This article is also available as a PDF in its published form CJOM, Vol. 11, No. 1, Winter 2000 (pdf)
Releasing the Fifth Missing Limb:
Strategies for the Treatment of Neurological Disorders
Ling Shu, Chapter 2, discusses the 5 shu (Transportation) points, describing the course of the channels in the four limbs. It then moves on to enumerate the heavenly points, known in the European tradition as Windows of the Sky points. The authors of the Ling Shu clearly saw the energetics of the neck as being of equal importance to that of the four limbs. The neck is the mediator between the brain and the organs, between the command post and what executes those commands. The importance of releasing the neck is of utmost importance in acupuncture, especially in neurological conditions.
In the Expo class I shall be discussing and demonstrating releasing the neck as key to treating neurological conditions, primarily in post-stroke (CVA) and head injury as treated using Kiiko Matsumoto’s methods. We must not ignore the role of organic disorders such as kidney, liver, thyroid, parathyroid, pancreatic disorders, as well as mineral imbalances as causes of neurological syndromes such as seizures, tremors, apnea, arrhythmia, neuropathy, insomnia, disorientation, and fatigue. All these must be addressed as well as releasing the neck. . Here I concentrate on the role of releasing the neck.
Most strokes occur inside the circle of Willis or at its enterances. The Circle of Willis is fed by the Internal Carotid and the Basilar (a continuation of the Vertebreal) arteries. Therefore, in order to affect circulatory problems in the head, we need to affect its circulatory gates which are the vertebreal and carotid arteries. These reflect on the SCM and on the occiput. The vertebreal arteries reflect on the side of the cervical spine. Congestion in the neck will affect the brain and releasing the neck can affect the brain.
The first area to check is the SCM. People who have had a stroke, head injury, whiplash, or motor control problems (e.g., Parkinson’s) have a very tight SCM, sometimes on one side only, sometimes on both sides. Often you can see the SCM sticking out like a tight rope. I palpate the SCM with the flat part of my fingers from the top down (not quite to the clavicle). The SCM can be released using ~SJ 8 and GB 40, both on the opposite side. The point “~SJ 8” is in fact above SJ 9 and is located on the Triple Warmer channel about one third of the way down from the elbow to the wrist (if you slide your hand up from the wrist to the elbow you will stop at the mound of the muscle, this is ~SJ 8). Make sure the point really does release the opposite side SCM. You should feel a softening on the SCM and the patient should feel no pain on the SCM once you press on opposite ~SJ 8. Often I look around for the point that releases the SCM the most. Once found, I needle ~SJ 8 perpendicularly and manipulate with tiny up and down movements.
If the patient has paralysis on the side on which ~SJ 8 is being needled, it might not release the SCM very easily because of the poor circulation on that side. In such cases, I add ST41 on the same side as the tight SCM assuming that side has better circulation.
Releasing the SCM is primary in treating brain neurological problems. It also releases the vagus nerve, which lies under the SCM, and hence resolves many organ problems related to autonomic nervous control (especially connected with sphincter problems).
In the back we have the vertebreal artery continuing into the basilar artery. It is especially important to check the occiput, UB 10 and GB 20 area, as this is an area where the artery curves, and any atherosclerosis here will have significant impact. I then further check the Hua Tuo of the cervical vertebra (this reflects the vertebreal artery as it moves up the vertebrae). I press on the occiput upwards, and on the cervicals toward the centre. The main points to release these areas are Liv 8 and ~SJ 8, both on the same side as the neck. Liv 8 is found with the knee slightly bent (its name, Bending Spring, dictates that) at the edge of the crease. I look for the gummy/noduley feeling and make sure that pressing on it releases the neck. I needle Liv 8 perpendicularly, often adding moxa. This is a great point for all tendon problems. ~SJ 8 is the same point discussed above, except that in releasing the occiput and cervicals, it is used on the same side as the neck tension. Supporting points to this combination are K 10, needled shallowly 10o upwards, and the Immune points (the area between LI 10 and LI 11 on the Triple Warmer channel, on the edge of the bone).
When the patient lies face-down, we use a combination called I-Hi-Kon to release the basilar and vertebreal artery reflexes in the neck. This is UB 40, 58, and 60. We take UB 40 more lateral, close to UB39: look for the painful spot that releases the neck. UB58 (be sure it is a point which releases the neck) and UB 40 are needled perpendicularly and shallowly. UB 60 is needled against the flow (up towards the knee) with a slightly thicker needle (#3) with up to 30mm of the needle and stimulating the needle. All points are used on the same side as the neck findings. For patients with tight occiput or cervicals, I-Hi-Kon will often release other pressure pain in the upper thoracic and sacral areas.
The treatment of head injury is very similar. We differentiate between injury to the tai yang zone versus the shao yang zone. For shao yang zone injury we use the opposite side ~SJ 8 and GB40, while for tai yang zone injury we use I-Hi-Kon (on the same side). It is usually not easy to tell which zone the injury was on, and more often than not both treatments are necessary. I check the effectiveness of the points against painful spots on the scalp.
For patients with a rapid pulse you may find that SJ 5 with GB 41 releases the opposite SCM or the opposite shao yang head injury site better than ~SJ 8 with GB 40. SJ 5 does not, however, release the back of the neck.
