A Discussion of Acupuncture and Herbal Formula Correlates
by Dr. Young Wei Chieh
Original Article "談據方用針治療新冠病毒"
Translated (with annotation) by Noach Bittelman
(The following article was written by my teacher Dr. Young Wei Chieh and published on his blog post on April 22, 2020. I translated the original article, "談據方用針治療新冠病毒", into English for Dr. Young, he posted the translation on April 29, 2020. I thought it would be useful for readers of this blog to have access to Dr. Young's unique thought process about substituting acupuncture for herbal formulas.}
The National Health Institute in mainland China has established a special herbal formula to treat the Wuhan Coronavirus. This formula has achieved a 90% success rate in treatment of the disease. The formula is a combination of four classical formulas, with the addition of a small number of other herbs. These four formulas are: 1. Ma Xing Shi Gan Tang, 2. Wu Ling San, 3. Xiao Chai Hu Tang, 4. She Gan Ma Huang Tang.
In many countries outside of China the herb Ma Huang/Herba Ephedra, an extremely essential component of the formula, is illegal. Given this situation, what are we to do when treating COVID-19? We can make use of the acupuncture-herb correlation technique, whereby we substitute acupuncture points for herbal formulas. The question then arises—which points should be chosen to substitute for the herbal formulas which make up the special Coronavirus formula? Herein I will respond to the inquiries from students and others about this question, and discuss my perspective on the acupuncture-herb correlates.
When analyzing the current Wuhan COVID-19 illness which began at the end of 2019, we can see that the primary disease mechanism is cold damp. The special formula mentioned above, known as “Qing Fei Pai Du Tang/Clear the Lungs and Detoxify Formula”, was established as the standard formula to treat COVID-19.
Formula components, rationale, and purpose:
Qing Fei Pai Du Tang consists of four famous formulas, all of which have their origin in the Han Dynasty classic Shang Han Za Bing Lun, (known in English as the Classic of Cold Induced Disorders), written by Zhang Zhong Jing. Formulas which are ascribed to Zhang Zhong Jing are known as classic formulas. The current formula, Qing Fei Pai Du Tang includes within itself the four classic formulas Ma Xing Shi Gan Tang, Xiao Chai Hu Tang, Wu Ling San, and She Gan Ma Huang Tang. Qing Fei Pai Du Tang has two primary medical goals—1) harmonizing the Shao Yang, and 2) spreading and draining the Lungs and clearing excess; clearing excess is the dominant component of the formula, which is what makes it so clinically effective.
This particular epidemic exhibits a number of Shao Yang level symptoms, such as a bitter taste in the mouth, eye discomfort, sore throat and lack of appetite, emotional vexation and dry heaves or vomiting, a sense of oppression in the chest and fullness in the ribcage area. This explains why Xiao Chai Hu Tang is used.
The Excess symptoms, which manifest as a very large amount of sticky, viscous fluids which fill the lung cavities and cause obstruction of the breathing process, represent a very predominant component of the way the illness manifests.
The Lungs becoming filled with sticky and viscous fluids is an indication that the patient has an overabundance of fluids and dampness; these fluids and dampness can obstruct the circulation of qi and blood in the Lungs.
Wu Ling San is able to warm the Yang and lead out fluids. On the one hand it can strengthen the qi transformation mechanism, and when the qi transformational capacity is strong it can transform water in the body into the Jin and Ye fluids the body requires. On the other hand Wu Ling San can help the body to lead out excess wastewater by way of urination.
During COVID -19 the fluids become thick, sticky, and viscous, with phlegm accumulating in the lungs. As the amount of phlegm in the lungs increases the lungs become obstructed, leading to a sensation of chest oppression and fullness accompanied by wheezing. The body’s natural instinct leads it to try to save itself by coughing in an attempt to expel the phlegm. The phlegm at this point is too thick and sticky and the body is unable to cough it out, and the cough becomes a dry cough. The dry cough does not necessarily indicate that there is no more phlegm, it may indicate that the phlegm has become too thick and sticky to expel.
The strategy at this point must be to liquefy and transform the now very viscous phlegm. The formula She Gan Ma Huang Tang can be employed in order to accomplish two goals, first it can help spread the obstructed and constrained Lung Qi, making it easier to expel the waste products which have built up in the lungs, and second, the large amount of herbs in the formula which transform phlegm can act directly to transform the phlegm buildup in the lungs.
If the obstructive accumulation of phlegm damp remains in the lungs for an extended period of time with out being transformed it can stagnate and transform to heat, becoming phlegm heat or damp heat. The transformation to heat will manifest as fever; if the amount of phlegm damp is small there will be a low fever, and if the amount of phlegm damp is large there will be a high fever. This situation calls for the formula Ma Xing Shi Gan Tang in order to clear the heat.
If I were to treat this illness I would needle LU10 and A.04 San Cha San (or TB2) during the entire course of treatment.
