Medical Acupuncture
A Journal For Physicians By Physicians

Spring / Summer1994 - Volume 6 / Number 1
"Aurum Nostrum Non Est Aurum Vulgi"

PETER ECKMAN, M.D., PH.D.

When Dr. Brad Lawrence contacted me in April, a year ago, soliciting my participation in the 1994 AAMA Symposium, he indicated that he would like a presentation that related somehow to neurology. I almost declined, on the basis that I do not have any special expertise in that field (despite having received a Ph.D. in neurophysiology over 20 years ago), but a vague idea seemed to be hiding in the back of my mind, about how traditional Oriental Medicine (TOM) views the nervous system in a developmental sense, and this is the subject I would like to  explore with you today.

If you pay close attention to the material I have previously presented on Korean Hand Acupuncture (KHA) (2), you will realize that the logical outcome of its theory is that all of acupuncture and much of the rest of many other approaches to healing, is a direct consequence of' the impact these techniques have on the nervous system, and specially the brain. The KHA pulse diagnostic system - based on comparing the blood flow of the carotid and radial arteries (where the radial artery is utilized as a substitute for the vertebral artery) - points to the balanced functioning of the brain as both an indicator of optimum health and a therapeutic goal. In this diagnostic approach, the caliber of the carotid and radial arteries should be equal on each side of the body. Those interested in a more thorough explanation of the relationship of KHA and carotid/radial pulse diagnosis to the brain should consult Koryo Hand Acupuncture, Vol. I, by Tae-Woo Yoo (3), and in addition, there will be an expanded discussion of this subject in Vol. II which is in the process of being translated and edited.

So what is the traditional Oriental medical viewpoint of the nervous system, the brain, neurology? You are all aware, I am sure, of the most basic teaching that the brain is considered the "Sea of Marrow" and that "Marrow" is an undifferentiated term including both bone marrow per se and the parts of the nervous system which are also enclosed within a bony protection - the spinal cord and brain, or CNS. You will also recognize the traditional teaching that the brain and central nervous system, like their bony covering, are dependent on the Kidney as the major organ responsible for their maintenance. This simple level of explanation is as far as most TCM texts in English go, and explain why in the neurological disorders of the elderly, such as Parkinson's disease and Alzheimer s disease, the focus of treatment is often in tonifying both the Kidney and the CNS by treating points on the Governing Vessel, especially on the head.

I£ we take the next step into traditional doctrine, we come across the notion that the brain and the spinal cord are members of a group of' Organs called Qi Heng Zhi Fu or Extraordinary or Curious Fu Organs. There is not much material taught on these in English. They include Brain Spinal Cord, Bone, Uterus, Vessels and Gall-Bladder. Their name, Qi (4), which is translated as Curious or Extraordinary is the same term as in the Curious Meridians, Qi Jing Ba Mo (Mai) but it is unsatisfactory to simply translate Qi Heng Zhi Fu as Curious Fu, because the adjective Heng is thereby totally ignored. Heng means constant, continuous, persevering. One interpretation is that these Organs are like the Fu in form - i.e., hollow (obvious for Bone, Uterus, Gall-Bladder and Vessels, but also, if you think about it, for Brain and Spinal Cord which have central canals), yet like the Zang in function-- i.e., continuous rather than intermittent-- not subject to the periodicities of digestion and excretion. Thus they are partly like Zang and partly like Fu, and are thus called Curious. But like most of traditional thought, there is a deeper meaning - what is contained in the hollowness of these Extraordinary Organs? The ordinary or regular Fu contain the products of the digestive and excretory systems: food, chyme, urine, stool - and these are all seen as impure materials which do not share in the essential nature of the organism. The Extraordinary Fu, however, contain only pure materials: Marrow, Blood, even Bile, which are seen as sharing in the essential nature of the organism. This essential nature is due to the fact that these Extraordinary Organs are all participants in the circulation and function of the Jing or Essence which takes us yet another step deeper into traditional thought.

