Master Tung's Beside Three Miles for Shao Yang type migraine, and other issues of the head & face

Listen to the podcast

Excerpted from Susan Johnson's Book:
Master Tung’s Magic Points: A Definitive Clinical Guide, Volume 1

77.22 Beside Three Miles - Ce San Li
77.23 Beside Three Miles Lower - Ce Xia San Li
Master Tung’s GB 34 (77.22-77.23)

Clinical Comments:

Energetic pathways:

It is interesting to note that Beside Three Miles points have the Reaction Areas of Lung and Teeth. Because metal (Lung) controls wood (Liver/ Gallbladder), these points are exceptionally useful in the treatment of tendons and ligaments, obtaining their strength from their proximity to GB34 Yang Ling Quan, the Sea of Tendons. Located between the Shao Yang and Yang Ming channels, they also draw from ST36 Zu San Li (Leg Three Miles), hence their name. In Tung’s body of work, many points found between the Stomach and Gallbladder channels are loosely classified as “Gallbladder channel points.” All of them have a powerful effect on the head and neck, face, jaw and five senses; therefore, it is important to determine the root cause of the pathology before choosing from the following points: Beside Three Miles, 77.05-77.07 Three Weights, 77.24-77.25 Leg Five/One Thousand Gold, 77.27 Outer Three Gates, 88.17-88.19 Four Horses, and 88.25 Center Nine Miles (GB31). All Gallbladder points deal with joints, tendons and wind, especially Beside Three Miles, but we also want to think of bone and bone marrow, as related to Shao Yang (blood and Sea of Marrow).

Migraines:

Beside Three Miles are primary points for treating one-sided (Shao Yang) migraine headaches, spasm or pain, which often includes TMJ, the sternocleidomastoid muscle, GB20 Feng Chi and GB21 Jian Jing. Eventually, I always cup patients who have migraines, carefully choosing the timing if I am going to include the face area, because cupping marks will remain on the face for as much as a week after the treatment. I often bleed the vein above the eye or in the temple area, as well, as this usually provides immediate and lasting relief; on occasion, bleeding this area one time has been the only treatment needed. Be careful to avoid the artery by palpating for a pulse prior to donning your surgical gloves. (See the book 1010.10 Four Bowels Second for additional bleeding instructions).

Ear disorders:

• Otitis media and ear pain: Because the Gallbladder channel wraps around the ear, Beside Three Miles points are excellent for otitis media and ear pain. Needle the side opposite the pain or bleed the same side. You can also needle opposite-side 22.06 Zhong Bai (Tung’s SJ3) or A.04 San Cha Three as a treating point; these also make excellent same-side Guiding Points (choose one of them). Another good treatment option for inner ear infection is to bleed 11.26 Control Dirt, if a vein is visible. Small veins found between GB39 and the lateral malleolus can also be bled to treat the ear; be careful not to damage the fibula by hitting the bone (insert at a 45-degree angle). To diagnose an inner ear infection, palpate SJ17 Yi Feng and SI19 Ting Gong with the mandible wide open. If these points are painful, it is usually otitis media. Use an otoscope to determine the condition of the eardrum. Once an eardrum bursts, the pressure is relieved and fluid or pus usually can be observed draining from the ear. Be sure not to allow any outside moisture into an ear with a punctured eardrum.
• Deafness and tinnitus: Sudden hearing loss can be treated with the above combination, adding SI19 Ting Gong, SJ21 Er Men, and/or GB2 Ting Hui on the opposite side as treating points; or choose from among these options for Guiding Points. SJ17 Yi Feng is also an excellent choice for deafness or tinnitus. When treating any problem related to the ear (other than otitis media), I cup the area of SJ17 to clear stagnation, and almost without exception, the skin is very dark after cupping.¹ Chronic hearing loss has a Kidney-deficient component, so always add 77.18 Shen Guan (Kidney Gate). I like to use my otoscope to rule out the possibility of excessive wax buildup when hearing has diminished. Many people never clean their ears because as children, they were told not to put anything in their ear. I am a firm believer in regularly and gently twisting a dry Q-tip in the ear after a warm shower to remove excess moisture and wax.

TMJ:

Active Qi Moving technique is an important part of treating TMJ. Once the needles are inserted, have the patient open and close their mouth or chew gum. Beside Three Miles points have the Reaction Area of the Teeth, and they can be chosen for opposite-side TMJ. However, if I am treating bilateral TMJ, I choose bilateral 66.03 Fire Hardness or 66.04 Fire Master. Also consider cupping the jaw, one cup at a time. (See the book 66.04 Fire Master, Comments on TMJ.)

Facial disorders (facial paralysis, Bell’s palsy, trigeminal neuralgia):

• Facial paralysis or Bell’s palsy: Beside Three Miles, among several other Tung’s acupuncture patterns, can be needled to treat facial paralysis. Keep in mind that if the right side of the mouth smiles, then the left side has the problem, so we needle Beside Three Miles on the right side. Bell’s palsy and facial paralysis are usually the result of external wind meeting internal wind. If the condition is treated right away, it should resolve quickly. The earliest telltale sign of Bell’s palsy is an inability to whistle. If Bell’s palsy is not completely resolved, the patient may have a residual facial tic and the paralysis will be more likely to return, especially in windy conditions common in early spring. In most cases of facial paralysis, I also cup the face to draw fresh blood into the area, increasing circulation while eliminating draft and spasm.
• Trigeminal neuralgia: Beside Three Miles can be used to treat trigeminal neuralgia, although we might also think about 77.05-77.07 Three Weights or any other point related to the affected branch of the trigeminal nerve. Cupping may also be helpful, but be cautioned, as it may exacerbate the condition. Place one cup with light suction, remove it after a few minutes, and observe any change. Cautiously add another cup only if the skin color is dark from cupping and the pain has improved. ( See book 22.04 Da Bai, Combinations, and 77.08-77.09 Four Flower Upper/Four Flower Middle, Combinations, for additional treatment information related to these conditions. )

One-sided musculoskeletal pain:

Beside Three Miles points are excellent for one- sided shoulder, elbow, wrist, hand and/or finger pain related to ligaments or tendons. Because of the connection between the Hand and Foot Shao Yang (SJ/GB), we might also add opposite-side SJ5 Wai Guan, and optionally 22.06 Zhong Bai (Tung’s SJ3) on the same side as a Guiding Point. Often patients complain of multiple issues on the same side; these will be either deficient (lax) or excess (tight). If the patient is weak and the symptoms are tight, they are more difficult to treat, and usually require tonifying blood and expelling wind.

