A Manual of Acupuncture (Second edition)

Since its publication in 1998, The Manual of Acupuncture's comprehensive text has rapidly become the standard acupuncture point book for students and practitioners throughout the English-speaking world. Detailed exposition of the names, locations, indications and actions of every point, it is characterised by hundreds of beautiful and anatomically exacting illustrations (one for every point), lengthy commentaries on the points, numerous point combinations drawn from classical texts and comprehensive indexes.

"The most scholarly, complete and detailed book on points to date; a must for any student and practitioner. The definitive and most authoritative book on points in the English language".
Giovanni Maciocia

"Finally! It's about time this book was published! For 25 years I've been dancing among French, English, American and Anglo-Chinese compilations of the functions and indications of the points. No single source, nor combination of sources, can match the thoroughness of A Manual of Acupuncture. My teaching has suddenly been made easier".
Joseph Helms, MD, Founding President, American Academo of Medical Acupuncture

If Chinese medicine is a treasure house, this book is a large treasure chest overflowing with glittering jewels. The clarity of the illustrations is particularly striking. Authoritative, thoroughly researched, and filled with detailed information of great clinical value, this is a 'must-have' book for students and practitioners alike".
Richard Blackwell, Academic Dean, Northern College of Acupuncture, York, England

"The scope and depth of this book, together with its truly wonderful illustrations, make it a 'must have' for any student or practitioner who is serious about the study of acupuncture".
Dan Bensky

"This is truly a well produced, thoughtfully prepared and exhaustively researched book. There is something for everyone. For the student and teacher it is an invaluable aid to learning; for the scholar and the practitioner it will be the work of reference. All will be excited and pleased by the level of excellence achieved by the authors".
Geoff Wadlow, President of The London School of Acupuncture & TCM

"We are deeply impressed by this absolutely outstanding work".

Verlag fuer Ganzheitliche Medizin "I love your book. It has everything a College Principal would want in recommending a text. For students it will become their ultimate reference manual that will last them their working lives. Your new book really is an outstanding contribution to the field of Chinese medicine. Its level of scholarship is exceptionally high with very full referencing of sources. It is a fantastic book".
Hugh MacPherson, Principal Northern College of Acupuncture, York, England

"My first choice as an instructional text for channels and points".
Paul Karsten, Seattle Institute of Oriental Medicine

"This is an indispensible book for any acupuncturist's library and clinic, an incredible source of knowledge, user-friendly, clear and free from obscurity. From student to practitioner to teacher, this is a book to grow with".
Dr. Reuven Barak, Israel

The book is essentially a description of each and every one of the 360 or so primary acupuncture points of Traditional Chinese Medicine. There is a good bit of material about methodology of point selection, but the real gem of this book is the intelligent and thorough descriptions of the points, their properties, and how to locate and needle them. The reason that I gave the book five stars is that it is far more complete and logical in its point descriptions than any of the Chinese texts used by my acupuncturist, a Chinese chiropractor who was a medical doctor Shanghai for eight years before coming to the US and becoming a chiropractor. Often when a discipline is translated from one language and culture to another, the highly systematized translation is more complete and sensible than the eclectic literature corpus upon which it is based. Those who devised this book have created a phenomenally comprehensive synthesis of over 3,000 years of Chinese medical tradition. They have taken on a monumental task and succeeded brilliantly. The quality of this reference is so high that I would even recommend it to practitioners from the orient who are coming to the US or other English-speaking countries to start a practice. First, it will it help them learn the English vocabulary of acupuncture jargon and help them understand our butchered pronunciations of the many Chinese words in an English acupuncturist's vocabulary. Second, they will be able to better communicate their activities to their patients. Finally, the book is as high a quality reference as anything they will have brought with them from Asia.
Jonathan Bailey (posted on Amazon)

Students of TCM, don't let the price tag intimidate you, and let me assure you that it is worth every penny. This hefty and handsome volume leaves nothing unsaid, and meticulously provides detailed information, plenty of informative quotes from a wealth of classical sources, and is a joy to handle, browse, and read from. Of particular interest and value are the sections which describe the special point groupings, because they not only provide the lists of points which belong to these categories, but also systematized and coherent explanations behind the workings of cleft-xi, yuan-source, luo-connecting, and many other point categories. Also of great value are the commentaries pertaining to each individual point, because they describe relationships and important pointers regarding the workings of each individual point, how their use and indications developed through history, and other tidbits of information which will open new avenues of investigation and application for astute students and practitioners. The commentaries on the points provide not only information, but are written in a lucid prose, the style of which aids memorization and learning of important information.

