33. Entry–Exit blocks
Chapter contents
Introduction258
What are Entry and Exit points?258
Diagnosis of an Entry–Exit block259
Treatment of an Entry–Exit block261
Ren and Du channel blocks261
Introduction
Aggressive Energy, Possession and Husband–Wife imbalances are major blocks to treatment because they can cause extensive deterioration to a patient’s health. An Entry–Exit block will not be as damaging, although if untreated it can still reduce or even stop the patient’s normal progress towards health. 1
1It is not clear from where this treatment originated, although Eckman states that it was taught in a Shanghai TCM College in the 1960s (see Eckman, 1996, p. 204). It is mentioned by Felix Mann in his book Acupuncture: the Ancient Chinese Art of Healing (Mann, 1971). In his article ‘Four LA blocks to treatment’ (Flaws, 1989), Bob Flaws stated that Entry and Exit points were taught to him by his teacher, Dr Tao Xi-Yu. Dr Tao learned it from his uncle in Beijing. Interestingly, Dr Tao was an associate of Wu Wei-Ping and translated for J. R. Worsley when he learnt from Wu Wei-Ping in Taiwan.
What are Entry and Exit points? (Table 33.1)
The Entry and Exit points are specific points close to the beginning and end of each channel. The 12 main channels are connected to each other and form a complete circuit. This circuit is outlined in the Ling ShuChapter 16. It is the same as the qi flow between the Organs described in the 24-hour clock which is discussed in the Law of Midday–Midnight in Chapter 2. The points where the channels connect are called the Exit and Entry points.
| Entry | Exit |
|---|---|
| Lu 1 | Lu 7 |
| LI 4 | LI 20 |
| St 1 | St 42 |
| Sp 1 | Sp 21 |
| Ht 1 | Ht 9 |
| SI 1 | SI 19 |
| Bl 1 | Bl 67 |
| Kid 1 | Kid 22 |
| PC 1 (PC 2 on a woman) | PC 8 |
| TB 1 | TB 22 |
| GB 1 | GB 41 |
| Liv 1 | Liv 14 |
What is an Entry–Exit block?
Sometimes the connection between the Entry and Exit point becomes blocked. This may be at the Exit point of one channel, which can no longer connect with the Entry point of the following channel. There may be either a complete or a partial blockage of the qi flow between the channels. Alternatively, the whole channel can be blocked. In this case the Entry point and Exit point of the same channel may be treated.
An Entry–Exit block may be treated by the practitioner at the initial diagnosis. More commonly it becomes evident during the course of treatment.
The Entry–Exit points
The circuit of Entry–Exit points takes qi through the channels in the following order:
Lung – Large Intestine – Stomach – Spleen – Heart – Small Intestine – Bladder – Kidneys – Pericardium – Triple Burner – Gall Bladder – Liver and back to the Lung.
The Entry points are
Lu 1LI 4St 1Sp 1Ht 1SI 1Bl 1Kid 1PC 1TB 1GB 1Liv 1
All Entry points except for one (LI 4) are the same as the first point on the channel. In women PC 2 is used in place of PC 1 due to its location on the breast.
The Exit points are
Lu 7LI 20St 42Sp 21Ht 9SI 19Bl 67Kid 22PC 8TB 22GB 41Liv 14
Some of the Exit points are also the last points on the channel. The others (Lu 7, St 42, Kid 22, PC 8, TB 22 and GB 41) are not the last point, although they are close to the end of the channels.
Diagnosis of an Entry–Exit block
Pulse diagnosis to detect an Entry–Exit block
An Entry–Exit block is usually detected by pulse diagnosis. A blockage is usually indicated in one of these three ways:
• a relatively full pulse is followed by a deficient pulse
• pulses on consecutive Organs/channels don’t change during treatment
• a similar quality pulse appears on the pulses of consecutive channels
A full pulse is followed by a deficient pulse
There may be a relatively full pulse on one Organ/ channel followed by a very deficient pulse on the next. This fullness does not change with normal treatments. This is most often felt between the Liver and Lung or the Spleen and Heart, but it can also
A patient who was treated as a Fire CF usually felt better after treatment. Over time, however, her progress slowed and she stopped feeling the benefits. The practitioner noticed that the Spleen pulse felt full and did not change following treatment. An Entry–Exit block between the Spleen and Heart was diagnosed. After treatment to clear the block the patient’s progress resumed.
occur when there is a block between the Triple Burner and Gall Bladder or the Large Intestine and the Stomach.