Let’s first analyze LU10:
LU10 is the Ying-Spring point on the Lung meridian
The Lung is in charge of the body exterior and the Wei Qi
LU10 has the capacity to regulate sweat
The Lung meridian corresponds to the Heavenly Stem “Xin”, the eighth of the 10 Heavenly Stems, “Xin” corresponds to the flavor “spicy”
LU10 is the Fire point on the Lung meridian, meaning it has a “warm” quality or capacity
Combining the above factors allows us to correlate LU10 with the spicy and warming formula Ma Huang Tang.
Since LU10 is the Ying-Spring point on the Lung channel, and Ying-Spring points have the capacity to control and respond to pathogenic heat in the body, LU10 can also be correlated with the spicy and cooling formula Ma Xing Shi Gan Tang.
So we see how this point, LU10, has the capacity to exert bidirectional adjustment and can be successfully used to treat pneumonia with fever, as well as being able to calm asthma and wheezing.
Now let’s look at the acupuncture point A.04 San Cha San. San Cha San is located adjacent to TB2 Ye Men, which as the Ying-Spring point of the Triple Burner channel is useful for treating externally contracted illnesses like colds and flus and reducing fever. Additionally, this point can expel dampness and treat fatigue (fatigue indicates the existence of significant dampness, and is one of the primary symptoms associated with COVID-19). These qualities together correlate San Cha San with the formula Xiao Chai Hu Tang.
When San Cha San is needled through to TB3 Zhong Zhu (TB3 can bring about the removal of fluids from the body) the point can then correlate with and replace the formulas Chai Hu Gui Zhi Tang and Chai Ling Tang, as well as including the functions of Wu Ling San.
If San Cha San A.04 is needled even deeper it will reach the Ying-Spring point of the Heart Meridian HT8 Shao Fu and include HT8 point functions. HT8 can strengthen the Heart, restore the Yang and rescue collapse. The combination of HT8 with LU10 correlates with the herbal formula Ma Huang Fu Zi Xi Xin Tang; this formula is useful for treating an externally-contracted illness which simultaneously attacks the Tai Yang and Shao Yin systems. Such a pathogenic attack is most common amongst older people (who tend to have Shao Yin level deficiency) and those who have an underlying Shao Yin level constitutional weakness. With the current Coronavirus we see that the elderly and those who have underlying medical conditions such as cardiovascular disease and diabetes are the most likely to become seriously ill, and Ma Huang Fu Zi Xi Xin Tang is the most suitable formula for these types of people.
Additionally, since both LU10 and HT8 are Ying-Spring points they can clear heat and treat heat which has stagnated internally, thus helping to clear viscous phlegm.
The combination of LU10 with TB2 has been used since ancient times as an especially effective combination for the treatment of sore throat. Pairing LU10 with A.04 San Cha San/TB2 is not only effective for the treatment of severe flu and pneumonia, it is also effective as a preventive measure. The preventive capacity of this two point pairing was most clearly demonstrated during a group trip to the Antarctic—those amongst the group who needled LU 10 together with A.04 San Cha San remained healthy during the trip, while those in the group who did not undergo such needling in fact caught a cold.
In cases where there is significant asthmatic-type wheezing the point LU5 can be added. LU5 is the Water point on the Lung (Metal) Channel and is thus good for Lung heat. It is also the He-Sea point on the Lung Meridian, He-Sea points are used to treat rebellious qi and can drain excess conditions, thus this point is excellent for cough and asthma. The point can be seen to correlate with the formula She Gan Ma Huang Tang.
If we wished to use a Master Tung point the correct point would be 1010.20 Shui Jin (or 1010.19 Shui Tong). In actual practice if the coughing and wheezing are very severe combining LU5 with 1010.20 would give an even greater clinical effect.
In addition to what has already been stated, we can see that both LU10 and LU5 are on the Lung Meridian and thus have the most direct curative effect for coughing and asthma/wheezing. LU5 is the Water point on the Metal Channel and as such correlates with the herbal formula Jin Shui Liu Jun Jian, which is very effective for night cough and cough/asthma/wheezing which worsens when the person lies down.
We can also consider use of the point KI7 Fu Liu in the treatment of COVID-19. KI7 is the Metal point on the Water Channel, and is the Jing-River point of the channel. Jing-River points treat cough, wheezing, heat and cold, and so are effective for fever with aversion to cold as well as being especially effective for stabilizing wheezing. KI7 is additionally the Mother point on the Kidney Channel, which makes it a useful point for strengthening the elderly and others with a Shao Yin deficiency type constitution.
Summary:
The basic needling consists primarily of 1. LU10, 2. TB2/A.04 San Cha San needled through to HT8, and 3. 1010.20 Shui Jin (or LU5).
LU10, A.04, LU5 and 1010.20 is a concise four point combination; if we needle either LU5 or 1010.20 on the upper part of the body, in combination with KI7 on the calf, we have an even better two point combination which couples the upper and lower parts of the body, and takes advantage of the mutually reinforcing interlinked functions of two Metal and Water points, making for an even greater full-body treatment effect!
The above is an example of the application of my “Acupuncture-Herbal Formula Correlation Technique” along with “Young Duet Needling- Point Pairing Technique”. These techniques are primarily based on the theories of the Five Phases and the Five Transport Points.