Lower Back Pain / Sciatica

The following article on Lower Back and Sacral Pain is excerpted from Master Tung's Magic Points, Volume Three: The Clinician's Best Friend. Though the following point patterns and commentary are useful in both male and female cases, I would also recommend reading the chapter on Male Urogenital Disorders, outlining specific treatments for Infertility, Noctural Emissions, Prostatitis, and more, which may also include lower back weakness and/or pain.

Diagnostic for the practitioner:

Trouble at different disc levels can be identified by the resulting type of sciatica:

Tai Yang (UB) channel sciatica is the most common type, and it connects to a bulging or herniated disc at L5-S1. This will be the case in 75% of the sciatica you will treat. Because it relates to the special relationship between the LU and UB channels, it is considered to be Lung-deficient-type sciatica.
Shao Yang (GB) channel sciatica relates to L4-L5, is not uncommon, and is seen approximately 20% of the time, frequently in combination with UB channel sciatica.
Spleen/Stomach channel sciatica is the least common type of sciatica, affecting the front of the thigh. You will see it 5% of the time, at most. This type of sciatica can be a little more challenging to treat.
If sciatica shows up on more than one channel, this indicates multiple disc involvement. It is more common to see UB thigh pain with GB calf pain than GB channel thigh with UB calf pain. Comments: Be sure to thoroughly cup the areas of UB36, UB54, GB29 and GB30 to clear toxins from the entire hip socket. When I am cupping a lower back/hip, I am always sure to cover UB36 (at the crease where the buttocks and hamstrings meet), as I consider dark cup color there to be “sciatica looking for a place to happen.” If this area is painful, it could mean lung cancer, in which case UB13 Fei Shu will also be painful. Do not alarm patients, but if both areas are painful, ask them to get a chest X-ray.

Acute lumbar strain:

Bleed the veins found in the popliteal crease (UB39-UB40 area). For acute conditions, this is the most effective treatment and immediately takes the pressure off the spine. I highly recommend this treatment.
1010.19-1010.20 Water Gold/Water Through, 11.12 Er Jiao Ming, bilaterally needled; cup the lumbosacral area.
1010.13 Horse Gold Water and 1010.19 Water Through, needled on the opposite side or bilaterally (Dr. Young, 2008).
22.07 Xia Bai and 001 Hand Golden Gate or 22.03 Shang Bai and 001 Hand Golden Gate, needled bilaterally or on the opposite side, this combination of points is used for middle back and waist pain.

Formulas:

Du Huo Ji Sheng Wan is my personal favorite.
Tong Qi San is effective for acute lumbar sprain (Dr. Young, 2008)
Tian Qi Du Zhong Wan
Qi Ye Lian
Boswellia, turmeric, omega-3

Comments: Er Jiao Ming has the Reaction Area of the Kidney. It tonifies the Kidney to treat Kidney-deficient conditions. Because the dorsum of the middle finger corresponds to the spine and DU Mai, Er Jiao Ming is remarkably effective in the treatment of spinal and lumbar pain. The points are especially useful in treating acute lumbar sprain or twisted lower back, when the patient cannot breathe, cannot stand straight and cannot move.

In this case, I might additionally advise either cupping the lumbar muscles or bleeding UB40 Wei Zhong (any vein in the popliteal crease) for a quick and solid fix.

“Master Tung treated acute back sprain using either Er Jiao Ming or Horse Gold Water. Clinically the two points are not needled simultaneously and either of the two points is sufficient. Horse Gold Water has the Reaction Areas of both Kidney and Lung and is very effective for lower back pain and Urinary Bladder type sciatica. Water Gold/Water Through has the Reaction Area of the Kidney, making them very useful to treat chronic low back pain. The combination of 1010.13 Horse Gold Water with 1010.19 Water Through is exceptional for both and is also useful to treat acute back sprain” (Dr. Young, 2008).

