Acupunture in pregnancy

III Medical Acupuncture in Pregnancy A Textbook Ansgar T Roemer, M.D University Gynecological Hospital Mannheim, Germany With contributions by: Thomas Kempfle, Ingrid Reuther 147 illustrations Thieme Stuttgart · New York I h II IV Library of Congress Cataloging-in-Publication Data Roemer, Ansgar T [Akupunktur für Hebammen, Geburtshelfer und Gynäkologen English] Medical acupuncture in pregnancy : a textbook/ Ansgar T Roemer ; with contributions by Thomas Kempfle, Ingrid Reuther ; [translator, Ruth Gutberlet ; illustrator, Enbe-Design Baasner] p ; cm Includes bibliographical references and index ISBN 3-13-135831-9 (alk paper) ISBN 1-58890-255-2 (alk paper) Acupuncture Pregnancy Alternative treatment Medicine, Chinese [DNLM: Acupuncture Therapy methods Pregnancy Pregnancy Complications prevention & control Medicine, Chinese Traditional methods Prenatal Care methods WB 369 R715a 2005a] I Kempfle, Thomas II Reuther, Ingrid III Title RG129.A25R64 2005 618.2'4 dc22 1st German edition 1999 2nd German edition 2000 This book is an authorized and revised translation of the 3rd German edition published and copyrighted 2002 by Hippokrates Verlag, Stuttgart, Germany Title of the German edition: Akupunktur für Hebammen, Geburtshelfer und Gynäkologen Contributors: Thomas Kempfle, Private Practice, Gevelsberg, Germany Ingrid Reuther, M.D., Private Practice, Grafschaft Karweiler, Germany Translator: Ruth Gutberlet, M.A., CHom, Fulda, Germany Illustrator: Enbe-Design Baasner © 2005 Georg Thieme Verlag, Rüdigerstrasse 14, 70469 Stuttgart, Germany http://www.thieme.de Thieme New York, 333 Seventh Avenue, New York, NY 10001 USA http://www.thieme.com Cover design: Thieme Marketing Typesetting by Satzpunkt Ewert, Bayreuth Printed in Germany by Druckhaus Götz, Ludwigsburg ISBN 3-13-135831-9 (GTV) ISBN 1-58890-255-2 (TNY) Important note: Medicine is an ever-changing science undergoing continual development Research and clinical experience are continually expanding our knowledge, in particular our knowledge of proper treatment and drug therapy Insofar as this book mentions any dosage or application, readers may rest assured that the authors, editors, and publishers have made every effort to ensure that such references are in accordance with the state of knowledge at the time of production of the book Nevertheless, this does not involve, imply, or express any guarantee or responsibility on the part of the publishers in respect to any dosage instructions and forms of applications stated in the book Every user is requested to examine carefully the manufacturers’ leaflets accompanying each drug and to check, if necessary in consultation with a physician or specialist, whether the dosage schedules mentioned therein or the contraindications stated by the manufacturers differ from the statements made in the present book Such examination is particularly important with drugs that are either rarely used or have been newly released on the market Every dosage schedule or every form of application used is entirely at the user’s own risk and responsibility The authors and publishers request every user to report to the publishers any discrepancies or inaccuracies noticed If errors in this work are found after publication, errata will be posted at www.thieme.com on the product description page Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made in the text Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain This book, including all parts thereof, is legally protected by copyright Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation, without the publisher’s consent, is illegal and liable to prosecution This applies in particular to photostat reproduction, copying, mimeographing, preparation of microfilms, and electronic data processing and storage V About this book Literature is not intended to replace classroom education This text aims to help midwives, obstetricians, and gynecologists who are studying acupuncture in selecting the correct acupuncture points A crucial aspect of this healing art is the proper stimulation of the specific acupuncture point Only practice and experience will provide the practitioner with this skill Textbook theory and hands-on experience in the classroom are the ideal combination for the student This textbook gives a concise overview of the theory of Traditional Chinese Medicine (TCM) for midwives, gynecologists, and obstetricians who want to go beyond the results of treatments that are based on common formulas The book serves as a guideline to applying the voluminous theories of TCM in daily practice The list of points and point categories as well as references to the TCM basics are part of the special focus that was placed on combining theoretical and practical aspects Usually, the complicated concepts have to be compiled from various sources Here, these concepts are clearly and concisely arranged, which makes this text valuable both for entry-level training and as a reference book It is recommended for beginners of obstetric/gynecological acupuncture as well as experienced practitioners With increased knowledge comes a greater understanding of the importance of experience in daily practice The practice of acupuncture is a never-ending learning process