Examination and syndrome differentiation of meridians
The theory of meridians and collaterals is the core of the science of acupuncture and moxibustion. The treatment of diseases with acupuncture and moxibustion is performed under the guidance of TCM theory, based on the diagnosis made by means of the four diagnostic methods (inspection, auscultation and olfaction, inquiry as well as palpation) and according to the syndrome differentiation (including syndrome differentiation of the eight principles, zang-fu organs, qi and blood as well as meridians and collaterals). It is also the important basis for the examination and syndrome differentiation in the clinical practice of acupuncture and moxibustion. Therefore apart from the general methods for diagnosis and syndrome differentiation in TCM, the examination of meridians, col-laterals and acupoints as well as syndrome differentiation of meridians and collaterals are specially significant in the clinical practice of acupuncture and moxibustion.
Examination of the meridians and collaterals
The examination is made according to the circulation and distribution of the meridians and collaterals through inspection and palpation as well as observation of the path-ological reactions in the distributing areas of the meridians.
Inspection of the meridians and collaterals: The inspection mainly concentrates on observation of the abnormal changes of the colour and shape of the skin and vessels. For example, darkish purple vessels are always the manifestations of blood stagnation；bluish vessels indicate cold or pain syndrome and reddish ones always signify heat syndrome. Pimples and blisters on the hypochondriac region indicate pathological changes of the gallbladder meridian of foot-shaoyang and the liver meridian of foot-jueyin. While skin lesions such as pimples and erythemas on the anteriorlateral side of the lower limbs are the manifestations of the pathological changes of the stomach meridian of foot-yangming.
Palpation of the meridians and collaterals: The distributing areas of the meridians and collaterals are pressed and touched to examine and inspect various reactions, including the states of pulsation on the arteries, subcutaneous nodes, lumps and cord-like mass, or looseness and depression as well as coolness, feverish-ness, pain, sensitivity and numbness of the skin. The affected meridians and collaterals can be identified according to the locations of the manifestations.
Examination of meridians and acupoints
The upper, lower, internal and external parts of the body are integrated into an organic whole through the system of meridians and collaterals which promotes the circulation of qi and blood through the whole body and harmonizes zang and fu organs as well as yin and yang. The acupoints are the specific sites through which qi and the blood of the zang-fu organs and meridians is infused. Under pathological conditions, meridians, collaterals and acupoints serve as the passageways for the transmission of diseases from the exterior to the interior and from the interior to the exterior. So the pathological changes inside the body can be manifested on the surface of the body. Therefore the pathological changes of meridians, collaterals, zang-fu organs and the location of the diseases can be identified through the examination of the abnormal changes of meridians, collaterals and acupoints, providing evidence for further differentiation of syndromes.
Examination of the acupoints
The acupoints and the reaction points are pressed for examining various abnormal changes, including whether there are tenderness or comfortable sensation, or aching and distention as compared with the adjacent regions, or subcutaneous nodes or code-like mass, or looseness and depression. These abnormal changes mainly appear on some special acupoints. For example, tenderness or comfortable sensation will be felt on Feishu (BL 13) when the lung is in disorder. Pathological reactions on Front-Mu acupoint Juque (CV 14) and Back-Shu acupoint Xinshu (BL 15) often indicate heart disease. Tenderness felt on the He-Sea acuppoint Zusanli (ST 36 ) and Shangjuxu (ST 37) or the area between them usually indicate the disorders of the hand- and foot-yangming meridians. Tenderness felt on the crossingpoint Sanyinjiao (SP 6) suggests the disorder of the foot triple yin meridians.
In clinical practice apart from the consideration of examining the meridians, collaterals and acupoints, the four diagnostic methods of TCM should be employed at the same time to have a comprehensive understanding of the pathological conditions and make a correct diagnosis of the disease in question.
Syndrome differentiation of meridians
The aim of syndrome differentiation of meridians and collaterals is to analyze the involvement of the meridians and the states of asthenia, sthenia, cold and heat accord-ing to the distribution and indication of meridians for the purpose of providing evidence for selecting the needling methods.
Syndrome differentiation methods
Identifying meridians through examining the location of diseases
Identifying meridians through examining the location of diseases means to identify the involvement of the meridians in the pathological conditions according to the distribution of the meridians where disease and pain occur. Take headache for example. The yang meridians run up to the head, but distribute differently. Yangming meridian runs up to the forehead, shaoyang merdian to the lateral side of the head, taiyang meridian to the posterior side of the head, and jueyin meridian to the vertex. Therefore headache over the forehead indicates the involvement of the yangming meridian, migraine indicates the involvement of the shaoyang meridian, and so on. Another example is toothache, the upper toothache is related to the foot-yangming meridian while the lower toothache is related to the hand-yangming meridian.
Identifying meridians according to symptoms
This syndrome differentiation method is mainly based on the pathological mani
festations of the twelve meridians recorded in the Chapter of Meridian in Lingshu (Spiritual Pivot). For example, the symptoms of the lung meridian are "Cough, asthmatic breathing, asthma, vexation and fullness in the chest", so cough and asthma are the symptoms of the lung meridian. The symptoms of the stomach meridian are "singing in a high place and running about without clothes", so the manifestations of mental diseases are related to the stomach meridian.
Identifying meridians through the location of disease and symptoms
Some parts or zang-fu organs are connected with several meridians, or one single disease can be manifested over several meridians. Hence in the syndrome differentiation of the disease, both the location of disease and the pathological manifestations of the meridians must be taken into consideration for making accurate diagnosis. For example, the heart is connected with the heart meridian, the spleen meridian and the kidney meridian.
Identifying meridians according to the zang-fu organs
The twelve meridians are related to the correspond-ing zang-fu organs respectively, so the involvement of the meridians in the pathological conditions can be identified according to the theory of zang-fu organs. Take retention of urine for example. It is a disorder of the bladder and kidney and the corresponding meridians are the bladder meridian and kidney meridian.
Syndrome differentiation of the twelve main meridians