Tung's Points - What do you do if 22.04, 22.05, 22.07 (ling gu, da bai and xia bai) don't work for low back pain?
This is a question I struggled with for several years when I first learned Master Tung's acupuncture. The above combination is so effective for many patterns of low back pain, and yet there are some cases that don't respond at all to these points.
My first breakthrough came when I started realizing that the Ling Gu combination was very effective for acute patterns, but often less effective for chronic conditions. However, there were also situations where Ling Gu, Da Bai, and Xia Bai were not adequate for acute cases that I was certain I could treat. Similarly, for some chronic conditions the combination worked wonders and gave the clients nearly instant results, even though they had suffered for many years.
With this I started questioning under what conditions the Ling Gu combo was most effective for, and I started developing strategies to implement if this combination didn't work. At first I applied traditional theories using the Balance Method, zang-fu pattern identification, and 5-element procedures. I also spoke with other doctors and acupuncturists about this, but it wasn't until I learned about the fascial lines described by Tom Myers, that I started being able to refine my understanding.
The Arm Fascial Lines
According to extensive anatomical research by Tom Myers, the connective tissues and fascia form what he calls fascial lines. These fascial lines include various muscle groups that are interconnected through the fascia. Additionally, structural and functional similarities exist between the muscles that are a part of any specific fascial line.
On the left side of the image you can see what is called the Deep Back Arm Line (DBAL), while the muscle group on the right is called the Superficial Back Arm Line (SBAL).
These fascial lines can give great insights into how Master Tung's points work, and can help us to get better results for even the most difficult cases.
Comparing Master Tung's points to the arm fascial lines we find that Ling Gu, Da Ba, and Xia Bai are all on the SBAL. Other points indicated for sciatica and back pain like 22.06, 33.05, 33.08, 33.09, and the Gu Ci points are also on the SBAL line.
When I first started studying these fascial lines and comparing them to Tung's points, I had two significant cases that helped me to better understand what was going on with Tung's points, and why the Ling Gu combination sometimes didn't work.
I will get back to that, but first I want to point out that the points 22.08 and 22.09, near SI 3, are on the small intestine meridian and DBAL.
Ok, so back to the case studies. One was a 45 year old woman with sciatica in the lateral aspect of the leg (GB meridian), the pain was extremely severe, and she had the pain for about one month. The area of GB 30 was also very painful, as was the sacral area. She was in menopause and had kidney yin and yang vacuity patterns.
The other client was a long term patient that would come for group acupuncture every few months. His main complaint was low back pain, sometimes he would injure his back from work and sports related activities. My typical procedure was to use the Ling Gu combination, which always worked wonders on him. However, on one particular day he came in for acupuncture - in severe pain - and the Ling Gu combo didn't even touch the pain at all. There was no result. As this was a long term client, and friend, I wanted to make sure to get him good results. After the Ling Gu combo didn't work, I was faced with the decision of what point combo to do next.
What do you do if the Ling Gu combos don't work?
With both the woman and man I began the treatments with the Ling Gu combo, and in both clients the results were non-satisfactory.
With the woman I added 33.08 and 33.09 as they were sensitive to pressure, and also indicated for GB sciatica. The results were minimal after the first session, but she did get some relief and resolved to come in again.
As I had been studying the fascial lines, and comparing them to the indications of Master Tung's acupuncture points, I decided my next best move for both clients was to needle the DBAL. As the points 22.08 and 22.09 are also indicted for back pain and sciatica, and reach different muscle groups, I used these points for both clients.
In the case of the man, I had used the Ling Gu combo and left them for 20 - 30 minutes, only to have him report no change in pain level. He also had difficulty moving and walking, and was in a slouched over position. Ok, try to time 22.08 and 22.09.
Guess what happened! Within 5 - 10 minutes the client reported a 70 - 80% improvement. With objective observations his posture was much improved, he was standing upright and walking around, and he had increased mobility in his legs and hips. Remarkable!!!
For the woman it was a much more complicated case, as her sciatica was very severe and a reoccurring chronic pattern. However, when I started working with 22.08 and 22.09 we saw better results, and the pain in the sacrum improved much faster than when I was using the Ling Gu combo. As I treated her several times over a short time period, I was able to test the variances between using the Ling Gu combo and 22.08 and 22.09. In her case, because she also had sacral pain, the overall condition improved better when I used 22.08 and 22.09. I also continued to use points like 33.08 and 33.09 for the GB meridian sciatica. In summary, this was a client that needed acupuncture in both the DBAL and the SBAL.
What defines your point selections and strategies?
Especially if your first selections give minimal results or don't work?
3-D Pattern Identification
As acupuncturists we know the importance of good pattern identification, and we also know that getting great clinical results requires identifying the proper syndrome.
Do you remember how profound it was to start using Dr. Tan's six systems and the Balance Method as a form of pattern identification? It was life changing right?
Using Tan's systems for acupuncture helped me to grow into a whole new level of clinical effectiveness. Sure I still use zang-fu and 5-elements, but for treating pain and doing acupuncture, Tan's systems work much better. Zang-fu is great for herbs, 5-elements has its applications, but for treating pain in the meridians - the Balance Method and Master Tung's points excel.
I also like using Master Tung's points and the Balance Method for internal conditions, and certainly TCM patterns should be applied to the Balance Method and Tung style acupuncture. However, the point I want to make is that having various methods of pattern identification and diagnostic skills helps us to widen our perspective.
Being able to work with zang-fu, 5-elements, and Tan's six meridian systems gives us increased fluidity and better diagnostic capabilities. Similarly, learning the fascial lines, and how they relate to Tung's acupuncture points, will widen your perspective and give you greater insight into how these points work. Knowing the fascial lines will also give you a greater command of Master Tung's points, and help you decide when to use one group of points over another group with similar indications.
With many groups of points available for all kinds of disorders, it is essential to have various methods of pattern identification available to us. It is also vital to have an intimate knowledge of the points, as well as the anatomy associated with the acupuncture points.
Knowing when to use 22.08 and 22.09 over the Ling Gu combo is vital for refining our clinical skills and effectiveness, and there are many other similar comparisons I could make.
For instance, how do we determine when to use the Lower Leg Emperors (77.17 - 77.19) over the Passing Through Kidney Points (88.09 - 88.11)? Remember that these points treat kidney and bladder disorders, and that the Lower Three Emperors are contraindicated in pregnancy, but the Passing Through Kidney points are fine for needling in pregnant women. How do you determine when to needle one group over the other? The fascial line model gives us detailed information about why these points work in similar ways, and why the Three Emperors are not to be used in pregnant women.
Seven Tigers (77.26) as Meeting Points for the Tai Yang and Shao Yang Meridians
The Seven Tigers are located between the UB and GB meridians and are indicated for scapular pain, lateral neck muscle pain, pleurisy, pain and inflammation in the clavicle, ribs, and sternum. They can also treat pain at SI 13, GB 21, and in the levator scapulae muscles.
Given their location these points relate to two fascial lines, and when we know the anatomy of these fascial lines we can understand why they treat the conditions they do.
In the Master Tung and Fascia Course I extensively cover the most important Tung points, the 10 fascial planes, and detailed anatomy which will help you to better understand the various actions and indications of these powerful points.
Whether you're at a beginner, intermediate, or advanced level, this course will give you the tools and knowledge to improve your clinical results. The course includes:
In depth coverage of over 50 points
6 PDF files on each of the fascial planes
5 hours of audio recordings
Immediate access to files
Master Tung's Points and Fascial Planes Course
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