J. Acupunct. Tuina. Sci. (2009) 7: 371-374 DOI: 10.1007/s11726-009-0371-6
Meridian and Acupoint
Clinical Application of Acupoint Neiguan (PC 6) CAI Xiao-gang (蔡晓刚) Department of Acupuncture and Moxibustion of Chinese Medicine Hospital of Hongdong County, Shanxi 041600, P. R. China
【关键词】穴，内关；癔症；心肌炎；胃炎 【Key Words】Points, Neiguan (PC 6); Hysteria; Myocarditis; Gastritis 【CLC Number】R246.2 【Document Code】B Acupoint Neiguan (PC 6) is first recorded in Ling Shu (Spritual Pivot). It is the Luo-Connecting point of the Pericardium Meridian and communicates with acupoint Waiguan (TE 15); it is also one of eight confluent points, and associates with the Yin Link Vessel. We often use Neiguan (PC 6) alone or as the cardinal acupoint to treat many disorders in clinical practice. It is now reported as follows.
flexor digitorum profundus in the deep; median cubital artery and vein, antebrachial interosseous dorsal artery and vein; medial forearm cutaneous nerve, lateral forearm cutaneous nerve, palmar cutaneous branch of median nerve and antebrachial palmar interosseous nerve.
1 Meanings of Neiguan (PC 6)
Perpendicular needling: Insert the needle into the acupoint 0.5-1.5 cun, or towards Waiguan (TE 15). Soreness and distension may occur upon needling this acupoint. Oblique needling with needle tip upwards: The needle is obliquely inserted, 1.0-2.0 cun, with its tip up towards the elbow joint. This needling technique is fit for the diseases on the trunk and upper arms. The needling sensation such as soreness, numbness and distension may be radiated to the elbow, armpit or chest. Oblique needling with needle tip toward the radial aspect: The needle is obliquely inserted, 0.3-0.5 cun, with the needle tip toward the radial aspect. This needling technique is fit for numbness of the fingers. The needling sensation primarily includes tingling and electric striking toward the end of finger. In this needling technique, the needle is not lifted and thrust, but rotated in small amplitude with a short period, just for tingling and numbness of the fingers, not injure the median nerve. In the case of difficult and stubborn disorders, a thumbtack-like needle may be perpendicularly inserted into the body, pressed and then fixed with some plaster. The needle is pressed 3-5 times a day.
In the nomenclature of nei guan, nei means internal, and guan means gate. Therefore, acupoint Neiguan (PC 6) signifies that qi of the Pericardium Meridian goes into the internal body from this site. 2 Location of Neiguan (PC 6) Neiguan (PC 6) is located at the crossing point between lower one-sixth and upper five-sixths of the forearm and between the tendons of m. palmaris longus and m. flexor radialis. Simple location: hold the forefinger, middle finger and index finger of one hand together, and then place the radial aspect of the second phalanx of the index finger against the wrist transverse crease of the other hand. Below the radial aspect of the index finger and between the tendons of m. palmaris longus and m. flexor radialis is the acupoint Neiguan (PC 6). Local anatomy: Between the tendons of muscle palmaris longus and muscle flexor radialis are flexor digitorum superficialis in the shallow and Author: CAI Xiao-gang (1969- ), male, attending physician of traditional Chinese medicine
3 Needling Methods
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J. Acupunct. Tuina. Sci. (2009) 7: 371-374
In summer, the needle is alternated once a day; in spring, autumn and winter, it is alternated once 3 d. The area where the needle keeps dry. In the performance of moxa-cone moxibustion, 3-7 cones are given in one treatment, while 1545 min for mild moxibustion.
4 Indications Neiguan (PC 6), the connecting point of Pericardial Meridian, associates with the upper, middle and lower energizers, and works on palpitation, chest pain and stuffiness in the upper energizer; stomachache and vomiting in the middle energizer; menstrual and urinary disorders in the lower energizer. This acupoint also has striking bidirectional effects on heart rate.
