Vol. 17, #1

Lighting The Fire Through Acupuncture
Energetics: Jing Luo And Beyond
Bryan L. Frank, MD

ABSTRACT
Physicians in our contemporary society increasingly see Burnout Syndrome. Various strategies to prevent or deal with burnout are considered in medical consultations, though acupuncture is not often presented as a modality for treatment. Classic energetic acupuncture treatment has particular implications for the prevention and treatment of burnout syndrome and is reasonable to initiate in an integrated fashion with other conventional or complementary therapeutics.
KEY WORDS
Burnout Syndrome, Acupuncture Energetics, Jing Luo, Blockages, Principal Meridians, Extraordinary Meridians, Distinct Meridians, Shu Mu, Hui Points, Auricular Therapy, Auricular Massage

INTRODUCTION
Burnout Syndrome
Following the landmark study by Maslach and Jackson1 that addressed the lack of a consistent definition, Burnout Syndrome is commonly regarded now as a state of physical, emotional, and mental exhaustion caused by unrealistically high aspirations and illusory and impossible goals. It is a cumulative process leading to emotional exhaustion and withdrawal. Burnout is associated with continuous job-related stress and may be noted when work is not fun or enjoyable any longer. Burnout often occurs in people who are idealistic, hard working, self-motivated achievers, rigid perfectionists, and those with unrealistically high standards of performance either from their supervisors or from within themselves. It is often seen in persons who experience a job with little recognition and few rewards or appreciation.

In the development of burnout syndrome, a person may experience a honeymoon phase at work where the job or work is wonderful and exhilarating. This may be followed by an awakening phase in which the initial expectations are felt to have been unrealistic; in addition, the person becomes increasingly bored, tired, confused, or frustrated with work and may question his or her ability to perform satisfactorily. Then, this may lead to the brownout phase in which early enthusiasm and energy gives way to chronic fatigue, irritability, changes in eating, sleeping, and escapist behaviors. Burnout syndrome itself may then manifest with despair as a dominant feature and may begin within months to several years of work. It is associated with a sense of failure, depressed feelings or mood, and exhaustion that is present physically, mentally, and/or emotionally.

In a review of the Deficiency Syndromes in common Traditional Chinese Medicine (TCM) acupuncture texts,2-4 no mention of burnout or exhaustion is noted in the Shanghai text or the Maciocia texts. Fatigue is discussed in detail in Helms' text5 although these discussions are based on classic energetic organizations of acupuncture physiology as opposed to a "traditional" (TCM) syndrome organizational paradigm.

According to Helms,5 fatigue and exhaustion will manifest in accordance with a patient's bio-energetic organization. The classic energetic organizations of acupuncture physiology will consider the physiology of the Jing Luo or energetic (Qi) movement through the channels and collaterals. This energetic organizational approach offers unique insight into understanding the nature of and treatment for burnout syndromes beyond the TCM syndrome organization.

Multi-Paradigm Acupuncture Considerations
To understand this classic energetic approach as opposed to the TCM syndrome organization of disease, a review of the multiple paradigms of acupuncture is warranted. Traditional Chinese Medicine acupuncture is that construct of acupuncture that emerged in the 1949 era as the Maoist regime sought to reinstitute some of its traditional healing arts in order to serve the health needs of the exploding population. Declared illegal in decades past and with spiritual, demonic, or "illogical" explanations for illness, acupuncture was reorganized into the now familiar Syndrome Diagnoses, having borrowed this classification or organization from the herbal practitioners' construction of illness. As with a prescription of herbal remedies for one of the many syndrome conditions, acupuncturists now could treat from a menu of points ascribed to the various syndromes. Thus, the diagnosis and treatment point selections in this model of acupuncture are no longer based on the energetic movement and subsequent clinical effects to changes in that movement within the Jing Luo, or the channels and collaterals.