“A physician came to my office at 6:00 am one day. That morning, while putting on his shoes, his back went into spasm. I needled 1010.19-1010.20 Water Gold/Water Through and had him walk around, twisting his back, lifting his legs, and trying to mobilize his back as much as possible. After the treatment, he returned home and took a short nap. At 10:00 am that same morning he went to his office and saw patients all day as usual. This doctor reported to me that when this had happened to him before, if he took very strong medicine for such back spasms, he had to stay in bed for three days and then would have side effects of headache and stomachache. If he took a lower dose so as not to have these side effects, he would typically have to remain in bed for seven days. When using these points to treat twisted back or back spasm, it is best to treat on the day it happens” (Dr. Lee, 1992).

Lower back pain:

Bleed UB40 (any veins in the popliteal crease), 99.07 Ear Back* or 99.08 Ear Apex*.
1010.19-1010.20 Water Gold/Water Through, bilaterally needled. SI3 Hou Xi, 22.04-22.05 Ling Gu/Da Bai needled on the opposite side (or bilateral for pain in the center), with same-side or bilateral UB65 Shu Gu as a Guiding Point.
1010.25 State Water*; 55.04-55.05 Flower Bone Three/Flower Bone Four. Often, I combine these two when the worst of the pain is at the L5/S1 hinge, as they both direct the qi to this area.
33.08-33.09 Arm Five Gold/Arm Thousand Gold are very good for back pain and sciatica occurring in both the UB and GB channels.
22.06-22.07 Zhong Bai/Xia Bai*, bilaterally or unilaterally needled with 66.09 Water Curve (GB41) or 66.14 Water Phase* as a Guiding Point (treats midline lower back pain).

Chronic deficient pain due to Kidney weakness:

77.18-77.21 Three Emperors, 1010.19-1010.20 Water Gold/Water Through, both bilaterally needled, 22.06 Zhong Bai (Tung’s SJ3) or SI3 Hou Xi, unilaterally needled (one point on each side).

Especially good for cough with lower back pain:

1010.19-1010.20 Water Gold/Water Through, 22.04-22.05 Ling Gu/Da Bai, needled on the opposite side, 22.06 Zhong Bai (Tung’s SJ3) or SI3 Hou Xi, unilaterally needled (one point on each side).

Comments: The above protocols are listed in my order of preference, though of course you should choose the combination most appropriate for your patient. Never underestimate the power of bleeding the popliteal crease for the most immediate relief of back pain. When a patient has both UB and GB channel sciatica, you may choose to try 33.08-33.09 Arm Five Gold/Arm Thousand Gold (please see Sciatica – Both UB and GB channels).

The combination of Middle White (Tung’s SJ3) and Water Curve (GB41) opens the Dai Mai (belt vessel) to address bilateral lower back pain, usually caused by Kidney deficiency. 1010.13 Horse Gold Water has a Reaction Area of the Kidney and Lung. 1010.14 Horse Fast Water has a Reaction Area of the Lung and Urinary Bladder. These points can be very useful to reat lower back pain and Urinary Bladder-type sciatica. 1010.19-1010.20 Water Gold/Water Through have a Reaction Area of the Kidney, making them very useful to treat chronic low back pain. The combination of Horse Gold Water with Water Through is exceptional for both and is also useful to treat acute back sprain.

“I usually combine Flower Bone Three and Flower Bone Four together to increase the strength and efficacy of the treatment. This is not so good for spinal pain but is effective for sciatica. There are many types of sciatica:

Spleen/Liver channel, Stomach channel, Gallbladder channel, and Bladder channel. This treatment is for the entire leg as well as numbness of the legs and feet. During treatment, typically the numbness gives way to tingling and then this tingling also goes away. If the patient complains about this, one should tell them that this is the normal procedure of recovery. While the patient is lying down and the needles are in place, have the patient raise their legs one at a time so that the stimulation passes down from their hips to their lower legs. If one does not move the legs thus, the effect is not as good. Otherwise, this is a very effective point combination with good results from only a few needles. It is also effective for leg and foot numbness” (Dr. Lee, 1992).

