It is possible to regard gynecology as a specialty, however, I find that this is not a useful notion as I rely heavily on treating the whole person, not just one symptom. Thus when treating gynecological symptoms, one cannot ignore previous medical problems that the patient has experienced in the past, or is still experiencing, and one often finds that one must treat those in order to fully address the gynecological issue at hand. This is done by clearing abdominal findings (see article in CJOM Fall 1999 10/4).
It is therefore extremely important to clear all abdominal findings and not just those related to gynecological disorders. Sometimes, addressing the abdomen as a whole, using non-gynecological approaches resolves the gynecological reflexes, while sometimes it is only through addressing the gynecological reflexes that the rest of the abdomen is released. Often it is a combination of both. In this style, we attempt to clear all pressure pain in the abdomen, neck, and back, so as to ensure that the whole body has been addressed and that no issue has been left untouched. When we leave an issue without being addressed, it is possible for that weakness to take hold of the body, to divert energy to itself, and to prevent healing.
The main gynecological reflexes are ST28 and Kid13. Pressure pain on ST28 reflects an ovary problem, while pressure pain on Kid13 reflect a uterus problems. Generally speaking, the ovaries are within the Kidney domain (in spite of reflecting on the Stomach channel), while the uterus is in the domain of the Spleen and the Liver channels. Beware that ST28 also reflects water stagnation (together with Ren9) as its name, Shui Dao – Water Pathways, indicates. Thus, one cannot assume an ovarian problem simply because there is pressure pain on ST28.
General Point Selection by Channel
Generally, one can check the Fire point of the related channel (that is Liv2, SP2, Kid2), and if there is pressure pain on the Fire point with 3kg pressure, than the Metal and Water points of that channel should be treated. Thus, we often treat Kid7 and Kid10 when there is pressure pain on ST28. Kid7 is the primary Kidney point to be checked in gynecological issues (regardless of pressure pain on Kid2), as it directly influences the ovaries. It is located where one feels a gummyness or puffiness and is needled upwards at a 30o angle.
Liv8, the Water point of Wood, is an important point for cysts. We locate the point at the edge of the crease when the knee is slightly bent, looking for a nodule-like feeling. It is needled perpendicularly and direct moxa is added. Liv4, the Metal point, is located one thumb’s width below the internal malleolous, medial to the tibialis anterior, and is needled superficially upwards with the channel flow. Liv4 is always used on the left side, with left LU5, if there is pressure pain on left ST26-ST27 area which indicates Oketsu (stagnant blood). Liv4 is used on both sides to release the inner thigh (Liv12) area, an area that is extremely important to release in gynecological complaints.
However, Liv5 is often the point of choice on the Liver channel for gynecological complaints, especially when involving inflammation or endometriosis. Liv5 is an anti-inflammatory point and strengthens the mucosal membrane in the lower Jiao. It is located just below half way from Liv8 to Liv4, on the bone, and where there is a dent. When one finds a dent on Liv5, it should be treated. The name of Liv5 is Worm Hole, which means that a worm (termite) is eating away at the wood channel. Use direct moxa on Liv5, with the patient feeling the moxa 21 times (the use of moxa can be thought of as smoking off the termites).
On the Spleen channel, SP5 and SP9 are the Metal/Water points. SP9 is needled superficially under the skin upwards toward the knee, using up to 1 inch of the needle. SP5 is also an anti-inflammatory and mucosal-membrane strengthening point (add moxa – patient should feel it 15 times). SP9 is the point of choice for congestion in the abdomen, allergies, and pain on G.B.21. The combination of SP5 with SP9 is the treatment of choice of any lower lymph system problems, hence it is useful for all gynecological issues involving infections. Other Spleen points to consider in gynecological complaints are SP7, especially if profuse bleeding or edema are involved, and SP3, especially if muscle cramps/spasms are involved (including uterine cramps). SP7 is located where the dent or nodule can be felt in the back of the bone, and direct moxa is applied here (needle in a slightly upward direction). SP3 is located slightly closer to SP4 than the TCM location, hence we call it SP3.2, and it is needled towards SP4, with direct moxa added if the foot is cold.
Another gynecological point combination I have adapted from Yi Tian Ni is Ren12, SP6 and S.J.4. I use direct moxa on these points (thread moxa on Shiunkou burn cream). Unlike the late Dr. Ni, I do not use pulse diagnosis to determine the points but rather palpation. Ren12 directly releases the gynecological reflexes in the lower abdomen. It is common to find tightness, hardness, or a nodule at Ren12 (or a line of tightness along the Ren channel around Ren12). Often SP6 will release that tightness at Ren12, and then Ren12, in turn, will release the gynecological reflexes. I use S.J.4 on the left side only in a position that is slightly distal to the TCM textbook location and in the centre the hand (rather than lateral to the tendon). This point tends to resolve any left over pressure pain on the right side of the abdomen, even though it is used on the left (I do not use right S.J.4 in this combination). If Ren12 is extremely tight and is not released by direct moxa on SP6, I use an Infinity treatment by Master Kawai using regular ion pumping cords. Needle LU7 on the left side (select LU7 in-line with the channel, close to the tendon) and attach the red clip of an ion pumping cord to it. Needle Kid6 on the right and attach the black clip of the IP cord to it. Using a second IP cord, connect left U.B.62 (red clip) to right S.I.3 (black clip). This creates an Infinity-sign shape loop from left LU7 (red clip) to right Kid6 (black clip) going below the legs to the left U.B.62 (red clip) across to S.I.3 on the right (black clip) and up above the arms to close the loop to left LU7 (the two IP cords cross the body, with each having the red clip on the left and the black on the right). I ensure this is the correct treatment by pressing on LU7 and ascertaining that this indeed relieves the pressure pain on Ren12 and on the gynecological reflexes in the lower abdomen. Then I proceed to apply direct moxa on SP6, Ren12, and S.J.4.