Through this book, years of acupuncture practice and teaching experience are made available to the reader An author still gains insights through the process of exchanging experience and thoughts with colleagues The publication of this textbook gives me the opportunity to express my gratitude to the people who made a special contribution to my knowledge and experience I would like to express special thanks to: — My acupuncture teachers, particularly Prof J Bischko (†), Prof G Kubiena, Dr G Stux, and the teachers I met during my studies in China — Colleagues who passed on their vast experience to me, particularly Dr M Adam (Geburtshaus Wien-Nußdorf) — My colleagues at the medical continuing education association Pro Medico who provided me — — — — — — with a lot of inspiration and advice, particularly Dr C Gabriel, Dr D Klein, Dr F Ramakers, P Rudolph, B Seybold, Dr K Zähres, and all the association's midwifery advisors Dr C Gabriel, for her knowledgeable critique of the manuscript; B Seybold for her many inspirations and her outstanding courses Hippokrates, for agreeing to various special requests and effectively implementing them in this book Dr U Novotny, the editor whose knowledge and patience greatly contributed to the creation of this book D Seiz (†) of Hippokrates; she was open to all requests and suggestions and made all the means of the publishing house available to the successful production of this book Angelika-M Findgott of Thieme International for her effective handling of the translation project and Ruth Gutberlet for rendering a fine translation Prof F Melchert (Director of the Gynecological University Hospital Mannheim), Prof M Weigel, and Prof W Zieger, for their advice and support in establishing acupuncture as part of medical training at the university level, as well as their support for various research projects and conventions I am most grateful to my family, particularly my wife, whose support and inspiration accompanied all my ventures into acupuncture Over the past years, only her patience and support have made it possible for me to integrate family, medical practice, community service, teaching, presentations, conventions, and the work on this book Finally, thanks to everyone who was not mentioned here by name but helped my journey into acupuncture Once again, I would like to mention the particular significance of the late D Seiz Over the course of the past decade, we owe the publication of outstanding TCM teaching material in large parts to her She had a unique way of joining opposites to help along the relevant matters This book was written in her memory Ansgar T Roemer VI Contents VII Contents Introduction to Acupuncture and Traditional Chinese Medicine (TCM) What is Acupuncture? í Acupuncture Arrives in Europe í Acupuncture as a Regulatory Therapy 2 The Basics of TCM 4 4 í Tao Life Force Qi Five Phases í Concepts of TCM í í í í í í The Theory of Yin and Yang The Five Fundamental Substances The Five Phase Theory The Internal Organ Theory (Zang Fu) The Disease Concept of TCM TCM Diagnostics Tongue Diagnosis Pulse Diagnosis Disease Patterns 10 13 14 17 18 19 20 í Extraordinary Channels í The Significance of the Channels for TCM 40 40 The 12 Regular Channels 42 The Yin Channels í Kidney Channel í Liver Channel í Heart Channel í Pericardium Channel í Spleen Channel í Lung Channel 43 43 44 45 46 47 48 The Yang Channels í Large Intestine Channel í Stomach Channel í Small Intestine Channel í Triple Burner Channel í Bladder Channel í Gallbladder Channel 49 49 50 51 52 53 54 The Extraordinary Channels í Ren Mai Channel í Du Mai Channel 55 55 56 Systematics í “Access To The Depth”—Xue: The Point í Acupuncture Points í Channel Points Four Main Categories The Five Transport Points Tonification and Sedation Points Acute (Xi) Cleft Points Intersection (Group) Points Confluence Jiao Hui Points The Eight Meeting Points (Influential, Master Points) The European Master Points Extraordinary Points (Extra Channel Points) A-Shi Points (Ouch Points) Somatotopic Areas Ear Acupuncture Symptomatic Points The Channel System of Acupuncture í System Overview Three Channel Circulations í Channel Partnerships Coupled Channels Corresponding Channels 24 24 25 26 27 29 29 30 30 30 32 34 34 34 34 35 36 36 36 38 38 38 VIII Contents Criteria and Rules Methods of Locating Points 58 Prerequisites For Acupuncture Therapy 60 Effects and Reactions í Scientific Background The Effects of Acupuncture on Pain 61 61 61 Integrating Acupuncture Into a Treatment Plan 64 Characteristics of Acupuncture During Pregnancy 67 Complications í General Recommendations 68 69 Treatment Rules and Therapeutic Guidelines 70 Treatment Technique Acupuncture Moxibustion Therapy Electrostimulation Laser Acupuncture PuTENS Injection Acupuncture Acupressure Qi Gong 74 74 79 80 80 81 81 81 82 Organizational Model í Therapy Categories í Point Categories í Ear Acupuncture 83 83 83 85 Prerequisites For Acupuncture Therapy in a Clinic 86 í í í í í í í í The Practice of Acupuncture in Obstetrics and Gynecology Obstetrics í List of Indications 88 88 Pregnancy í General Regulation Based on Mental/ Emotional Balance í Hyperemesis Gravidarum í Heartburn and Vomiting í Early Labor and Impending Premature Delivery í Infections During