5 Case Studies 5.1 Hysteria A 70-year-old man came for the first time on Feb. 20, 2009. Main complaint and history of present illness: Sudden loss of consciousness and failure to make speech and sounds after emotional fluctuation for 4 hours. Head CT scan, electrocardiogram and laboratory examinations found no abnormality. The patient did not respond to general symptomatic treatments. Past history: He had the history of coronary heart disease and hypertension for over 30 years. Forty years before, he had had lunacy for 3 years, but basically recovered after treatments. He also had the history of heart stent surgery. Physical examination: passive posture, direct vision of two eyes, poor consciousness, round and equal pupils well reactive to light, absence of trembling eyes; normal muscle strength of the limbs but not move freely, presence of physiological reflex, absence of pathological reflex, supple neck, heart and lung stethoscopy (-), blood pressure 17.6/9.3 kPa. A red tongue with thin and whitish coating, tongue body unable to move, full stringlike pulse. Diagnosis: Hysteria. Treatment principle: Regulating qi activity, unblocking orifices. ●
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Treatment procedure: Neiguan (PC 6) and Tiantu (CV 22) were selected. After routine disinfection, a filiform needle of 0.40 mm in diameter and 25 mm in length was used to puncture the left-side Neiguan (PC 6) about one cun with the needle tip toward the elbow joint; then the needle was lifted and thrust rapidly in a small range to give even reinforcingreducing technique. In the acupuncture of Tiantu (CV 22), the patient lay on his back with his head backwards. The acupuncturist pressed the fossa above the breastbone with the forefinger of one hand, where the patient felt sore and distended, and the acupuncturist felt the deepest. After routine disinfection, the acupuncturist inserted a filiform needle of 1 cun in length downwards rapidly with the angle less than 15°. When the needle felt resisted, it was indicated that the needle tip reached the periosteum of suprasternal fossa. After the patient felt sore, numb and distended, a smallamplitude of needling technique was conducted to induce the needling sensation downwards along the Conception Vessel[1]. The needles in Neiguan (PC 6) and Tiantu (CV 22) were manipulated intermittently for total 3 min. During the needling manipulation, the patient could raise his right hand, make sounds and shed tears. After another 15-minute needling treatment, the patient revived and felt well except for general weakness. Survey next day found that the patient was recovered and discharged. Note: Peaceful spirit is essential for body’s physiological and psychological activities. Once the spirit is disturbed, the body’s yin and yang, qi and blood must be adverse and lunacy results. In this patient, sudden mental irritation causes qi and blood adversity, and brings about lunacy. As a conventional treatment, Shuigou (GV 26) and Yongquan (KI 1) were used. However, this patient had the history of heart disease, hypertension and heart stent surgery, so Neiguan (PC 6) and Tiantu (CV 22) are needled instead. Needling these two acupoints produces less irritation, and can downbear adversity, loosen chest and activate qi. Simultaneous intermittent manipulation at these two acupoints can not only promptly arouse the body’s potential, but also prevent iatrogenic accidents in needling Shuigou (GV 26) and Yongquan (KI 1). We have treated 21 cases of hysteria from various origins by needling or pressing Neiguan (PC 6) and Tiantu
︱Copyright©2009 Shanghai Research Institute of Acupuncture and Meridian
J. Acupunct. Tuina. Sci. (2009) 7: 371-374
