Meng Pei-yan, Xu Min, Yan Hong-mei

1 College of Acupuncture and Traumatology, Hubei University of Traditional Chinese Medicine, Wuhan 430061, China

2 Wuhan No.7 Hospital, Wuhan 430071, China

Examples of Application of Ligou (LR 5)

Meng Pei-yan1, Xu Min1, Yan Hong-mei2

1 College of Acupuncture and Traumatology, Hubei University of Traditional Chinese Medicine, Wuhan 430061, China

2 Wuhan No.7 Hospital, Wuhan 430071, China

To study the application and mechanism of Ligou (LR 5) in the treatment of urinary and reproductive system diseases from its location, meridian, application alone and combined application in clinic based on syndrome differentiation, and to guide its application in clinic.

Points, Ligou (LR 5); Acupuncture Therapy; Testicular Hydrocele; Dysmenorrhea; Prostatitis; Pruritus Vulvae

Ligou (LR 5), also called Jiaoyi, is from Chapter Jingmai of Ling Shu (Miraculous Pivot). It is located in the medial side of the shank, 5 cun above the tip of the medial malleolus and on the medial aspect of the medial border of the tibia (Fig.1). Ligou (LR 5) is the Luo-Connecting acupoint of the Liver Meridian and can connect the Liver and Gallbladder Meridians. We choose this acupoint alone or combine with other acupoints to treat urinary and reproductive system diseases. Now it is summarized as follows.

Fig.1 Ligou (LR 5)

1 Application Alone

1.1 Testicular hydrocele in children

A boy, 4 years old, first visited on July 6th, 2011.

Chief complaint and history of present illness: The left testis became swollen and large. He was diagnosed with hydrocele and advised for surgery. For such a young age, the patient might not cooperate and therefore came to ask for acupuncture treatment.

Physical examination: The left scrotum was as large as an egg. Transillumination test was positive. The scrotum fell down during the day and back into the abdominal cavity at night.

Diagnosis: Testicular hydrocele.

Therapeutic principle: To soothe the liver and drain water.

Treatment: Bilateral Ligou (LR 5) were selected. We used filiform needles of 0.30 mm in diameter and 40 mm in length to puncture the acupoints subcutaneously for 0.5-0.8 cun along the Liver Meridian of Foot Jueyin upward. After needling sensation arrived, even reinforcing-reducing manipulation was conducted 2-3 times during 30-min retaining time. The treatment was given once every other day and the patient was cured after 5 sessions.

Note: Testicular hydrocele is called edema of scrotum in traditional Chinese medicine (TCM), mainly caused by congenital insufficiency, disorder of water metabolism and subsequent downward flow of water-dampness. The main symptom is pain and swelling of the scrotum, or scrotum becoming large and bright as crystal. The Liver Meridian of Foot Jueyin passes by external genitalias and its collateral also connects with genitals. According to the principle that“an acupoint can treat the disorders where its meridian distributes”, Ligou (LR 5) is the Luo-Connecting acupoint of the Liver Meridian, can soothe the liver and drain water, which is the key acupoint to treat hernia[1]. Our research chose Ligou (LR 5) alone and its efficacy was confirmed. It further proves the therapeutic effect of Ligou (LR 5) for reproductive system diseases.

1.2 Dysmenorrhea

A female patient, 28 years old, first visited on October 26, 2011.

Chief complaint and history of present illness: From menarche, the patient with dysmenorrhea felt pain and tenderness in lower abdomen during menstruation. The menstrual was less than normal and dark with blood clots. The patient also felt untouchable pain in the breast. Before menstruation, she experienced chest tightness and sigh. The tongue was dark, and the pulse was taut and uneven. She was depressed and emotionally unstable. She has never been pregnant after 5 years of marriage. She once received gynecological examinations to exclude the possibility of secondary dysmenorrhea. The patient used to take medicine, but the efficacy was not stable, so she came to ask for acupuncture treatment.

Diagnosis: Dysmenorrhea.

Therapeutic principle: To soothe the liver and regulate qi.

Treatment: We chose bilateral Ligou (LR 5). We used filiform needles of 0.30 mm in diameter and 40 mm in length and punctured subcutaneously for 0.8-1.2 cun upward along the Liver Meridian of Foot Jueyin. After the needling sensation arrived, even reinforcing-reducing manipulation was conducted 3 times to increase stimulation and made the needling sensation up to perineum along the Liver Meridian of Foot Jueyin during 30-min retaining. At the same time, we used mild moxibustion. The treatment was given twice a week and stopped during menstruation. The patient was cured after 2 months and it didn’t relapse in 6 months.