Separate from this "traditional" (TCM, initially deemed the "New Chinese Acupuncture")4 model of organization are the previous and still continuing organizations or paradigm of acupuncture physiology commonly known as "energetic" acupuncture. Consistent to these paradigms are classic energetic approaches to acupuncture found throughout the acupuncture literature of centuries past and present. These paradigms of acupuncture lead to an assessment of illness and direction of treatment based on the state or condition of energy (Qi) and movement of that energy within the channels (meridians) and their collaterals. These may be presented with Japanese Meridian Therapy, Classic Energetic (pre-TCM Chinese) acupuncture, French Energetic acupuncture (classic Chinese infused with French thought), and others, as well as from the expressions of life as understood in the Five Elements (Five Phases) model. In these organizations of diagnosis and treatment, the physician may consider evaluation of and treatment of the Principal Meridians (PM), the Curious (Extraordinary) Meridians (EM), the Distinct Meridians (DM), the Shu Mu subsystem, and Hui Points.

In a contemporary, integrated, and inter-disciplinary model, the medical acupuncturist will commonly utilize the contemporary neuro-anatomic models as part of the acupuncture diagnosis and treatment, with consideration of neuro-anatomy and neurophysiology, and with anatomic and physiologic diagnoses. As with conventional medical diagnostics, the physician considers the location of pain or dysfunction, whether the condition or pain is acute vs chronic, and any associated dysfunctions, diseases, or depletion.

Further, the acupuncture microsystems are often employed in a multi-paradigm approach to acupuncture diagnosis and treatment and may include Auricular Therapy and Auricular Medicine, the hand, scalp, or facial microsystems, and others. Many view these microsystems to be a form of holographic acupuncture, where a part of the whole organism contains all the information of the organism and is thus available to have diagnostic and treatment implications for the entire body, while seemingly only addressing a small part of that body.

A common clinical approach in this multi-paradigmatic acupuncture then is to treat the local condition, the regulatory mechanisms or physiology, and a microsystem treatment.

Diagnostic criteria important for classic energetic acupuncture as well as TCM syndrome acupuncture include an evaluation of the classic pulse qualities of excess or deficiency, and many other qualities readily described in reference texts. Tongue diagnosis and evaluation of the San Jiao will also give great insight to the patient's condition, and Hara Diagnosis from the Japanese tradition may be very enlightening as well. Evaluation of symptoms from classic, traditional, or contemporary models give valid and important reflex information. Microsystem analysis of the ear, hand, face, or scalp will commonly give significant diagnostic information as well as be useful for treatment.

Shu Mu Treatments
In the author's practice, treatment of the Shu Mu subsystem is often indicated for those with burnout syndrome or any deficiency state. This treatment will often "light the fire" within the patient in order that he or she may then be able to integrate the other treatment applications made. If a pretreatment of the Shu Mu subsystem is not performed, the patient may be too energetically depleted to effectively integrate the energetics of the body acupuncture treatments otherwise initiated.

Table 1. Shu Mu subsystem points and indications.

Shu Points

Vertebral level

Organ

Mu Points

BL 13

T-3

LU

LU 1

BL 14

T-4

PC

CV 17

BL 15

T-5

HT

CV 14

BL 18

T-9

LR

LR 14

BL 19

T-10

GB

BG 24

BL 20

T-11

SP

LR 13

BL 21

T-12

ST

CV 12

BL 22

L-1

TE

CV 5

BL 23

L-2

KI

GB 25

BL 25

L-4

LI

ST 25

BL 27

S-1

SI

CV 4

BL 28

S-2

BL

CV 3


The 12 paired points along the inner Bladder line from T3 to S2 in the Shu Mu subsystem constitute the back Shu points, and may be used to access the 12 primary organs' function or energy. By convention, though with some exceptions, the back Shu points, being Yang in presentation, are commonly activated to support the energy and function of the Yin organs. Typically, they will be activated in tonification to reinforce an energetic deficiency. Similarly, the front Mu points, present on the Yin surface of the anterior thorax and abdomen, are by convention, commonly activated to support the energy and function of the Yang organs (Table 1).

