SKIN DISEASES 1.

Urticaria
Urticaria is an allergic skin disease with skin wheals as the main manifestation. It is essentially anaphylaxis limited to the skin and subcutaneous tissues and can be due to drug allergy, insect stings or bites, desensitization injections, or ingestion of certain foods (particularly eggs, shellfish. nuts, or fruits). Clinically, it is marked by the appearance of wheals over the skin with abrupt onset and rapid disappearance, severe itching and burning sensation on the diseased region, repeated attack with long course and leaves no trace after recovery. According to TCM, urticaria belongs to Yin Zhen (hidden eruption), Pei Lei (urticaria), Feng Zhen Kuai (wind eruption), or You Feng (wandering wind disorder), and it is due to deficiency of the body resistance, attack of external pathogens, improper food or accumulation of internal heat. I. STANDARD TREATMENT Urticaria is usually divided into three types - wind-cold, wind-heat, and spleen and stomach deficiency. Points of the Stomach, Spleen and Urinary Bladder Meridians are frequently selected. 1. Wind-Cold Manifestations: Abrupt onset of pale or light-colored wheals and severe itching of the diseased region, which are both aggravated by cold or wind, aversion to cold. Tongue: White coating. Pulse: Floating. Treatment Principle: Dispel wind and disperse cold. Point Prescription & Manipulation: Primary points: GB-20 FengchiLI-11 QuchiBL-12 Fengmen-^ BL-13 Feishu-^ SP-10 XuehaiExplanation: GB-20 Fengchi, the Crossing Point of the Gallbladder Meridian and Yangwei Meridian, controls the exterior of the body, dispels wind and cold and relieves exterior syndrome; BL-12 Fengmen, the Crossing Point of the Foot-Taiyang and Du Meridians, and BL-13 Feishu, the Back-Shu Point of the Lung Meridian, improve the exterior yang, regulate the lung and dispel wind and cold; LI-11 Quchi and SP-lO Xuehai promote qi flow and activate blood circulation. Secondary points according to conditions: 1 Repeated attack of intractable cases-ST-36 Zusanli [+^], BL-21 Weishu [+^] and BL-20 Pishu [+^].

2. Wind-Heat Manifestations: Red wheals, burning sensation and severe itching on the affected region, which become aggravated by heat and milder by cold, thirst, fever, aversion to wind. Tongue: Thin and yellow coating. Pulse: Floating and rapid. Treatment Principle: Expel wind and clear heat. Point Prescription & Manipnlation: Primary points: DU-14 Dazhui LI-11 QuchiSP-10 Xuehai GB-20 Fengchi Explanation: DU-14 Dazhui, the Crossing Point of the Du and Hand and Foot Yang Meridians, clears heat and dispels wind; GB-20 Fengchi, the Crossing Point of the Gallbladder Meridian and Yangwei Meridian which controls the exterior of the body, dispels wind and heat and relieves exterior syndrome; LI-11 Quchi and SP-lO Xuehai promote qi flow and activate blood circulation; HT -7 Shenmen calms the mind and relieves itching. Secondary points according to conditions: 1 Insomnia-HT-7 Shenmen [-]; 2 Vomiting and diarrhea-PC-6 Neiguan [-] and ST-36 Zusanli [+]; 3 Sore throat-LU-10 Yuji [-] and LU-11 Shaoshang [-]. 3. Deficiency of Spleen and Stomach Manifestations: Attack of wheals induced by intake of certain food, cold limbs, aversion to cold, abdominal pain, loose stools, distressed sensation of the epigastrium, poor appetite. Tongue: Pale body with white coating. Pulse: Thready and slow. Treatment Principle: Warm the middle-jiao, reinforce the spleen and regulate yin and wei. Point Prescription & Manipulation: Primary points: ST - 36 Zusanli+^ SP-6 Sanyinjiao+^ RN-12 Zhongwan+^ PC-4Ximen+