Why do I say deeper? Because in traditional thought the Essence, Jing, is at the root of the mystery of life, and along with its companion term Spirit or Shen, it is the aspect of traditional thought that has been all but expunged from contemporary TCM, a pragmatic simplification of TOM that is designed to resolve medical problems that can be conceptualized in a dialectically materialistic context, but not in the spiritually, more inclusive context of the originators of TOM. To quote Ted Kaptchuck, "These Curious Organs are actually of little importance in theory and practice ..." (5). However, the very language used for describing neurological, mental, psychiatric disorders, etc. in Chinese, involves Jing Shen - Essential Spirit. The following terms all include Jing Shen in their formulation: mental activity, alertness, psycho-physiology, mental illness, psychotherapy; psychogenesis. Thus it is only by starting from the Jing or Essence, that we can properly approach the issue of neurology in TOM.

We have come full circle, for the central nervous system, i.e., Brain and Spinal Cord, is quite clearly connected to the Jing in the classics:

"When an individual is created first the Jing is formed; from the Jing comes the Brain and Marrow" (6). "The Jing of the five grains (post-natal) forms a cream, seeping into the empty spaces of the Bones to nourish the Brain and Marrow" (7). "The Brain is the Sea of Marrow" (8).

If' we now go back to the concept Jing in its ancient, as opposed to TCM sense, a much broader vista opens up. It gives us firstly a quite different view of why the Curious Organs and Curious Meridians are called by the same term, Qi, which is also translated as Extraordinary, Marvelous, Wonderful. Thus Qi appears in the expressions: a wonderful affair, an eminent person, an adept or mystic. What ties the Curious Organs and Meridians together is that they both participate in the circulation of Jing, this precious Essence. Thus one way to approach neurology would be through the Curious Meridians, which would be perfectly appropriate, but there is already a fair amount of information on this in the material developed by A.F.A. based on the works of Drs. Chamfrault and Van Nghi, which has been incorporated into the basic classes put together by Dr. Helms. This material, however, is still on a plane that is compatible with TCM.

I would like to jump over now into some material that is beyond the pale of TCM, and as indicated in the title of this talk, owes its origin to the Daoist tradition. The material I am going to present cannot be found in any texts published in English because it is maintained and developed mainly as an oral tradition, although significant parts of it are contained in the texts of the Dao Cang or Daoist Cannon, particularly the text known as the Huang Ting Jing or Yellow Court Classic (c. 2nd Century). My information on this tradition comes primarily from the teachings of Jeffrey Yuen, a Daoist priest whose family has participated in this oral transmission over many generations.

I think you are already familiar with the connection of Daoism and meditation, and specially its focus on the Curious Meridians. What is being circulated is the Jing, but the Curious Meridians are one mechanism of Jing circulation among many. I have already indicated that the Curious Fu also participate in this Jing circulation: the Bones through their Marrow, the Vessels through their Blood (Essence and Blood are of the same origin - jing xue tong yuan) (9), the Uterus through the germ plasm, the Gall Bladder through the Bile (a substance of purely internal origin), and the Brain and Spinal Cord which can now be seen as a mechanism for circulating the Essence to every part of the organism. In effect, via the Curious Meridians and the Curious Fu, all the basic functions or mechanisms of the organism are supplied with Essence - we have the musculo-skeletal system via the Bones, the digestive system via the Gall Bladder, the circulatory system via the Vessels, the reproductive system via the Uterus (Prostate), and the nervous system via the Brain and the Spinal Cord. Only one major system is missing -- which one? The respiratory system. And which Organ dominates it? The Lungs. Thus we can almost deduce that there must be a special system for circulating Jing to the Lungs, which in turn can circulate it to the whole organism since they also oversee the circulation of the Meridian system as a whole.

This special circulation of Jing to the Lungs is described in Daoist texts as the activation of the Mo points or so-called "alarm points". Before I describe the Daoist tradition in this regard, let me first review the prevalent teachings about the Mo points.