Consideration of Other Disorders
When addressing many gynecological complaints, it is extremely important to consider other health issues as causative, or contributing factors. These include thyroid conditions, low blood pressure, viscero-ptosis, structural issues, hormonal manipulation (as in taking or having taken birth control), edema, weak immunity, and mental depression, amongst others. Often one will not be able to treat the gynecological issue successfully using only the leg Yin channels, as described above, until one has successfully addressed such contributing or causative factors. In fact it is hard to say whether one should address the gynecological findings first or the other issues first, and the determination is made by evaluating which strategy releases the most stagnation in the abdomen and neck. It is my strongest recommendation that one should address all causative factors in the same treatment as much as possible, as one can never tell which factor might pull the body’s energies back toward a disease stage.
Thyroid conditions are extremely prevalent in women. Some estimate that 30% of all women have abnormal thyroid activity that is often undetected. One should always suspect thyroid issues in fatigue, depression, dry skin and hair, and muscle aches, especially in the neck and shoulder area. The thyroid, adrenals, and ovaries work in synergy and are antagonised by the parathyroid and pituitary (as well as insulin). In Chinese terms, the thyroid is located at ST9, Ren Yin, meaning the point where one welcomes ones humanity, or, perhaps, puberty. It thus influences the whole body and particularly the rest of the stomach channel, influencing the internal organs. The thyroid itself, much like the ovaries, is in the influence sphere of the Kidneys, which channel circles the throat and is intimately related to all glands.
Thyroid conditions will reflect on the thyroid area itself, that is ST9, L.I.18 and below – the lower third of the throat, as well as pressure pain on the abdomen on the Stomach channel, anywhere between ST20 and ST30 (of course pressure pain here can be a reflection of many other conditions, depending on location).
The main thyroid releasing points by Master Kawai are on the back of the ear. The points are found when the ear is folded toward the front. The first point is under the tendon that sticks out when the ear is pulled forward, where the ear meets the skull. This is the point the “Shanghai text” (Acupuncture – A Comprehensive Text, page 491) refers to as Yang Linking. The other point is in the groove that is on the back of the shoulder area in the ear, directly behind the point the Shanghai text calls Thyroid #1. People with thyroid conditions often show a darker discoloration in this area. These points are used regardless of hyper- or hypo-thyroidism.
Master Nagano differentiates hyper- and hypo-thyroidism, though both are considered to be in the Kidney domain. In hyperthyroid patients, it is common to find pressure pain on Kid2, and hence Kid7 and Kid10 are needled, as well as ~S.J.8, one third down from the elbow on the San Jiao channel. In hypo-thyroidism, Kid3 is needled, toward the achilles tendon, with S.J.4. Master Nagano further emphasizes the use of the Du channel in hypothyroidism, using any painful spots along DU2, DU4, DU6, DU9, and DU14: if the point under the vertebra is painful it is needled upwards with the channel flow, while if the Hua Tuo area is painful, it is needled at a 45o angle toward the spine. Select only the points that are tender upon palpation.
One can use both the Kawai and the Nagano approaches. With each point selected, make sure that the pressure pain on the thyroid area (below ST9, L.I.18) is diminished when pressing on the selected treatment point, and that the treatment point also alleviates pressure pain on the gynecological reflexes (Kid13, ST28). Because of the intimate relationship between ovaries and thyroid, thyroid points are likely to greatly influence pressure pain on ST28, the ovary reflex, and may do a lesser job for the uterine reflex of Kid13.
Blood pressure problems play an enormous role in all disease processes, because blood pressure is an indication of the flow of Qi and Blood. If blood pressure is too low, Qi and Blood are not moving well, and thus no amount of needling will produce results until that is corrected. Many systems depend on proper blood pressure for their proper functioning, including the lungs, digestion, and kidney filtration. These in turn will influence other systems. Blood pressure disorders are also viewed as an autonomic system disorder with systolic pressure representing sympathetic NS and diastolic pressure representing the parasympathetic NS.
The understanding of high blood pressure is not absolute. Up until recently European doctors would not prescribe hypertensive medication in the elderly as freely as their American counterparts. This is because of the belief that blood pressure naturally rises with age. Nonetheless, I assume all patients who come with a medical diagnosis of HTN to indeed have high blood pressure that needs to be addressed. People with low blood pressure are often not even aware of that fact, because unless they go into shock, the medical establishment has little to offer and does not view it as a disease. Unfortunately low blood pressure patients suffer not only dizzy spells, but also often complain of digestive and gynecological problems. The differential between systolic and diastolic pressure should be at about 40 mm Hg. If this differential is greater than 50 or less than 30, one must consider the blood pressure as a possible problem.
There is no one specific reflex for blood pressure, where one can say that pressure pain on this area/point indicates high/low blood pressure. The diagnosis is done through standard blood pressure measurements. However, pressure pain on the occipital ridge is common in blood pressure disorders (as well as in other diseases, such as pituitary disorders).
In treating blood pressure disorders, we do not differentiate between high and low pressure, and both are treated in the same manner. The main treatment point is a point under the third toe, in the centre of the phalangeal-tarsal crease. I only use Seirin #1 needles here. Other points are SP6, SP9 and Pericardium points. The Pericardium point to be needled is chosen based on response to pressure on P.8. If P.8 is painful upon 3kg pressure, then P.3 and P.5 are needled, both with the flow of the channel. P.3 is taken as between the two tendons of the bicep, not medially to the meidal tendon as in the TCM location. If the patient likes the pressure on P.8, P.8 is needled (again I use Seirin #1). If the patient likes the pressure on P.8 but refuses to have it needled, then needle the point we call P.4, which is 3 fingers below P.3 (described above) where the depression is found upon very light palpation. If the patient neither likes nor dislikes 3kg pressure on P.8, P.6 is needled. All pericardium points are needle lightly and with the flow of the channel.
