In my last column [June], I discussed important ideas related to treating and managing the clinical challenge of heat with herbal medicines, specifically heat damaging yin, congealing blood, and transforming into damp heat. This clinical concept also applies to acupuncture point combinations, which can be used along with herbal medicines or in isolation to target these key aspects of heat management.
One of the main reasons why I find the concept of managing heat so important is the clinical reality of my practice existing in a geographical environment that experiences long periods of seasonal heat. My patients' pattern presentations are born and evolve within an atmosphere of almost constant heat, making it extremely important to be aware of predictable and potential evolutions of each patient's unique clinical presentation.
Heat Damages Yin
This aspect of potential heat challenge is extremely common in environments that experience long periods of extreme heat. Over time, constant exposure to hot climates can damage the fluids and eventually result in patterns of underlying yin deficiency. In my private practice, this is the most common clinical presentation of heat evolution.
I have found that the most common symptoms presented in this aspect of heat evolution are sleep disturbances and mental malaise. It is important to always ask patients if they are experiencing such accompanying symptoms, as many patients assume these to be "realities of life," as one patient expressed.
This specific evolution of heat in the body typically arises in cases of chronic disease or in patients who have extremely busy and stressful work environments. In such cases, it is important to consider points which not only clear heat, but also nourish yin and clear unique expressions of deficient heat. My favorite two-point acupuncture combination for this clinical challenge is: Kid 2 + Kid 3.
This combination of the ying spring and shu stream / yuan source point of the kidney meridian is extremely effective for clearing heat while also nourishing fluids / yin. Kid 2 cools the blood and clears deficiency heat, while Kid 3 nourishes the kidneys and benefits the essence.
These two points can be added to point combinations that are treating heat in order to prevent further damage to the patient's fluids / yin. For example, if a patient is experiencing liver qi stagnation causing heat issues, but also has an underlying fluid deficiency due to chronic stress / chronic heat exposure, possible point combinations could be:
Liv 2 + LI 11 + LI 4 + Kid 2 + Kid 3
LI 4 + Liv 3 + St 44 + Kid 2 + Kid 3
LI4 + GB 34 + LI 11 + Kid 2 + Kid 3
Heat Congeals Blood
This aspect of potential heat evolution is extremely common in hot climates, as excess sweating easily damages the fluids, causing blood deficiency and concomitant blood stasis. In this clinical scenario, it can be quite effective to add Sp 10 to acupuncture point combinations. Sp 10 has the unique actions of harmonizing and nourishing the qi and blood, cooling the blood, clearing heat, removing blood stasis, and regulating menstruation.
Clinicians can add this point to acupuncture point combinations addressing a wide range of potential pattern presentations. If a patient is experiencing liver qi stagnation with accompanying heat with blood stasis, such combinations may be:
LI 4 + Liv 3 + Liv 2 + Sp 10
LI4 + Liv 3 + GB 34 + Sp 10
Sp 10 is particularly important to keep in mind for patients living in extremely hot environments, as the wide-ranging actions of this point can both treat and prevent pattern presentations that are both caused and/or aggravated by exposure to environmental heat / excess sweating.
Heat Becomes Damp Heat
This potential aspect of heat evolution is an extremely common occurrence in environments that have long periods of humidity coupled with heat. When heat transforms into damp heat, it becomes particularly challenging to treat. The point combination of Sp 9 + Sp 10 is an extremely important two-point combination to keep in mind when encountering such challenging scenarios.
Sp 9 resolves damp, benefits urination, removes obstructions from the channel, and benefits the lower jiao. When these actions are coupled with the powerful actions of Sp 10, powerful therapeutic options emerge. I find the following point prescriptions to be clinically effective in cases of heat transforming into damp heat, particularly in patients living in hot, damp climates:
LI 4 + Liv 2 + Sp 9 + Sp 10 + Ren 6
LI 4 + Liv 3 + GB 34 + Sp 9 + Sp 10 + Ren 6
Both acupuncture point combinations clear heat, drain damp heat, and nourish the fluids. These actions are extremely effective for targeting chronic issues that evolve and emerge within damp, hot environments.
Take-Home Points
The potential evolutions of heat should inspire you as a clinician to think creatively and preventively when encountering heat patterns in the clinic. Always keep in mind both the unique pattern presentation of the patient and the unique environment in which the patient lives. Keeping these factors in mind can make all the difference when helping patients reach their health goals.
As modern medical standardization continues, the field of traditional Chinese medicine has the advantage of comprehensive personalization. For rare or complex cases, deeper consideration of constitution is invaluable. Proper constitutional assessment, especially with first-time clients, can guide desirable and predictable outcomes. This leads to a higher rate of return, and greater trust between you and your patient.
Though the creation of a financially sustainable, health-promoting model feels far away today, we are casting a vision for a full return on health, believing that this compels us to keep one foot firmly rooted in caring for the sick and the other foot firmly founded in maintaining health. Shifting from a fee-for-service model to value-based care using a phased approach is paramount.
Laser therapy has emerged as a powerful tool in the realm of traditional Chinese medicine (TCM). This new modality fits beautifully into the toolbox of the modern acupuncturist, as it can be used as a hybrid form of stimulation to acupuncture points, meridians, organs, nerves, and symptomatic areas in a new way that blends both moxa and energetic needle-like responses.