The term Mo (Mu) first appears in the Nei Jing (10) and is also mentioned in the Nan Jing (11) along with its coupled term, Yu, but the identification of the specific points involved, I think, is first found in the The Systematic Classic of Acupuncture and Moxibustion (12). Western teachings about this group of points, along with most of how we think about acupuncture is heavily influenced by Soulie de Morant (13), who first called them Heraut, that is, Herald or Alarm points, an interpretative name that is not reflected at all in the Chinese word, Mo.

Mo actually means to summon, raise, collect, or enlist (14). The implication in Chinese is to collect in order to support (as in the clergy) or defend (as in troops). This dichotomy of support/defend is a familiar one that brings to mind the polarization of Qi into Nutritive and Defensive Energy or Ying and Wei Qi, which again brings us back to the Lungs, which initiate the distribution of these two forms of Qi. Clearly, however, there is no implication of "Alarm" which is a neologism, although not necessarily a Western one, as later Chinese commentators may have been the inspiration for Soulie de Morant's translation. However, even modern Chinese texts, such the Essentials of Chinese Acupuncture (15) simply define the term Mo as those points on the chest and abdomen where the Qi of the respective Zang/'Fu Organs is "infused". Faubert (16) goes so far as to claim that the idea of Alarm points is a Western concept, although he recognizes that they become spontaneously tender when their related Organs or Meridians are malfunctioning, and there is no question that virtually all schools of traditional acupuncture - Chinese, Japanese, Korean and European use the palpated sensitivity of these points diagnostically.

In English, the term Alarm points originated with Felix Mann (17), who basically reflected Soulie de Morant's teachings, and this translation has been adopted by most other authors (from Lawson-Wood (18) and Worsley (19) to the contemporary writing of Mark Seem (20) and even Wiseman and Boss whose Glossary of Chinese Medical Terms (21) is rigorous although frequently opaque. The shining exception is Maciocia (22) who sticks with the correct literal translation, "Collecting" points. I have not mentioned Porkert (23) who calls them "Conquisitoria", since I do not know Latin (actually it means recruiting officer) but Porkert says that in them, the specific energy of the orbs is structively collected and accumulated. As a final comment on Western translations, I would like to point out that Kespi (24), the president of A.F.A., opts for a totally unique interpretation, as he does for describing their usage, which I will get to shortly. Kespi claims that the meaning of Mo is to be found in the words: membrane, film, soft, supple, flexible and accommodating. It appears to me that he is translating an homophonous Chinese word, Mo (25), although he does not explain this discrepancy in characters. Needham's account in Celestial Lancets (26) reflects this same garbling of characters.

Having clarified the terminological history, let's look at how the various authors describe the use of the Mo points.

Porkert (27) - to treat energetic stagnation and chronic diseases of the orbs. Soulie de Morant (28) -- to tonify a meridian as a supplementary tonification point. Used for illnesses of the Yang in the Yin - e.g. if Organ problems (Yin) came from perturbed feelings (Yang).

Niboyet (29) - agrees with Soulie de Morant and adds that the pulse lags behind its position (Yin) and that tonifying the Mo point increases the Yang quality.

Lavier (30) takes an opposite viewpoint - they are usually used to sedate an acute Excess although he adds they can be tonified.

Chamfrault (31) -- could not find any teachings about them worth translating.

Mann (32) follows Soulie de Morant - used for Yin disease with cold, depression, weakness, but adds that they will be tender. Usually used to tonify but can be sedated.

Blustrated Dictionary of Chinese Acupuncture (33) - used especially for Fu Organ diseases.

Maciocia (34) follows Lavier in saying that they are mostly for acute disease but can be used also for chronic disease, and they can be tonified or sedated.

Seem (35) points out that in common clinical practice, usually a harmonizing strategy is adopted by treating both Mo and Yu points together.

Kespi (36) takes the radically different interpretation that the Mo points do not relate to the Zang/Fu Organs or even to the Five Elements, but rather to what he sees as a separate level of energetics called the Four Elements (Heaven, Earth, Fire and Water) with a Center or Source. As his interpretation is so at odds with all other commentators and with the Daoist material I am going to present, I will say no more about it.