On the back, you will find tension/pressure pain in the area between S.I.9 and S.I.10. Needle this area up and out (toward the deltoid). This area will release upper body pain, especially between the scapulas.
Although the use of blood pressure treatment is determined primarily by the patient’s blood pressure readings, all points can be checked against other abdominal findings. If blood pressure is indeed a major contributor to the disease process, pressing on the various blood pressure points, as per above, will indeed release the abdomen, at least to some extent, regardless of what the abdominal findings represent.
Autonomic Nervous System
The autonomic nervous system (ANS) influences all systems in the body and is highly correlated to the hormonal system. We find a primitive analogue in that the nervous system can be said to conduct signals electrically while the hormonal system does the same chemically. Signs of a mal-adjusted ANS can be sweating easily, easily nervous, palpitations, temperature imbalance, insomnia, and lack of time adjustment (that is, sleepy during the day yet overly awake at night and unable to sleep).
A typical pulse in ANS disorders is a pulse Master Nagano calls a tight pulse. This pulse is often thready and has a “wiry” or tight quality. Most significantly this pulse either disappears or changes quality upon deeper palpation.
There are many abdominal and other reflex areas that will display pressure pain in an ANS disorder. However, none of them are conclusive. Ren17 is called “anxiety reflex” and typically shows in ANS type patients. Pressure pain (with 3kg pressure) on P.8 may be an indication of ANS disorder: if on one side P.8 is painful but on the other side it is not, this is a clear indication of ANS disorder as we consider the Pericardium channel to be the ANS channel. The occipital region can also reflect ANS problems, especially blood pressure imbalances (both low and high blood pressure). Tightness in the SCM muscle is commonly seen as well, as the vagus nerve runs through the SCM, and tightness in the SCM congests the parasympathetic action of the vagus nerve.
It is not necessary to have an ANS pulse or any particular body reflex for the diagnosis of an ANS imbalance. One can diagnose an ANS disorder from the symptoms, and we confirm the diagnosis by ascertaining that ANS treatment points indeed resolve, or help resolve, the abdominal findings and other reflexes.
If there is SCM tightness, this should be resolved first, to allow parasympathtic function to flow into the organs. We release the SCM using opposite side Shao Yang points. If the patient has a rapid pulse we use S.J.5 and G.B.41 opposite the tight SCM, making sure that the tightness is softened and the pressure pain is eased. If the pulse is normal or slow, we us ~S.J.8 and G.B.40 (still on the opposite side of the SCM to be released). The point we call “~S.J.8” is about one-third down form the elbow to the wrist, and is at the mound of the muscle (it is in fact above S.J.9). If the point releases the SCM on the opposite side, then it is the right point.
Ren17 pain is released by use of Pericardium channel points. However prior to using the Pericardium channel, we use S.J.5 with G.B.41, bilaterally, especially if the patient has a rapid pulse.
The use of Pericardium points is extremely important in ANS disorders, and is determined as explained in the blood pressure section.
We always differentiate between rapid pulse and slow pulse for ANS patients, as the pulse rate determines the treatment strategy. Rapid pulse patient requires emphasis on the abdomen, while slow pulse type patient is treated on the back. Rapid pulse is considered 85 beats per minutes or faster. Slow pulse is 65 BPM or less. We normally treat patients with a pulse rate of 65-85 BPM as if they had a rapid pulse. It is very important to not mix the two strategies.
For the rapid pulse type, we treat the point under the 3rd toe, in the centre of the phalangeal-metatarsal joint (plantar side). This point often releases Ren17, as well as the occiput (on the opposite side of the toe used). The third toe does not have any points on it and is in the domain of the Stomach sinew meridian. Akabane determined that it relates to the chest and diaphragm. We also use Ren6 and Liv12 for rapid pulse type. We needle Liv12 superficially and towards the pubic bone. It is important to find the tight spot around Liv12. Tightness on Liv12 may be disrupting blood circulation into the abdomen, and can be a cause of gynecological disorders.
If the patient has a slow pulse rate, then DU2, needled superficially upwards, is used in lieu of Ren6 and Liv12. (It is important to not stimulate the abdomen when a patient has a slow pulse as abdominal stimulation can further slow the pulse rate.)
Structural Issues Affecting Gynecology
Blockages in the inguinal, inner thigh, sacral-iliac, and gluteal regions have a tremendous impact on gynecological complaints. Tightness in these areas can lead to poor abdominal circulation, and to gynecological problems. Press on all these areas and ensure there is no tightness there and that the patient does not feel any discomfort upon your pressure. These areas can develop into tight ropes which further constrict circulation into the abdomen.
Tightness in the inner thigh (Liv12 area) can be on the Kidney, Liver, or Spleen channels. Check the area just below the pubic bone, about 1 inch below. Liv4 usually releases tightness in the inner thigh, but if other channels are involved, consider Kid7 or SP9 as well. After the area has been released, it can be needled directly for greater effect. Needle the inner thigh shallowly towards the pubic bone.
G.B.31 is a point which releases the inner thigh, groin and perineum, and should be used as a supporting point in all gynecological complaints where inner thigh tension or perineum irritation are present.