SP-IO Xuehai+^ Explanation: ST-36 Zusanli and SP-6 Sanyinjiao reinforce the spleen and stomach; RN-12 Zhongwan reinforces the middle- jiao and promotes transportation and transformation to nourish qi and blood; PC-4 Xi men calms the mind and relieves itching; SP-10 Xuehai promotes qi and blood circulation. Secondary points according to conditions: 1 Palpitation and insomnia-HT-7 Shenmen [+]. II. EXPERIENTIAL TREATMENT 1. Cupping on RN-8 Shenque Indication: Various types of urticaria. Point Prescription: RN-8 Shenque Manipulation: Ask the patient to lie down on the back. Make cupping on the point for 3-5 minutes, remove the cup, and repeat this course three times. The treatment is given once daily, with three treatments as a course. Usually, within one course of the treatment the disease will be cured. To intractable urticaria, 2-3 courses may be needed. 2. Puncturing SI-3 Houxi Indication: Various types of urticaria. Point Prescription: SI-3 Houxi Manipulation: Insert a 1-cun long needle perpendicularly into the point 0.8 cun deep. Lift, thrust and rotate the needle for 3-5 minutes and retain the needle for 20-40 minutes. The treatment is given once daily, and usually, within 10 treatments the disease will be cured. 3. Pricking and Cupping on BL-40 Weizhong Indication: Obstinate urticaria. Point Prescription: BL-40 Weizhong of one side. Manipulation: Prick .BL-40 Weizhong and make cupping on the point for 5 minutes to make about 10 ml of bleeding. The treatment is given once daily, and usually the disease will be cured by 2-3 treatments. In case the treatment result is not effective, the opposite BL-40 Weizhong can be treated the same way. 4. Ear Acupuncture

Indication: Various types of urticaria. Ear Point Prescription: The most painful point, Lung, Adrenal Gland, Shenmen, Endocrine, Anti-Sensitive Point and the Point corresponding to the Diseased region. Manipulation: See page 255-256. Comment: Zhenjiu is effective in treatment of urticaria. In most cases, their disease can be cured by Zhenjiu treatment.

2. Eczema
Eczema is a commonly seen allergic inflammatory dermatosis. Its cause is closely related to heredity, improper diet and emotional stress. Clinically, it is marked by itching on the affected part, polymorphic skin lesion, orrhorrhea and frequent recurrences. According to TCM, eczema belongs to different categories according to its location and the patient's' age. It Includes Nai Xiang (tinea due to milk appearing in infants), Chan Er Chuang (boils appearing on the external ear), Shen Lang Feng (wind in the kidney sac appearing on the scrotum), Si Wan Feng (wind in the four turning regions appearing on the elbows and knees), and Shi Du Chuang (carbuncle due to noxious dampness appearing on the local region but with a severe condition). It is due to attack of the skin and muscles by exogenous pathogenic damp, heat, and noxious factors, or blood deficiency leading to poor nourishment of the skin. I. STANDARD TREATMENT It is usually divided into two types-damp-heat and blood deficiency. Points of the Taiyang, Yangming and Taiyin Meridians are frequently selected in its treatment. 1. Damp-Heat Manifestations: Diffuse redness, clusters of red papulae, blisters, erosion, exudations with burning sensation of the skin, severe itching. Tongue: Red body with yellow and sticky coating. Pulse: Soft and rapid. Treatment Principle: Clear heat and dampness. Point Prescription & Manipulation: Primary points: LI-4 HeguSP-9 Yinlingquan LI-11Quchi SP-10 Xuehai SP-6 Sanyinjiao Explanation: LI-4 Hegu and LI-ll Quchi clear heat; SP-9 Yinlingquan and SP-6 Sanyinjiao remove dampness; SP-10 Xuehai clears heat from the blood and promotes blood flow. Secondary points according to conditions: 1 High fever - DU-14 Dazhui [-]; 2 Extreme itching - HT -7 Shenmen [-]; 3 Itching and rashes in the anterior yin region (the region around the external genitalia)- LR-5 Ligou [-]; 4 Obstinate cases -ST -40 Fenglong [-]. 2. Blood Deficiency

Manifestations: Thick and rough skin with skin desquamation, pigmentation and sensation of severe itching that is aggravated in the night. Tongue: White coating. Pulse: Thready and weak. Treatment Principle: Nourish the blood, moisten the dryness. Point Prescription & Manipulation: Primary points: LI-ll QuchiSP-10 Xuehai + SP-6 Sanyinjiao + BL-17 Geshu + ST-36 Zusanli + Explanation: LI-11 Quchi clears heat from the blood for relieving itching; SP-10 Xuehai and BL-17 Geshu nourish blood and activate blood flow; SP-6 Sanyinjiao and ST-36 Zusanli reinforce the spleen and stomach and promote production of blood. Secondary points according to conditions: 1 Palpitation and poor memory - HT-7 Shenmen. II. EXPERIENTIAL TREATMENT 1. Ear Acupuncture Indication: Various types of acute or chronic eczema. Ear Point Prescription: The point corresponding to the diseased portion, Lung, Spleen, Sanjiao, Large Intestine, Endocrine, Heart, Shenmen, Erzhong, Adrenal Gland. Manipulation: See page 255-256. 2. Hydro-Puncture Indication: Intractable chronic eczema. Point Prescription: ST-36 Zusanli LI-11 Quchi Manipulation: Inject 0.1 mg of vitamin B 12 to each point. The treatment is given once daily with 10 treatments as a course. The next course can be given after an interval of 5-7 days. Generally, the disease can be cured within one therapeutic course. Comment:

