By Shmuel Halevi Ph.D.
David, age 55, a mechanical engineer by profession, is an old and close
friend of mine. Our friendship began some 10 years ago when he called upon me to treat his
nine year old daughter. She was hospitalized then for severe stomachache of unknown
aetiology, from which she was suffering intermittently for a long time. I treated her with
acupuncture and ever since she remained healthy. Another outcome of that treatment was our
two families' friendship and my appointment as their family doctor from that day on...
several occasions during the past ten years I also treated David himself. He was
complaining of rather acute pressure behind both his eyes, and was diagnosed as having
glaucoma. Before getting acquainted with Chinese medicine David took conventional remedies
for his glaucoma. Despite that, the problem only seemed to worsen in the long run, but the
medications had nevertheless some symptomatic benefit.
When I started to treat David for his glaucoma it was clear to me that it was related
to a liver imbalance as the main pattern of disharmony. David had a wiry strong quality on
his liver pulse (left hand middle position, deep level), and somewhat soggy floating
quality to his lung pulse (right Cun position). He also had a red lean tongue, with a
pointed redder tip. Both his inner eyelids were very red, and his sclera gave the
impression of being blood shot.
To give a more detailed description of David's whole picture, one would probably be
surprised not to find any liver Qi stagnation personality characteristics. David is hardly
ever angry, nervous or depressed. On the contrary, he is a sworn optimist and an energetic
and cheerful man. He is a red haired, freckled faced of middle build man, very intelligent
and learned. David is a great expert in wines, and is very fond of the gastronomic arts,
especially French cuisine. Oh, yes, and he develops occasional cancerous skin growths,
resembling small warts, mainly on his face and head. These are removed when necessary by
surgery. These growths usually appear after an exposure to direct sunlight, which David
can not stand anyway.
Thus, configuring and weighing all these findings, I made up my mind that the primary
imbalance in my friend's case was a heated liver. Liver Yang which ascends to his eyes,
reddening his sclera and the flesh inside his eyelids, causing a heat stagnation there -
resulting in glaucoma. The cause for this imbalance, as I explained to my bewildered
friend, was an inherited tendency, which was activated by his behavior. His fondness for
quaffing, the rich meals, coffee drinking, his demanding job, all these, I put forward to
him, have contributed during the years to his condition. Being a general-manager of a big
industrial plant, responsible for many employees, had had an impact too on his nervous
system, accelerating at times the liver Yang mechanism which affected his eyes. Being of
an internal heat pattern of imbalanced energy, David couldn't bear the direct heat of the
sun which aggravated his skin condition and his eye pressure. Speaking of his skin
condition, I concluded that here was a case of an insult to the lung system by the liver.
The lungs have the role of the liver controller on the KO cycle of the 5 elements law.
Metal controls wood. When wood is overactive and creating an ascending heat as in this
case, metal is no longer able to restrain it and gets weaker. We say then that wood has
insulted the metal element. An outcome of this phenomenon in this case, is a skin
hypersensitivity to heat, producing on its extreme a skin cancer. The skin, we are told in
Chinese physiology, is an organ related to the lung system.
This pathology was evidenced by David's pulse which was soggy and floating on his right
Cun position, as was described previously. To summarize this in a diagram, here is an
outline of David's condition when I treated him for his glaucoma.
The treatment, which was carried out some five years ago, consisted mainly of points
such as: G-20 feng chi, tai yang (extra) and Liv-2 xing jian. Puncturing point G-20 feng
chi would usually result in immediate release of pressure behind David's eyes, giving him
a sensation, as he had put it rather picturesquely, of a deflated tire... After some ten
treatments the glaucoma resolved, and David did not need any more treatments for this. At
the time I did not address at all the skin/lung pathology, nor did I try too hard to
balance the pulse equilibrium. I merely suggested to David some way-of-life modifications
in order to check his liver and not aggravate the skin condition. I suppose that the
limitation on was because I refused any payments for my treatments, and David did not like
the idea to be treated on a prolonged basis without paying. One way or the other, when
David came to my clinic again five years later (which is a few months ago), I had a sense
that the current incident could have been avoided had I treated him more thoroughly last
This time David presented himself with a hoarseness to the degree that he could be
barely heard at all. This had been going on for a few weeks already, getting worse all the
time. A visit to an E.N.T specialist a few days earlier, established a diagnosis of two
small tumors on the vocal cords. This was confirmed later by another examination, which
was followed by an appointment for surgery. At that time David called me, whispering
hoarsely through the phone the whole story, asking for my advice.
The next day, when David came to see me, he revealed the following story. Approximately
one month ago he caught a severe cold with sore throat, cough and fever. This seemed to be
a little stubborn and he had to travel abroad. He then took a course of antibiotics
following the advice of his GP, and then traveled abroad to the USA. In the USA his
condition worsened, and upon returning to Israel he had already lost his voice. Examining
David I took note of the following facts:
Besides being hoarse to the degree of almost muteness, David was constantly trying to
clear his throat, coughing up sputum and making strange noises while doing so.