Inguinal tightness and blockage can lead to hardness below the navel, big pulsation around the navel, and compression of the lymph nodes. Release this are by use of Kid7, G.B.26, and Inner Yin, a point on the Kidney channel level with Liv9, about 5 fingers above Kid10. Often the combination of Liv3 with G.B.41 with the use of ion pumping cords releases the inguinal ligament area. Place the red cord on G.B.41 and the black cord on Liv3.
Tight sacro-iliac ligaments can be released first by use of Liv8, and then one can needle into the gummy spots in the sacro-iliac joint. The sacrum is extremely important in gynecological issues. A puffy sacrum often indicates hormonal imbalances. The sacrum itself can treat hormonal imbalances, specifically U.B.32. If the sacrum itself is extremely tight and painful, it can be released using Kid6 and U.B.62 with ion pumping cords. Kid6 is needled toward the achilles attachment and holds the black clip, while U.B.62 is needled toward the small toe and receives the red clip of the IP cords. Once the sacrum is released, it should be needled. If when pressing on the sacrum, sacro-iliac ligaments, or the area below the posterior iliac spine, the area feels cold, then Kyutoshin (warm needle) technique is necessary. A cold buttock will lead to lack of warmth in the uterus. It is common, especially in women with ANS imbalance, to have the skin feel warm, but when pressing in, the tissue under the skin feels extremely cold. In such cases you must still use Kyutoshin.
Tight gluteal/piriformis area and coldness will also lead to frigid uterus, lacking circulation. Release the piriformis with Fukaya G.B.31, a point that is 2 fingers above G.B.31 and then two fingers back toward the U.B. channel. This point can be needled, and works best with direct moxa (patient should feel the moxa 7 times). Then the gluteal region can be needled, and warmed with moxa.
Another area to release is G.B.26 which can be released using Kid7. Again, if G.B.26 is cold, deeper – not at skin level, needle it with the use of Kyutoshin.
Because cold contracts and stagnates, it is extremely important to break down all tight areas leading structurally to the pelvis and to warm them up. If the patient wears tight underwear which restricts circulation (this includes pantyhose, tights, as well as panties, all of which might leave a mark on the skin when moved), advise them to wear looser clothes around the pelvis and inner thigh. If the area is cold, advise them to wear flannel or other warm underwear. Teach the patient self massage with either a rolling pin or a tennis ball to release tight inner thigh (use a rolling pin), buttocks and sacro-iliac ligamenst (use a tennis ball). They can also warm up cold areas by use of a heated brick or a microwaved sock with barley or other grains in it. These devices generate a penetrating heat that will go deeper than a heating pad.
Many women with cysts, fibroids, and other gynecological disorders have very tight para-spinal muscles, especially in the lumbar area. Always check L4, L5 both on the Du line and the Hua Tuo line. Tight para-spinal muscles create a “valley back” where the spine looks like it is in a valley surrounded on both sides by hills of tight muscles. An exaggerated lordotic lumbar curve can also contribute to gynecological problems. In both cases check the sacro-iliac ligaments and the area below the posterior iliac crest carefully, and needle the most gummy spots, which release lumbar pressure pain, and apply Kyutoshin if cold.
Tight para-spinal columns throughout the length of the spine can indicate a hormonal/pituitary imbalance. Add S.I.13, which we call posterior-pituitary Shu, to release the paraspinals. Tight muscles can also be a result of a sugar imbalance, in which case treat SP3 and Nagano ST22, which in on the right side, midway between the lower edge of the ribs and the navel, on the line drawn at a 45o angle to the horizon. (Imagine a line going from the navel to the liver, creating a 45o angle with the Ren line as well as with the Dai line – place the point on this line about half way between the ribs and the navel). On the back treat Hua Tuo of T11, T12, at a 45o degree toward the spine.
Shifts in the tailbone will create further problems up along the spine and can thus affect gynecological complaints. Most commonly a tailbone shift can occur during childbirth, and can be a contributing factor in post-partum depression. Palpate the tailbone on all sides (it is common to have the tailbone curved forward at an almost 90o angle: this is not normal) with the patient’s underwear on. Tailbone shifts can also reflect on the abdomen at right ST27 area. Use LU8, U.B.66, or Hua Tuo of C7, T1 to fix tailbone pain. LU8 is taken quite a bit closer to the tendon (towards the Pericardium channel) then the TCM location, and it is needled towards LU9.
Although it is generally best to address internal imbalances before addressing structural ones (both should be addressed, if present, in one treatment), sometimes a structural imbalance is the predominant factor. However, because in this style we tend to treat the front side first, and only then the back (in the same patient visit), and since much of the structural imbalances are addressed on the back, it does follow that we treat the internal organs first. Nonetheless, structural imbalances on the back can reflect on both the inguinal ligament and the inner thigh on the front. Those should be resolved while the patient is lying face up.
This is a special category of structural imbalance that is often created by gynecological issues such as hysterectomies, C-sections, or multiple childbirths. The tightness and pressure pain on the inguinal ligament, the area between G.B.28 and ST30, is created by the falling down of the organs, either through pushing in childbirth or because of the vacated space created by a hysterectomy. Women with very large breasts often also display tightness in the inguinal ligament and suffer from back pain.
Release the inguinal ligament by use of ST13, needled superficially outwards, toward LU1, supported by G.B.26, and Inner Yin. Weak immunity can also contribute to a weakness in the inguinal ligament, thus add the Immune Point which is between L.I.10 and L.I.11 on the San Jiao channel, on the edge of the bone. Direct moxa is always added on this point. If multiple abdominal operations are the cause of the ptosis, consider the use of P.4 (3 fingers below P.3) which is considered to supply blood to the abdomen.