Pregnancy í Treatment of Addictions During Pregnancy í Breech Presentation í Gestosis í Pain Conditions During Pregnancy í Childbirth Preparation using Rưmer’s Scheme (Mannheim Model) 89 Peripartal Induction of Labor Acupuncture During Delivery Analgesia During Delivery Dysfunctional Labor and Insufficiently Coordinated Uterine Contractions í Cervical Dystocia í Placental Detachment Disorders 100 100 100 101 í í í í 89 90 90 91 92 92 93 94 95 97 102 103 104 Puerperium í Involution Disorders í Functional Disorders of The Breast í Mental/Emotional Disorders During Confinement í Constipation í Urinary Disorders í Emergency Points 106 106 106 Acupuncture and Gynecology Significance of Acupuncture Acupuncture Indications For Gynecological Disorders General Therapy Rules í Premenstrual Syndrome (PMS) í Dysmenorrhea í Functional Disorders of the Menstrual Cycle í Amenorrhea í Infertility í Menopausal Syndrome í Vaginal Discharge í Pruritus Vulvae í Adnexitis í Chronic Pelvic Pain í Low-Back Pain in Women í Headache Syndrome—Hormone-Related Migraine í Urethritis and Cystitis 111 111 108 109 109 110 114 115 115 115 116 117 117 117 118 118 118 119 119 120 121 Contents í Chronic Recurring Infections 121 í Emesis and Chemotherapy 122 í Mastopathy and Mastodynia 122 IX í Chronic Recurring Nonpuerperal Mastitis 122 í Pain Following Mastectomy 123 í Outlook 123 Point Atlas LU = Lung LI = Large intestine ST = Stomach SP = Spleen HT = Heart SI = Small intestine BL = Bladder KI = Kidney PC = Pericardium 126 128 131 139 144 146 147 159 163 GB = Gallbladder LR = Liver GV = Governing vessel CV = Conception vessel EX-HN = Head and neck EX-CA = Chest and abdomen EX-B = Back EX = “Breast point in front of the axilla” EX-LE = Lower extremity 165 171 172 177 185 188 189 190 191 Qi Gong The History of Qi Gong Qi Gong in Traditional Chinese Medicine Perceivable Phenomena Learning Qi Gong Indications for Qi Gong Exercises Contraindications Side Effects 213 213 214 215 216 218 220 220 Chinese Nutrition Therapy and Qi Gong Chinese Nutrition Therapy í Introduction í Points of Practical Importance The Five Flavors The Five Thermal Food Natures Basic Recipes í Gynecological Aspect í Indications 196 196 197 197 198 198 199 202 í í í í í í í Appendix American and International Tai Ji and Qi Gong Associations 223 Further Reading 225 Index 227 Qi Gong Fig 40a, b 215 Professor Jiao Guorui demonstrates the exercise “the crane spreads its wings” both standing and seated which is filled with content through the mental exercises The visualizations used while practicing are primarily taken from nature—for example the moon, a tree, water, animal movements (Fig 40a,b; cf Fig 42a,b)—and are intended to guide the practitioner on the path to natural balance Breathing is natural, soft, deep, and fluid The three aspects—physical and mental exercises in harmony with the breath—support the free flow of qi and blood The experienced practitioner may perceive this as a flow of warmth throughout the body Cultivating Qi During the practice of qi gong, focus is directed to certain energy centers, so-called dantians (Fig 39) Over the course of time, sensations such as fullness, warmth, or tingling that indicate a change develop at these centers An increase of vitality, energy, and creativity that lasts past the actual practice is an indication for the development of “true qi” (zheng qi) Cultivating qi also strengthens the immune system and decreases the number of infections or allergic episodes This dynamic is also described by expressions such as “utilizing latent energies” or “ supporting the positive and eliminating the negative.” í Perceivable Phenomena People who are neither familiar with the cultural background of Chinese medicine nor the terminology that describes it can experience the effects of qi gong Once the body perceives certain effects, it is possible to visualize the deeper balancing effects on the organism during the exercises Practitioners of the West and the East observe the same phenomena during and after the exercises The pleasant, desirable, and directly noticeable sensations include: ț Sensation of warmth in the lumbar area, the area ț ț ț ț ț ț ț ț ț of the lower pelvis, and the extremities Mild, pleasant perspiration Relaxation of body and mind Increased salivation Stimulation of digestion Lightness and spaciousness in the chest area Improved sleep Increased vitality Mental clarity Balanced emotions, internal calm, and composure 216 í Chinese Nutrition Therapy and Qi Gong Learning Qi Gong Variety of Methods It is not necessary to practice for years in order to benefit from qi gong exercises Often, the first positive signs such as warm hands and feet, pleasant body sensation, or improvement of pain are perceived during the initial practice Only skillful practice (gong fu), developed over time, allows one to produce positive effects at will instead of experiencing them randomly When the effects can be controlled, they are of use in times of increased physical and mental stress In general, teaching oneself qi gong with the help of books or videotapes is not recommended It is quite possible to practice incorrectly, which usually causes the practitioner to abandon the exercises soon because they are experienced as