A Shu Mu treatment that is useful to stimulate the Wei Qi production includes tonification of the Liver (LR), Kidney (KI), Large Intestine (LI), and Small Intestine (SI) back Shu points. This tonification may be accomplished by piquring and using moxa or low frequency (less than 10 Hz) electrical stimulation to the back Shu points of BL 18 (LR), BL 23 (KI), BL 25 (LI), and BL 27 (SI). Stimulation of these points or any points that are tender or hollow to palpation, for only 6-10 minutes, may be a potent pretreatment for energetically depleted patients. As presented in classic acupuncture physiology, deficiency states or conditions are to be tonified and excess conditions are to be dispersed. In the burnout patient or any significantly depleted patient, more attention typically needs to be given to tonifying the deficiencies in this Shu Mu pretreatment phase.

Principal Meridian Treatments
Following pretreatment of the Shu Mu subsystem, the practitioner commonly activates the Principal Meridian (PM) system, those channels associated with the 12 classic organ-functions in acupuncture physiology. These channels are the surface surprojections typically seen on acupuncture charts or models and are organized as paired synergistic and coupled Yin and Yang channels, including the Kidney (KI) and Heart (HT), Bladder (BL) and Small Intestine (SI), Liver (LR) and Pericardium (PC), Triple Energizer (TE) and Gallbladder (GB), Lung (LU) and Spleen (SP), and Large Intestine (LI) and Stomach (ST). In classic Chinese parlance, these paired channels present as Shao Yin (KI and HT)/Tai Yang (BL and SI), Jue Yin (LR and PC)/Shao Yang (TE and GB), and Tai Yin (LU and SP)/Yang Ming (LI and ST) (Figure 1). Treatment is directed to addressing excess or depletions identified through the diagnostic examinations on the channels that are most likely the source of the presenting or underlying pathologies.

Table 2. Accessory Shu points and influence.

SI 15

Lower cervical and scapula

SI 14

Lateral shoulder

SI 10

Upper arm

BL 16

Du Mai

BL 17

Esophagus and diaphragm

BL 17.5

Pancreas

BL 22

Adrenal

BL 24

CV 6, "Sea of Qi"

BL 26

CV 4, Energy and Blood

BL 29

Sacrum and buttocks

BL 30

"White Circle" (Anus)


In the Helms' school,5 these channels are treated commonly with an "N›N+1" circuit, where a number of needles inserted on 1 synergistic channel is offset by 1 more needle placement on the opposite synergistic channel. The needle count utilizes only the 5 command points (Ting [Jing-well], Ying, Shu, Jing, He) and the +1 needle is placed on the Yin channel for tonifying chronic, depleted cases and on the Yang channel dispersing for acute, excess conditions. In this convention, treatment protocol is to 1st, piqure the Command Points, then the local or Ah Shi points, as well as appropriate Barrier Points, or other indicated points. Treatment time is typically 8-12 minutes, and one may consider the use of electrical stimulation or moxa stimulation. Specifically, burnout conditions frequently present as deficiency conditions and thus the electrical stimulation will typically be low frequency (less than 10 Hz) to support the Yin depletion. If indicated, higher frequency stimulation (above 10 Hz) may be used to move excess or obstructed energy through the channels, commonly on the Yang aspect.

Table 3. Hui Points and spheres of influence.

CV 17

Sea of Energy or Qi

BL 11

Bone

GB 34

Tendons

GB 39

Marrow

BL 17

Blood or Xue

LR 13

Zang, solid [Yin] organs

CV 12

Fu, hollow [Yang] organs

LU 9

the system of Vessels


This N›N+1 application to the PM is derived from classic Chinese energetic acupuncture physiology with French Energetic theories. A single needle placement creates a local agitation, while a 2nd needle in the circuit gives an agitated equilibrium. A 3rd needle or +1 needle in the circuit leads to dynamic disequilibrium, thus creating a flow within the channel. As noted above, the +1 needle is placed on the Yin channel for chronic, deficiency states to reinforce Yin condition, and the +1 needle is placed on the Yang channel for acute, excess states to move through the Yang condition.