Now I am almost ready to present the Daoist interpretation of the Mo points, but I do want to preface that material by pointing out that it is one of a number of schemata used to try to make sense of the issue of "constitution" in TOM. It is of course not surprising that a system which deals with the Jing or Essence also relates to the constitution or root of' an individual. There are several different paradigms for treating with acupuncture at the root or constitutional level such as Korean Constitutional Acupuncture (37) which uses the Five Element command points, as does Worsley's approach (38) in terms of the Causative Factor (CF), the Japanese Curious Meridians Schools (39) which use their distal Command Points, and the Japanese Meridian Therapy schools (40) which combine both Five Element and Curious Meridian distal Command Point treatments with central treatment of the Hara through use of both Mo and Yu points (Hashimoto (41), Fukushima (42)). The Daoist understanding of the Mo points is the basis for this approach.

We are finally ready to look at the Daoist conceptualization. Daoist beliefs about human energetics are based on meditational insights. One of these insights is the concept of' Anterior and Posterior Heaven which I will paraphrase as Heaven's rules before there was me, and Heaven's rules after there was me. "Me" starts not as we think in Western terms at conception, but in Oriental terms at birth, with the first breath, the separation as an independent entity from the mother. Thus fetal and post-partum physiology are dependent on different laws. What happens at birth? The Daoists say that the fetus is born with a muddy substance in its mouth called the "mud-pill" which descends to the umbilical area where it lodges under the control of the kidneys. Part of its energy is used to heal the trauma to the umbilical cord, while the rest is stored and slowly released under the control of the Triple Heater mechanism as a way of distributing the Yuan Qi, source energy or jing, Essence, while the rest of the mud-pill is dispersed by the first breath, going to the Mo points. Lest there be any doubt as to the nature of this energy which the Mo points receive, I should point out that the Daoists refer to the Brain as the "sea of the mud-pill', so it is clearly the pre-natal Jing which goes to the Mo points and that is what they "Mo" or collect. The energetics of its subsequent distribution is the cycle of the Five Elements, which only becomes operative at birth, and begins with Metal.

The first breath carries the Jing from the throat at ST11 (Abode of Qi) out along the collar bone to ST13 (Doorway of Qi) where it contacts the outside world and continues to LU2(Cloud Gate) which, according to Daoist teaching, was the original Mo point of the Lungs. (The standard Mo point of the Lungs is LU1 (Central Storehouse) and can be used interchangeably with LU2 in Mo point treatment). From the Lungs the Jing goes to ST25 (Celestial Pivot) the Mo point of the Large Intestine which is at the level of the navel. This all happens with the first breath, which carries the Jing to the Dan Tien where it is activated as the Fire of the Vital Gate, Ming Men. ST25 is said to tonify Yuan Qi - Original Energy, which means it facilitates this rooting and activation of Jing/Ming Men or Kidney Fire for dissemination by the Triple Heater to all the Source Points. If you look at the trajectory from LU2 to ST25, it will be seen to cross ST17, the nipple, which is the baby's first goal after taking a breath.

From metal, the Jing is then distributed to Water. From ST25 it moves laterally to contact the Dai Mo at GB26 and then up to GB25 (Gateway to the Capitol, which for the child is the breast) the Mo point of the Kidneys, which helps the baby bond and receive post-natal nourishment. Simultaneously, the Jing also descends to CV3 (Central Pole) the Mo point of' the Bladder which helps the baby explore polarity and relationship. This involves movement, and so CV3 connects to the Tendinomuscular Meridians and the Yu points on the back where it also supports GV4 (Ming Men - Gate of Life) and GV14 (Great Hammer). This distributive and developmental process is played out over time. The child is born in the fetal position - a circle - but a few months later the head starts to lift sporadically - the activation of GV14. This is the beginning of being able to see ahead and experience time. A few weeks later, the child begins to "bounce kick" as GV4 is activated. This is the first movement towards a goal and represents spatial awareness.