The point location information is accurate, albeit in a few cases too brief, in my opinion. The illustrations are very detailed and actually useful (unlike in other texts) in locating the points. The notes and cautions on needling of points in sensitive areas are placed where they are readily visible, and provide information on the local anatomy of the point, and what the consequences of inappropriate insertion could be.

There are charts which show major points per anatomical region (which are actually legible and understandable), and indexes aplenty: pinyin and chinese point names, english point names, and a particularly interesting point indications index. There is also a Glossary of the Wisemanese-seeming terminology used by the authors, which although similar to that of A Practical Dictionary, is not exactly the same.

Should you buy this book? ABSOLUTELY!!! You will never need another acupoint book, EVER. There is a companion set of Point cards by the same authors, which uses the same illustrations and a summary of point information based on the contents of the book. One word of advice, though: if it stays standing on the shelf for too long, the pages tend to sag. However, given the amount of use this book has, that's unlikely to happen.
Cintain (posted on Amazon)

Deadman and colleagues should be commended for this major contribution to the English-language literature of Chinese medicine. It does what it does exceedingly well. It does so, in part, because of what it is not.

It should be understood that the Manual is chiefly an atlas and desk reference of acupuncture points and channels, not a classroom textbook or a clinic handbook or a self-study guide per se, though it does list some illustrative combinations with each point. Other books are available that fill the role of textbook better than this one does. This one's audience is the person who already knows something of the foundations and clinical applications of acupuncture.

The manual is not encyclopedic when compared with the larger Chinese-language works of acupuncture, but it does draw on them in a concise and informative way that conveys the character, historic application and contemporary application of each point, using carefully selected information from a wide range of primary sources. Accordingly, it could be viewed more as a work of editorship than of creativity, and in a reference work of this sort, that is exactly what is desired.

It often goes unmentioned, but Deadman is zealous in his ongoing support of his publications. Errata and updates are available, for free, from his web site. The Manual is also available in CD-ROM format, and Deadman has even produced flashcards based on the substance of the Manual.

The illustrations are in fact of excellent quality, some of the best ever in a book of this sort. Pair the illustrations with the detailed treatment of point location and application, great typography, durable construction, and well-chosen excerpts from primary sources ranging from ancient to modern, and you have an acupuncture reference you can use to deepen your knowledge for years to come.
Jeffrey Chapman (posted on Amazon)

The Manual of Acupuncture by Deadman is the ULTIMATE Acupuncture Book that is a necessity for every acupuncture student and practitioner. With 670 illustrated pages, this book is worth every penny. The newest version of this book is also tabbed by channels - so it is much easier to find information.

While I was a student, I didn't always carry this book with me because it was so big. However, I did photocopy the anatomical point charts and indications lists from the back of the book to aid my clinical point selections.

Now as a practitioner (this booked definitely helped me pass NCCAOM exams), I refer to this book often to take my acupoint knowledge to the next level and to provide more comprehensive treatment plans.

Buy this book now! If you are a TCM student, I also highly recommend the companion FLASH CARDS by Deadman. They make it easy to study acupuncture points with a location/illustration on one side of the card and actions/indications on the other.
Dr. Julie Gorman (posted on Amazon)

How very much easier it would have been studying Chinese medicine twenty years ago had I had access to texts of the calibre of A Manual of Acupuncture. Thanks to an extremely lucid and accessible layout, locating any meridian pathway or point is straightforward and, unlike some of the previous English language acupuncture texts, this manual describes uses and combinations of points which are based on reputable and classical sources. Added to this are extensive commentaries on the clinical uses and history of each point - particularly interesting based as they are on not only ancient and modern texts but also the experience of the authors themselves (spanning some several decades amongst them) in acupuncture clinics in the West. The authors of A Manual of Acupuncture have demonstrated a high level of scholarship, integrity and thoroughness in their task of collating a huge wealth of information from many sources and have produced a superb text that describes all the meridian pathways, all the acupuncture points and nearly all the [possible ways they can be used and the reasons why.
Jane Lyttleton, Australia

A reviewer should declare his bias at the outset. My heart was won as soon as I read the introduction to A Manual of Acupuncture, which states "with a tradition as lengthy and unique as that of Chinese medicine, it is important first to establish what the tradition actually is, so as to innovate with care and respect". There is no doubt that we in the West are heroic innovators, but surely this should be based on thorough understanding of the fundamental tradition before we begin tinkering.