(CV 22), and they were all cured after one treatment. 5.2 Myocarditis A woman, 35, came for the first time on Feb. 9, 2008. Main complaint and history of present illness: Palpitation, chest stuffiness and general weakness for three months, worsened for one week. Three months prior to the treatment, she experienced palpitation, precordial dull pain, shortness of breath, chest stuffiness, vertigo and weakness after a cold. She was admitted to a local hospital and diagnosed with viral myocarditis; after 18-day admission, the clinical symptoms were relieved and she was discharged from the hospital. After heavy work and fierce movements, she occasionally developed precordial discomforts and palpitation, or even mild pain in the left chest, chest stuffiness, weakness and insomnia. In the past week, the symptoms above happened frequently, and she was given Zhi Gan Cao Tang (Honey-fried Licorice Decoction) by oral administration and 5% 250 mL glucose injection with 2.0 g ceftriaxone sodium by intravenous drip for 3 d，but the result was not significant. Physical examination: Heart rate 92 beats/min, normal rhythm and powerful beat, blood pressure 14.7/11.3kPa, good spirit, pale red tongue with thin whitish coating, skipping and intermittent pulse. Diagnosis: Palpitations. Treatment principle: Calming heart and spirit, boosting qi and activating blood. Treatment procedure: She was asked to lie on the bed. The right Neiguan (PC 6) and Shenmen (HT 7) were selected. After routine disinfection, the thumbtack-like needles were perpendicularly inserted into right Neiguan (PC 6) and Shenmen (HT 7), and then pressed and fixed with some plaster. The needling aera was prohibited from water. She was told to press the needles three to five times every day. The needles were alternated after 3 d. Zhi Gan Cao Tang (Honey-fried Licorice Decoction) was also administered and the other medicines were discontinued. In her second visit, all symptoms disappeared. Physical examination showed pale red tongue with thin whitish coating, and slow pulse. For her weakness and insomnia, Baihui (GV 20) was punctured 0.8 cun backwards at the angle of less than 10°; right Zusanli (ST 36) was
perpendicularly punctured 1.5 cun; right Zhaohai (KI 6) and Shenmai (BL 62) were punctured 0.8 cun at the angle of 45° along the bony suture of ankle joint with even reinforcing-reducing techniques by rotating the needles. The needles were retained for 30 min and manipulated once every 10 min. The needling treatment was given once a day and herbs were not given any longer. After another three times of needle embedding and 10 needling treatments, her clinical symptoms disappeared. Telephone follow-up one year later found no relapse. Note: Viral myocarditis refers to the diffuse or localized inflammation in the heart muscle resulting from multipe viruses. It is often seen in the children and the youth. In recent years, its morbidity increases obviously. A majority of patients can be cured after appropriate treatments, without any symptoms or signs left; very few patients die of acute myocarditis; some patients still have heart hypofunction, arrhythmia or altered electrocardiogram, which is called myocarditis sequela. In western medicine, symptomatic treatment and support therapy are often employed. In Chinese medicine, viral myocarditis is considered to be caused by exogenous pathogenic factors, and classified into palpitation. According to Chinese medical theories, we embedded thumbtack-like needles at Neiguan (PC 6) and Shenmen (HT 7) to calm the heart and spirit, harmonize the stomach, loosen chest and relieve vexation. Besides, Baihui (GV 20), Zusanli (ST 36), Zhaohai (KI 6) and Shenmai (BL 62) are added for clinical symptoms. Consequently, excellent results have been obtained, indicating that acupuncture has good effects on viral myocarditis. 5.3 Gastritis A man, 51, came for the first time on Apr. 25, 2002. Main complaint and history of present illness: Stomachache for more than three months, worsened for half a month. He has been taking western and Chinese medicines for stomachache and dyspepsia. Half a month prior to the treatment, after improper diet he experienced stomachache, tender on palpation, worsened after meals, belching, acid regurgitation, nausea, poor appetite, occasional vomiting of indigested food, and pain relief after vomiting, frequent gas, and loose stool. B-ultrasonic
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J. Acupunct. Tuina. Sci. (2009) 7: 371-374
