DIAGNOSIS AND TREATMENT BY THE THEORY OF MERIDIANS IN CLINICAL ACUPUNCTURE

Tian Zhanyuan

(Shanxs Institute of TCM, Taiyucin)

The theory of meridians, an important component part of the theories of traditional Chinese medicine, deals with physiological and pathological changes of the human body, and serves as a guiding principle of diagnosis and treatment of the diseases. For example, according to Ling-Shu (a medical classic, meaning "miraculous hinge"), "pain occurs in both elbows while disease exists in the lungs and heart. Discomfort occurs in the axillae while disease occurs in the liver. Symptoms are experienced in the thighs when the spleen is unhealthy. Soreness occurs in the knees when the kidneys are under malfunction." These examples are from the chapter called Xike (meaning foreign pathogenic factors). The elbows, the axillae, the thighs, and the knees are just the certain points on a person's body surface through which the Qi (vital energy) of the meridians of the associated internal organs passes. In clinical practice, a patient whose lungs are diseased usually has pain and soreness in his chest and arm; a patient with heart disease usually has pain in his chest as well as trembling hands; a patient with liver disease usually has pain in his ribs and elbows; a patient with spleen disease usually has pain and soreness in his abdomen and thighs; a patient with kidney disease usually has pain in his waist as well as weak knees. In the studying of the theory of meridians, the nature of the cause of the illness and the type of symptoms and the pathogenesis, all of which play an important part in clinical diagnosis, can be discerned.

As mentioned above, it is obvious that lung disease is associated with pain and soreness in the chest and arms and liver disease with pain in the ribs and elbows. But diagnosis are not easy. In some cases, two meridians or more show the same symptoms on the same part of the body. Take the symptom of coughing and asthma for example, acupuncturists all know it is usually a disease in the Lung Meridian that leads to this symptom. But, when the Ren Meridian is on set the symptom of coughing and asthma may also occur. So here arises the question of whether the Lung meridian or the Ren Meridian is abnormal. Besides coughing and asthma, there are other symptoms. According to whether the symptoms appear at the same time or in a different order, the meridians might be followed in different ways in order to make the diagnosis. Besides coughing and asthma, the symptoms of a stuffy feeling in the lungs, tightness in the chest, pain in the supraclavicular fossa and pain inside the shoulder also appear. It is clear that it is a Lung Meridian disease. With coughing and asthma, the symptoms of hemoptysis, of being easily frightened, of being easily flustered, of feeling discomfort in the lower abdomen (feeling as if something inside the internal organs were rolling up) and some others appear, part of the Ren Meridian course-from the lower abdomen upward to the kidneys, and then through the liver to the lungs, and out of the lungs to the heart-should be followed by analysis, the conclusion is the Kidney Meridian disease. "To identify the pain, all areas around it should be examined carefully. To find out whether the disease belongs to the heat type or the cold type, the exact meridian from which the disease comes should be followed". This is from the Chapter in Ling Shu called Guan Neng (meaning function). In other words, by following the course of the meridians and analyzing the information available, whether the disease belongs to the cold type or heat type and in which meridian the disease exists- This is the differentiation principle of the meridian system in diagnosis.

Meridians are the paths through which pathological factors as well as physiological Qi and blood pass. By studying the theory of meridians, not only can some complicated pathological changes be diagnosed, but also the theory can be used as a guide to treat the diseases in clinical acupuncture, i,e, in selecting points.

In clinical practice, by treating with acupuncture on the points of the hand and foot, diseases of head and viscera may be cured. This is done by means of the circulating transmission of the meridians. After the meridians and their acupoints have been identified and located the principles of treatment in the diseases of head and viscera are available. For example, when the different areas, such as the forehead, the nucha, or both sides of the head (from the temples to the cheeks) are affected, different points may be selected by following the courses of the meridians. Those who have pain in the nucha should be regarded as having a Taiyang meridian type of headache, and hence the point Houxi of the hand or point Kunlun of the foot ought to be acupunctured. If pain occurs in both sides of the head (from the temples to the cheeks), it would be a Sho Yang meridian type of headache. Therefore, the point Yemen of the hand or the point Qiaoyin of the foot should be acupunctured. If the pain is in the forehead, the point Hegu of the hand or the point Netting of the foot or other points should be selected in order to treat what could be a Yangming meridian type of headache. All the headaches caused by colds (the exogenous pathogenetic factors) should be cured by selecting the exact points according to the affected areas of the head. For the symptoms occurring in other meridians, the locations of the points may be deduced by analogy.

To sum up, the theory of meridians plays an important part not only in the relations between physiological functions of the human body and the mechanisms of disease, but also in the theoretical principles in the diagnosis and treatment of the disease.