Distinct Meridian Treatments
The Distinct Meridians, considered to be exclusively animated by Wei Qi circulation, are organized into coupled Yin/Yang Organ pairs and depart from the PM at the "access point;" then travels directly to the organ, then to its coupled organ, and then emerges at the "return point." The DM is considered appropriate applications for dense, material dysfunctions including histopathological abnormalities. Clinical examples may include chronic interstitial cystitis, prostatitis, bronchitis or emphysema, and other pathologies presenting with histopathology rather than just energetic disturbances.

Figure 1. Principal Meridians (adapted from Helms5)

Figure 2. Distinct Meridians (Bryan L. Frank, MD)

Figure 3. Curious Meridians (adapted from Helms5)

In the application of the DM treatment plan, 1st, the Yin/Yang PM "access points" are piqured, followed by the Yang PM "return point" (Figure 2). The energetic focus is made through picuring Shu Mu points or local, anatomical, or Ah Shi points. Treatment may include electrical stimulation as previously described or moxa, and typically is of 15-20 minutes duration.

The PC/TE DM address deep pathways influencing the body's autonomic and neuro-vegetative activities. This may be the most appropriate DM for activation in burnout syndrome, although history and physical findings may lead the physician to address others. If the patient has an ongoing pathology of dense, material significance, treatment may address this condition, move it into an energetic realm that allows for recovery, and thus remove the pathology from contributing to the burnout syndrome. Hence, the KI/BL, the SP/ST, the LU/LI, the LR/GB, or the HT/SI DM may be appropriate inputs in burnout syndrome, depending on the individual history and findings.

Curious (Extraordinary) Meridians
The Curious or Extraordinary Meridians (CM) is responsible to maintain the energetic order of the organism. The 8 CM serve from conception as the matrix for cellular differentiation and energetic organization. They further serve as reservoirs of energy, available to fill the PM if deficient, or to receive overflow from excess PM energy. The CM is rich in Yuan Qi, or original, ancestral energy.

Application protocol for the CM is to piqure the Master and Couple Points (Figure 3) bilaterally, then to piqure the Focusing Points. As with the PM applications, one may utilize the "N›N+1" model by combining the specific CM being addressed with another CM, or with a PM of opposite polarity to the CM being addressed.5 Treatment may include electrical stimulation or moxa, and is typically 15-20 minutes in duration.

The Chong Mai CM (Sea of the Twelve PM) addresses menstrual and fertility pathologies, depleted vitality, prostadynia, and endocrine disorders. Chong Mai is the manifestation of the movement of Yuan Qi, is an axis of vitality, and nourishes all organs and meridians. The Chong Mai will thus often be appropriate energetic input for many who have burnout syndrome and may lead to dramatic clinical response in energetic levels and restoration of vitality.

Figure 4. Auricular Massage 7,8,10

Centripetal Massage

Centrifugal Massage
Other CM include the Dai Mai (Belt Meridian), useful for lumbar pain radiating anteriorly, abdominal fullness, cold feet and buttocks, vaginal discharge or pain, dysuria, and pelvic pain. The Ren Mai (Conception Vessel) addresses pathologies of menstruation, menopause, and fertility problems. Du Mai (Governing Vessel) is useful for treating pain and stiffness of the low back or neck with muscle spasm, vertigo, urinary retention, hemorrhoids, and seizures.

Yinweimai (Yin Linking Vessel) will treat lumbar and genital pain, heaviness in the chest, insomnia, anxiety, and restlessness. Yangweimai is indicated for muscle contractions with joint stiffness, generalized achiness and puffiness, occipito-frontal headaches, cervical myalgias, and lateral body pain. Yinqiaomai addresses somnolence or insomnia with agitation, pain at the medial conjunctiva, frontal headaches near the eyes, diffuse pelvic pain, cystitis, and dysmenorrhea. Yangqiaomai will be indicated for pathologies of lateral body tone, acute headaches associated with Wind invasion, facial paralysis, cerebrovascular accident (CVA) sequelae, and dorsal unilateral pain.
As with treatment of the other PM or DM channels, associated pathologies or diseases may direct the physician to consider any of the above CM in relieving conditions that may exacerbate burnout syndrome, and thus greatly improve the patient's clinical response.