unpleasant or ineffective This is rather unfortunate, considering the possible benefits when practiced correctly One should look for an experienced teacher A list of certified qi gong teachers can be obtained through qi gong associations (for addresses, see p 222) Qi Gong is Complex and Simple at the Same Time Qi gong exercises are based on simple principles (see below) and can be easily learned and practiced At the same time, this is why they are often undervalued It is challenging to imagine the profound effects stemming from such simple exercises Thorough understanding can only be achieved through consistent practice This presents another challenge: the methods of qi gong are only truly effective if they are practiced regularly Thus, to enjoy the benefits of qi gong, a certain degree of determination and patience, the desire to take care of oneself, and to implement this goal into daily life are required Fig 41 Basic stance with knees slighty bend and relaxed pelvic area, hands rest on the dantien One of the most frequently asked questions in connection with qi gong is: “What exercises or exercise sequences are recommended for my individual condition and constitution?” Due to the variety of schools and methods, the answer to this question will reflect the training and beliefs of the qi gong instructor rather than state a proved fact: Comparative research that tests various qi gong methods and their effects on individual conditions and constitutions does not exist The instructor selects exercises or sequences from his/her personal repertoire which obviously represents only a small section of the variety of methods One exercise may affect a great range of complaints and, on the other hand, one particular complaint may be treated with a variety of exercises (Jiao, 2001) Exercises can be performed while lying down, sitting, standing, and walking, depending on a person’s state of health and energy (Figs 41, 42a,b) Some exercises focus on muscles and joints through dynamic Qi Gong Fig 42a, b Many pregnant women perceive the exercise “the elephant moves its hips in circles” as particularly soothing movement (movement exercises = dong gong) Other exercises require little or no external movement because they nourish and cultivate “internal powers” (stillness exercises = jing gong) Generally, every exercise contains stillness and movement Stillness exercises provide internal movement and movement exercises provide internal stillness The Development of Firmness at the Bottom and Lightness at the Top It is more important to convey a solid understanding of the inherent ideas and principles than to teach the routine of a particular exercise (according to Jiao): 217 Relaxation, stillness, and natural demeanor Stillness and movement belong together Qi and imagination follow one another Firm at the bottom, light at the top Due measure Step-by-step practice Most of the above principles can be easily understood At this point, it appears helpful to elaborate on point in the above “Firm at the bottom, light at the top.” Chinese medicine recognizes the pattern “upper body repletion and lower body vacuity” This is a frequently encountered pattern and corresponds to what we would call “top-heaviness.” Symptoms of upper body repletion include headache, hypertension, pressure sensation on the ears or tinnitus, obstructed nose, blurry vision, sensation of a lump in the throat, tightness of the chest, and heart palpitation Symptoms of lower body vacuity include cold feet, unsteady gait and foothold, disorders of menstruation and sexual functions, and infertility All of the latter are signs of cold and weakness in the lower part of the body All symptoms are accompanied by unpleasant sensations When practicing qi gong, the goal is to revert this condition and achieve firmness (repletion) at the bottom and lightness (vacuity) at the top Focus and qi are directed toward the center and the roots (the feet) The goal is to reach a state that the East and West associate with health and wellness: A cool, clear head and warm feet 218 Chinese Nutrition Therapy and Qi Gong Teaching Qi Gong Qi gong exercises appear to be simple and are therefore frequently presented by people who are beginning practitioners themselves An instructor's training should be thorough because qi gong not only comprises stillness and movement but also a vast amount of philosophical, therapeutic, and cultural aspects There are currently no official regulations or a general consensus about the necessary amount of training for a qi gong instructor In practice, the following has proved to be effective: Every instructor should have practiced daily for at least two years This should not be considered lost time, because every student benefits from his/her time of study Competence is obvious Even a lay person will recognize if the instructor possesses good skills (gong fu) í Indications for Qi Gong Exercises In accordance with the TCM concept that defines a good physician as one who prevents diseases, the practice of qi gong should begin prior to the onset of a disorder As in the case of a balanced and individually tailored nutritional routine, qi gong exercises can be recommended for everyone The exercises are intended to balance physiological