JOURNAL OF CHINESE MEDICINE NUMBER 30 MAY 1989

THE TREATMENT OF BY ACUPUNCTURE

GORDON PECK
route, from finest branches through luo to main chanACCORDING TO TCM, GOOD HEALTH DEPENDS ON THE FREE AND nels, that moxa is able to influence the ying flowing in the plentiful flow of Qi and blood. When this regular flow of main channels). Qi and blood is disturbed, pain or dysfunction may arise. Scars belong under the heading of trauma in the group of neither internal or external factors causing disease. TREATMENT Obviously most scars occur in the superficial tissues, and penetrate to varying degrees. A superficial scar Often mild cases of local obstruction clear themselves will therefore have its main effect on the Muscle chanwhen the Qi is increased either locally (by treating a nels (Jing Jin), comprising the smallest branches of the channel running through the scar) or systemically with luo - the Sun luo. At this level Wei-Qi would be involved acupuncture or herbal treatment. More specific treatpredominantly, as the blood/ying flow concentrates at a ment may be necessary if a scar is very painful or deeper level. With progressively deeper scars the effect particular problems are not resolving and a scar is suswill begin to manifest more obviously on the main pected as the culprit. There are several methods of channels - the Jing Mai - themselves, and stagnation will treatment using acupuncture, the strength of the treatbecome more substantial once blood is involved. ment increasing with the severity of the problem: In a healthy person the Wei-Qi will find a way to by-pass any superficial scar and relatively normal func1. Superficial Needling tion will return in time. Even deeper lesions involving the ying/blood or the circulation through the zangfu While this is a very mild technique, working mainly at themselves should be able to heal if the person is generthe level of the muscle channels, it can also affect quite ally well. severe stagnation involving very large and deep scars. The problems come when either the blockage is Fine needles (often half-inch length) are placed horizonsevere - a large, coarse or deep scar - or the Qi is too weak tally at each end of the scar, pointing towards it, for 1 to to overcome the local resistance produced. 2 fen. In larger or irregular scars, more needles may be Local effects may range from mild numbness to used. They are left for 20 minutes or so, and it is common severe pain and possibly inflammation and/or swelling for the whole length of the scar to become quite pink depending on the relative strength of the obstruction during this time. If a small section remains unchanged, and of the patients Qi (particularly Wei-Qi). it may be necessary to add one or more needles nearby to Systemic effects will depend on the site of the scar encourage the flow. If channels crossing the scar area and the state of the channel/s affected. Thus even in a have been used in previous treatments with mediocre relatively healthy person a scar on a channel which is Xu results, they will often show very obvious effects when may cause problems. If, for instance, the Stomach or used with or after this scar treatment. Repeated treatSpleen channels are crossed by a scar in someone with a ment of the scar itself is not usually necessary, but may tendency to Spleen-Qi-Xu, the background problem could be considered. be exacerbated, accentuating any of the Spleen-Qi-Xu 2. Mild Moxibustion symptoms. One of the mixed blessings This method works in a ..... specific treatment may be necessary if a scar of modern medicine is the similar way, and is obvirealization that fibrous tisously more useful where is very painful or particular problems are not sue bundles in the abdomen cold, or Qi-Xu is compliresolving and a scar is suspected as the culprit are orientated horizontally. cating the problem. A mild Incisions along these lines, moxa stick is moved back called Skin Cleavage Lines, heal with minimal scarring, and forth over the scar, again for about 20 minutes. This but inevitably cut through more channels, usually at a technique may be combined with the superficial needeep level. The ugly keloid scars which often resulted dling method described above, but will yield good refrom vertical cuts on the abdomen would have formed sults when used alone. The skin around the scar will much more formidable obstacles but often seemed to redden, and the increased flow of Qi may cause itching miss nearby channels. (Note: even superficial scars may locally. Midline scars over Qihai REN-6 or Guanyuan have some effect on the main channels as they ramify REN-4 are well suited to this method for obvious reainto the luo and sun luo. It is presumably through this sons.

SCARS

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JOURNAL OF CHINESE MEDICINE NUMBER 30 MAY 1989

3. Chong Mai
Scars on the chest or abdomen may disrupt Qi locally, producing such symptoms as colic, chest pains, and in one case where the patient had been hit on REN-17 with a hockey ball, profound anxiety. In such cases the use of Chong Mai, either by needling the master and coupled points alone (Gongsun SP-4 and Neiguan P6), or with the superficial needling method, can produce particularly good results. Chong Mai is also known as the Highway or Penetrating channel, reflecting its functions of distributing Qi and clearing obstructions. This is particularly so on the trunk along the main pathway of the channel. Even severe cases can respond to this form of treatment, and the popularity of bikini scars means that a needle placed at either end often coincide with Qichong ST-30 - a happy coincidence. Obviously symptoms could still indicate the use of Chong Mai even if the scars were disregarded, but if the symptoms have only arisen since surgery or other local trauma we can assume a connection.