Well, here is the most complete rendering of the fundamental tradition of Chinese acupuncture point information that I have yet seen in English.A Manual of Acupuncture will certainly become the standard textbook for acupuncture in the Western world, since its comprehensiveness and lucidity beg for translation into the other major European languages. Unlike many textbooks, however, it will not be discarded after exams, for it is also an encyclopaedic reference on channels and points that will be utilised throughout the practising life of the graduate.

Although much of the information is available in Chinese, nowhere is it compiled, collated and as easily retrieved as in this volume, and the discussion of each point function under the 'Commentary' sections are excellent, and can be found nowhere else.

This commentary section is perhaps the most unique aspect to the book, each well-thought out and illuminating, reflecting what a well-educated Chinese specialist in acupuncture may have achieved in the understanding of each point, but only after many years of comparative study of the Classics. Yet here it is, all presented for us, in total, in one spot! Very hard to come by.

The point cards are wonderfully useful, primarily due to their portability. I had a Chinese set during my early studies in Taiwan that eventually became dog-eared through continual residence in, and draggings-forth-from, various pockets. Whether learning the points for the first time, or going over the set to renew old but forgotten acquaintances, the addition of these point cards is a tremendous contribution to acupuncture learning in English.

My only reservations were unworthily selfish. While looking over the very comprehensive contents, I suddenly had a sinking feeling. Horrors! Here were acupuncture point-selection methods I thought were well locked up in my Chinese 'secrets' box, all paraded in naked English for anyone to read! Now my only chance is to improve my needling skills!

The only thing we need now to round out the acupuncture curriculum is a text of equal quality setting forth the extensive literature on acupuncture needling techniques. Gosh, are we never satisfied?
Steve Clavey

The publication ofA Manual of Acupuncture is a major event. We have here at last an in-depth, comprehensive and thoroughly researched English-language text on the locations, actions and indications of the points. I confidently predict that this book will rapidly join the small number of well used books which can be found on the shelves of any serious English- speaking practitioner of Chinese medicine, such as Maciocia'sFoundations of Chinese Medicine and Bensky and Gamble'sFormulas and Strategies.

A Manual of Acupuncture is worthy of such status because of the remarkable wealth of information it contains. This is clearly the result of years of in-depth research into both classical and modern literature, and this is borne out by an examination of the bibliography which includes 68 classical texts and 56 modern texts. These labours have resulted in a huge and remarkably comprehensive piece of work. We are treated for example to four pages of detail on ST-36, a page and a half on DU-4, and even a relatively minor point such as SI-7 merits more than a page of detail.

Accompanying the text are a huge number of remarkably clear illustrations. There is at least one illustration for every point, and some points have as many as three illustrations showing the bony anatomy, the bones plus tendons and muscles, and then the surface anatomy. The crisp and carefully drawn diagrams of the channels are pleasing to the eye and have just the right amount of detail. The illustrations of both points and channels are the best I have seen anywhere. As an additional visual treat, the names of every point and all the channels are accompanied by the Chinese characters in lovely calligraphy.

The book starts with chapters discussing channel theory, point categories, point selection methods, and point location and needling. The latter has a welcome emphasis on safe practice and detailed discussions of pneumothorax and needling close to major organs. The main body of the book then begins. Each channel system is dealt with in turn, starting with the courses and functions of the primary, luo-connecting, divergent and sinew channels.

Following this, each point is dealt with in turn. We are given the name in English, Pinyin and Chinese characters, followed by sections on location and needling. The point location information is concise but clearly the result of much study, discussion and thought, with the aim of producing the most practically useful description possible. The location descriptions are accompanied by helpful extra tips, such as for LU-5 "locate slightly lateral to the tendon rather than immediately next to it". At times the authors have taken quite bold and laudable decisions on point locations. For example, for HE-7 and LU-9 they say "since wrist creases are a superficial and variable anatomical feature, it is better to locate this point in relation to the underlying/nearby pisiform bone". The clarity and authority of the point location information will doubtless be welcomed by students and practitioners alike, but of course there are varying opinions about the locations of some points. An example is LIV-5, which some texts clearly locate over the tibia not behind it, or Anmian, which is sometimes given several different locations. In these cases I would have welcomed more discussion from the authors as to what methodology they followed to settle on the location they have given. Perhaps this will make a separate journal article?

