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Abdominal Acupuncture and Its Management of Musculoskeletal Disorders
Abdominal Acupuncture and Its Management of Musculoskeletal Disorders
DOI: 10.1016/j.dza.2013.11.004 13 D t. Z t s c h r . f. A k u p u n k t u r 5 6 , 4 / 2 0 1 3
Keywords Schlüsselwörter
Abdominal acupuncture, musculoskeletal disorders, holograph, Abdominelle Akupunktur, muskuloskelettale Störungen, Holo-
somatotope, microsystem gramm, Somatotop, Mikrosystem
Introduction
Based on the theories of traditional Chinese medicine (TCM), of the body could be treated through needling their correspond-
Abdominal acupuncture is a method of acupuncture and moxi- ing holographic points on the abdomen.
bustion directed at specific points on the abdomen [1]. Abdom- At the deep layer of the abdominal wall, there exists a Zang-fu
inal acupuncture was invented by Dr. Bo Zhi-yun in 1972 and organ system. The projection of the five interiorly-exteriorly
was formally established in 1991, known as Bo’s Method of Ab-
dominal Acupuncture (BMAA). Dr. Bo found out that besides
the traditional meridian system in Chinese medicine, there are
another two regulatory systems at different layers of abdomen
wall. They developed from the Shenque fetal circulatory system,
which served as a regulatory system of the human body by de-
livering blood and nutrients to the fetus via the umbilical cord.
Immediately after birth, the infant transits to the postnatal cir-
culatory system. However, elements of the prenatal system and
its ability to distribute qi and blood still exist, and are centered
at navel, where the acupuncture point Shenque (CV8) is located.
Needling an abdominal acupoint at different depth may perform
different functions because different layers of the abdominal
wall are attributed to different regulatory systems.
DZA
Originalia | Original articles
German Journal of Acupuncture & Related Techniques
paired zang-fu organs and the upper, middle and lower Energiz- and then further inserted to the middle or deep level if meridian
ers are distributed in eight zones around the navel, called eight and Zang-fu organs need to be adjusted. Then, the practitioner
Kuo, which are represented by eight acupoints in each zone. The needs to confirm whether there is change of the presenting
eight acupoints are summarized with the post-heaven Eight Tri- symptoms. If there is no change, then mildly twists the needle,
gram in eight orientations (Table 2, Fig. 2). but does not lift and thrust it. If there is still no change after 3
Between the superficial and deep layers is the traditional merid- to 5 mins, try to adjust the depth and the needle tip direction a
ian system. There are 48 meridian points on six meridians: 14 little bit to promote the effect. Since needles used in Abdominal
on Conception vessel, 11 on Kidney meridian, 12 on Stomach acupuncture are thin and manipulations are mild, it is almost
meridian, 5 on Spleen meridian, 2 on Liver meridian and 4 on painless. In Abdominal acupuncture, no conventional needle
Gallbladder meridian. sensations, such heaviness, soreness, numbness, or distention
In order to locate acupuncture points accurately, the abdominal (deqi) are required. Needle retention is approximately 20–30
points are located with a combination of traditional bone pro- minutes.
portional measurement method and ruler measurement method.
The distance from Zhongting (CV16) to Shenque (CV8) is 8 cun. Abdominal acupuncture formulae
The distance from Shenque (CV8) to Qugu (CV2) is 5 cun. The Dr. Bo has established standard formulae for commonly seen
horizontal line between the right and the left lateral borders of conditions. The formula specifies the acupoints, sequence and
the abdomen at the level of the center of the umbilicus is 12 depth of needle insertion. The practitioner may add or elimi-
cun. The practitioner measures these horizontal and vertical lines nate certain acupoints based on the individual patient’s situ-
with a ruler and converts the corresponding cun into centimeter. ation. At present, fourteen standard formulae have been issued
Then acupoints are located with the help of ruler and marked formally and thirty formulae are under research. Nine of the
with a pen. formal issued formulae are for disorders and five for regula-
tion of the zang-fu and meridian functions [1]. Six out of the
Needles and manipulation procedure nine formal issued standard formulae are for musculoskeletal
Abdominal acupuncture is administered with tube guided dis- conditions.