“To treat low back pain, bleed Ear Back or Ear Apex. The best time to bleed is between 1pm-5pm in the afternoon, because at that time qi and blood circulate in the Hand Tai Yang (SI) and Foot Tai Yang (UB) meridians” (Dr. Young, 2008).

“While visiting a clinic in China, a patient was presented to me who had lower back pain and had been treated repeatedly without much improvement. He was leaning against the wall as I inserted four needles into his chin (Water Gold/Water Through). The other doctors watched skeptically. Only a few minutes later, the patient let out a deep cough. In that moment, everyone simultaneously realized that the patient was radically improved. His pain was practically gone. Those of us who primarily use Master Tung’s points are not surprised by this type of instantaneous result” (Dr.Lee, 1992) Dr. Lee told me that when she began needling these points, the other doctors were openly laughing at her.

Lower back and groin pain:

SI3 Hou Xi or A.04 San Cha Three, 22.04-22.05 Ling Gu/Da Bai, 33.12 Heart Gate (Tung’s SI8)*, needled on the opposite side with same-side LV3 Tai Chong, 66.09 Water Curve (GB41) or UB65 Shu Gu as a Guiding Point (choose one).
SI3 Hou Xi, 22.04-22.05 Ling Gu/Da Bai, and/or 22.06-22.07 Zhong Bai/Xia Bai, 33.12 Heart Gate (Tung’s SI8)*, all needled on the opposite side. Guiding Points are optional.

Cupping for groin pain with sciatica:

If a patient is experiencing groin pain and sciatica, position them on their side, bending their top leg to thoroughly cup the affected side. Be sure to cup both GB29 and GB30 specifically. I also recommend cupping UB36 while the patient is lying on their side, as the skin color after cupping here is often extremely dark (indicating toxin buildup) whether or not the patient has UB channel sciatica. I often refer to UB36 as “sciatica looking for a place to happen.”

Comments: SI3 opens the DU Mai, so it can be used as a treating point for lower back issues. Heart Gate acting as SI8 is specific for the groin, but it does not cover the same function as SI3. One or both points may be utilized. If SI3 is used, it is best combined with UB65 as the same-side Guiding Point. However, if Heart Gate is used without SI3, then San Cha Three or Zhong Bai can be added as Treating Points, with GB41 as the Guiding Point to open the Dai Mai or LV3 as a Guiding Point for the groin. Consider a simplified version of the above choices by needling opposite-side 33.12 Heart Gate (Tung’s SI8), 22.05 Ling Gu, and A.04 San Cha Three with the appropriate Guiding Point(s) (Dr. Young, 2008). Dr. Young’s treatment is especially useful for lower back pain that travels to the knee; A.06 Ci Bai also includes this specific indication (Renaud).

Lower back stiffness:

Cup the low back.
SI3 Hou Xi with UB65 Shu Gu
KD3 Tai Xi with UB60 Kun Lun, bilaterally needled.
UB40, bled (any veins in the popliteal crease).
11.12 Er Jiao Ming, bilaterally needled.

Comments: For chronic, early morning lower back muscular stiffness that alleviates with movement, but does not necessarily respond to cupping, provide the patient with stretches for their psoas muscle. The psoas muscle attaches to both the femur and the anterior lumbar vertebrae, acting to help raise the leg. For patients who sit too often, a tight psoas is common. As the muscle passes deeply through the abdomen, it is best contacted by lying on the back and raising one knee, keeping the foot down on the table. Using the opposite hand, firmly and deeply push the tips of the fingers just medial to the anterior superior iliac spine until the tight psoas muscle is felt. Hold the fingers in place and rock the knee back and forth (medially and laterally) for a count of ten. Switch sides. This will be painful, but it immediately softens the psoas, relieving the stiffness or pain, and is a good treatment that the patient can do at home multiple times per day, or at least just before getting out of bed.