The next focus of the Jing is on the Wood element. From GB25 it moves up to LI14 (Cycle Gate) and GB24 (Sun and Moon). Both of these points allude to cyclical phenomena and polarity. What's good, what's bad? What does mommy want, not want? This leads to guilt and shame as the child either is obedient to mommy but denies its own desires to explore the world (shame) or lies and is disobedient (guilt).

From Wood, the Jing next focuses on the Fire element, which represents the development of a sense self, independence. From GB24 the Jing moves up to the Mo point of the Pericardium CV17 (Chest Center) which is an altar to the Spirit. The Pericardium is where life becomes self-conscious. One has to choose the level of protectiveness for the Pericardium -- what to let in, what to keep out. This choice is relative and individual, reflecting personal values. The Jing also moves up from CV3 to CV5 (Stone Gate) the Mo point of the Triple Heater, which is in the center of the lower Dan Tien or Cinnabar Field and is an important point along with CV17 in internal alchemy - the transmutation of Jing into Qi and ultimately into Shen. From CV17, centrally protected by the breast bone, the Jing also descends to CV14 (Great Tower Gate) the Mo point of the Heart, where the bony protection is left behind, and to CV4 (Origin Pass), the Mo point of the Small Intestines. These points relate to the Imperial Fire which transmutes the Jing and Yuan Qi to care for the Shen.

Finally the Jing is focused on the Earth Element, which ends the cycle of Mo points and begins the cycle of influential Points. Moving out to LI13 (Chapter Gate) the Mo point of the Spleen and CV12 (Middle Completion) the Mo point of the Stomach. Both point names refer to the end of a sequence which is the distribution of Jing to the Zang/Fu Organs. Thus LI13 is the influential point of the Zang and CV12 is the influential point of the Fu. This symbolically represents the completion of the individual's development, and spiritually corresponds to compassion (associated with the Earth Element), where the individual transcends his self and the separation of subject/object.

I am not speaking as an expert in neurology, so I am only going to briefly touch on how the foregoing material can relate to neurological disorders, and for that purpose I am going to include psychological disorders and character development because as we know, the body, mind and spirit are all one.

The baby is born with a focus on the Metal Element. What happens if something goes wrong with the energetics of this process? On the physical level, the body may just not work right, perhaps there is mental retardation or other birth defects, perhaps just a failure to thrive. This is problem of the Po, or animal spirit, the spirit of' Metal, and it can present on that level as autism, reflecting a failure of some aspect of the child to be born, to come into Posterior Heaven.

If the perturbation disrupts the Water Element, we might expect problems with bonding, polarity and movement. Physically, this can manifest as neuromuscular disorders, like cerebral palsy or muscular dystrophy. On the mental and spiritual plane, the Zhi or will is associated with cleverness, the knack for doing things. Abnormalities can manifest as all sorts of confusion, the worst being schizophrenia.

The Wood Element has to do with guilt and shame, repression versus disobedience. On a physical level, this can manifest as various forms of epilepsy and later in life as spastic or flaccid hemiplegia, or with the rigidity of Parkinson's disease. Spiritually, the problem is with the Hun or spiritual soul, which gives life inspiration and direction. Characterologically we might see manic-depressive states, character disorders or other such problems.

The Fire Element is in some ways the most complicated, involving four Organs or Officials. It has to do with the balance between the Pericardium's function of shielding and protecting as opposed to the Heart's function of establishing personal independence. Perhaps the best example of what happens when it is malfunctioning is the old-fashioned diagnosis of neurasthenia - being neurotically oversensitive to any stimulus - which would correspond to a lack of pericardial protection. If the Pericardium is overactive and the Heart underactive, the character becomes dependent, overprotected rather than independent. Physically; fire imbalances often end up manifesting symptoms resulting from the failure of the Triple Heater to properly distribute Jing and use it to neutralize Xie Qi or perverse energy. Toxicity is internalized, and the outcome can be Alzheimer's disease where the individual deteriorates back to a state of total dependency.