functions This gives them either a preventive or a therapeutic purpose In the therapy of chronic diseases or rehabilitation, qi gong exercises are particularly valuable The following quote refers to this fact: “It is good to heal through remedies, it is better to heal through nutrition, it is the best to heal through qi.” Some special aspects of qi gong exercises in the female life cycle will be presented below This does not imply that these exercises are not just as useful for men Men and women are equally affected by some disorders such as hypertension, back pain, or asthma and the relaxing and balancing qi gong exercises have been proved to have an equally positive effect Dysmenorrhea For many women, this monthly pain is quite naturally part of being a woman Unimpeded menstrua- tion, however, is pain-free Qi gong supports the free flow of qi and xue (blood) and consequently assists the unproblematic course of menstruation During the exercises, special attention is paid to the pelvis The sensation of warmth that is created in the pelvic and lumbar area improves the regulation of the autonomic nervous system and muscle relaxation Women frequently report a cessation of the monthly pain shortly after starting the practice of qi gong Migraine Most types of headache are categorized as “pattern of upper body repletion” and can be approached with the principle of “firmness at the bottom, lightness at the top.” This applies to prevention and management of an existing headache The type of headache, whether classic migraine, tension headache, or headache caused by hormonal imbalance during menstruation, is irrelevant Pregnancy—Birth—Childbed Pregnancy is a time of manifold physical change Almost nothing remains the same and daily changes are added At this time it is especially beneficial to have a method like qi gong available that allows the functions of the entire organism to be balanced Numerous reports about qi gong and pregnancy are available (Weber, 1996; Simeone, 1996) What they all have in common is the sense of gratitude that a method exists which allows those who practice it to listen carefully to their body and to adapt to the multitude of changes Many pleasant experiences are listed in the reports, including the sensation that is present when the fetus adapts to the gentle, rhythmic movements and virtually participates (Fig 42a,b) Qi gong effectively deals with or prevents complaints during pregnancy For example, due to hyperlordosis and a shift in the center of gravity toward the front in the later part of the pregnancy, muscle tension and back pain may develop The basic stance in qi gong, with slightly flexed knees and the pelvis tilted posteriorly/inferiorly, relaxes the muscles of the back and tones the pelvic floor and the abdominal muscles (cf Fig 41) If the patient begins with the practice of qi gong as part of childbirth preparation, there is still time to learn some exercises that improve well-being and the perception of body sensations True skill requires longer practice Qi Gong 219 Birth is an energetic process and the woman can adapt to it through an energetic method During the pregnancy, the focus was on holding, closing of the pelvis, and nourishing (yin qualities) During birth, the focus shifts to opening and eliminating (yang qualities) The yin within the yang of delivery is to allow, to surrender, and to soften Of great help is the natural breathing that has developed over the course of the qi gong practice It can be transformed at any time into gentle, deep abdominal breathing Children of women who practiced qi gong regularly during pregnancy are described as particularly at ease, calm, and yet energetic (personal testimonies) In any case, childbed is a time when the mothers have to regain strength During this time, calmness exercises, breathing exercises, and internal exercises that collect internal strength with little external effort are especially useful During this time, the energy of the kidney network, the root qi decreases The kidney can no longer hold on to the qi, which now can ascend The principle “firmness at the bottom, lightness at the top” takes on new meaning during the climacteric period By directing the energy downward, women can counteract the discomforts of menopause They are not helpless toward the changes in their bodies but can make positive use of the energy Symptoms such as insomnia, hot flashes, palpations, and depression can be alleviated and made bearable through the practice of qi gong Many women make profound changes at this point in their lives Qi gong can help one find personal needs, realize one’s own potential, and express the possible need for creativity Stress Old Age Many women have to “stand their ground” at work This means that they have to deal with the great demands placed upon them and to adopt male virtues The stresses of daily life often repress yin qualities A balance of yin and yang is necessary to maintain health—for men and women Whatever might be difficult to implement in professional life can be exercised in qi gong Calmness, relaxation, softness, introspection, meditation, and the nourishment of energy are yin qualities Qi gong restores the rhythm of stillness and movement, tension and relaxation When this