posable stainless acupuncture needles. The needle diameters are
0.16, 0.18, 0.20 and 0.22 mm, and needle bodies are 30, 40 and Example of a standard formula for cervical spondylosis
50 mm in length. Needle gauge selection is based on the pa- Basic points: Zhongwan (CV12), Guanyuan (CV4), Shangqu
tient’s physique and condition. The needle insertion depth is (KI17) (both sides), Huaroumen (ST24) (both sides)
limited to the anterior abdominal wall, the needle should not Sequence: CV12 ൺ CV4 ൺ KI17 ൺ ST24
invade the abdominal cavity. The needling depths are divided Depth: CV12 (medium), CV4 (deep), KI17 (shallow), ST24
into 3 levels: superficial (heaven) level for regulation of the dis- (medium)
eased part of the body, middle (Human being) level for regula- Supplementary points: Add Shiguan (KI18) for nerve root type
tion of meridians and deep (earth) level for regulation of Zang- of cervical spondylosis; the location of KI18 varies with the
fu organs. Needles are firstly all inserted to the superficial level, painful area on the nape. If the painful area near the spine,
Table 1 Holographic reflex acupoints at the superficial layer of abdomen wall
DZA 14 D t Z t s c h r f A k u p. 5 6 , 4 / 2 0 1 3
Originalia | Original articles
Y. W a n g e t a l . Abdominal acupuncture and its management of musculoskeletal disorders
then locate the KI18 closer to the anterior abdominal midline are the basic points for all types of cervical spondylosis. Sup-
from its standardized location; if the painful area on the lat- plementary points should be selected as needed, which help to
eral side of nape, then KI18 is located laterally to its original resolve sufferings for individual patient.
location.
Add point Superior Xiawan (CV10) for vertebral artery type of Discussion
cervical spondylosis: for osteoproliferation at C7 select CV10,
for osteoproliferation at C4–C5 select the point 0.5 cun superior Mechanism of Abdominal acupuncture
to CV10, and points for osteoproliferation at other cervical ver- Abdominal acupuncture can be categorized as a kind of holo-
tebrae can be deduced by analogy; gram acupuncture or microsystem. However, compared with
Add Huaroumen (ST24) Triangle for pain and tingling sensation other hologram acupuncture systems, such as the auricle acu-
on upper limbs: ST24 Triangle refers to a group of three points. puncture, scalp acupuncture and hand acupuncture, abdomen
Taking Huaroumen (ST24) as the vertex of an equilateral trian- acupuncture is unique in its location. Abdomen is an important
gle with the side being 0.3–0.5 cun in length, the three vertexes part in the body. In TCM theory, the abdomen is where all the
are the points; Fu organs and most of their interiorly-exteriorly related Zang
Add Qixue (KI13) (both sides) for headache, dizziness or memory organs reside. Original qi, the dynamic motive force that arouses
loss; and moves the functional activities of all the organs [3], also
Add Qipang (AB7) (both sides) for tinnitus or blurred vision. lodges in abdomen. Thus, stimulating abdominal point may treat
Analysis: Cervical spondylosis is the degeneration of cervical systemic disorders through regulating the imbalance of Zang-
vertebra and it is related with the dysfunction of muscles around fu organs. Modern research find out that the enteric nerve sys-
the cervical vertebra. In TCM theory, kidney controls bone and tem is quite similar to the central nervous system in structure.
spleen controls muscle, thus cervical spondylosis patients are They use the same structure of sensory and motor neurons, in-
considered as spleen and kidney deficiency. CV12 and CV4 is a formation processing circuits and same neurotransmitters.
pair point formula in Abdominal acupuncture call Heaven-earth Hence, the enteric nerve system has been referred to as a second
Needling. CV12 is the Front-mu point of Stomach, needling on brain – the abdominal brain. The enteric nerve system provides
the medium level functions to regulating spleen and stomach, evidence for the existence of the Shenque circulatory system in
improving muscle function. The deep layer of CV4 represents abdomen, which functions to regulate the whole body. Dr. Bo
Kidney and Bladder. Thus, needling on these two points have Zhiyun maintains that the Shenque system performs the func-
the function of tonifying Spleen and Kidney, strengthening mus- tion of transporting qi and blood to the whole body of the fetus
cle and bone. ST24 is the point of the Foot-yangming meridian, from mother through umbilical cord during pregnancy. After
which is abundant of qi and blood. Needling on the medium birth, though human body does not use this system to transport
layer, it has the function of dredging meridians and promoting nutrition any more, the systemic regulation system still exists.