On very nervous patients and children I use a tiger-warmer in the ear (same side of SCM) to release the SCM, concentrating on the cavum conchae and bottom of the intertragic notch (endocrine point area). Warming up this area releases the vagus nerve and in turn releases the SCM and relaxes the patient.
The 8 Ba Feng points (in the web of the toes) are excellent points for oxygenating the brain. Master Nagano calls these points “essential depression points” and uses them for headaches, depression, post-stroke, and brain damage.
Under-3rd-Toe is a point at the centre of plantar junction of the third toe and the foot (phalangeal/tarsal joint). This is an essential blood pressure control point (for both high and low blood pressure) and an autonomic nervous system (ANS) disorder point. Many CVAs are highly correlated to hypertension. In acute intracerebral hemorrhage, blood pressure should not be dropped drastically, but as acupuncturists we do not see the acute phase and thus need not worry about this.
Under-3rd-Toe is a major point for sympathetic dominance disorders where the sympathetic nervous system is overactive with reduced parasympathetic involvement. Typical presentation includes anxiety, palpitations, insomnia, temperature imbalances, sweating. The typical pulse is what Master Nagano calls “tight” pulse. This is a pulse that can be characterised in TCM as thin and wiry and which disappears upon deeper pressure. Under-3rd-Toe releases opposite side UB 10 and GB 20 area. We especially consider this point when the pulse is rapid.
In ANS disorders we also use Ren 6 (if pulse is rapid) or DU 2 (if the pulse is slow), we release the SCM (using the opposite SJ/GB combination), and upper thoracics (often by needling the Hua Tuo tender points). We also use a point close to UB 17 (look for a tendinous/gummy feeling) which we call ANS Shu, or Insomnia Shu, or Asthma Shu. We always add direct moxa on this point. We consider the Pericardium channel to be the ANS channel. We check P 8 (the Fire point) for pressure pain. If P 8 is painful (n 3kg pressure), needle P 3 and P 5 (Metal/Water). If the patient likes the pressure on P 8, needle it (or P , 4 fingers below P3, if patient does not like the idea of a needle in the palm. If the patient neither likes nor dislikes the pressure on P 8, then needle P 6. All Pericardium points are needle with the flow of the channel. Unlike TCM, P 3 is located between the two tendons. You need to check P 8 sensitivity on each side separately.
It is extremely important to release the upper thoracics in all neurological syndromes, especially in the elderly. This is the area where kyphosis and shrinking takes place affecting the brain and face. Of special note are T4 and T5, Shifts on T4 can affect dizziness and eye problems, while T5 is an extremely important area for releasing the neck. Prior to needling these areas we can release them using the Ear Brainstem point (on the antitragus) for T4 and H 7 for T5. Then the Hua Tuo of the sensitive vertebra can be needled (at a 45-degree angle toward the spine). The area between SI 9 and SI 10, needled up and out toward the deltoid, can also release the upper thoracics.
A typical pulse in brain damage is what Master Nagano calls “wiry” pulse. This is an excess pulse that might feel wiry and slippery and which does not disappear upon deeper pressure. When such a pulse is found (often in Parkinson’s and atherosclerosis), we needle GB 39 (superficially, upwards against the channel using a thicker needle) and tonify the Spleen (using SP9 or SP10). The Gall Bladder channel is considered to be the brain channel (it circles around the brain, it is an extraordinary fu, and it provides the opening to the brain for the yang wei and yang qiao vessels). If GB 38 is painful (the Fire point of the GB), needle GB 43 and GB 44 (Metal/Water).
Many people have tightness in the neck that is a result of tight muscles, not necessarily reflecting the vertebreal artery. The vertebreal artery reflex is felt close to the bone (occiput or cervicals) and feels like extra gummy tissue that is like an adhesion on the bone. Tight trapezius muscle is felt slightly further out from the bone. A tight trapezius can still affect neurological syndromes, and can be released with a point we call Inner Yin, a point on the kidney channel level with Liv 9. Many people have sugar metabolism issues which affect muscle tightness and spasms: fluctuating between hyper- and hypo-glycemia activates the muscles and then relaxes them. In these cases release the muscle spasms with Sp 3 and the Oddi point. The Sp 3 we use is slightly more towards Sp 4 than the one described in TCM, and it is important to be sure it in fact releases the neck. Once found, it is needled towards Sp 4. The Oddi point is around St 22 (Gate of Gate) on the right side only. It is half way from the navel to the edge of the ribs, on a line drawn from the navel to the ribs at a 45-degree angle to the horizon.
Another neck area to be released is the scalenes. This is the area above the clavicle between the two heads of the SCM. This reflects neurovascular compression or thoracic outlet and is often also involved in RSI of the arms. I press here gently with the flat part of the tips of my fingers to check for sensitivity. When sensitivity is found it is released using Sp 3, sometimes adding Lu 8 (needled close to the tendon towards Lu 9).
Releasing the neck is the key treatment for post-stroke and other neurological syndromes in the Nagano style. Master Kawai uses scalp points as well as local arm/leg points. Both techniques will be demonstrated in the class. Together these techniques are highly effective in treating post-stroke paralysis and aphasia. Even patients who 10 years after their stroke still had their hands knotted in fists and elbows curled in, have been able to release the hand and gain movement even in within one treatment.
Of course, releasing the neck and throat are also very important for many internal disorders (especially if involving anxiety/stress), and one can also use the above techniques simply to resolve neck pain, shoulder and arm problems.