Many women who have taken birth control pills, or have otherwise been manipulated hormonally, have a pituitary involvement. This is especially true with women who have taken birth control in the earlier days when dosages were rather large, yet, individual sensitivities are such that one woman can be adversely affected by a pill which does not seem to produce any results in another. Some women take a double dose as a “morning after” pill, and this one time-episode can be enough to produce symptoms. In fact women who have gotten off the pill because the pill made them feel ill, are far more likely to display pituitary involvement then those taking the pill for years with great satisfaction.
Always check for pituitary involvement in women with a history of having taken birth control, and in women with multiple hormonal problems, e.g., thyroid with diabetes, with cysts, etc. Pituitary involvement can result not only in gynecological symptoms but in many other complaints, from back pain to digestive problems.
Pituitary involvement usually shows as pressure pain around U.B.2 and on the occipital ridge (U.B.10 area). However, occasionally one can diagnose pituitary involvement without tenderness on these areas by determining that pituitary points do indeed resolve various abdominal findings.
Typically, if there is pituitary involvement, pressing both U.B.1 points together (squeezing toward Yin Tang), or pressure on U.B.2 will alleviate the gynecological reflexes on the abdomen, or other abdominal findings. U.B.1 has been called Ming Men, and hence comes the assumption that it is connected with control of hormones (gate of life). U.B.2 is used instead for convenience.
U.B.2 is considered to be the Pituitary Mu and U.B.10 the Pituitary Shu. (In applied kinesiology techniques, both points are used to adjust the pituitary gland also.) S.I.3 is the master point of the Du, and by extension of the brain, and hence it is used for pituitary issues. It is needled up toward the bone. We do not needle U.B.10, and use it primarily for diagnosis. U.B.2 is used for diagnosis as well as treatment. Find the painful spot around U.B.2 (this may be closer to Yu Yao), and ensure it releases abdominal findings. Then release U.B.2 with S.I.3, and then if the abdominal findings are still present, needle U.B.2. I needle U.B.2 shallowly toward the eye, using Seirin #1 needle. There is usually a slight depression in the tender area.
On the back we consider S.I.13 to be the Pituitary Shu, more commonly representing the posterior pituitary, which deals with vasopresin and oxytocin (that is with urination, uterine contraction, and lactation). Typically we use this point if the patient complains of night urination even when they drink no water in the evening, and when the paraspinals are very tight. (Yi Tian Ni used S.J.15 – Tian Liao, Heavenly Hole – for hormonal purposes and to affect the pituitary: it turned out we were using the same point. One can think of hormonal issues as belonging to the San Jiao, the regulator of fluids, and of S.J.15, the Heavenly Hole, as affecting the pituitary, a heavenly gland, or one can think of hormonal issues as belonging to the small intestine which separates the pure from the turbid. It is also worth noting that S.J.15, Tian Liao can affect U.B.10, Tian Zhu, the Heavenly Pillar which reflects hormonal status.)
Do not confuse all hormonal issues, or hormonal points, with pituitary control. For example, U.B.66 is the water point on the water channel, and is used for many hormonal issues, yet it is not considered a pituitary point, and while acne is often a manifestation of a hormonal imbalance, it does not necessarily indicate a pituitary issue.
Water Accumulation and Edema
Many women with gynecological complaints have puffy limbs, especially in the legs. Often when you press on leg points, you will notice pitting edema. This may be one of the symptoms that has brought them to see you, or it may be something that you notice. Water accumulation needs to be treated regardless of the main complaint because with excess water the Qi and Blood cannot move properly, circulation is constricted, and the heart is being placed under heavier demand.
Water stagnation typically reflects on Ren9 (Shui Fen – Dividing Water) and ST28 (Shui Dao – Water Pathways). Ren9 can also reflect digestive disorders or sadness. If it is part of a number of points that are tight around the navel, then it might represent allergies. ST28 reflects ovaries as well as water stagnation. What a particular point reflects depends on the patient history and presentation. Sometimes, pressure point on a particular point can reflect multiple issues.
Treat water stagnation with SP3, SP7 and SP11 to move the water. SP7 is the point in the back of the bone that leaves a dent when you press on it. You might also feel a nodule-like feeling on this point, but in cases of edema the more significant finding is the dent (pitting edema). This point is needled (I needle it slightly upwards) and direct moxa is added. SP11 is taken quite a bit lower than the TCM location. Look for the point where the skin feels overly stretched, where it is hard to pinch the skin.
U.B.63 is a supporting point for this treatment (or any Spleen treatment involving too much water or blood). It is a point that is used to remove excess accumulations such as boils, diarrhea with blood and puss, etc.
Once the water has been moved, using the Spleen points, the Kidneys need to be stimulated in order to excrete the water. This is done by stimulating the quadratus lumborum, the kidney muscle. With the patient lying on the side, needle G.B.25 down towards the spine, and then add U.B.20, U.B.23, and U.B.25 all needled toward the buttock, with the channel flow. Any points that feel cold, should have Kyutoshin (moxa on top of the needle) added. You can retain the needles on one side for 10 minutes, and then turn the patient around, so as to repeat on the other side and stimulate the other quadratus lumborum muscle. After this treatment, it is normal for the patient to urinate more and for the urine to have a slightly stronger smell, as this indicates that the stagnant water is moving.
Weak immunity is not unique to gynecological complaints. In fact weak immunity can be the cause or contributing factor of almost any disorder. Weak immunity will lead to weak ligaments and other connective tissue, and thus expose the patient to a myriad of disorders that do not seem related to an original infection.
It is quite common for a patient to not respond to any treatment points, and once the Immune Points are needled, all the other treatment points seem to bear fruit. This is because the body-energetics is being caught up with an immune problem, and only once the weak immunity is being addressed, is the body able to respond to other stimulii.