Note: Dysmenorrhea appears during, before or after menstruation. The patients may have symptoms such as periodic abdominal pain, even lumbosacral or unbearable pain. Sometimes it can affect daily work or lives. It is mainly caused by depression or anger continuing for a long time, which leads to liver dysfunction, qi stagnation. These factors cause blood stasis in the uterus, the Thoroughfare and Conception Vessels, the stasis can lead to pain. Ligou (LR 5) is the Luo-Connecting acupoint of the Liver Meridian. It can connect and coordinate the Liver and Gallbladder Meridians. It has the efficacy of soothing the liver to regulate qi, regulating menstruation to relieve pain. So in this case, we chose Ligou (LR 5). It is according to the principle of choosing the acupoint by meridian and syndrome differentiation. Although the dysmenorrhea has been for many years, choosing this acupoint is effective.

2 Application Based on Syndrome Differentiation

2.1 Chronic Prostatitis

A male patient, 42 years old, first visited on March 10, 2012.

Chief complaint and history of present illness: Frequent urination, dribble of urine and bulge and pain in perineum for 2 years. Half a year ago, after examination, he was diagnosed with chronic prostatitis. He used to take many antibiotic medicines, but the response was not steady. He also had the symptom of wetness and itch in the scrotum, accompanied by red face and eyes, and migraine. The patient was impatient and worked very tired. The tongue had yellow coating and the pulse was taut and rapid.

Diagnosis: Chronic prostatitis.

Therapeutic principle: To soothe the liver and gallbladder to eliminate damp-heat.

Treatment: We chose Ligou (LR 5), Zhibian (BL 54), Shuidao (ST 28), Zhongji (CV 3) and Zulinqi (GB 41). We used filiform needle of 0.45 mm in diameter and 115 mm in length and punctured perpendicularly for 3 to 4 cun, Zhibian (BL 54) towards Shuidao (ST 28). After the qi arrived, lifting and thrusting techniques were conducted and made the needling sensation go upto the perineum. We used a filiform needle of 0.30 mm in diameter and 40 mm in length at Ligou (LR 5) and punctured subcutaneously for 1.0-1.2 cun upward along the Liver Meridian of Foot Jueyin. After the needling sensation became obvious, reducing manipulation was conducted. We punctured perpendicularly for 1.0-1.2 cun at Zhongji (CV 3). After the needling sensation arrived, even reinforcingreducing manipulation was conducted and made the needling sensation go up to the perineal area, while mild moxibustion at the acupoint was done. At Zulinqi (GB 41), we punctured perpendicularly for 0.3-0.5 cun, and lifting and thrusting techniques were conducted and made the needling sensation go up. The needles were retained for 30 min, and the manipulations were conducted 2 to 3 times. The treatment was given twice a week. The patient was not allowed to eat anything greasy or spicy, and was asked to control intercourse. After 12 sessions, the symptoms disappeared and didn’t relapse in 6 months.

Note: Chronic prostatitis is one of the chronic inflammations caused by specific or non-specific infection of prostate and it is called stranguria in TCM. Patients often present with frequent urination, urgency, dysuria, dribble of urine pain in the testis, the lower abdomen and the lumbosacral area. It could also be showed as sexual dysfunction and neurasthenia. The patient is impatient and irritable. When the liver fails to disperse and dredge, the qi stagnation will transform into heat; when the qi stagnation of the liver affects the spleen, the spleen will have difficulty in transporting and transforming, and thus dampness and turbidity will be produced; the heat and dampness combine together and go down to the lower jiao, and finally induce the onset of chronic prostatitis. Ligou (LR 5) is the Luo-Connecting acupoint of the Liver Meridian, and it can eliminate damp-heat of the Liver and Gallbladder Meridians to stop itching. Puncturing Zhibian (BL 54) towards Shuidao (ST 28) could clear damp-heat in the lower jiao. Zhongji (CV 3) is the Front-Mu acupoint of the bladder, can eliminate damp-heat. Zulinqi (GB 41) can soothe liver, promote bile secretion, refresh brain and make eyes brighter. The joining effort of these acupoints can eliminate damp-heat, soothe liver, promote bile secretion, and finally relieve the symptoms.

2.2 Pruritus vulvae

A female patient, 39 years old, visited for the first time on October 26, 2011.