After the point location information comes the point actions and then a detailed list of indications. These are taken mostly from classical texts and have been helpfully arranged into groups of related indications. The indications of the points are of course of immense clinical value. The authors say in their introduction that the attribution of actions to points is mostly a twentieth century practice, but one clearly based on the classical indications. However, I believe they are right to draw our attention to the importance of also studying the indications themselves. As they say "the more indications there are, the easier it is to form an impression of the nature and forte of each point".

Following the indications, for each point there is a lengthy and detailed commentary. These commentaries are one of the book's greatest strengths, and a source of new inspiration for even the most experienced of practitioners. We learn for example that HE-8 is indicated in the classical texts more for lower jiao heat and that upper jiao heat with mental agitation and insomnia is emphasised much more in the indications for P-8 or P-7. We learn that KID-7 is strongly indicated for oedema, for sweating, and for lower jiao damp-heat, but not for impotence. The traditional indications for BL-58 strongly emphasise its use for excess patterns in the upper body. KID-4 firstly reinforces and regulates the relationship between Kidney and Lung, secondly has a strong action on the emotions like many lug-connecting points, and has among its indications "desire to close the door and remain at home". The commentaries on the points are full of references to classical discussions and contain a wealth of detail on pattern differentiation, pathological mechanisms and point combining, so that when studying the uses of a particular point one is also deepening one's understanding of broader topics.

The sections on each individual point conclude with a list of point combinations, again taken mostly from classical sources. The combinations have been well selected in that they make sense to a modern practitioner and they address symptom patterns seen in our clinical practice.

After more than 500 pages of detail on the channels and on each point in turn, including extra points, there are a series of excellent illustrations showing the major points of different areas of the body, from the eye region and the side of the head to the top of the foot. These illustrations are beautifully executed and show the surface anatomy in a realistic way so that one can immediately appreciate the relationships between the points in an area.

The thoroughness and attention to detail continues with a good glossary and excellent indexes. The indications index allows the reader to look up a symptom such as cough and find a wealth of detail, including cough with stubborn phlegm, SI-12, and cough with redness and heat of the face, SJ-6. The general index enables one to find the parts of the text where there are discussions of specific topics, from abdominal masses to window of heaven points.

This is a large book of 667 pages and given the regular use I'm sure it will receive from practitioners it is good to know that it has an attractive cover and is solidly bound. I understand there will also be available a large box of point cards, one for each point, which will have the illustration, location, actions and a precis of the most important uses of the point. These cards should be very useful for students and should also sit nicely in the clinic.

The overall impression is of a book put together throughout with impressive scholarship, loving care and attention to detail. I am sure this will rapidly become a major set text at acupuncture colleges throughout the English-speaking world, and the great "quantity" and detail of the information mean that it is also an essential text for practitioners.
Richard Blackwell