Zhenjiu is effective in treatment of eczema. In many cases, eczema can be cured by Zhenjiu treatment. However, for most cases of chronic eczema, a long term of treatment is needed. It is important to advise the patient not to take hot taste food, not to eat chicken and fish, and not to drink alcohol during treatment period. Also it is important to persuade the patient avoiding to scratch the itching skill or to have hot shower for a long period.

3. Herpes Zoster
Herpes zoster is a kind of acute herpetic skin infection caused by the herpes zoster virus. Clinically, it is marked by abrupt onset of groups of crowded blisters arranged in zonary fashion along one side of the nerve distribution, accompanied with nervous pain in the diseased region. According to TCM, herpes zoster belongs to the categories of Chan Yao Dan (erysipelas along the waist), Huo Dai Chuang (fire-strip boil) and She Chuang (boil with snake shape). It is caused by attack of pathogenic heat or damp-heat, or depressed liver qi turning into fire. I. STANDARD TREATMENT Herpes zoster is generally divided into three types - wind-fire of the liver and gallbladder, damp-heat, and stagnation of qi and blood. Points of the Liver and Gallbladder Meridians and local points are frequently selected in its treatment. 1. Wind-Fire of Liver and Gallbladder Manifestations: Abrupt onset of groups of papular eruptions at the affected part with pain and heat sensation and accompanied by restlessness, thirst, bitter taste in the mouth. Tongue: Red body with yellow coating. Pulse: Wiry and rapid. Treatment Principle: Clear heat from the liver and gallbladder, cool blood, and stop pain. Point Prescription & Manipulation: Primary points: GB-34 YanglingquanLR-8 Ququan GB43 XiaxiLR-2 Xingjian SP-10 Xuehai 3-4 points surrounding the diseased region Explanation: GB-34 Yanglingquan, GB-43 Xiaxi, LR-8 Ququan and LR-2 Xingjian, the HeSea Points and Ying-Spring Points of the Gallbladder and Liver Meridians, clear heat from the gallbladder and liver; SP-10 Xuehai cools blood and removes blood stasis; 3-4 points surrounding the diseased region promote qi and blood flow in the local region, remove heat and toxin, and relieve pain. Secondary points according to conditions: 1 Constipation - SJ-6 Zhigou [-]; 2 Skin lesion appearing on the face and neck -GB-20 Fengchi [-], LI-4 Hegu [-] and SJ-5 Waiguan [-].

2. Damp-Heat Manifestations: Erythema, pain, burning sensation, clusters of blisters or exudation at the affected part, restlessness, poor appetite, loose stools. Tongue: Red body with yellow and sticky coating. Pulse: Soft and rapid. Treatment Principle: Clear heat and dampness, stop pain. Point Prescription & Manipulation: Primary points: SP-I0 Xuehai SP-9 Yinlingquan SP-6 Sanyinjiao LR-3 Taichong GB-34 YanglingquanST-44 Neiting 3-4 points surrounding the diseased region Explanation: SP-10 Xuehai cools blood, improves blood flow and relieves itching; SP-9 Yinlingquan and SP-6 Sanyinjiao remove dampness; LR-3 Taichong and GB-34 Yanglingquan clear heat from the liver and gallbladder; ST-44 Neiting clears heat; 3-4 points surrounding the diseased region promote qi and blood flow in the local region, remove heat, dampness and toxin, and relieve pain. Secondary points according to conditions: 1 Skin lesion appearing on the face and neck-GB-20 Fengchi [-], LI-4 Hegu [-] and SJ-5 Waiguan [-]. 3. Stagnation of Qi and Blood Manifestations: Crust formation of the blisters with some red, brown spots and pigmentation on the diseased region, persistent stabbing local pain. Tongue: Dark-red tongue with purple spots. Pulse: Wiry and thready. Treatment Principle: Soothe liver, promote blood circulation, activate collaterals and stop pain. Point Prescription & Manipulation: Primary points: SP-10 Xuehai LR-3 Taichong PC-6 Neiguan LI-4 HeguBL-17 Geshu -