Commentary (Dr. Miriam Lee, OMD):

“I use Beside Three Miles for a wider range of indications than the book suggests. I use them for many one-sided complaints. Needle Beside Three Miles to treat pain on the opposite side of the body. Treat the right using the left points and treat the left using the right points. While the needle is in place the patient should mobilize the affected area or the practitioner should either passively mobilize or massage the affected area” (Dr. Lee, 1992).

Stroke:

While I agree with Dr. Lee’s statement above, it relates mostly to tendon and ligament issues involving the upper limb, neck or head (including migraine). (For the treatment of stroke, please see in my book 88.25 Center Nine Miles (GB21), Comments section, for my comprehensive hemiplegia/stroke protocol.)

Location:

77.22 Beside Three Miles:

This point is located on the lateral side of the lower leg, 1.0-1.5 cun lateral to 77.08 Four Flower Upper (ST36). In the proper location of this point, we utilize the exact method of locating Four Flower Upper: with one finger on the proximal head of the fibula and another on the base of the tibial tuberosity, draw a horizontal line from the base of the tibial tuberosity that intersects a vertical line drawn directly downward from the head of the fibula. Divide your horizontal line into equal thirds. 77.08 Four Flower Upper is located one third of the distance lateral from the base of the tibial tuberosity. 77.22 Beside Three Miles is located laterally, two thirds of the distance on this same horizontal line. Alternatively, measure one third of the distance medially on the same line, diagonally downward from the head of the fibula. (Please see the line drawing.)

77.23 Beside Three Miles Lower:

This point is located 2.0 cun (three fingers) distal to 77.22 Beside Three Miles, two large finger breadths lateral to the anterior tibial crest. Beside Three Miles Lower is only occasionally found directly inferior to Beside Three Miles. Measure carefully and palpate for the precise location, as this point is easily felt and is a good point for palpation practice.

Meridian:

Between Stomach and Gallbladder

Reaction Areas:

Lung, Teeth

Indications:

• Neck and shoulder strain or sprain (Shao Yang)
• Migraine (one-sided, Shao Yang)
• Shooting pain in the head
• TMJ
• Trigeminal neuralgia
• Facial pain
• Facial paralysis including Bell’s palsy
• Facial twitch or tic
• Inner ear pain
• Otitis media
• Toothache
• One-sided pain of the body: neck, shoulder, elbow, wrist and heel
• Gingivitis

Needling Notes:

Needle sensation:

When these needles are properly inserted, the patient may feel a zing of energy descend down the leg. I fish for this qi sensation if it does not happen spontaneously, because I have found the treatment to be immediately effective when the sensation happens. Often the sensation stops at GB40, in which case it is necessary to massage the area, beginning approximately two cun below the points, focusing on the ankle and the dorsum of the foot. Gently tug on the fourth toe or stimulate the needle until the sensation reaches either LV3 or GB41. Do not leave the energy stuck at GB40, or the patient may have difficulty walking after they get off the table.

Opposite-side needling vs. bilateral needling:

Beside Three Miles are nearly always needled on the side opposite the indications, as they are the most useful for one-sided issues. However, it is not forbidden to needle them bilaterally. If you obtain a strong “da qi” sensation in one leg, the patient may or may not feel the same sensation in the other leg, but if they do feel it, work to move the qi beyond the ankle, as described above.

Tonification vs. sedation:

If the patient is strong, or if the needle is tight when inserted, sedate the point. If the patient is weak, or if the needle is soft when inserted, tonify. Dao Ma: 77.22 Beside Three Miles (Chief Point) is always needled with 77.23 Beside Three Miles Lower (Supporting Point).

Depth:

1.0-1.5 cun

Combinations:

Migraine headache:

Needle opposite-side 77.22-77.23 Beside Three Miles. If migraines are cyclic, add 11.06 Return to the Nest, 11.24 Gynecological Points. With anger and/ or depression, add 11.17 Wood (Anger). Bleed above the eye or in the temple area (see 1010.10 Four Bowels Second for further information).

Headaches related to tight tendons in the neck:

Needle 77.22-77.23 Beside Three Miles, adding 66.05 Golden Gate if there is nausea and vomiting.

Bell’s palsy, facial paralysis, trigeminal neuralgia:

See 77.08 Four Flower Upper (ST36), Combinations, for additional treatment information.

Heel pain (severe):

Needle opposite-side 77.22-77.23 Beside Three Miles or 88.25 Center Nine Miles (GB31) (Dr. Young, 2008).

One-sided shoulder, elbow, wrist, hand and/or finger pain (related to ligaments or tendons):

Needle opposite-side 77.22-77.23 Beside Three Miles.

¹ I consider the area directly behind the earlobe to be an upper Toxin Point. Toxin Points are characterized by deep black color when cupped, without corresponding pain. Almost every patient I have cupped behind the ear has had very dark cup marks there, regardless of their chief complaint. Pull the earlobe forward to avoid cupping it.