1. The channels and collaterals
2. The functions of the channels
3. The twelve primary channels
4. The twelve divergent channels
5. The eight extraordinary vessels
   1. the Penetrating vessel
   2. the Girdling vessel
   3. the Yang Motility vessel
   4. the Yin Motility vessel
   5. the Yang Linking vessel
   6. the Yin linking vessel
6. The Luo-connecting channel
7. The twelve sinew channels
8. The twelve cutaneous regions
9. Point categories
10. The five shu points
    1. the jing-well points
    2. the ying-spring points
    3. the shu-stream points
    4. the jing-river points the he-sea points
11. The five phase points
12. The xi-cleft points
13. The yuan-source points
14. The luo-connecting points
15. The back-shu points
16. The front-mu points
17. The hui-meeting points
18. The confluent points of the eight extraordinary channels
19. Ma Dan-yang's heavenly star points
20. The four and six command points
21. The points of the four seas
22. The points of the window of heaven
23. The thirteen ghost points of Sun Si-miao
24. The nine needles for returning the yang
25. Chart of the meeting points of more than one channel
26. Point selection methods
    1. Selecting local points
    2. Selecting adjacent points
    3. Selecting distal points
    4. Selecting proximal points
    5. Selecting points from below to treat above
    6. Selecting points from above to treat below
    7. Selecting points from the front to treat the back
    8. Selecting points from the centre to treat the extremities
    9. Selecting points from one channel to treat its interiorly-exteriorly related channel
    10. Selecting points from one pair of the six channels to treat disease of the other
    11. Selecting points according to channel connections
27. Cross needling
28. Selecting empirical points
29. The chain and lock point association method
30. Alternating points
31. Point combinations
32. Point location and needling
33. Cun measurements
34. Needling
    1. depth of needling
    2. avoidance of pneumothorax
    3. needling the abdomen
    4. needling close to major organs
    5. illustration of the location of major organs
    6. needling close to major blood vessels
    7. needling close to major nerves
35. Surface anatomy
    1. how to locate and count the ribs
    2. how to locate C7
    3. how to locate L3 and L5
    4. how to locate the sacral foramina
    5. how to locate the sternocostal angle
    6. palmaris longus
36. The Lung channel
37. The Large Intestine channel
38. The Stomach channel
39. The Spleen channel
40. The Heart channel
41. The Small Intestine channel
42. The Bladder channel
43. The Kidney channel
44. The Pericardium channel
45. The Sanjiao channel
46. The Gall Bladder channel
47. The Liver channel
48. The Conception vessel
49. The Governing vessel
50. The Extraordinary points
51. Body area illustrations
    1. major points of the eye region
    2. major points of the face
    3. major points of the side of the head
    4. major points of the top of the head
    5. major points of the back of the head
    6. major points of the neck region
    7. major points of the shoulder region
    8. major points of the upper arm
    9. major points of the chest
    10. major points of the upper abdomen
    11. major points of the lower abdomen
    12. major points of the upper back
    13. major points of the lower back
    14. major points of the back (Governing vessel and Bladder channel)
    15. major points of the anterior thigh
    16. major points of the anterior lower leg
    17. major points of the lateral lower leg
    18. major points of the medial lower leg
    19. major points of the lateral foot
    20. major points of the medial foot
    21. major points of the top of the foot
52. Areas reached by the channels
53. Appendices
54. Chinese dynasties
55. Bibliography
56. Glossary of terminology
57. Indexes
    1. Point names index
    2. Point indications index
    3. General index
    4. Point numbers index
58. About the authors

XINGJIAN LIV-2 - Moving Between Ying-Spring and Fire point of the Liver channel

Location
On the dorsum of the foot, between the first and second toes, 0.5 cun proximal to the margin of the web.

Needling
0.5 to 1 cun obliquely towards the heel, or perpendicular insertion 0.5 cun to 0.8 cun.

Actions
Clears Liver fire
Spreads Liver qi
Pacifies Liver wind
Clears heat and stops bleeding
Benefits the lower jiao

Indications

• Headache, dizziness, redness and pain of the eyes, lacrimation, eye diseases.
• Nosebleed, thirst, burning heat of the face, dark green complexion, death-like green colour.
• Throat painful obstruction, dry throat with agitation and thirst, clutching sensation in the throat, bitter taste in the mouth, heat in the body.
• Propensity to anger, sadness, propensity to fright, closes eyes and has no desire to look, excessive fright and little strength, propensity to fear as if seeing ghosts, madness, insomnia, palpitations, epilepsy, loss of consciousness, chronic and acute childhood fright wind.
• Contracted sinews, windstroke, fullness of the four limbs, deviation of the mouth, tetany, hypertension.
• Pain and itching of the genitals, pain of the penis, sudden involuntary erection, the seven kinds of shan disorder, cold shan disorder, painful urinary dysfunction, enuresis, retention of urine, difficult urination, white turbidity, red and white leucorrhoea, cold or damp (dong) diarrhoea, constipation, abdominal distention.
• Incessant uterine bleeding, menorrhagia, inhibited menstruation, early menstruation, lower abdominal fullness, abdominal (jia) masses in women, difficult lactation.
• Coughing blood, vomiting, pain of the Heart and the Liver, distention and pain of the chest and lateral costal region, pain of the chest and back, pain below the Heart, much sighing, inability to catch the breath all day long, difficulty in catching the breath, shortness of breath.
• Four limbs counterflow cold, wasting and thirsting disorder with desire to drink, malaria, lotus flower tongue in children.
• Lumbar pain with difficulty in flexing and extending the back, swelling of the knee, pain of the inner aspect of the leg, heat in the shin, leg qi with redness and swelling, pain and swelling of the instep.