Bulging or herniated disc (L5-S1):

1010.25 State Water*, needled in combination with bilateral 55.04-55.05 Flower Bone Three and Flower Bone Four. State Water sends the qi down the spine, whereas Flower Bone Three and Flower Bone Four send the qi up the legs; together they meet at the hinge (L5-S1 area). This is a very powerful treatment if you are comfortable needling Flower Bone points with the patient lying on their back. You do not want to ask a patient with bulging or herniated discs to turn over from a prone position. See comments, below.

1010.19-1010.20 Water Gold/Water Through, bilaterally needled.
Bleed veins found in the popliteal crease (UB39-UB40 area) to release pressure in the lower back.

If there is severe, unresponsive Gallbladder channel sciatica:

DT.08 or DT.09, bled. Palpate for the most sensitive spots in the area of the back where the arm connects to the torso, close to SI9 and SI10 and extending to the region of the supraspinatus process of the scapula.

Comments: If the patient has a herniated disc, you will not be able to press gently between the vertebrae without pain. Do not cup directly over the spine if there is a herniated disc. You can still cup alongside the spine and the sacral area, just not directly over the spine. If you can press into the area without pain, the disc is not herniated. In this case, you can cup directly over the vertebrae, which are moveable joints that collect toxins. Bulging discs can be fixed if the patient does not undo your treatment. To hold on to this treatment, be sure to tell your patient not to cross their legs, since crossing the knees puts a twist into the lower back, which immediately reverses the effect of the treatment. The patient can cross their ankles, as this does not alter the position of their sits bones.

Flower Bone Three and Flower Bone Four send the qi up the legs and to the spine, and they may be combined with 1010.25 State Water, which sends the qi down the spine; the ascending and descending qi connect at the lumbosacral hinge. I frequently use this combination when there is a bulging or protruding disc at L5-S1. With both the patient and practitioner standing, first insert 1010.25 State Water horizontally downward beneath the skin. Then, help them to lie down on their back by cupping your hand over these needles as they gently lay their head on the pillow. Carefully withdraw your hand and advise them not to lift their head or turn it radically. Place a bolster under their legs. Needle Flower Bone Three and Flower Bone Four. If the overhang of the feet created by this position makes it difficult for you to needle the Flower Bone points, they may be needled with the patient lying face down. However, people with bulging discs are not able to turn over easily, so I suggest that you teach yourself to needle these points with the patient lying comfortably on their back.

“Master Tung said, ‘Medical doctors always use surgery to treat disc herniation, but even after surgery, additional surgeries may be needed. The root cause of the disc herniation is Liver disease.’ For lumbar disc herniation resulting in severe bilateral leg pain, Master Tung needled 88.12-88.14 Three Yellows with 88.09 Passing Kidney, and sometimes added 88.03 Passing Heaven” (Dr. Wang, 2013).

If disc herniation is due to Liver, the Three Yellows points will be extraordinarily sensitive. There are multiple reasons for disc herniation, injury being the most frequent, in which case Three Yellows will not be painful unless the patient also has liver disease.

“I use State Water quite often to treat lower back pain. While the needles are in place, I have the patient mobilize their lower back. The treatment should continue until their pain or numbness is relieved. I also often use Flower Bone Three and Flower Bone Four for the treatment of lower back pain. While these needles are in place, the patient can also mobilize their lower back similar to the above. These two points are even more powerful than State Water” (Dr. Lee, 1992).

Sciatica - General (UB, GB, SP and ST):

22.04-22.05 Ling Gu/Da Bai*, needled on the opposite side.
UB40 Wei Zhong* (any vein in the popliteal crease), bled for lower back pain and sciatica.
DT.08 or DT.09, bled (palpate for tenderness) if there is severe unresponsive GB channel sciatica.
77.14 Four Flower Outer (Tung’s ST40)*, bled.

Other good options:

1010.25 State Water, needled.
1010.22 Nose Wing, needled on the opposite side. (Though Nose Wing is usually needled on the left side, it may be needled on the right side when treating left-sided sciatica.)