Hui Points
Hui Points are loci where Qi and Jing of 8 different tissues and functions converge. These points may be piqured as focusing points to energetic channel applications described above, or may be piqured as extra points for specific input related to their sphere of influence (Table 2). The Hui Points include CV 17 (Sea of Energy or Qi), BL 11 (bone), GB 34 (tendons), GB 39 (marrow), BL 17 (blood or Xue), LR 13 (Zang, solid [Yin] organs), CV 12 (Fu, hollow [Yang] organs), and LU 9 (the system of Vessels). The points may be piqured during application of the other energetic movements and are thus typically left in place for 15-20 minutes. Moxa is very energizing to these points for energy-deficient conditions.

Auricular Therapy
Auricular Therapy has emerged in the last 50 years as the predominant acupuncture microsystem. Often considered for the treatment of pain, addictions, functional illness, and psycho-behavioral issues,6-16 there is application appropriate for the treatment of burnout syndrome, as well. In addition to treating active auricular points for pain, functional conditions, and emotional issues that may exacerbate burnout in a patient, auricular massage techniques have been applied for decades for deficiency conditions with good clinical response. In this consideration, a centripetal massage pushes the energy from the concha toward its source at "Zero Point" (Vagus Nerve, CN X) (Figure 4). This movement dampens the parasympathetic tone of the ear, especially if accompanied by massage, which enhances the sympathetic tone of the rest of the pinna. This massage is useful to intensify the sympathetic tone of the dominant ear and thus, of the dominant hemisphere. It is most useful when applied with massage of the opposite ear in an opposite direction.

Centrifugal massage moves the energy from the "Zero Point" (Vagus Nerve, CN X) to the periphery of the concha (Figure 4). This movement will energetically spread or enhance the parasympathetic tone, especially if accompanied by massage, which dampens the sympathetic tone of the est of the pinna. This massage is useful to intensify the parasympathetic tone in the non-dominant ear and thus the non-dominant hemisphere. As with the centripetal massage, this is best utilized in conjunction with the massage of the opposite ear in the opposite direction.

These auricular massages should be considered for treatment of laterality problems, ADD/ ADHD, stuttering, dyslexia, fatigue, drowsiness, and exhaustion (burnout syndrome). Commonly, the stimulation is made for 4-5 |minutes on each ear twice daily or more; within a few days to weeks, many patients will report significant clinical effect. Treatment frequency may be tapered once clinical response has been achieved.

Blockages of "Foci"
From a more contemporary, though perhaps still a "complementary or alternative" organization, evaluation of scars and their potential for promulgating or exacerbating pain or dysfunction are the evaluation of "foci" or blockages to diagnosis and treatment.8,17 These blockages are presented as foci of irritation, often silent and painless, which may interfere with energy, healing, and treatment response. They may result from gross trauma, psycho-emotional trauma, toxicity by environmental or iatrogenic sources, or by colonization (often "sub-clinical" in conventional medicine) of bacteria, viruses, or parasites.

Psycho-emotional blockages or foci include the corpus callosum, the "R" Point in Auricular Therapy, and the pineal gland. Toxic blockages or foci commonly present in the sinuses and vermiform appendix as dental lesions, scars from physical or surgical trauma, and cancers, as well as metal toxicity to any other structures.