Commentary
The Liver, entrusted with the ministerial fire, is known as the 'indomitable zang' and corresponds to the energies of Spring, growth and forcefulness. Although the Liver free-flowing function assists the ascent and descent of the qi of all the zangfu, its own qi direction is upwards, hence the saying "The Liver governs uprising". Since its yang activity is by nature exuberant, fierce and strong, the Liver easily becomes overheated and the normal ascending of Liver qi readily flares up into excess. The Great Compendium of Acupuncture and Moxibustion says "When the Liver is excess, reduce Xingjian LIV-2" whilst according to the Classic of Difficulties2 ying-spring points are indicated for 'heat in the body'. Xingjian LIV-2, the ying-spring and fire point of the Liver channel, is therefore the principal point on this channel, indeed in the whole body, to clear Liver fire and descend Liver yang. It has three principal spheres of activity: the head, the emotions and the lower jiao.

The Liver primary channel ascends along the neck and posterior aspect of the throat to the nasopharynx and the tissues surrounding the eye, and then ascends across the forehead to link with Baihui DU-20 at the vertex. Xingjian LIV-2 consequently is much used clinically to treat headache, dizziness, burning heat of the face, nosebleed, throat painful obstruction and dry throat, red and painful eyes, lacrimation and other eye diseases due to Liver fire ascending to the head, although it is interesting to note that headache, dizziness and nosebleed are modern indications and do not appear in any of the major classical acupuncture texts. When extreme, Liver fire or Liver yang may give rise to stirring of interior wind, and Xingjian LIV-2 is used to treat such consequences of this development as epilepsy, loss of consciousness, childhood fright wind, contracted sinews, windstroke and deviation of the mouth.

The Spiritual Pivot3 says "The Liver stores blood and the blood is the residence of the ethereal soul [hun]; when Liver qi is deficient there is fear, when excess there is anger", whilst the Essential Questions4 says "Anger easily injures the Liver". The free and unobstructed spreading of the Liver qi is closely related to the harmonious interplay of the seven emotions. Repression of any of the emotions will cause the Liver qi to stagnate, and after time to transform into fire. At the same time, stagnation of Liver qi, and even more so the blazing up of Liver fire, will render a person prone to experience feelings of irritability and anger. At the stage of qi stagnation, acknowledgement and expression of the appropriate emotion will help free the qi and dispel stagnation, thus Fei Bo-xiong said "Joy, anger, melancholy, anxiety, grief, fear and terror are common to everyone. Giving vent to joy, anger and melancholy as occasion requires is what is meant by venting emotions properly"5. When Liver fire is blazing, however, it is like a fire with an unlimited supply of fuel, and giving vent to rage and anger will not only fail to dispel the fire but will continually stoke and encourage it. At the same time, the anger itself will injure the body, and at this stage moderation of excessive emotion and not spontaneous expression must be practised. Thus Cao Tong of the Qing dynasty recommended in Common Sayings on Gerontology "When faced with something exasperating, one should calmly consider which is more important, anger or health. This comparison will enable one to gradually eliminate one's anger"6. Li Yi-ru of the Qing dynasty, however, said "Of the seven emotions, anger is the hardest to control". Acupuncture treatment seeks to quell and douse the fire, and Xingjian LIV-2 is the primary point to subdue blazing Liver fire giving rise to such manifestations as raging anger with a red face and clutching sensation in the throat. The Spiritual Pivot7 says "with anger the qi rebels upwards and accumulates in the chest". If Liver fire and stagnant qi attack the chest and Lung they will give rise to distention and pain, shortness of breath, sighing and difficulty in catching the breath. If, as is commonly seen clinically, Liver fire and stagnant qi transmit to the Heart there will be pain of both the Liver and Heart, as well as severe disturbance of the spirit manifesting as mania disorder, insomnia, palpitations etc. If there is a deeply established pattern of repression of anger, usually deriving from early childhood experiences, then the stagnant qi and fire will have no appropriate outlet and a person may become sad and tearful. Anger, overt or hidden, is not the only emotion associated with the Liver however, as stressed by the statement in the Spiritual Pivot that "when Liver qi is deficient there is fear". The Liver and Gall Bladder are associated in Chinese culture with decisiveness and courage. If the Liver is deficient, especially Liver blood, or if a person is unable to acknowledge their anger and thus embrace their power and courage, there may be fear and fright with a feeling of lack of strength and a tendency to close the eyes and have "no desire to look".