The main immune reflex is in the area of S.J.16, the gland area behind the SCM. The main treatment points are the Immune Points, the area between L.I.10 and L.I.11 on the San Jiao channel, on the edge of the bone. Look for the weird adhesions on the muscle attachment to the bone. This point should release the gland area as well as many abdominal findings. Direct moxa is always added on this point (patient should feel the moxa 7 times). Other immune points include the Hua Tuo of C7 (these are also moxa points), and Kid6 (needled down toward the posterior edge of the calcanous). In severe cases, direct moxa on S.J.16 is required (after the area has been released with the Immune Points).
Pain, weakness, and tightness below the posterior iliac crest are common in menopause and in women with cysts. This area is also a reflection of weak immunity. Resolve the pressure pain below the PSIS by using the Immune Points, and then needle into the gummy area, and add Kyutoshin if you feel cold inside.
Although many practitioners associate depression and other mental states with gynecological issues, in many cases the correlation is not exact. However, post-partum depression is clearly a result of a gynecological issue. In TCM it might be said the depression is due to loss of Blood and Jing. We believe that the factors in post-partum depression are disruption to the lower Dan Tian, which is similar in nature to the Blood/Jing Deficiency theory, and tail bone shift, which is structural in nature.
When the lower Dan Tian is disrupted in the process of labour or in cases of a C-section, it looses strength and the trauma flushes upwards, first through the middle Dan Tian, represented as pressure pain on Ren17, and then in the upper Dan Tian, represented as pressure pain on DU20 (or Si Shen Cong). At this stage we call it Blood Stagnation in the Head. Blood Stagnation in the Head reflects as pressure pain, looseness of the skin, or warmth in the DU20 area, with each finding representing an increase in severity: pressure pain being the least severe and warmth being the most severe.
The treatment for Blood Stagnation in the Head is SP6, SP9, LU5, and Pericardium. We choose the Pericardium points according to pressure pain on P.8, as described above in the section on blood pressure. SP6 is a point that directly relates to DU20. We choose this point closer to the bone than many TCM practitioners. LU5 is taken more laterally than the TCM location and is described as midway between the lateral edge of the crease and the bicep tendon. It is needled down with the flow of the channel.
Tail bone injuries/shifts, can by virtue of affecting the spine, affect the brain. The tailbone is also the ground of the chakra emotional system. Rigidity in the tailbone and pelvis can result in rigidity in ones emotional outlook. Tailbone injuries can cause symptoms many years afterwards, including neck and back pain, disc problems, constipation, etc.
The tailbone is treated by use of any or all of LU8, U.B.66, and Hua Tuo of C7-T1.
There are three main emotional reflexes on the abdomen: Ren17 which is called “anxiety reflex,” Ren15 which is called “worry reflex,” and Ren9 which is called “sadness reflex.” Note that all of these can also reflect other issues, and one cannot indiscriminately assume that pressure pain on any of these implies an emotional disposition.
Ren17 pressure pain is treated by first resolving the lower abdomen, and then resolving any pressure pain left on Ren17. The Pericardium channel is used to treat Ren17, in accordance with P.8 pressure point diagnosis (see section on blood pressure). However, prior to using Pericardium points, in case of rapid pulse, use S.J.5 and G.B.41. If the pulse is slow, release the SCM if it is tight. Also, in case of a rapid pulse, use the point under the third toe (see blood pressure section). Then choose Pericardium points. Because it is impossible to needle Pericardium points while San Jiao points are still being needled, leave the patient with the Yang points needled for about 10 minutes, take the San Jiao needles out, turn the arm over, and work the Pericardium channel after the San Jiao points have been used.
Ren15 pressure pain is treated by use of SP3 and P.4 (3 fingers below P.3), or other Pericardium points (according to P.8 pressure pain diagnosis).
Ren9 pressure pain or pulsing, is treated by using right ST24 (the Slippery Flesh Gate, which is used to treat pulsing/slippery flesh under the navel, the watchtower of the Shen).
Any abdominal scars should be addressed, especially if there is still pressure pain on the scar, if the scar still has a discoloration, or if the scar is very thick and ropy. After releasing the scar pressure pain with remote points, you can place diode rings or a diode chain on it.
After addressing all general abdominal findings and medical issues, one can then address the specific gynecological condition.
Cysts and fibroids are seen as the result of congestion of Qi, blood, or other tissue. It is common for women to develop cysts if they have cold feet, low blood pressure, structural imbalances that constrict blood flow to the abdomen (tight inguinal ligament, tight sacral ligaments, tight inner thigh), if they use tight clothing that restrict circulation, or have used hormonal pills. For cysts in the breast, check the pectoralis muscle (LU1 area) for tightness constricting circulation into the breast.
Tight paraspinals in the lumbar area, puffy sacrum, lordotic back and puffiness in the back of the knees (U.B.40 area) are typically found in cystic patients.
Ovarian cysts and uterine fibroids patients will display pressure pain on ST28 (ovary reflex) and Kid13 (uterus reflex), as well as on Kid16 (Adrenal reflex). L4-L5 Hua Tuo reflect female hormone imbalance. If the fibroid is palpable, I use the fibroid itself as a reflex. There is usually no pain on the actual fibroid, but the patient can feel it (especially in the breast) and feel whether it shrinks with the use of certain points. Always choose the points that the patient says make the fibroid smallest.
It is important to release the inguinal groove (G.B.28 to ST30 area), the inner thigh (Liv12 area), the gluteal region, and the sacral-iliac ligaments.