GB-34 YanglingquanBL-18 Ganshu 3-4 points surrounding the diseased region Explanation: LR-3 Taichong, PC-6 Neiguan and U-4 Hegu promote qi flow; SP-10 Xuehai, BL-17 Geshu and BL-18 Ganshu activate blood and remove blood stasis; GB-34 Yanglingquan dredges the Shaoyang Meridian and promotes qi flow; 3-4 points surrounding the diseased region promote qi and blood flow in the local region, remove hardness and toxin, and relieve pain. Secondary points according to conditions: 1 Skin lesion appearing on the face and neck -GB-20 Fengchi [-], and SJ-5 Waiguan [-] . II. EXPERIENTIAL TREATMENT 1. Moxibustion with Cotton Indication: Herpes zoster at early or middle stage. Point Prescription: The diseased region. Manipulati on: Cover the diseased region with a thin layer of the cotton, ignite the cotton and let it burn on its own course. Usually, only one treatment is effective to cure this disease. If not, repeat the treatment next day. 2. Moxibustion on EX-B- 10 Herpes Zoster Point Indication: Herpes zoster. Point Prescription: EX-B-10 Herpes Zoster Point, locating on the midline of the back, at the point where the ends of a thread, which is as long as the patient's head circumference, reach when the line circles the neck with its ends at the midline of the back. Manipulation: Place a piece of garlic on the point, and a moxa cone on the garlic, ignite the cone for moxibustion. Usually, only one treatment is effective to cure this disease. If not, repeat the treatment next day. Comment: Zhenjiu is very effective in treatment of herpes zoster, In most case, the disorder can be cured by Zhcnjiu treatment in a short period.

4. Contact Dermatitis Contact dermatitis refers to an acute inflammatory reaction on the skin or mucous membrane through contact of certain substances. Clinically, it is marked by the skin lesion being limited to the contacted parts. According to TCM, contact dermatitis belongs to Qi Chuan (dermatitis rhus), Hua Fen Chuang (poIlen sore), Gao Yao Feng (adhesive plaster dermatitis) and Ma Tong Xiang (contact dermatitis of buttocks). It is caused by attack of toxic pathogen and deficiency of body resistance. I. STANDARD TREATMENT Contact dermatitis is generaIly divided into three types - toxic heat, damp-heat, and blood dryness. Points of the Liver and GaIlbladder Meridians and local points are frequently selected in its treatment. 1. Toxic Heat Manifestations: Red maculae and red populous with burning sensation or pricking pain in the affected region, fever, thirst, scanty and dark urine, constipation. Tongue: Red body with yellow coating. Pulse: Wiry and rapid. Treatment Principle: Clear heat, remove toxin and cool the blood. Point Prescription & Manipulation: Primary points: LR-3 TaichongST-44 NeitingGB-34 YanglingquanLI-11 Quchi SP-10 Xuehai GB-31 Fengshi Explanation: GB-31 Fengshi, LR-3 Taichong and GB-34 Yanglingquan soothe the liver and clear heat; ST-44 Neiting and LI-ll Quchi clear heat and remove toxin; SP-10 Xuehai cools blood and relieves itching. Secondary points according to conditions: 1 High fever - DU-l4 Dazhui [-]; 2 Constipation - SJ-6 Zhigou [-]. 2. Damp-Heat Manifestations: Erythemata, blisters, erosion, exudation and limited edema on the affected region, accompanied by itching, heat sensation and pain, poor appetite, abdominal distention, distressed sensation in the epigastric region. Tongue: Red body with yellow and sticky coating.