Finally we have the Earth Element, which is responsible both for balance and harmony, and for transitions and completions of cycles. Its spirit, Yi, or intention, determines how we focus our energies. If it malfunctions, we become selfish and are prone to obsessive compulsive disorders that keep us from ever finishing anything and moving on. Even a minor degree of imbalance here can keep us from transcending our selves, and experiencing the oneness and balance and harmony of the universe or Dao. Physically we can think of all problems with balance, ataxias especially, and we even have a symptom called "intention tremor" in this category.

I do not mean to imply that every instance of these abnormalities results from the mechanisms I have used as illustrations - these are just common mechanisms that can serve as a beginning in diagnosis and treatment. What is nice about the Mo point analysis is that you can go directly to the point and confirm its inadvancement by testing for pressure sensitivity. This leads smoothly into treatment via the Mo points which I will also describe only briefly.

The basic idea in treatment is to direct the flow of Jing, or constitutional energy, to the Zang or Fu that is at the root of the patient's problem. This is done by needling the corresponding Mo point, but supplementary points are also added. One traces the pathway of Jing flow to the Mo points via the Five Elements, and searches for any Mo points that are either spontaneously tender, or whose stimulation relieves that tenderness at the root Mo point. Any that do are needled, along with their corresponding Luo or Connecting point to release any trapped Xie Qi or Perverse Energies - this is often done by Plum-Blossom needling.

For example, if you diagnose a root imbalance of the Large Intestine presenting with sensitivity at ST25, then you would want to explore specifically LU2, GB25, and CV3, to see if massage at any of these locations relieves the tenderness at ST25. Let's assume massage at LU2 does relieve the tenderness at ST25. Then the treatment would be to first needle ST25, next needle LU2 in the direction of ST25 and finally use Plum-Blossom needling on

LU7.

Let me end by saying a few words about the implications of this method of treatment. It seems that one of the primary goals of treatment is to use the needles to call awareness to one or more aspects of the body-mind-spirit through its built-in icons, known as the Spirits of the Points. The needles are actually aimed at, or focused on, one of these icons in particular; which is brought to awareness, either on a conscious or subconscious level (more likely both). This process is in keeping with the Daoist teaching that the goal of life and health is to transmute Jing into Qi and then into Shen or awareness. For spiritual growth or health maintenance and longevity, this is done through meditation on the internal energy flows or meridians, but in an actual health problem, this process is merely speeded up by using needles to pattern the flow of energy and awareness.

FOOTNOTES

1.- This article is closely based on the notes prepared by the author for a lecture given at the 1994 AAMA Symposium. Scottsdale, AZ. April 10, 1994.

2.- This material was presented at the 1991 AAMA Symposium and, among other places, can be found in AAMA Review Vol. 3, No. 1, pp. 7-10.

3.- Koryo Hand Acupuncture, Vol. l by Tae-Woo Yoo, edited by Peter Eckman. Eum Yang Mek Jin Publishing Co. Seoul, 1988. (available through Koryo Institute. Newton Center, MA).

4.- The Chinese word Qi, meaning Curious is not the same as the more familiar Chinese word Qi, meaning Vital Energy. Although they are spelled the same and pronounced the same, they are written with different characters in Chinese, and are not related in meaning. They are simply homonyms.

5.- Kaptchuck, T. The Web That Has No Weaver. Congdon & Weed. New York, 1983. Appendix F, p. 336.

6.- Ling Shu, Chapter 10.

7.- Ling Shu, Chapter 36.

8.- Ling Shu, Chapter 33.

9.- A traditional aphorism cited in the Dictionary of Traditional Chinese Medicine., The Commercial Press. Hong Kong, 1984. p. 36.

10.- Su Wen, Chapter 47.

11.- Nan Jing, Chapter 67.

12.- Huang Fu-Mi. Zhen Jiu Jia Yi Jing, 282 A.D. This work has not yet been translated into English.