rhythm works properly, psychosomatic disorders can be prevented (Seemann, 2000) Qi gong is filled with rhythm and poetry Through introspection, it reintroduces a person to his/her own internal tune, which is especially healing for the soul The same may apply to a woman who forgoes nondomestic work, particularly if she raises children Women who are exposed to the double and triple burden of taking care of children, household, and a job, not have much time to take care of themselves Often they feel guilty when they something for themselves When learning and practicing qi gong, women are only occupied with themselves “Taking time for oneself” is an important wholesome aspect of qi gong (Belschner, 1998) After practicing qi gong, women can effectively handle the tasks of daily life with new energy, patience, and composure The bones become fragile, the hair turns gray and thins, and teeth fall out All of these symptoms are signs of decreasing or exhausted essence (jing) Exhausted essence cannot be renewed The only way to prevent exhaustion is to conserve energy in younger years In texts on qi gong, it is often stated that qi gong can prevent premature aging However, a change in lifestyle, in addition to the exercises, is most likely required to avert the decline of essence Periods of exhaustion should always be followed by periods of calmness In modern times, people live longer but they frequently suffer from chronic diseases A prolonged life does not always imply a good quality of life Nearly every older person suffers from pain of the musculoskeletal system caused by arthrosis and osteoporosis Qi gong has proved effective in the nondrug pain therapy, particularly with pain in the musculoskeletal system (Zumfelde-Hüneburg, 1997) The practice of firmness in the lower body counteracts an unsteady gait and can diminish the number of falls and bone fractures (Wolf, 1996) New research has shown that the practice of qi gong as well as tai ji quan can slow down osteoporosis in postmenopausal women (Qin, 2001) Seniors can stay physically fit through the practice of qi gong Especially for older people, qi gong offers a wonderful opportunity to stay active (see Fig 43) But qi gong has even more to offer When energy dwindles, it is high time to begin a spiritual journey At any point in time it is possible to transcend the personal level through the practice of qi gong Menopause 220 Chinese Nutrition Therapy and Qi Gong (Belschner, 1998) The greater picture can be recognized, the puzzle of life makes sense in a larger context, and wisdom and buoyant calmness develop The Right Time It is never too late to begin the practice of qi gong Some people discover the energetic exercises at a young age Often times health problems, times of change, or life crises lead middle-aged or older people to the practice of qi gong At this point, the motivation for regular practice is rather strong Any time is a good time í Contraindications True contraindications for the practice of qi gong are few If the principles “due measure” and “step-bystep practice” are observed, only the following contraindications have to be considered: Certain movements should not be performed during pregnancy Beginners and practitioners who lack pelvic holding strength should, for example, Fig 43 Mrs A, 82, has been practicing qi gong for the last two years Her diagnosis was humeroscapular periarthritis with partial stiffness of the right shoulder, hypertension practice the wide and deep horse stance (horsemen position, Fig 43) with its strongly lowering effect only in a modified form to avoid premature labor This stance should not be practiced too wide or deep, only while seated, or not at all The same applies to the time of menstruation to avoid excessive bleeding For advanced practitioners who are able to control their energy, this is a relative cautionary measure Also, intense twisting of the torso and deep bending can have negative effects when the volume of the uterus is increased Qi gong exercises are guided by visualization, which distinguishes them from gymnastic exercises Thus, people whose mind is confused cannot perform the exercises with the original intent Caution is required particularly in the case of psychoses If reality and imagination cannot be separated, visualizations should not be used Just the movement by itself can be practiced í Side Effects In due consideration of the basic principles of qi gong, the relative contraindications, and with the guidance of a skilled instructor, qi gong is free of negative side effects On the other hand, positive side effects are possible It may, for example, be that someone begins qi gong because of their asthma and quickly realizes that their dysmenorrhea has disappeared; or migraine is their reason for practicing and the first thing they notice is an improvement of their constipation; or someone begins to practice qi gong because they are plagued by back pain and they inadvertently find themselves on a spiritual path Appendix 222 Appendix American and International Tai Ji and Qi Gong Associations 223 American and International Tai Ji and Qi Gong Associations http://www.worldtaichiday.org/Associations.html http://www.nccaom.org/find.htm Qigong Association of America 1220 NW Kings