Pulse: Soft and rapid. Treatment Principle: Clear dampness and heat. Point Prescription & Manipulation: Primary points: GB-34 Yanglingquan SP-9 Yinlingquan SP-10 Xuehai SP-6 Sanyinjiao LI-11 Quchi Explanation: GB-34 Yanglingquan and LI-ll Quchi clear heat; SP-9 Yinlingquan and SP-6 Sanyinjiao remove dampness; SP-10 Xuehai cools blood and relieves itching. Secondary points according to conditions: 1 Severe itching - GB-35 Fengshi [-]. 3. Blood Dryness Manifestations: Chronic and inflammatory infiltration with brown spots, cracked and lichenoid change on the affected region, local itching. Tongue: Red body with yellow coating. Pulse: Wiry. Treatment Principle: Nourish blood, activate blood circulation, moisten dryness and disperse wind. Point Prescription & Manipulation: Primary points: SP-10 Xuehai + SP-6 Sanyinjiao + ST-36 Zusanli + LI -4 QuchiLR-3 TaichongKl-3 Taixi + Explanation: SP-10 Xuehai and SP-6 Sanyinjiao tonify yin and nourish blood; ST-36 Zusanli promotes production of qi and blood; LI-4 Quchi clears heat from the blood and relieves itching; LR- 3 Taichong clears heat from the liver; KI -3 Taixi generates water and moistens dryness. Secondary points according to conditions: 1 Insomnia and palpitation - HT-7 Shenmen [+]. II. EXPERIENTIAL TREATMENT

1. Cupping on RN-8 Shenque Indication: Contact dermatitis. Point Prescription: RN-8 Shenque Manipulation: Apply cupping with a glass cup until the umbilicus becomes purplish, usually after 5-10 minutes. The treatment may be given once every other day, with four treatments as a course. Precaution: The cupping should be used cautiously on children to avoid protrusion of the umbilicus. 2. Acupuncture and Moxibustion on DU-14 Dazhui Indication: Contact dermatitis. Point Prescription: DU-14 Dazhui Manipulation: Puncture DU-14 Dazhui and manipulate the needle to induce arrival of qi, retain the needle for 30 minutes and apply cupping on the point during the retention of the needle. The treatment is given once dally with five treatments as a course. Comment: Zhenjiu is effective in treatment of contact dermatitis. However, in some severe cases, Zhenjiu is usually is not the first choice. 95. Neurodermatitis Neurodermatitis refers to a chronic skin disease with pruritic inflammation, which is usually induced by mental injury or localized physical irritation. Its cause is uncertain. Clinically, it is marked by lichenoid skin lesions accompanied by paroxysmal itching. In the initial stage, there is localized itching, with dense groups of falciform pimples occurring as the result of extensive scratching, As the condition develops, deep dermatoglyph, dermal ridging, and brown pachyderma appear. According to TCM, neurodermatitis, called Niu Pi Xiang in Chinese, is caused by attack of exogenous pathogens such as wind, dampness and heat, leading to obstruction of flow of qi and blood in the skin, or by deficiency of blood, leading to internal generation of wind and insufficient nourishment of the skin. I. STANDARD TREATMENT Neurodermatitis is generally divided into two types - wind-heat and blood dryness. Points of the Large Intestine, Spleen and. Liver Meridians are frequently selected In Its treatment. 1. Wind-Heat

Manifestations: Paroxysmal itching, reddish crowds of papulae on the skin. Tongue: Red body with thin, yellow coating. Pulse: Wiry and rapid. Treatment Principle: Clear heat, disperse wind, cool blood and stop itching. Point Prescription & Manipulation: Primary points: LI-4 HeguLI-11 Quchi GB-20 Fengcbi SP-10 Xuehai GB-31 Fengshi Explanation: LI-4 Hegu and GB-20 Fengchi dispel wind; Ll-11 Quchi and GB-31 Fengshi clear heat and relieve itching; SP-10 Xuehai cools blood and relieves itching. Secondary points according to conditions: 1 High fever - DU-14 [-]. 2. Blood Dryness Manifestations: Paroxysmal itching, thick, rough and dry skin with fine and broken scurf, irritability, and insomnia. Tongue: Red body with little coating. Pulse: Thready. Treatment Principle: Replenish blood, moisten dryness, calm wind and stop itching. Point Prescription & Manipulation: Primary points: SP-10 Xuehai + SP-6 Sanyinjiao + ST-36 Zusanli + LI-4 Hegu I LR-3 Taichong I PC-6 Neiguan I Explanation: SP-10 Xuehai and SP-6 Sanyinjiao tonify yin, nourish blood and moisten dryness; ST-36 Zusanli promotes production of qi and blood; LI-4 Hegu and LR-3 Taichong calm wind due to blood deficiency to relieve itching; PC-6 Neiguan calms the mind. 'i'