The Liver stores the blood, and the Liver channel converges with the Conception vessel in the lower abdomen at Qugu REN-2, Zhongji REN-3 and Guanyuan REN-4. Liver fire can easily transmit to the uterine blood and induce wild and reckless flow, manifesting as ceaseless uterine bleeding, menorrhagia and early menstruation. If heat condenses the blood and causes stagnation, or if Liver qi stagnation is prolonged, uterine (jia) masses may form or there may be inhibited menstruation. Disturbance of the blood by Liver fire may also give rise to coughing of blood and nosebleed.

The Liver channel encircles the genitals and penetrates the lower abdomen, whilst the Liver assists the free movement of qi throughout the body. If there is qi stagnation or consequent fire or damp-heat in the lower jiao, especially the genital region or Bladder, there may be a variety of symptoms such as itching and pain of the genitals, sudden involuntary erection, painful urinary dysfunction, retention of urine, difficult and turbid urination, leucorrhoea and shan disorder. If qi stagnation binds the intestines there may be constipation. In all these cases Xingjian LIV_2 may be used.

One special condition for which Xingjian LIV-2 is indicated is the symptom of hands and feet counterflow cold, where only the hands and feet are cold but the body is warm. This may occur in the pattern known as 'true heat, false cold', where heat constrained in the interior prevents the yang qi from circulating to the limbs. Despite the apparent cold, the other symptoms, as well as the pulse and the tongue, are indicative of heat and constraint. In clinical practice, this symptom is often encountered in patients with Liver qi stagnation rather than heat, where the stagnant qi prevents adequate circulation of qi to the extremities.

According to the Spiritual Pivot8 "The Liver governs the sinews", and Xingjian LIV-2 is indicated in many classical sources for pain of the lumbar region. Although more commonly ascribed to Kidney deficiency or painful obstruction, stagnation of Liver qi or Liver blood deficiency may also give rise to lumbar pain due to contraction and inflexibility of the sinews. However the frequency with which Xingjian LIV-2 appears in classical combinations for lumbar pain, points more towards an empirical application rather than a theoretical one.
Finally, Xingjian LIV-2 is indicated for swelling of the knee, pain of the inner aspect of the leg, heat in the shins and pain and swelling of the instep, and the Song of Points for Miscellaneous Diseases says "for leg and knee pain covet Xingjian LIV-2".

Combinations

• Lacrimation: Xingjian LIV-2 and Shenting DU-24 (Supplementing Life).
• Liver qi night blindness: Xingjian LIV-2 and Jing-ming BL-1 (One Hundred Symptoms).
• Dry throat with desire to drink: Xingjian LIV-2 and Taichong LIV-3 (Thousand Ducat Formulas).
• Pain of the Liver and Heart: Xingjian LIV-2 and Tai-chong LIV-3 (Thousand Ducat Formulas).
• Pain of the Heart with a green complexion like death, inability to catch the breath all day long, pain of the Liver and Heart: Xingjian LIV-2 and Taichong LIV-3 (Systematic Classic).
• Heart pain: Xingjian LIV-2 and Yinxi HE-6 (Supplementing Life).
• Fright epilepsy, mad walking and madness: Xingjian LIV-2, Jinsuo DU-8, Qugu REN-2 and Yingu KID-10 (Thousand Ducat Formulas).
• Retention of urine and pain of the penis: Xingjian LIV-2 and Ququan LIV-8 (Supplementing Life).
• Severe thirst of wasting and thirsting disorder: Xingjian LIV-2 and Yongquan KID-1 (One Hundred Symptoms).
• Lumbar pain with inability to stand for long or to move: Xingjian LIV-2 and Jingmen GB-25 (Systematic Classic).
• Lumbar pain that radiates down the leg: Xingjian LIV-2, Huantiao GB-30 and Fengshi GB-31 (Song of Points).
• Lumbar pain with inability to bend and extend: Xingjian LIV-2, Weiyang BL-39, Yinmen BL-37, Taibai SP-3 and Yinlingquan SP-9 (Thousand Ducat Formulas).
• Lumbar pain with difficulty in moving: Xingjian LIV_2, Fengshi GB-31 and Weizhong BL-40 (Glorious Anthology).
• Inability of the legs to support the body: Xingjian LIV-2 and Tianzhu BL-10 (Thousand Ducat Formulas).