Pulses on consecutive Organs/channels don’t change
Treatment does not change the pulses of a number of Organs/channels along the circuit.
A patient who was a Fire CF was mainly treated on the Small Intestine. After some time treatment did not change the pulses as expected. The practitioner also noticed that there was no change on the Bladder and Kidney pulses and the patient had a twitch around the inside corner of her right eye. Treatment was given to clear through the Small Intestine, Bladder and Kidney channels using Ht 9, SI 1, SI 19, Bl 1, Bl 67 and Kid 1. This cleared the block. The patient felt an immediate improvement at the time of treatment and the eye symptom also improved.
Similar pulse qualities appear on consecutive Organs/channels
There may be a similar quality on the pulses of two consecutive Organs/channels or the pulses of two consecutive Organs/channels are extraordinarily deficient compared with the other pulses.
A patient who was diagnosed as a Water CF complained that he was getting easily upset by his girlfriend. The practitioner noted the similar soft quality on the Kidney and Pericardium and treated Kid 22 and PC 1. This, along with further treatment on the CF, helped the patient to feel stronger in himself emotionally.
Other signs and symptoms of an Entry–Exit Block
Along with the pulse diagnosis, certain signs and symptoms might indicate the presence of an Entry–Exit block. These are:
• treatment stops working
• signs and symptoms appear around the area of the blockage
• signs or symptoms appear in two Organs or Elements that follow each other along the circuit of qi
• the patient who was improving has an unexpected treatment reaction
Treatment stops working
Treatment might become less effective or it might stop working entirely. The above example of the patient with the Spleen/Heart block is an example of this. There may, of course, be many reasons why treatment is not as effective as hoped, but Entry–Exit blocks are an example of this.
Signs and symptoms around the area of the blockage
There may be symptoms around the area of the Exit and Entry points or along the channel, such as pain, discomfort or swellings.
A patient in her late twenties suffered from extremely blocked sinuses. The condition had started when she was 17, soon after the death of her beloved grandmother. She still missed her grandmother intensely and she felt that this was because her grieving had been repressed by her family. After the Entry–Exit block between the Large Intestine and Stomach had been cleared by stimulating LI 20 and St 1, the patient experienced a huge improvement in her sinuses. When asked some weeks later and subsequently, she said that she no longer felt the loss of her grandmother anything like as intensely as she had. The suppression of her grief had caused imbalance in her Large Intestine which had led to the Entry–Exit block.
Signs or symptoms indicate imbalance of two Organs or Elements that follow each other along the circuit of qi
A patient with a significant Entry–Exit block may manifest diagnostic signs from different Elements. For example, a block between the Triple Burner and Gall Bladder channels could be suspected if the patient was both green and showed lack of red, lack of shout, lack of joy and scorched. If a significant block is subsequently cleared practitioners should re-assess their CF diagnosis, as the key diagnostic signs can change dramatically.
Patient who was improving has an unexpected treatment reaction
Occasionally an Entry–Exit block is diagnosed when a patient who has been making good progress has a reaction following treatment. In this case the patient may feel extremely unwell for no obvious reason. The practitioner may feel confused by this sudden downturn in the patient’s health. This kind of block is ironically caused by the extra qi that has been generated from treatment. The Exit or Entry point of the channel involved may have been partially blocked for a long period of time, but the patient had no symptoms as a limited amount of qi was flowing through the channel. As treatment progresses and the patient’s health improves, a greater amount of qi begins to travel through the channel. As the qi builds, the area where the qi enters or leaves the channels comes under increasing strain.