Secondary points according to conditions: 1 Poor memory and palpitation - HT-7 Shenmen [+], EX-HN-I Sishencong [+]; 2 Severe itching - GB-31 Fengshi [-]. II. EXPERIENTIAL TREATMENT 1. Puncturing ST -36 Zusanli , etc. Indication: Neurodermatitis. Point Prescription: ST-36 Zusanli The courses of the Bladder Meridian on the upper back Affected region Manipulation: Firstly, puncture ST-36 Zusanli with middle-degree stimulation, manipulate the needles to induce arrival of qi, and retain the needles for 20 minutes. Then, during the retention, tap the courses of the Bladder Meridian on the upper back and the affected region with a seven star needle until there is slight bleeding. The treatment is given once daily, 10-15 treatments are needed in curing this disease. 2. Acupuncture and Moxibustion on HT-5 Tongli Indication: Prolonged or intractable neurodermatitis. Point Prescription: HT-5 Tongli Affected region Manipulation: Firstly, puncture HT-5 Tongli 1- 1.5 cun deep, with the needle tip towards the midline of the forearm, perform the needles with reducing manipulation, and remove the needles without retention. Secondly, tap the affected skin from its border gradually to center, making slight bleeding. Lastly, apply moxibustion with moxa stick on the affected skin from its border to center gradually until the patient can not stand, usually for 20-50 minutes. The treatment is given twice per week. Usually, 5-20 treatments are needed for cure this disease. 3. Ear Acupuncture Indication: Neurodermatitis. Ear Point Prescription: Lung, Liver, Endocrine, Adrenal Gland, Wind Stream, Heart, Shenmen, Occiput, Subcortex and Apex of Ear. Manipulation: See-page 255-256. Comment: Acupuncture is effective to relieve itching and other symptoms of the neurodermatitis. In some cases, their neurodermatitis can be cured by acupuncture treatment. But

neurodermatitis is an obstinate disease. Usually.jrecent result may be good, but late result may be not satisfactory because it is easy to reoccur. Therefore, a long-term treatment course is often .needed in its treatment. Mental factors affect this disease strongly. Usually, such poor mental conditions as emotional depression, grief, or irritability aggravates the patient's symptoms and signs. Thus, a doctor should let the patient know it and try to avoid or overcome poor emotional state.

6. Cutaneous Pruritis Cutaneous pruritis refers to a kind of dermatosis which has a sensation of selfconscious itching on the affected part, which may occur secondary to various diseases such as endocrine dysfunction, parasitosis, diabetes mellitus, hepatic illness, nephritic disorders, or tumors. According to TCM, cutaneous pruritis belongs to Yang Feng (itching due to wind), and it is caused by dryness due to blood deficiency leading to failure of the skin in nourishment, attack by exogenous wind pathogen, or stagnation of heat in the blood leading to internal production of wind. I. STANDARD TREATMENT Cutaneous pruritis is usually divided into three types - wind-dryness due to blood deficiency, wind-dryness due to heat in the blood, and accumulation of damp-heat. Points of the Spleen, Stomach and Large Intestine Meridians are frequently selected. 1. Wind-Dryness due to Blood Deficiency Manifestations: Paroxysmal itching on the affected part of the skin which becomes worse in the night, dry skin, atrophic, thick and lichenoid skin lesion. Tongue: Pale body. Pulse: Thready. Treatment Principle: Nourish blood, moisten the dryness, dispel wind and arrest itching. Point Prescription & Manipulation: Primary points: SP-10 Xuehai + SP-6 Sanyinjiao + GB-20 Fengchi + SP-9 Yinlingquan + ST-36 Zusanli + Explanation: SP-10 Xuehai nourishes blood and promotes blood flow; SP-6 Sanyinjiao and SP-9 Yinlingquan reinforce the spleen , nourish blood and moisten dryness; GB-20 Fengchi dispels wind and relieves itching; ST-36 Zusanli reinforces the middle-Fao to promote production of qi and blood. Secondary points according to conditions: 1 Extreme itching - HT-7 Shenmen [+]; 2 Poor memory and palpitation - DU-20 Baihui [+] and HT-7 Shenmen [+]. 2. Wind-Dryness due to Heat in Blood Manifestations: Severe itching and burning sensation of the affected skin which are aggravated by heat, thirst, dark urination.