1. Female, 34 years, seen in 1978 Three years prior to coming for treatment, she had surgery to remove an ovarian cyst, leaving a scar from around REN-7 to REN 4. She could not bear to have the scar touched although it was not painful. Since the surgery she had been very lethargic, unable to sleep soundly, had frequent urination, and intermenstrual bleeding. Her pulse was thready and her tongue was pale with a few red prickles at the tip She was treated with massage (not on the abdomen) and 20 minutes mild moxibustion over the scar. Two nights later she woke with a distinct sensation of movement in the abdomen and from that time improved steadily. The bleeding stopped, sleep became sound, energy slowly increased, and urinary frequency normalized. The only other treatment was massage 3 weeks later. The patient was reinterviewed during March 1989 and said that the scar had not been sensitive since treatment and there had been no relapse aside from a brief recurrence of the metrorrhagia in 1985 after a period of great stress. 2. Female, 36 years This patient suffered from severe periodic abdominal distention. While under observation in hospital she managed to gain 9 lbs in retained fluid during an afternoon. She had improved to a limited extent with acupuncture treatment but did not respond nearly as well as I had hoped. It was discovered that she had undergone cosmetic surgery for breast augmentation, and was left with a scar running along the base of each breast. As they had cut through the Stomach channel both scars were treated by the superficial needling method, and an immediate improvement was observed. She required more treatment before the problem was resolved, but from that time onwards the other points yielded the results one would expect.

large or irregular scars may need more needles. The handles are connected to a stimulator set to dense-disperse or to around 8 cycles per second continuous, and sufficient current used to give a strong but comfortable sensation for 10 to 20 minutes. The treatment may need to be repeated. If in doubt about which method to use, it is always worth beginning with superficial needling, as surprisingly profound effects may be seen. In my own, albeit limited, experience I have not needed to use electrical stimulation in painful cases. If there is no response, one or more of the stronger methods should be considered, and if there is still no response, then it is worth re-assessing whether the local stagnation is in fact relevant. The old adage of the carpenter with only a hammer seeing all his problems as nails applies here as in any specialized area of acupuncture.

Summary

4. Local and Distal Points

This method is suitable in painful cases where superficial needling or mild moxibustion have not had sufficient effect or where a point lying close to the scar would be appropriate for treatment in any case. The most suitable local point is chosen and combined with a distal point on the same channel or one which will move Qi in the affected area. This could be a Xi-Cleft point, a point found empirically to be effective, or one having useful systemic effects. The local point is needled in its usual direction and manipulated until Qi arrives, and the distal point may be manipulated to direct Qi towards the scar. Intermittent manipulation is given for 20 to 30 minutes, and the treatment may need to be repeated several times.

As this article has shown, scars can not only impede Qi but can also release its flow with appropriate treatment. Obviously the cases mentioned here are relatively dramatic. Others have shown more mediocre results and some, in the writers earlier and more eager days, none at all. Others, particularly where Chong Mai was used, have cleared symptoms such as regurgitation of faeces, but could have involved processes other than the scars themselves. I hope you will be able to confirm the usefulness of these techniques in your own practice and let the results 3. Female 44 years This patient experienced constant tender- speak for themselves.
ness in the area where 3 successive caesarians had been performed, with the incision being made along the same line each time. The uterus was very tender, and there were repeated bouts of thrush and abdominal distention since the last operation which had left her exhausted. The first treatment was Neiguan P-6, Taichong LIV-3, and Ququan LIV-8. The scar was needled at each end (superficial needling method) once the other needles were in place. Within a minute an icy sensation began to develop around the scar, then heat, then a tremor which gradually spread to the whole body. The patient became acutely aware of Qi moving in trunk and limbs. Two months later she returned for treatment. Despite family catastrophies which had prevented an earlier return, she reported no abdominal discomfort, thrush or bloating, and her energy was greatly improved.

Acknowledgements
The first, dramatic, demonstrations of the treatment of scars that I observed were by J. D. Van Buren at the International College of Oriental Medicine. Professor Qiu Mao Lian of the Nanjing College of TCM explained the use of local and distal points, and treatment with electro-acupuncture. The use of Chong Mai is my own development, based on the understanding of its actions gleaned among others, from Mr. Van Buren and Giovanni Maciocia.

5. Electro-acupuncture
In view of its strong dispersing effect, electro-acupuncture is reserved for cases involving severe pain. This implies both strong Qi and strong blockage and sterner measures are appropriate. A needle is inserted horizontally along each side of the scar, running parallel to it for up to 3 cun. Very
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