, and Yintang (EX- HN 3), an extra point on the head, can smooth the qi in the meridians on the head. For yin-deficiency of liver and kidney, Taixi (KI 3), the Yuan-Source-point of kidney meridian, and Ganshu (BL18), the Back-Shu point of liver, can nourish liver and kidney; together with Baihui (GV 20), Hegu (LI 4) can treat the diseases on the head caused by yin deficiency and subsequent yang hyperfunction. For disharmony between heart and kidney, Xinshu (BL 15), the Back-Shu point, and Tongli (HT 5 ), the Luo-Connecting-point of heart meridian, in combination with Zhishi (BL 52), a point of bladder meridian on the back have the effect to harmonize heart and kidney, nourish heart and calm mirid. For spleen-kidney yang deficiency, Pishu (BL 20), the Back-Shu point of spllen, Yinlingquan (SP 9), the He-Sea-point of spleen meridian and Sanyinjiao (SP 6) on spleen meridian are selected to warm qi of spleen and kidney. For liver hyperactivity due to yin deficiency, Zhaohai (KI 6) on the kidney meridian is selected to invigorate kidney yin, Tai-chong (LR 3), the Yuan-source-point of liver meridian, is selected to clear liver heat, Daling (PC 7), the Yuan-Source-point of pericardium meridian, is selected to nourish heart and quieten mind.

Indication: Climacteric syndrome. Women at the age of around 50 exhibit menstrual disorder, more or less, vexation, agitation, irritability, depression, anxiety, nervousness, bad mood, unusual crying and laughing, even absolutely depressive psychosis, occasional mania and delusion. Case with deficiency syndrome may present psychentonia, flushed face, vexation, irritability, dizziness, tinnitus, memory decline, aching lumbus and bone, red tongue with thin coating, wiry, thready and rapid pulse. Case with disharmony between heart and kidney manifests palpitation, insomnia, dreaminess, susceptibility to fright, dry throat, bitterness of mouth, feverish sensation in the chest, palms and soles, red tongue with little coating, thready and rapid pulse. Case with spleenkidney yang deficiency is accompanied by bright white complexion, poor spirits, chill, cold limbs, edema of lower extremities, weak appetite, loose stool, frequent nocturia, profuse and thin leukorrhea, light tongue with white coating, weak and deep pulse. Case with yin deficiency and liver-hyperactivity presents grief, desire to cry involuntarily,  red tongue with little coating,  wiry, thready and rapid pulse.

Performance: Fengchi (GB 20) is punctured 0.5 -1.2 cun with the needle tip towards the nasal apex instead of towards the contralateral tragus or the front edge of tragus to avoid the penetration into cranial cavity and reducing manipulation is performed by rotating and twirling the needle. Guanyuan (CV 4 ) is vertically punctured 1. O- 1.5 cun and reinforcing manipulation is performed by rotating and twirling the needle. Qihai (CV 6) is vertically punctured 1.0 - 1.5 cun and reinforcing manipulation is given by rotating and twirling the needle. Zhongwan (CV 12) is perpendicularly punctured 1.0 - 1.5 cun and reinforcing manipulation is given by rotating and twirling the needle. Shenshu (BL 23) is vertically punctured 0.5 -1.0 cun and reinforcing manipulation is given by rotating and twirling the needle. When Hegu (LI 4) is punctured, the fist should clench by half; the needle is vertically or obliquely upward inserted 0.5 - 1.0 cun; the artery must be not punctured and reinforcing or reducing manipulation is given by rotating and twirling the needle. Zusanli (ST36) is vertically punctured 1.0 - 2.0 cun and reinforcing manipulation is given by lifting, thrusting, rotating and twirling the needle. Qugu (CV 2) is perpendicularly punctured 0.5 - 1.5 cun, but less depth for filling bladder.

Yintang (EX - HN 3) is obliquely punctured 0.3 -0.5 cun. Jiaoxin (KI 8) is vertically punctured 0.5 - 1.0 cun.

The needles in the acupoints are retained for 20 -30 minutes and manipulated on the concrete conditions of disease. The treatment is given once a day.

Clinical material: Dr. Xie treated 30 cases with climacteric syndrome by acupuncture, whose ages ranged from 40 to 60. Menopause occurred in 20 cases, menstrual disorder in 7 cases and non-stopped menstruation in 3 cases; the duration of menopause ranged from 4 months to 20 years. The chief clinical manifestations were headache, dizziness, insomnia, stomachache, abdominal pain, back numbness, palpitation, breathlessness, poor appetite, mental depression, abnormal vaginal bleeding, etc. Acupoints Dazhui (GV 14), Guanyuan (CV 4), Qihai (CV 6), Zhongwan (CV 12), Shenshu (BL 23), Hegu (LI 4) and Zusanli (ST 36) were selected and Qugu (CV 2) and Yintang (EX- HN 3) were added. Results showed all symptoms disappearing in 27 cases, improvement in 1 case, unknown effect in 1 case and ineffectiveness in 1 case. [ Newly-edited Chinese Acupuncture and Moxibustion, Shanghai Scientific and Technologic Press, Aug, 1992]

Ma Yindu treated climacteric syndrome by puncturing three points with six needles. Points Shenmen (HT 7), Zusanli (ST 36) and Sanyinjiao (SP 6) on both sides were punctured from the upper to the lower and even reinfor-cing-reducing technique was given; the needles were manipulated during the needle retention. Taiyang (EX- HN 5) and Hegu (LI 4) on both sides were added for headache; bilateral Neiguan (PC 6) was added for pain in hypocondrium; Zhongwan (CV 12) and Qihai (CV 6) were added for abdominal fullness; bilateral Shenshu (BL 23) and Yanglingquan (GB 34) were added for aching pain of lumbus and legs; bilateral Zhigou (TE 6) were added for constipation; bilateral Yongquan (KI 1) were added for hypertension. Generally, needles were retained for 30 minutes and manipulated once every 10 minutes; 3 continuous treatments made up one course and next course continued after 1-day interval. The cases were mostly cured after 2 - 5 courses of treatment. [-Zhejiang Journal of Traditional Chinese Medicine, 1992, (3). 115]

Typical case: A Mrs. Zhang, aged 48, was seen on Aug 16 in 1989. She had dizziness and vexation for 1 year. Her menstruation was about to pause, accompanied by scanty and dark menstruation, leukorrhea, insomnia, dreaminess and flushed face. It was diagnosed as climacteric syndrome in hospital affiliated to He' nan Medical University. She was treated by many Chinese and western medicines but in vain.  Physical examination showed flushed complexion, vertigo, vexation, insomnia, forget-fulness, aching lumbus, fatigue, sentimentality, swelling of face and lower limbs, non-pitting edema in lips, red tongue with thin and white coating, wiry and rapid pulse. Bilateral Shenmen (HT 7), Zusanli (ST 36) and Sanyin-jiao (SP 6) were punctured in sequence, and even reinfor-cing-reducing manipulation was given. The needles were retained for 30 minutes. Instantly after treatment, she felt asleep that night and thus she was pleased; vertigo abated greatly with happiness. Three courses of treatment, she was cured without the help of medicine. [Zhe-jiang Journal of Traditional Chinese Medicine, 1992, (3): 115]

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