Tongue: Red body with yellow coating. Pulse: Rapid. Treatment Principle: Clear heat, cool the blood, dispel wind and arrest itching. Point Prescription & Manipulation: Primary points: GB-20 Fengchi SP-10 Xuehai Ll-11 Quchi DU-14 Dazhui SP-6 Sanyinjiao LI-4 HeguExplanation: LI-4 Hegu and GB-20 Fengchi dispel wind and relieve itching; SP-10 Xuehai, LI-Il Quchi and DU-14 Dazhui clear heat from the blood; SP-6 Sanyinjiao nourishes yin and moistens dryness. Secondary points according to conditions: 1Severe itching - HT-7 Shenmen [-] and PC-6 Nciguan [-]. 3. Accumulation of Damp-Heat Manifestations: Itching, swelling, redness and exudation in the external pudendum, bitter taste in the mouth. Tongue: Red body with yellow and sticky coating. Pulse: Slippery. Treatment Principle: Clear heat, promote diuresis and arrest itching. Point Prescription & Manipulation: Primary points: SP-9 Yinlingquan SP-6 Sanyinjiao LR-5 LigouLI-11 Quchi ST-40 FenglongLR-2 Xingjiao RN-10 XiawanExplanation: SP-9 Yinlingquan and SP-6 Sanyinjiao remove dampness; LR-2 Xingjian, LR-5 Ligou and Ll-11 Quchi clear heat; ST-40 Fenglong transforms phlegm and relieves itching; RN-10 Xiawan regulates the middle-jiao and removes dampness.

Secondary points according to conditions: 1Constipation - SJ-5 Zhigou [-J. II. EXPERIENTIAL TREATMENT 1. Puncturing SP-10 Xuehai Indication: General cutaneous pruritis. Point Prescription: SP-10 Xuehai Manipulation: Insert a needle into the point until the operator feels a tight, heavy and difficult sensation in the area around the needle tip. Perform reinforcing manipulation by slow- rapid insertion and lifting to patients belonging in deficiency category, and use reducing manipulation by slow-rapid insertion and lifting to the cases with excessive syndrome. Retain the needle for 20-40 minutes. The treatment is given once daily, with 10 treatments as a course. 2. Puncturing EX-UE-14 Xiadu Indication: General cutaneous pruritis. Point Prescription: EX-UE-14 Xiadu of the diseased side, on the dorsum of the hand, between the 4th and 5th metacarpal bones, and proximal to the joint of the metacarP9phalangeal joint. Manipulation: Insert a needle into the point along the space of the carpal bones 0.51 cun deep, rotate the needle to induce arrival of qi, retain the needle for 20-40 minutes, and manipulate it every 10 minutes. If the patient still feels itching during the retention of the needle, puncture the opposite Xiadu EX-UE-14 with the same manipulation additionally. The treatment is given once daily, with 10 treatments as a course. 3. Ear Acupuncture Indication: General cutaneous pruritis. Ear Point Prescription: The point corresponding to the diseased region, Lung, Spleen, Liver, Heart, Shenmen, Subcortex, Middle Ear and Apex. Manipulation: See page 255-256. Comment: Acupuncture is effective to relieve itching and other symptoms of cutaneous pruritis. In some cases, it can be cured by acupuncture treatment.

7. Acne Vulgaris
Acne vulgaris is a chronic inflammation of hair follicle and sebaceous glands which is a common problem of adolescence. It is' mainly caused by hormonal disturbances, improper diet and chronic constipation. Clinically, it is marked by papulae, nodules and acne on the face . According to TCM, acne vulgaris belongs to the categories of Fei Feng Fen Ci (acne due to attack of the lung by wind), or Fen Ci (acne). It is caused by exogenous wind-heat invading the lung or by indulgence in spicy or greasy food, resulting in accumulation of heat in the stomach and intestines. 1. STANDARD TREATMENT Acne vulgaris is generally divided into three types-heat in blood, accumulation of phlegm, and toxic heat. Points of the Large Intestine, Lung and Stomach Meridians are frequently selected in its treatment. 1. Heat in Blood Manifestations: Red papules, tubercles, acne and inflammatory infiltration around them on the face. Tongue: Red body with thin and yellow coating. Pulse: Smooth and rapid. Treatment Principle: Clear heat and cool blood. Point Prescription & Manipulation: Primary points: SP-10 Xuehai SP-6 Sanyinjiao LI-4 HeguST-44 Neiting LI-11 Quchi LR-3 TaichongExplanation: SP-10 Xuehai and SP-6 Sanyinjiao nourish yin and cool blood; LI-4 Hegu, ST-44 Neiting and LI-11 Quchi clear heat from the Yangming Meridians which distribute on the face; LR-3 Taichong clears heat from the liver and cools blood. Secondary points according to conditions: 1Severe or chronic cases - BL-40 Weizhong and DU-IO Lintai are punctured with reducing manipulation and the area around the needle holes are squeezed to let out several drops of blood immediately after removing the needles; 2 Bitter taste in the mouth GB-34 Yanglingquan [-]. 2. Accumulation of Phlegm Manifestations: Acne, indurative acne or cystic acne on the face.