qi and blood movement, helps to make the joint, muscle and Dr. Bo Zhi-yun believed that there are three regulatory systems
tendon movement freely and smoothly. Dr. Bo believes that ST24 in the Abdominal acupuncture. The whole body from the head,
is a necessary point for neck, shoulder, elbow and wrist disor- face, torso and four limbs to meridian and Zang-fu organs could
ders. KI17 is the representative point of the junction of neck and all be regulated by inserting needles on corresponding points at
shoulder, where most cervical spondylosis patients complain three different levels of the front abdominal wall. The distinc-
pain and stiffness. Shallow needling on KI17 helps to relieve tions among various levels of systems come from the long time
the symptoms on the neck and shoulder. The above four points clinical experience of Dr. Bo Zhi-yun.
D t Z t s c h r f A k u p. 5 6 , 4 / 2 0 1 3 15 DZA
Akupunktur
Deutsche Zeitschrift für
DZA
Originalia | Original articles
German Journal of Acupuncture & Related Techniques
Shoulder periarthritis
Basic points: Zhongwan (CV12), Shangqu (KI17) (healthy side), Huaroumen (ST24) Triangle (affected side)
Sequence: CV12 ൺ KI17 ൺ ST24
Depth: CV12 (medium), KI17 (medium), ST24 (shallow)
Supplementary points: If shoulder pain is located in a larger area, then the side length of the Huaroumen (ST24) Triangle are longer,
while the shoulder pain area is small, then the side length of the Huaroumen (ST24) Triangle are shorter, which means that the distance
between the three points vary with the size of the shoulder pain area.
DZA 16 D t Z t s c h r f A k u p. 5 6 , 4 / 2 0 1 3
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Y. W a n g e t a l . Abdominal acupuncture and its management of musculoskeletal disorders
Abdominal acupuncture and abdominal diagnosis ventional acupuncture in shoulder periarthritis. Ninety-six
Abdomen is also an important portion for diagnosis in Chinese participants were divided according to clinical stage (painful
medicine, which is first recorded in Classic of Difficulties (Nan- stage or frozen stage), and were treated with either Abdominal
jing). Japanese acupuncturists further develop the abdominal acupuncture or conventional acupuncture. Patients received
diagnosis based on the allocation of abdominal area to five Zang treatment three times weekly for three weeks. The effective-
organs in Classic of Difficulties (Nanjing): the condition of the ness of Abdominal acupuncture versus conventional acupunc-
lung is assessed to the right of the navel, that of the liver to the ture in the painful stage group was 95.8 % and 91.7 % respec-
left of the navel, of the heart in the epigastric region, of the kid- tively, and the effectiveness in the frozen stage group was
ney below the umbilicus, and of the spleen just around the im- 91.7 % and 79.2 % respectively. The authors concluded that
mediate areas of the umbilicus [4]. In Dr. Bo’s Abdominal acu- Abdominal acupuncture is an effective therapy for shoulder
puncture, the deep level of the abdominal wall is allocated to periarthritis [6].
the 5 interiorly-exterioly paired Zang-fu organs and three En- The Abdominal acupuncture technique has been shown to be
ergizers (Upper, Middle and Lower Energizers) around the um- synergetic when combined with both conventional bone ma-
bilicus based on the distribution of the post-heaven eight tri- nipulation and conventional acupuncture. A study in patients
grams. The representing acupoints on each zone are used for with cervical spondylotic radiculopathy observed that the
adjusting zang-fu organs but not for diagnosis. As to the allo- short and long-term effectiveness of Long’s bone-setting ma-
cation of zang organs on different parts of abdomen, Bo’s nipulation alone to be 63.64 % and 30.9 % respectively; Ab-
method is different from that of the Japanese abdominal diag- dominal acupuncture alone to be 58.9 % and 50.0 % respec-
nosis: Liver corresponds to the right of the navel, while Lung to tively; and the combined group to be 80.7 % and 68.4 %
the left. respectively [7].