13.- George Soulie de Morant began publishing material about acupuncture in French in 1929. As yet, none of his work has appeared in English, but his magnum opus, L'Acupuncture Chinoise, is slated to be translated and published by Paradigm Press sometime in 1994-1995.

14.- Mathews' Chinese-English Dictionary, revised American Edition. Harvard Univ. Press. Cambridge, MA, 1979. p. 642, character 4585.

15.- Essentials of' Chinese Acupuncture. Foreign Languages Press. Beijing, 1980. p. 88.

16.- Faubert, A. Traite Didactique d'Acupuncture Traditionelle. Editions de la Maisnie. Paris, 1977. p. 207.

17.- Mann, F. Acupuncture: The Ancient Chinese Art of Healing. William Heinemann Books. London, 1962. Second Edition, 1971. pp. 116-118.

18.- Lawson Wood, D. and J. Acupuncture Handbook. Health Science Press. Wellingborough, 1964. Second Edition, 1973. p. 15.

19.- Worsley, J. Traditional Chinese Acupuncture, Vol. I. Element Books. Tisbury, 1982. p. 285.

20.- Seem, M. Acupuncture Energetics. Thorsons. Wellingborough, 1987. pp. 47-48.

21.- Wiseman, N. and Boss, K. Glossary of Chinese Medical Terms and Acupuncture Points. Paradigm Publications. Brookline, MA, 1990. p. 172.

22.- Maciocia, G. The Foundations of Chinese Medicine. Churchill Livingstone. Edinburgh, 1989. p. 337.

23.- Porkert, M. The Theoretical Foundations of Chinese Medicine. MIT Press. Cambridge, MA, 1974. p. 337.

24.- Kespi, J.M. Acupuncture. Maisonneuve. Moulins-les-Metz, 1982. pp. 535-542.

25.- Mathews' Chinese-English Dictionary. Op. cit. p. 640, character 4563.

26.- Needham, J. and Lu, G.D. Celestial Lancets. Cambridge Univ. Press. Cambridge, 1980. pp. 66-67.

27.- Porkert, M. Op. cit. p. 337.

28.- Soulie de Morant, G. L'Acuponcture Chinoise. Maloine. Paris, 1972. Tome II, Chapter X; Tome V, p. 668.

29.- Niboyet, J. Nouveau Traite D'Acupuncture. Maisonneuve. Sainte-Ruffine, 1979. pp. 861-862.

30.- Lavier, J. Histoire, Doctrine et Practique de l'Acupuncture Chinoise. Tchou. Geneva, 1966. pp. 235-237.

31.- Chamfrault, A. Traite de Medecine Chinoise, Tome I. Editions Chamfrault. Angouleme, 1964. p. 92.

32.- Mann, F. Op. cit. p. 351.

33.- Illustrated Dictionary of Chinese Acupuncture. Sheep's Publications. Hong Kong, 1958. p. 138.

34.- Maciocia, G. Op. cit. p. 351.

35.- Seem, M. Op. ci~. p. 47.

36.- Kespi, J.M. Op. cit. pp. 535-542.

37.- A treatment style developed by Kuon Dowon in Seoul, first announced in the Journal of the International Congress of Acupuncture and Moxibustion. Japan Acupuncture and Moxibustion Society, 1965. pp. 149-167.

38.- A treatment style developed by J. R. Worsley in England, and taught at his school in Leamington Spa as well as by several schools in the U.S. The Medical Acupuncture Video Library, Berkeley, CA, has a collection of six tapes which cover this material.

39.- The schools are diverse, but derive their inspiration from the work of the late Dr. Yoshio Manaka.

40.- Also a diverse group, but in this case deriving their inspiration from the work of the late acupuncturist Sorei Yanagiya.

41.- Hashimoto, M. Japanese Acupuncture. Liveright. New York, 1966. p. 65.

42.- Fukushima, K. Meridian Therapy. Toyo Hari Medical Association. Tokyo, 1991. See for example case 1, pp. 217-220.

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