The main point for treating ovarian cysts is Kid7. For cysts and fibroids in ovaries, uterus, or breasts, treat Liv8 (with direct moxa) and Pi Gen. Liv8 is taken as the nodule at the edge of the crease when the knee is bent. I also find that the area above Liv8 (for about 3-4 inches) is often gummy, noduly, tight, or puffy in women with hormonal issues and/or cysts, in which the area needs to be massage daily (one can use a rolling pin). Pi Gen is a cyst shrinking point which can be either G.B.43 or the point between G.B.43 and ST44 (that is it is like a Ying Spring point between the 3rd and 4th toes). Do not use Pi Gen until you have needled all other points. This is because Pi Gen can shrink a fibroid to the point of it not being palpable, and thus one looses a reflex area prior to addressing the Liver and Kidney deficiency aspect, making it harder to determine the exact, most effective, location of Kid7 and Liv8.
For tension in the inner thigh, use G.B.31. You can also needle Kid16 (Adrenal reflex) after it has been released with Kid7. Always check G.B.26 area for tightness and cold. Release G.B.26 with Kid7, and then needle it adding Kyutoshin if cold. After releasing ST30, it can be needled at a 45o angle toward the leg.
On the back, release the sacrum first and then needle U.B.32 (with Kyutoshin if cold). Find the most sensitive, gummy, or puffy spot for U.B.32. Needle (and add Kytoshin if cold) the ropy areas on the sacro-iliac ligaments, and on the area below the posterior iliac crest. Use the sacro-iliac ligaments to release tightness on the lumbar paraspinals and then needle the tight Hua Tuo of L2-L5.
For cystic breasts use Hua Tuo of T2-T6 and S.I.11. I do moxa on S.I.11 with the patient sitting up so that she can palpate the breast and give me feedback as to which point around S.I.11 shrinks the cyst the most. S.I.11 is a direct moxa point.
The treatment of endometriosis is also the treatment for inflammation of the fallopian tubes as well as PID and other inflammatory conditions in the lower Jiao (including UTIs).
In these conditions the whole lower Dan Tian area feels uncomfortable, often even without you pressing on it. However, ST28, the ovary reflex, usually shows most painful most clearly. Kid13, the uterus reflex, shows also, but is usually less painful.
The main treatment points are SP5, Liv5 and Kid7. You can needle SP5, but direct moxa is the treatment of choice. Liv5 is a moxa point only and is located on the bone, below half way from Liv8 to Liv4, where one feels a dent/hole in the bone. SP5 and Liv5 are both anti-inflammatory points for the lower Jiao, and also help strengthen mucosal membrane and connective tissue. Because we want to disperse an inflammatory conditions, the patient should feel the moxa on these points at least 21 times.
It is also typical for this type patient to have pressure pain on Kid2, in which case Kid10 is added to Kid7.
Endometriosis patients often show tightness around U.B.14/U.B.15 (Heart and Pericardium Shu), and I tend to needle, and apply direct moxa on, those points as well as on the gummy/tight area found around U.B.17/U.B.16.
G.B. points below the knee can also be used as supporting points. Kiiko Matsumoto recommends the use of G.B.34 with direct moxa as well as S.J.4 or S.J.5. However, I prefer the use of points below G.B.34, around G.B.36 (called Wai Qiu – Qiu meaning accumulation or mound) with direct moxa.
Heavy bleeding and hemorrhaging can be pure Spleen deficiency but also the results of fibroids, cysts, and hormonal imbalances.
The main Spleen point for abnormal bleeding is SP7 (with direct moxa), which we find on the back of the bone, where there is a nodule-like feeling or a dent.
For hormonal type bleeding, use Hua Tuo of L2 (make sure you find the exact tight/gummy spot) at a 45o angle toward the spine, and leave press tacks, or preferably intradermals – to sustain the needle angle, after the treatment. U.B.66 is another hormonal point normally used for heavy menstruation rather than light. It is most common that the feet will be cold, calling for the use of direct moxa. Direct moxa on Liv2 can also help with bleeding problems.
Late menstruation which is not a result of a pituitary miscommunication, is often accompanied by coldness in the pelvis, or lack of blood. Release and warm the tight pelvis (sacro-iliac, gluteal, iliac crest, G.B.26, inner thigh, inguinal, all as described above n the section on structural imbalances). In lack of blood the pulse is short: the third position of the pulse (Kidney position) is missing. This is not the same as a weak third position signifying Kidney deficiency. In these cases, no matter how deep one feels for the pulse, it cannot be found. This is considered a Spleen deficiency, where the Spleen is unable to produce enough blood to fill the pulse. Treat SP6 (with Kyutoshin) and SP10 (moxa or Kyutoshin) with P.4, the point that supplies blood to the abdomen.
Treat Liv5 and P.4 (3 fingers below P.3) and have the patient do moxa (tiger warmer) daily on these (except during menstruation). Check Liv2 for pressure pain and treat Liv4 and Liv8.
G.B.31 is often a useful point in discharge with tension in the inner thigh, or pubic area. U.B.67 can be used for any irritation in the Ren1 area, including itching, burning, yeast infection, sperm allergies, and herpes.
Pre-menstrual symptoms can involve any of the cofactors listed above, such as low blood pressure, ANS disorders, hormonal imbalances, etc. Once those are treated, check the Fire points of the leg Yin channels (Kid2, SP2, Liv2) and treat the perspective Metal/Water points. I find that Kid7 is an extremely important point for all premenstrual complaints.
Menstrual cramps are often be treated by SP3.2, Nagano ST22 (Oddi point – described in the section on structural issues), and the Sugar points (T11, T12 Hua Tuo). In such cases advise the patient to avoid sugar.