Treatment of an Entry–Exit block
Points
Entry–Exit blocks are most commonly treated by using the Exit point of one channel and the Entry point of the next, for example Liv 14 and Lu 1. The practitioner may choose to use Exit and Entry points along more than one channel. For example, GB 41, Liv 1, Liv 14, Lu 1, Lu 7, LI 4.
Less commonly the Entry and Exit points can be used to clear through one channel only. To do this the practitioner treats the Entry point first, then the following Exit point. For example, if a patient has symptoms along the Liver channel and a block is suspected, use Liv 1 followed by Liv 14.
A patient who had been prescribed large quantities of antidepressant drugs in the past would often point to the area around her Liver saying that it felt congested. Command points on the Liver channel had very little effect. After the Entry and Exit points of the Liver were treated, the patient returned the next week to say that the congestion had disappeared.
Needle technique
Needle technique depends on the fullness or deficiency of the channel being treated. If the pulse of one channel is full whilst the following channel is deficient, sedate the Exit point and tonify the Entry point. For example, if the Liver pulse is full and the Lung pulse deficient, sedate Liv 14 for 5–10 minutes then tonify Lu 1. Then remove needles from both points.
If the pulses of two consecutive channels are both deficient, tonify both points – usually without retention of the needle. For example, if a block is suspected between Small Intestine and Bladder, tonify SI 19 bilaterally and remove the needle, then tonify Bl 1 and remove the needle.
Entry–Exit blocks can be found between consecutive channels of the same Element but are most often found between two channels of different Elements. These may be the Spleen and Heart, Liver and Lung, Small Intestine and Bladder, Triple Burner and Gall Bladder, Large Intestine and Stomach, or Kidney and Pericardium.
It is important to treat the Entry and Exit points bilaterally although the block is often only present on one side of the body. It is common for the patient to feel more intense sensation at the point where the block is present. Also one point often produces a much more significant pulse change than the others.
Reactions from clearing Entry–Exit blocks
As with any block, the patient’s signs and symptoms will change after the block is cleared. After the block has been broken normal Five Element treatments can be resumed. The practitioner can expect the patient to progress and the pulses to change more readily.
Ren and Du channel blocks
The Ren and Du channels can sometimes be blocked although it is rare. A Ren and Du block may be diagnosed if:
• all of the pulses are extremely deficient and do not respond to any other treatment that would normally tonify the patient
• there are symptoms around the area of the Exit and Entry points or along the Ren and Du channels
If this block is diagnosed the Entry and Exit points are Ren 1, Ren 24, Du 1, Du 28 and needles are inserted in this order using tonifying technique.
A patient had an episiotomy when giving birth to her first child. Some years later she still felt numb around the area and also said her health had never recovered from the birth. The practitioner diagnosed and treated a Ren and Du block, after which her health slowly began to improve.
Needling the points
Because of the positions of these points, especially Ren 1 which lies in the centre of the perineum, extreme care and sensitivity is required on the part of the practitioner when carrying out this treatment. It is important for the practitioner to be aware of a patient’s potential embarrassment about having these points treated and to keep the patient covered as much possible in order to preserve their privacy. If a male practitioner is treating a female patient he should ask a female practitioner to carry out the treatment. If this is difficult he should discuss this with the patient and ask her to bring in a companion while the treatment is carried out.
Summary
1 The 12 main channels form a circuit of qi and are connected via Entry and Exit points that are close to the beginning and end of each channel.
2 Sometimes the connection between two channels becomes blocked. The Exit point of one channel and the Entry point of the other channel are normally treated.
3 The whole channel can be blocked. In this case the Entry and Exit point of the same channel is treated.
4 The Ren and Du channels can also become blocked but this is rare.
5 An Entry–Exit block is diagnosed by the pulses and by signs and symptoms around the area of the blockage.
6 After an Entry–Exit block has been cleared, a patient’s signs and symptoms will improve and the subsequent treatments will progress more easily.