Tongue: White and sticky coating. Pulse: Smooth. Treatment Principle: Transform phlegm, resolve masses. Point Prescription & Manipulation: Primary points: LI-4 HeguST -40 Fenglong SP-6 Sanyinjiao / RN-12 Zhongwan / ST-36 Zusanli + Explanation: LI-4 Hegu promotes circulation of qi of the Yangming Meridian and resolves masses on the face; ST -40 Fenglong transforms phlegm and resolves nodules; SP-6 Sanyinjiao, RN-12 Zhongwan and ST-36 Zusanli reinforce the spleen, regulate stomach, and transform phlegm. Secondary points according to conditions: 1 Obesity-SP-9 Yiniingquan [-] and ST-25 Tianshu [-]; 2 Constipation-SJ-5 Zhigou [-]. 3. Toxic Heat Manifestations: Facial malar flush, scattered inflammatory nodules, acne, abscesses and furuncles on the face, thirst, bitter taste in the mouth, scanty urine, constipation. Tongue: Red body with yellow coating. Pulse: Smooth and rapid. Treatment Principle: Clear heat, cool blood, detoxify poison and resolve nodules. Point Prescription & Manipulation: Primary points: SP-10 Xuehai ST-44 NeitingLI-4 HeguGB-34 Yanglingquan LR-2 Xingjian ST-40 Fenglong Explanation: SP-10 Xuehai cools blood and resolves blood stasis; ST-44 Neiting reduces fire. and detoxifies poison; LI-4 Hegu clears heat from the Yangming Meridian, which distributes on the face;

GB-34 Yanglingquan and LR-2 Xingjian clear heat from the liver and gallbladder and detoxify poison; ST-40 Fenglong transforms phlegm and resolves nodules.

Secondary points according to conditions: 1 Severe or chronic cases-BL-40 Weizhong and DU-tO Lintai are punctured with reducing manipulation and the area around the needle holes are squeezed to let out several drops of blood immediately after removing the needles; 2 Constipation-SJ-5 Zhigou [-]. II. EXPERIENTIAL TREATMENT 1. Breaking the Reaction Points Indication: Acne vulgaris. Point Prescription: The reaction points on the back. Like rushes, they are 2-4 rom in diameter, usually with dark-yellow, green-dark-yellow, reddish, or white color. Their distribution lies over the region from 0.5 cun lateral to the spinal column to 3 cun lateral to the spinal column and from the first to the 12th thoracic vertebra. Manipulation: Ask the patient to sit down in a chair and to expose his/her back as much as possible. Rub the bilateral sides of the spinal column with the palm several times and look for the reaction spots. Then, fix the skin around the spot with the thumb and index finger of one hand, hold the three-edged needle with the other hand, quickly prick arid break the skin of the spot at an angle of 15-30 degrees that is formed between the needle and skin. Continuing, insert the needle deeply into the subcutaneous tissue, make the needle shaft tilt and then gently move it upward to break some of fibrous tissues. Squeeze the local skin to make a little bleeding. Finally, cover the operated region with sterilized cotton and fix the cotton on the skin. Each time 1.2 reaction spots can be broken and the next operation may be done 5-7 days later. Usually 3- 8 treatments are needed for curing this disorder. 2. Puncture and Cupping on DU14 Dazhul Indication: Acne vulgaris. Point Prescription: DU-14 Dazhui Manipulation: Ask the patient to sit down on a chair to expose his/her DU-14 Dazhui region fully. Puncture DU-14 Dazhui with the needle tip obliquely downward, manipulate it to induce needling sensation, and retain the needle for 40 minutes Then, apply cupping on the point during the retention for 20-30 minutes. The treatment is given once daily, with 10 treatments as a course. Usually 1-3 courses are needed. 3. Ear Acupuncture Indication: Acne vulgaris.

Ear Point Prescription: Lung, Stomach, Large Intestine, Endocrine, Midpoint of Rim, Adrenal Gland and Apex of Ear. Manipulation: See page 255-256. Comment: Acupuncture is effective in treatment of acne vulgaris and in some cases can cure it. During treatment, the patient should be advised to keep the bowel movement regular to prevent constipation.