Blvd Corvallis, OR 97330 http://www.qi.org Qigong Institute 561 Berkeley Ave Menlo Park, CA 94025 www.qigonginstitute.org National Qigong Association P.O Box 252 Lakeland, MN 55043 http://www.nqa.org Qigong Alliance P.O Box 750 Ely, MN 55731 http://www.qigong-alliance.org TCM World Foundation 396 Broadway Suite 501 New York, NY 10013 http://tcmworld.org Traditional Chinese Medical Qigong, Inc 1722 S Glenstone Ave Suite QQ Springfield, MO 65804 www.eftneigong.com 224 Appendix Further Reading 225 Further Reading Academy of Traditional Chinese Medicine, ed Essentials of Chinese Acupuncture Beijing: Foreign Languages Press; 1980 Academy of Traditional Chinese Medicine, ed An Outline of Chinese Acupuncture Beijing: Foreign Languages Press; 1975 Belschner W, Hildenbrand G, Geißler M, Stein S, eds Das Qi kultivieren – die Lebenskraft nähren Uelzen: Medizinisch Literarische Verlagsgesellschaft; 1998 Focks C, Hillenbrand N Leitfaden Traditionelle Chinesische Medizin 2nd ed Munich: Urban & Fischer; 2000 Gerhard I, Postneek F Auricular AP as a possible treatment for female sterility [abstract] AJA 1988; 16: 373 Taken from: Geburtsh Fr 1988; 48: 165–171 Gerhard I, Postneek F Auricular acupuncture in the treatment of female infertility Gynecological Endocrinilogy 1992; 6: 171–181 Hecker H-U, Steveling A, Peuker E, Kastner J, Liebchen K Color Atlas of Acupuncture Stuttgart, New York: Georg Thieme Verlag; 2001 Hecker H-U, Steveling A, Peuker E, Kastner J Practice of Acupuncture Stuttgart, New York: Georg Thieme Verlag; 2005 Hildenbrand G, Kahl S, Stein S Qigong und China Materialien 41 Bonn: Institut für Internationale Zusammenarbeit des Deutschen Volkshochschulverbandes e V.; 1998 Huang-ti Nei-Ching Ling-Shu Original ed Wuhan; 1852 Huang-ti Nei-Ching Su-wen Basic discourses, Part of the Yellow Emperor’s Classic of Internal Medicine, new ed Beijing: Publishing House of the People’s Hygiene; 1963 Jiao G Qigong Yangsheng 4th ed Uelzen: Medizinisch Literarische Verlagsgesellschaft; 1994 Jiao G Die 15 Ausdrucksformen des Taiji-Qigong 6th ed Uelzen: Medizinisch Literarische Verlagsgesellschaft; 2001 Jiao Shu-De Ten Lectures on the Use of Medicinals from the Personal Experience of Jiao Shu-De Brookline, MA: Paradigm Publications; 2001 Jilin L, Peck G Chinese Dietary Therapy New York: Churchill Livingstone; 1988 Kastner J Chinese Nutrition Therapy Stuttgart, New York: Georg Thieme Verlag; 2004 Kirchhoff S, Kempfle T Wallchart Kötzing: VGM Verlag für ganzheitliche Medizin, E Wühr; 1997 Qin L et al One-year tai chi exercise retards bone loss in postmenopausal women Osteologie 2001; 10: Suppl Rapkin AJ Pelvic pain and dysmenorrhea In: Berek JS, Adashi EY, Hillard PA, eds Novak’s Gynecology Baltimore: Williams & Wilkins; 1996: 408–13 Schnorrenberger CC Pocket Atlas of Tongue Diagnosis Stuttgart, New York: Georg Thieme Verlag; 2005 Seeman H Freundschaft mit dem eigenen Kưrper schlien Über den Umgang mit psychosomatischen Schmerzen Leben lernen 115, 3rd ed Stuttgart: Pfeiffer 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Appendix Index 227 Index A a-shi (ouch) points 34, 58, 84, 113 abdomen 14 acupressure 81 acupuncture 2–3 complications 68–69 ear 34–35, 85 effects 61–63 injection 81 laser 80–81 pain 61 points 25–35, 58–59, 83–85, 125–193 pregnancy 67 and surgery 65 treatment plan 64–66 acute (xi) cleft points 29–30, 33 addictions 92 adnexitis 118–119, 202 age 219–220 alarm (mu) points 26, 33 amenorrhea 117, 202–203 analgesia 61 anxiety 89 Artemisia vulgaris associated (shu) points 33 B back 95–96, 119–120, 203 bacteria 65 basic recipes 198–199 birth 97–99, 218–219 bladder channel 22, 53 bleeding 68 breast 106–108, 112, 207–208 breech presentation 93–94 broth 198 C cardinal points 30–31, 33 carpal tunnel syndrome 96, 203 cervix, dystocia 103 channels 5, 37 bladder 22, 53 circulation 36–38 corresponding 38–40 coupled 38–40 du mai 25–26, 30, 40, 56 extraordinary 30, 40, 55–56, 112 gallbladder 22, 54 heart 22, 45 intestine 22, 49, 51 kidney 22, 43 liver 22, 44 lung 22, 48 pancreas 22 patterns 21 pericardium 22, 46 qi gong 214 ren mai 25–26, 55 spleen 22, 47 stomach 22, 50 and traditional Chinese medicine 40–41 triple burner 22, 52, 212 wondrous 112 yang 28, 36–38, 42, 49–56 yin 28, 30, 36–37, 40 zang fu organs 19 chemotherapy 122, 207 childbed 218–219 chong mai (sea of blood) 112 channel 30, 40 circadian rhythms 13 cold 17, 72 confluence (jiao hui) points 30, 33 congee 199 constipation 109, 203–204 contractions 102–103 corpuscles 25 Crohn’s disease 135 cun 58–59 cycles 11 cystitis 121, 212 D da qi 196 dai mai channel 30, 40 dampness 17, 72 dysmenorrhea 206 heat 212 dantians 215 de qi 78–79 delivery 96, 101–102 depression 108–109 diagnosis 17–20, 64, 113 diathesis 65 disease patterns 20 don gong 217 drugs 92 dryness 17, 72 du mai (sea of yang) 112 channel 25–26, 30, 40, 56 dysmenorrhea 115–116, 204–206, 218 dysregulation 68 E ear acupuncture 34–35, 85 earth 5, 12–13, 28 edema 94, 206–207 electrostimulation 80 elements see phases emesis 122, 207 emotions 112 endocrine system 35 Escherichia coli 107 extraordinary channels 30, 34, 40, 55–56, 112 F fatigue 69 fire 4, 12–13, 28 five flavors 197–198 five phase theory 2, 4–5 fu (functional) organs 14 G galactostasis 106–108, 207–208 gallbladder channel 22, 