examination showed negative liver, gallbladder and chronic superficial gastritis. He was given Bao He Wan (Pachyma Compound Digestive Tonic Pill), Domperidone and herbal medicines, but the effects were not satisfactory. Physical examination: Abdominal stiffness, refusal to press, pale red tongue with thick slimy coating, and slippery pulse. Diagnosis: Stomachache. Treatment principle: Promoting digestion to eliminate stagnation, nourishing spleen and harmonizing stomach. Treatment procedure: He lay on his back. After routine disinfection, filiform needles of 0.4 mm in diameter and 40 mm in length were perpendicularly inserted into Zhongwan (CV 12) 1.2 cun, right Neiguan (PC 6) 1.0 cun with the needle tip towards the elbow joint. Even reinforcing-reducing technique was performed by small range of lifting, thrusting and rotating the needles until as something moved leftwards and downwards beneath Zhongwan (CV 12) and the needling sensation like tingling and distension radiated from Neiguan (PC 6) to the elbow joint along the medial aspect of the forearm. Then, a thick hard paper with a hole in the middle was set around Zhongwan (CV 12) to prevent from burning the skin, and hence a 1-cm moxa stick was inserted around the needle handle and burned from its lower end. When a moxa stick was burnt out, another stick was alternated until the warm sensation inside the abdomen moves leftwards and downwards. Meanwhile, the needle at Neiguan (PC 6) was manipulated once every 15 min. Stomachache disappeared after 30 min. Another 90 min later, the needles were removed. On the visit next day, he told that the symptoms were eliminated except poor appetite and frequent gas. He was told to care for his diets, and not to smoke, drink, and eat pungent raw and cold food. In addition, he was asked to perform moxibustion by himself with moxa stick at Zusanli (ST 36) for 10 min every day. One month made up one course, and the next course continued after 10-day interval, for a total of over six months. Survey after one year found that his stomachache was not relapsed any more. Note: Food retention is the common cause of stomachache, usually by anorexia. This patient was constitutionally weak in the spleen and stomach. ●
pancreas; gastroscopic examination indicate Immoderate eating and drinking results in obstruction of qi activity in the middle energizer, displaying stomach fullness and pain, refusal to press, belching and acid regurgitation, nausea, poor appetite, worsened after meals. Zhongwan (CV 12) is the alarm point of the stomach and the meeting point of bowels. Its afferent neuron is the seventh thoracic nerve and the second lumbar nerve, which overlap the afferent nerves of the stomach and intestine, therefore, needling Zhongwan (CV 12) can regulate the stomach and intestine functions, resolve dampness and harmonize middle energizer, downbear adversity and relieve vomiting[2]. Neiguan (PC 6) communicates with the Yin Link Vessel, and the Yin Link Vessel associates with the Spleen, kidney, Liver, Stomach Meridians and Conception Vessel, which all run along the chest and abdomen. So, Neiguan (PC 6) can harmonize the stomach and downbear adversity, regulate qi activity and relieve pain, and thus becomes a frequent acupoint for stomach and intestine disorders[3]. After needling Zhongwan (CV 12), if the patient feels something moving leftwards and downwards, this is the optimal needling sensation and the basis for good results. Ninety-minute moxibustion and tingling sensation from Neiguan (PC 6) radiating toward the elbow joint along the medial aspect of the forearm again guarantee the curative effects. Moreover, long-term moxibustion at Zusanli (ST 36) can strengthen spleen and stomach, warm middle energizer and disperse cold to prevent relapse. We have treated 72 cases of stomachache due to food obstruction with this therapy and obtained wonderful results.
References [1] CAI Xiao-gang. Two Needling Techniques for Acupoint Tiantu (CV 22). Shanghai Journal of Acupuncture and Moxibustion, 2004, 23 (1): 31. [2] LIU Li-gong, GU Jie. Analysis of Acupuncture Treatment Characteristics of Epigastric Pain in Ancient Times. Journal of Acupuncture and Tuina Science, 2005, 3(2): 4-6. [3] YAO Jie, NI Cheng-hao. Clinical Observation of Needling Neiguan (PC 6) in Treating Abdominal Pain. Shanghai Journal of Acupuncture and Moxibustion, 1999, 18(4): 23.
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Translator: XIAO Yuan-chun (肖元春) Received Date: September 8, 2009