Structural blockages include irritation of the Stellate Ganglion (due to displacement of the 1st rib), sacro-iliac joint dysfunction, temporomandibular joint dysfunction (TMJ), and any vertebral subluxations (Figure 5).7,8,10

Figure 5.
Auricular Blockages7,8,10

    LEGEND
    A.Stellate ganglion
    B.Corpus callosum
    C.TMJ
    D.Dental foci
    E.Sinteses
    F.Sacro-iliac joint
    G."R" point
    H.Epiphysis (Pineal gland)


CONCLUSIONS
Burnout syndrome affects a growing segment of the population. Conventional medicine alone may not fully enable the patient to successfully recover from the physical, mental, and emotional exhaustion experienced in burnout syndrome. While considerations of lifestyle, job and career, nutrition, and rest patterns are all appropriate and important, acupuncture may enhance the speed and quality of recovery from burnout syndrome. A multi-paradigm approach to acupuncture may yield more favorable results than when working from a single model alone.

REFERENCES

  1. Maslach C, Jackson SE. The measurement of experieinced burnout. J Occup Behav. 1981;2:99-113.
  2. Maciocia G. The foundations of Chinese medicine a comprehensive text for acupuncturists and herbalists. Edingburgh, London: Churchill Livingstone; 1992.
  3. O'Connor J, Bensky D, Eds. Acupuncture: A Comprehensive Text, Shanghai College of Traditional Medicine. Seattle, WA: Eastland Press, Inc.; 1994.
  4. Seem M. Acupuncture Imaging: Perceiving the Energy Pathways of the Body. Los Angeles, CA: Healing Arts Press; 1994.
  5. Helms JM. Acupuncture Energetics: A Clinical Approach for Physicians. Berkeley, CA: Medical Acupuncture Publishers; 1995.
  6. Frank BL. Principles of Pain Management. In Wilderness Medicine, 4th edition. St. Louis: Mosby, Inc; 2001.
  7. Frank BL, Soliman NE. Atlas of Auricular Therapy and Auricular Medicine, 2nd Edition. Edmond, OK: Acupuncture Arts & Press, LLC; 2004.
  8. Frank BL, Soliman NE. Auricular Therapy: A Comprehensive Text, Auricular Phases, Frequencies, and Blockages. Bloomington, IN: AuthorHouse; 2005.
  9. Frank BL, Soliman NE. Obesity Treatment Through Auricular Therapy and Auricular Medicine. Medical Acupuncture. 2002;14(1):33-35.
  10. Frank BL, Soliman NE. Pocket Atlas of Auricular Therapy and Auricular Medicine. Edmond, OK: Acupuncture Arts & Press, LLC; 2004.
  11. Frank BL, Soliman NE. Shen Men: a critical assessment through advanced auricular therapy. Medical Acupuncture. 1999; 10(2):17-19.
  12. Frank BL, Soliman NE. Zero Point: a critical assessment through advanced auricular therapy. Medical Acupuncture.1999;11(1):13-15.
  13. Nogier PFM. From Auriculotherapy to Auricular Medicine. Sainte-Ruffine, France: Maisonneuve; 1983.
  14. Nogier PFM. Handbook to Auriculotherapy. Sainte-Ruffine, France: Maisonneuve; 1969.
  15. Nogier PFM, Nogier R. The Man in the Ear. Sainte-Ruffine, France: Maisonneuve; 1985.
  16. Soliman NE, Frank BL. Auricular Acupuncture and Auricular Medicine. In Physical Medicine & Rehabilitation Clinics of North America. 1999;10(2): 547-554.
  17. Frank BL. In Physical Medicine & Rehabilitation Clinics of North America. Neural Therapy. 1999;10(3):573-582.

AUTHOR INFORMATION
Dr Bryan Frank, past AAMA President (1999-2001), serves as President of ICMART (2004-2006), and has authored or co-authored numerous texts,
atlases, chapters, and articles. Dr Frank regularly teaches around the world in acupuncture and medical symposia and congresses, and serves as a medical missionary overseas as Executive Director of Global Mission Partners, Inc., a 501-c-3 charitable organization.

Bryan L. Frank, MD, FAAMA*
President, Acupuncture Arts & Press, LLC
PO Box 30415
Edmond, OK 73003-0007
Phone: 405-623-7667 • Fax: 405-341-5342 • E-mail: BFrankMD@aol.com
*Correspondence and reprint requests

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