54 genitals 112 gestosis 94 Golgi-Mazzoni corpuscles 25 gong fu 216 gu (grain) qi 9, 196 gynecological disorders 114 H he (ho) points 26, 28, 33 headache 96, 120–121, 208–209 heart channel 22, 45, 112 heartburn 90–91, 209 heat 17, 72–73 hematomas 68 holistic medicine 15 homeostasis points 35 hormones 72 Huang Di Nei Jing 213 228 Appendix Huneke phenomenon 35 hyperemesis gravidarum 90, 209–210 hypertension 95, 210 I immune system 35 infections 65, 68–69 chronic 121, 203 pathogenic factors 70 pregnancy 92 infertility 117, 212 injection acupuncture 81 injury 68–69 insomnia 211 intersection (lo) points 30, 33 intestine channels 22, 49, 51 involution 106, 210 J jiao hui (confluence) points 30 jin ye (body fluids) 8, 10 jing (essence) 8, 10 gong 217 luo channels 36 points 27–28, 36 K kidneys 112 channel 22, 43 dysmenorrhea 204–205 edema 207 essence (jing) 202 vaginal discharge 212 ko (controlling) cycle 5, 11 Krause corpuscles 25 L labor 97–99 dysfunctional 102–103 early 91 induction 100 phases 13 premature 211 laser acupuncture 80–81 liver 112 channel 22, 44 dysmenorrhea 205 hyperemesis gravidarum 209–210 lo (intersection) points 30, 33 lung 22, 112 channel 48 luo (network) points 26–27, 33 M P Mannheim Model 99 mastectomy 123 master points 30–33 European 32 mastitis 106–108, 122–123, 203, 208 mastodynia 122 mastopathy 122 meeting points 26, 30–31 Meissner corpuscles 25 Méniere-like attacks 157 menopause 117–118, 210–211, 219 menstruation 112 menstrual cycle 116–117, 208 premenstrual syndrome (PMS) 115, 211–212 mental state 72 meridians see channels metal 4–5, 12–13, 28 midwives 86 migraine 96, 120–121, 208–209, 218 miscarriage 211 modalities 71–72 moxa plant 79 moxibustion 2, 79–80 mu (alarm) points 26, 33 mucous 209–210 pain 61–62, 68 back 95–96, 119–120, 203 galactostasis 207–208 mastectomy 123 pelvis 119 points 35 shao yang type 120 tai yang type 120 yang ming type 120 palpation 73 palpitation 59 pancreas channel 22 pattern therapy 73 pelvis 119 pericardium 22 channel 46 phases 4–5 labor 13 phlegm 72, 208 placenta 104–105 PMS see premenstrual syndrome pregnancy contraindications 67 infections 92 nutrition 200–202 phases 12–13 qi gong 218 premenstrual syndrome (PMS) 115, 211–212 pruritus vulvae 118 psychiatric disorders 66 puerperium 106–110 pulse 19–20 PuTENS 81 N needles complications 68 insertion 77 manipulation 78–79 material 74–75 moxibustion 79–80 positioning 74 removal 77 sensations 79 treatment duration 75–77 Nei Jing nei ma 80 networks 14 (luo) points 26, 33 nicotine 93 nutrition 72, 197–212 O obstetrics 88 organ clock organ networks 11–12 organ points 26 ouch (a-shi) points 34, 58, 84, 113 Q qi 4–5, 8–10, 13, 24, 36 see also da qi; de qi, gu qi; wei qi; xie qi; yuan qi qi and blood 10 amenorrhea 203 diagnosis 111 disharmony 21 dysmenorrhea 205 puerperium 107 treatment 70 qi gong 5, 84, 214–222 R ren mai (sea of yin) 112 channel 25–26, 30, 40, 55 repletion 7, 78 dysmenorrhea 206 pain rhythms, circadian 13 rule of three 71–73 Index S sadness 17 safety 64–65 san jiao (triple burner) channels 14, 22, 52, 212 sciatica 95–96 sedation 69, 78 points 29, 33, 35 segmented points 26 shen (spirit) 8, 10, 89 sheng (creative) cycle 5, 11 shi (repletion) shu (associated) points 26–27, 33 skin 58–59 sleep disorders 89, 212 insomnia 212 somatotopic points 34 source (yuan) points 26–27, 33 spleen 112, 197 channel 22, 47 edema 207 hyperemesis gravidarum 209 nutrition 201 and vaginal discharge 212 Staphylococcus 107 stomach 197 channel 22, 50 hyperemesis gravidarum 209–210 stress 219 symptomatic points 35 symptoms 15–17 diagnosis 113 emotions 112 T tai ji quan 5, 213 tao tension 89 thermal natures 198 thorax 14 tongue 18–19 tonification points 29, 33 tonifying 78 tooth imprints 19 transport points 11, 27–29 treatment guidelines 70–73 technique 74–86 triple burner (san jiao) channel 14, 22, 52, 212 tui na (massage) U urethritis 121, 212 urination 109–110, 212 urogenital region 14 uterus 14, 112 V vacuity 7, 70, 78 dysmenorrhea 204–206 and nutrition 197 vagina 118, 212 vomiting 90–91, 209 W wai ma 80 Wang Xuetai 72 water 4–5, 12–13, 28 weather 71 wei (antipathogenic) qi 9, 16, 70, 196 wind 16–17 wood 4, 12–13, 28 wu (rebellious) cycle 11 229 X xi (acute) cleft points 29–30, 33 xie (evil) qi xu (vacuity) xue (blood) 10 xue (point) 24 Y yan qiao mai channel 30 yang channels 28, 30, 36–38, 40, 42, 49–56 yin, channels 28, 30, 36–37, 40, 42–48 yin-yang balance concepts 5–8 disharmony 20–21, 84 puerperium 106–110 qi gong 214 treatment 70 ying (nutritive) qi 196 yuan (source) points 26–28, 33 qi 9, 196 Z zang (storage) fu 5, 13–14, 19 organs 14 zhen jiu see acupuncture zheng qi (true qi) 9, 196 zong (ancestral) qi ... Medicine (TCM) Yang Ring finger Middle finger Index finger KI–TB SP–ST LU–LI Yin BL–KI GB–LR SI–HT Ring finger Middle finger Index finger Slow pulse: (less than four beats per respiration) in cold... pricking without consideration for Chinese fundamental principles Only since the mid- 20th century has acupuncture been practiced increasingly in line with the principles of Chinese medicine In. .. onset of shifting pains, fluctuating fever in case of infectious diseases “Inner wind” is characterized by vertigo, changing discomforts, and trembling of muscles Long-lasting wind symptoms lead