He felt as if something was stuck inside his throat, which he was unable to swallow or
He felt constantly as if he had the flu, weak, tired and perspiring very easily. He
also had a dull ache inside his left ear.
His pulse felt much the same as I remembered from the past, only the lung pulse quality
was harder on the most superficial level, and soggier on the deeper level. The liver pulse
quality remained wiry.
His tongue also did not change significantly, except that it had now a yellowish,
filmy, damp coating.
L-1 zhong fu on the right side as well as Liv-14 qi men on the right were both quite
Being familiar with David's energetic imbalances from the past, I took into account the
possibility of plum-seed in the throat pathology as the core problem here (1).
This "plum-seed" phenomenon is a prevalent pattern, in which people have a
sensation of something stuck in their throat. This pathology is, in most cases, attributed
to liver Qi stagnation affecting the throat, through where the liver inner branch ascends
to the eyes and head. A stagnation (mostly of heat or Yang-Qi) in this route, combined
with accumulation of phlegm, may give rise to this plum-seed sensation. In our case, the
combination of excess liver Yang-Qi ascending through the throat, plus an external attack
of Wind and Damp, caused the formation of these two small tumors in the vocal cords canal.
The pre-existing lung Qi deficiency, which was described previously, was a contributing
factor to this pathology. Also the lung internal meridian ascends to the throat (before
descending to the lung organ), having the vocal cords resonating to the relative strength
and amplitude of lung Qi. (2)
Taking antibiotics in this case, for that was probably only a viral infection, had its
own role in lowering the body resistance mechanism - the Wei Qi. Wei Qi is an important
component of lung Qi, and being depressed caused another insult to lung Qi, thus
contributing to building up the stagnation in the vocal canal.
SUMMARY OF CLINICAL MANIFESTATIONS
Severe hoarseness, almost unable to speak at all.
Weakness and tiredness, as if having the flu.
A plum-seed sensation in the throat.
Constantly trying to clear his throat.
A damp and phlegmy cough.
A dull ache inside the left ear.
A wiry strong liver pulse, and a soggy, superficially harder, floating lung pulse.
A thin red tongue, even a little redder on its tip, with a filmy, wet, yellowish coating.
Tender right side liver and lung Mu points.
A history of glaucoma caused by a liver Qi pathology, which had been resolved by
acupuncture some five years ago.
Occasional small cancerous skin warts on the upper parts of the body. Mainly aggravated by
direct exposure to the sun.
THE TREATMENT PLAN
In my experience, even diseases that have already formed anatomic, or tissue changes,
such as tumors, cysts, warts and the like, and that are of a relative short duration, may
respond favorably, in many instances, to acupuncture. I told David so and suggested that
we commence right away with the treatment. My plan was to work from the outside in. I
wanted to get rid as quickly as possible of the external symptoms, and only then
concentrate my efforts on reestablishing a proper circulation in the throat. The points'
prescription for the first phase was therefore as follows:
Li-4 hegu, Li-11 quchi and Du-14 dazhui - as a combination to clear external pathogenic
Wind and Damp from the face and head regions, to facilitate Qi flow and promote sweating.
Du-16 fengfu, B-12 fengmen, B-58 feiyang. This combination was used in conjunction with
the previous one, in order to strengthen the action of dispelling the Wind systemically.
The addition of B-58 feiyang has the effect of lowering an excessive upward moving of Yang
The patient lay prone during this treatment procedure, and all the needles were
manipulated in dispersion. I used a strong thrust right to the appropriate depth, followed
by relatively quick, gentle withdrawals of a few millimeters at a time to the superficial
level, and so forth.
After some ten minutes the needles on the back were substituted with cupping for
fifteen more minutes - to conclude the treatment. This precise treatment was carried out
twice, in two consecutive sessions, after which all the flu symptoms were virtually gone.
David felt much stronger on the third day and resumed his optimism.
The next phase of the treatment was aimed directly at the hoarseness and the tumors.
For this I have formulated these combinations:
L-10 yuji, Li-18 futu, K-3 taixi. L-10 yuji is indicated especially for hoarseness,
loss of voice and obstructions in the throat. It is a lung channel Fire point, and has the
ability of cooling heat obstructions in the route of this meridian.
Li-18 futu was combined with L-10 yuji as a local point which belongs to the lung
coupled meridian, the large-intestine. This point is capable of transforming phlegm in the
throat, and of facilitating lung Qi. Among its indications are hoarseness and:
"sounds in throat like a duck..."(3). (These duck-like sounds were quite
descriptive of the queer sounds David had been performing while trying to clear his
K-3 taixi was chosen for its role as a major tonifying point, being able to assist both
in subduing liver Yang, as well as in grasping lung Qi and facilitating its flow. Besides
that it has a specific indication for clearing throat blockages.
These points too were reduced except for K-3 taixi which was mildly tonified. The
tonification here was applied by pricking the point and gently maneuvering it, until a
slight radiation started to propagate upward the medial calf. Li-18 futu was reduced in
several directions after obtaining Qi, and then redirected medially towards the Adam's
apple on both sides.