Chief complaint and history of present illness: Genital itching and vaginal discharge for 1 year. One year ago, the patient started to feel itchy coupled with yellow, smelly vaginal discharge. The patient felt upset and bitter taste in the mouth, dry lips and mouth. The tongue tip was red and with little yellow coating. She used to take many medicines, but the efficacy was not obvious, so she came to ask for acupuncture treatment. Diagnosis: Pruritus vulvae.

Therapeutic principle: To eliminate damp-heat of liver.

Treatment: We chose bilateral Ligou (LR 5), Ququan (LR 8), Yinlingquan (SP 9) and Taichong (LR 3). We used filiform needle of 0.30 mm in diameter and 40 mm in length to puncture Ligou (LR 5) subcutaneously for 1.0-1.2 cun upward along the Liver Meridian of Foot Jueyin. After the needling sensation became obvious, reducing manipulation was conducted. We punctured perpendicularly for 0.5-0.8 cun at Ququan (LR 8). After needling sensation arrived, even reinforcing-reducing manipulation was conducted. At Yinlingquan (SP 9), we punctured perpendicularly for 1-1.2 cun, and strengthened stimulation by rotating the needle. At Taichong (LR 3), after needling sensation arrived, even reinforcing-reducing manipulation was conducted. The needles were retained for 30 min, and the manipulation was conducted 2-3 times. The treatment was given twice a week. The patient was not allowed to eat anything greasy or spicy and was asked to control her emotion. After 8 treatments, the symptoms disappeared and didn’t relapse in 6 months.

Note: Pruritus vulvae refer to genital itching in women, sometimes the itch is so unbearable that the patients are restless, maybe accompanied by leukorrhagia. It is mainly caused by depression, anger, so it leads to liver qi stagnation, transforming into heat. The liver-qi stagnation may affect the spleen, resulting in dampness. The damp-heat may in turn flow downward to cause yellow vaginal discharges. Ligou (LR 5) is the Luo-Connecting acupoint of the Liver Meridian. It can eliminate damp-heat of the Liver and Gallbladder Meridians, soothe the liver and regulate qi, regulate the menstrual function and solve the vaginal discharge problem[2]. Ququan (LR 8) is good at clearing damp-heat of middle and lower jiao. Yinlingquan (SP 9) is the He-Sea acupoint of the Spleen Meridian and can invigorate the spleen and clear dampness. Taichong (LR 3) is the Yuan-Primary acupoint of the Liver Meridian and can soothe the liver to regulate qi. The joining effort of these acupoints can soothe the liver, invigorate the spleen, clear damp-heat, and finally relieve symptoms.

3 Experience

Ligou (LR 5) is the Luo-Connecting acupoint of the Liver Meridian of Foot Jueyin, and it can soothe the liver and regulate qi, eliminate damp-heat of the Liver and Gallbladder Meridians, relieve dampness to stop itching. From the ancient to the present time, Ligou(LR 5) is frequently used in treating urinary and reproductive systems diseases caused by liver depression and qi stagnation, damp-heat of the liver and gallbladder. It can also be used in treating the ear, nose and throat (ENT) conditions caused by dysfunction or heat of the liver and gallbladder.

Ligou (LR 5) is located in the medial side of the shank with simple local anatomy, not involving important organs. The operation is simple, convenient and safe. It can be used both alone and based on syndrome differentiation with good efficacy in treating urinary and reproductive systems diseases. Regarding other therapeutic effects and mechanisms of this acupoint, it is worthy of further exploration and study[3-5].

[1] Yang SQ. Treat hydrocele in children with Ligou (LR 5). Zhongyi Zazhi, 1986, 27(9): 21.

[2] Wang JX, Wu GC, Yang X. Overview of treating gynecological disease from liver. Hunan Zhongyi Zazhi, 2012, 28(5): 168-170.

[3] Luo BH. Clinical observation for cervical spondylosis on exercise therapy of Ligou (LR 5). Liaoning Zhongyi Zazhi, 2008, 35(4): 597-598.

[4] Luo BH. Clinical observation on 48 cases with stiff neck treated with combining exercise with acupuncture at Ligou (LR 5). Sichuan Zhongyi, 2008, 26(2): 117-118.

[5] Ren CX. Treatment of scrotal eczema with acupuncture. Guiyang Zhongyi Xueyuan Xuebao, 1991, (1): 38.

Translator: Ni Wen-ting

R224

A

Date: December 8, 2012

Author: Meng Pei-yan, M.D., associate professor. E-mail: m2003w@163.com