Menstrual headaches will often respond to SP6 in combination with P.6 (or another Pericardium point as per above), or with LU7.
Treat water accumulation by use of SP3, 7, 11 (see above). Puffy hands and fingers can be treated by use of Kid6.
Aside from thyroid, pituitary and general vitality issues, always check all structural problems in the pelvis. If the pelvis is cold, then it is hard for the uterus to harbor enough warmth for the arrival of spring (conception). Sacral shifts are extremely common in infertility problems, as is occipital tension (which can be structural or reflecting a hormonal imbalance), and inner thigh tension (all the way down to Liv8).
After addressing all these issues, do direct moxa on Fukaya’s fertility points which are below the navel, at the corners of an equal-sided triangle with the top corner at the navel. The sides of the triangle are measured as the width of the patient’s mouth.
TBM (Total Body Modification – a chiropractic technique developed by Dr. Victor Frank, using applied kinesiology techniques) offers some of the best fertility treatments I have encountered. The scope of this article does not allow a detailed explanation of those, however, these adjustments demonstrate the importance of releasing tight sacro-iliac ligaments and buttocks, releasing the inner thigh (adductors), and releasing the occiput.
Menopause is still seen in this style as a Kidney deficiency, and the Adrenal treatment (Kid6 with Kid27 – with Kid6 being needled superficially down toward the achilles tendon, and Kid27 needled superficially in, towards Ren21) is often the treatment of choice. Kid2 is commonly painful in menopausal women, and calls for the treatment of Kid7 and Kid10. Substitute Kid7 for Kid6 in the Adrenal treatment if the pulse is slow, if there are ovarian problems, or if there is bone pain or osteoporosis. Because menopausal women often take many chemicals (even if so-called natural ones), and will often show Liver signs due to weakness in breaking down estrogenic compounds, I often use Kid9 with Kid27 (Liver signs here mean pressure pain on right Liv14 or under the right ribs).
Thyroid issues are also common during menopause, and should be addressed (see above in thyroid section).
Aside from ST28 and Kid13, the ovarian and uterine reflexes, Ren15, the subcostal area, and Liv14 may also show pressure pain in hot flushes, as well as pressure pain on G.B.29 (defined as the area between G.B.28 and ST30). If the patient has a rapid or tight (ANS type) pulse, release G.B.29 by use of SP9, and then needle G.B.29 down and out toward the leg. Left G.B.29 tends to release Ren15, and right G.B.29 releases Liv14 area. Then, if indicated, add the Adrenal or Kidney Metal/Water treatment.
In cases of puffy sacrum and ropy sacro-iliac ligaments, use Kid6 with U.B.62 with ion pumping cords (red on U.B.62, black on Kid6), and then needle the ropy spots on the sacro-iliac ligaments, adding Kyutoshin if cold. Also find any gummy/ropy spots under the posterior iliac crest, and needle those (with Kyutoshin if cold).
Needle U.B.32 or U.B.33 and add Kyutoshin if cold. These are essential points for hormonal imbalance.
Have the patient use tiger-warmer on SP6 and P.6 daily.
For any dryness issues, use U.B.66 (hormonal moistening point).
Although the main dogma for menopause is Kidney deficiency, an aspect of Spleen deficiency is very common, as evidenced by the treatment strategy of using SP9. This Spleen deficiency will often be exacerbated by sugar and plain carbohydrate consumption, calling for the Sugar treatment (SP3.2, Nagano ST22, T11, T12). A Spleen deficiency can then create a Gall Bladder Excess according to the overacting cycle rule of Wood Yang invading Earth Yin. It is therefore more common to see menopausal and post-menopausal women with gall bladder problems. But even without clear manifestations of gall bladder problems, it is common to find amongst this age/gender group pressure pain on right side G.B.24. This is treated using Stomach Qi, the bumps and dents along the stomach channel, the adhesions of the tibialis anterior to the tibia, between ST37 and ST41. The bumps are needled down and slightly toward the bone, and the dents are treated with direct moxa. Find the exact spot that releases the gall bladder.
The main diagnostic areas for the breast are the pectoralis (LU1 area) and T2-T6 vertebrae. It is common to find upper thoracic compression in breast problems, and whenever finding two upper thoracic vertebra which seem squeezed together, that area should be treated as prevention.
Congestion and tightness in the pectoralis will congest the lymph system and block circulation into the breast. Release this tightness by use of G.B.26 (if G.B.26 is too tight to needle, release it first by use of Kid7). Teach the patient to massage the pectoralis muscle and loosen it, so as to increase circulation and lymph flow. Also, ensure the patient does not wear metal supported bras, and that their bra is not too tight.
On the back, it is important to release any upper thoracic vertebrae that are compressed. Release the pressure pain on these vertebra (or Hua Tuo) by use of the area between S.I.9 and S.I.10, needled up and out toward the deltoid. Needle between the squeezed-together vertebra, 45o into the spine. It is common to find extra-spaced vertebra either above or below the squeezed-together ones. Moxa the extra wide space.
Breast cysts are treated similarly to lower Jiao cysts and fibroid, using Liv8, and then adding S.I.11, the “breast Shu.”
Liv9 is the main point to be used in cases of breast cancer or family history of breast cancer. It is also used for any other type of cancer. In cancer always be sure to check both the Liver and thyroid, and treat according to your findings.
In summary, in using this style one does not treat gynecological problems as a specialty requiring special, unique, points. We address gynecological problems as we would any other problem: by addressing any previous traumas, medical history, sensitivities and tendencies. There are very few special “tricks” regarding gynecological issues, with the main technique being aware of the many connections involved: thyroid, blood flow, hormonal imbalances, structural imbalances, and constitutional tendencies.