In Japan, there is another kind of abdominal diagnostic method Additionally, a study in patients with knee osteoarthritis showed
having no direct relationship with acupuncture. It is developed that overall effectiveness for the conventional body acupunc-
by herbal medicine practitioners, guided by theories in Treatise ture group, Abdominal acupuncture group, and the combined
on Febrile Diseases (Shang Han Lun) and Synopsis of Golden group was 88.6 %, 91.4 % and 97.1 % respectively [8].
Chamber (Jin Gui Yao Lue). Herborists collect signs from ab-
dominal palpation and compare with the original text in Zhang Conclusion
Zhong-jing’s book to help choosing herbal formulas. The location of the Abdominal acupuncture system makes it an
important hologram resp. microsystem in the body. A wide va-
Abdominal acupuncture for musculoskeletal disorders riety of conditions can be treated with Abdominal acupuncture
Abdominal acupuncture has good effect in treating musculo- because of its owing of three regulatory systems. The six stand-
skeletal disorders. Besides the above mentioned disorders, Ab- ard Abdominal acupuncture formulae for musculoskeletal dis-
dominal acupuncture is also used for other musculoskeletal dis- orders offer new choice for acupuncturist when dealing with
orders, such as heel pain, ankylosing spondylitis and TMJ musculoskeletal disorders. The Abdominal acupuncture, as a
dysfunctions, etc. highly effective therapy for musculoskeletal disorders, can be
The main characteristic of Abdominal acupuncture for muscu- used alone or in conjunction with conventional acupuncture
loskeletal disorders is holistic treatment. For example, of the and bone manipulation.
basic points for cervical spondylosis, KI17 helps to relieve local
symptoms; ST24 to dredge meridian to facilitate the function of
muscle, tendon and bones; CV12 and CV 4 to regulate the body
on the Zang-fu level to treat the root of the disease. References
1. Zhi-yun Bo. Abdominal Acupuncture, China Press of Traditional Chinese
The standardized formula and manipulation guarantee the treat- Medicine. Beijing. 2010
ment effect by different acupuncturists, while the flexibility in 2. Zhi-yun Bo. Abdominal Acupuncture Points Wall Chart. Beijing Science &
locating the point according to the affected size of the symp- Technology Press, Beijing. 2004
3. Giovanni Maciocia. The foundations of Chinese medicine: a comprehensive text
toms and the modification of a formula with the supplementary for acupuncturists and herbalists (1st ed). Edinburgh: Churchill Livingstone,
points help to solve each individual patient’s problem. Another 1989; 41–2
advantage of Abdominal acupuncture lies in using fine needles 4. Skya Gardner-Abbate. The art of palpatory diagnosis in oriental medicine.
Churchill Livingstone Press. 2001. 25
and mild manipulation, which are easily accepted by patients. 5. Bo ZY, Niu QQ, Niu WG, et al. Multicenter controlled study on Abdominal
Over the last ten years, several controlled studies have shown acupuncture for treatment of nerve root type cervical spondylosis. Zhongguo
Zhen Jiu, 2005 Jun;25(6):387–9. Chinese (English Abstract)
that Abdominal acupuncture is helpful for the management of 6. Yang R, Liu YX. Clinical observation on shoulder periarthritis treated with Bo’s
musculoskeletal disorders. A multicenter controlled study of Abdominal acupuncture in stages. Zhongguo Zhen Jiu. 2012 Jan;32(1):26–30.
Abdominal acupuncture for the treatment of nerve root cervi- Chinese. (English Abstract)
7. Fan DH, Liu G, Wang TC, et al. Observation on short and long-term effects of
cal spondylosis showed that the short-term and long-term ef- cervical spondylotic radiculopathy treated with Abdominal acupuncture plus
fectiveness of Abdominal acupuncture in nerve root cervical Long´s bone-setting manipulation. Zhongguo Zhen Jiu. 2010 Nov;30(11):909–12.
spondylosis was 97.3 % and 92.7 % respectively [5]. Chinese (English Abstract)
8. Meng CR, Fan L, Fu WB, Li Y. Clinical research on Abdominal acupuncture plus
Beijing University of Chinese Medicine conducted a study to conventional acupuncture for knee osteoarthritis. J Tradit Chin Med. 2009
compare the effectiveness of Abdominal acupuncture and con- Dec;29(4):249–52. Chinese (English Abstract)
D t Z t s c h r f A k u p. 5 6 , 4 / 2 0 1 3 17 DZA