The second combination utilized these points:
Liv-5 ligou and Ren-22 tiantu. Liv-5 ligou is the luo point of the liver channel, and
among other tasks it deals specifically with the phenomenon of plum-seed sensation in the
throat. (JCM No.19 p. 18). It spreads liver Qi and facilitates its flow in the meridian.
Ren-22 tiantu is indicated for diseases of the vocal cords, it transforms phlegm and
facilitates the flow of lung Qi in the throat.
These two points together enhance Qi flow in both of the meridians involved, while
exerting a strong effect specifically on the diseased area. Liv-5 ligou was manipulated in
dispersal, producing an upward Qi sensation along the tibia. Ren-22 tiantu was punctured
obliquely until a Qi sensation was achieved through the entire throat, climbing
distinctively and reaching both ears.
These two combinations were used together in each treatment, in the order of the
listing of the points. They were used over a span of four weeks, three sessions per week.
In the course of the first week I also had to address the problem in David's left ear.
This was done by puncturing locally of G-2 tinghui, and distally of G-43 xiaxi, both on
the left side only. These two points were inserted, manipulated and withdrawn immediately.
Twice was sufficient to eliminate the ear problem.
Starting from the fifth treatment David's voice started to clear up. It had its ups and
downs during the treatment process, but with a definite improvement tendency. David was
instructed not to eat Damp producing foods such as dairy products, fruit, too sweet or
salty intakes, and the like. He was also asked not to strain his voice, and to speak as
little as possible.
At the end of these four weeks David's voice came back to approximately 90% normal.
There were times when his voice seemed completely clear, but at other times, especially
when he was tired or upset, he got hoarse again. His pulse at this stage was less wiry on
his liver Guan position, and less soggy on the Cun lung position on thr other hand. This
time, I said to myself, I was going to straighten this out and harmonize the pulse for the
sake of David's health in the future.
Occasionally, when I confront in my practice stubborn pulse patterns such as this one,
I resort to a five-element needling technique which I find immensely helpful to correct
pulse abnormalities (4). By this technique, one must define which are the excessive and
deficient elements, and their relation to each other in the Sheng, or Ko, or the
superficial flow of energy cycles. In David's case, as mentioned previously, his Wood
element was in excess, while the lung-Metal element was deficient. This pattern presented
itself in two planes. First, in the Ko cycle the Metal element was insulted by the
excessive Wood, being thus unable to exert its controlling effect. The second was the
superficial flow of energy, by which the excessive liver channel was unable to pass its
free flowing Qi onto the lung channel which succeeds it.
In order to correct this imbalance I punctured Liv-4 zhongfeng - the Metal point of the
liver channel - in sedation, and then the luo-connecting point of its coupled meridian
G-37 guangming. This was done in order to open the hinge for the excessive Wood energy to
flow into the Metal phase. Right after that I punctured both L-11 shaoshang, the Wood
point of the Metal meridian, along with L-9 taiyuan, the source point of the lung. To
complete the procedure, Liv-14 qimen, the exit point of the liver channel, was reduced
only on the right side, while L-1 zhongfu, the entry point of the lung channel, was
supplemented on the right side. The reader may recall that these two points, being also
the Mu points of both channels respectively, were found tender when David came for the
first treatment. This was the reason why I chose to treat them only on the right side.
This new prescription had a dramatic effect both on David's pulse quality, as well as
on his disease. After three treatments during nine days, David's pulse was in excellent
equilibrium, and the remains of his hoarseness were gone completely.
A month or so later David found time to go again to the E.N.T specialist, complying
with my request. Both of the small tumors could not be found at this time.
JCM No. 15 p. 17 "The Differentiation of Syndromes According to Zang Fu -
JCM No. 31 P. 17 "A Discussion on the Relationship Between the Lungs and
All the points' actions were drawn from these sources:
A - Acupuncture - A Comprehensive Text, by the Shanghai College of Traditional
B - Acupuncture Points Images and Functions by Arnie Lade, 1992.
Wu Wei P'ing, Taipei, personal communications.
the author: Shmuel Halevi Ph.D.
Shmuel Halevi Ph.D. has practiced Chinese medicine in Israel since 1980.
He studied Chinese medicine in the U.S.A and in Taiwan, and obtained his Ph.D. degree in the U.S.A.
Shmuel has written many articles concerning Chinese medicine, in the past 20 years. Most of his articles have been published in the Journal of Chinese Medicine in England. He has also contributed a case-study article to the book: "Acupuncture In Practice " (Case history insights from the west - compiled by Ted Kaptchuk and Hugh MacPherson, Churchill Livingstone 1997).
Shmuel is the author of the book: Chopsticks Acupuncture (Trafford Publishing, B.C. Canada Jan. 2003). In this book he presents a totally new self-treatment technique by chopsticks, devised especially for the lay person.
For more details please visit: http://www.acumedico.com
Shmuel Halevi Ph.D.
Expert of Chinese Medicine
P.O.Box 159 Kfar Veradim