Comments: Seventy-five percent of sciatica cases seen in the clinic are found along the Urinary Bladder channel and are related to the disc between the fifth lumbar vertebrae and the sacrum. Twenty percent are connected to the L4-L5 disc and reflect on the Gallbladder channel. The remaining five percent are L3-L4 disc related, affecting the Spleen or Stomach channel. If more than one disc is compromised, sciatica affects multiple channels. Ling Gu and Da Bai are the only Dao Ma combination found in Tung’s acupuncture that can address all channels simultaneously.

When treating sciatica, it is very important that the patient move their legs and hips (Active Qi Moving) while the needles are retained, even if they can only make micro movements.

Bleeding UB40 is most effective. Let your patients know that just because the pain goes away does not mean they should challenge it to see how much better it is nor over-exercise. If both UB13 Fei Shu and UB36 Cheng Fu are painful, it could indicate lung cancer, so suggest a chest X-ray. If sciatica goes away and comes back quickly, there could be a lung issue.

Clinical Insights: Energetic connections related to sciatica (excerpted from Volume One, 22.05 Ling Gu):

In TCM, the Kidney is said to govern the lower back and legs. Through the five-element relationship of metal (LU) as the mother of water (KD), the Lung and Kidney are connected. The points also strengthen the lower back due to the LU/UB special relationship (described above), as well as the internal/external relationship between the Kidney and Urinary Bladder, and the points’ Kidney tonification function that is activated when the needles contact the bone.

Among these Kidney connections, an extremely important one is the special relationship between the Hand Shao Yang (SJ) and Foot Shao Yin (KD). Many patients experience sciatica that is primarily along the Gallbladder channel or is a combination of Urinary and Gallbladder types. Because Hand Shao Yang and Foot Shao Yang (SJ/GB) share a pathway, this powerful relationship between Shao Yang and Shao Yin (SJ/KD) enables Ling Gu and Da Bai to treat both channels.

Additionally, holography/imaging systems (Dr. Young/Dr. Tan) reveal a correspondence between the fingers and the hips. There are further connections to lower back and Kidney: Ling Gu is located on the lower jiao segment of the hand, and the Kidney and Large Intestine channels are opposites on the Chinese clock (horary).

Because Yang Ming (LI/ST) and Tai Yin (LU/SP) both connect to the earth element, Ling Gu and Da Bai are also effective in the treatment of sciatica along the Spleen or Stomach channel.

Sciatica due to cold

Patients who eat irregularly or consume cold food or beverages extinguish their Small Intestine fire and may experience abdominal distension or pain. Because the Hand and Foot Tai Yang (SI/UB) are connected, this can also cause Urinary Bladder channel sciatica due to cold, because the Small Intestine fire is not sufficient to nourish the Urinary Bladder.

Sciatica - Urinary Bladder channel (L5-S1):

SI3 Hou Xi with 22.04-22.05 Ling Gu/Da Bai, needled on the opposite side, with UB65 Shu Gu needled on the same side as a Guiding Point.
UB40 Wei Zhong* (any vein in the popliteal crease), bled.
1010.22 Nose Wing, needled on the opposite side. (Though Nose Wing is usually needled on the left side, it may be needled on the right side when treating left-sided sciatica.)
1010.25 State Water, needled on the midline.

Comments: Urinary Bladder channel sciatica arises from Lung deficiency and will be worse with movement or exercise. Urinary Bladder channel sciatica is related to L5-S1. For sciatic pain behind the knee, needle opposite-side SI3.

Sciatica due to lung cancer

I remember a particular case in Dr. Lee’s clinic in which UB channel sciatica resolved quickly but returned the following day. This made Dr. Lee suspect a lung condition, so she ordered a chest X-ray that identified the patient’s lung cancer. Lung weakness may show up on the Urinary Bladder channel as either sciatica or scapular pain.

“Ling Gu/Da Bai can be used to diagnose lung cancer or lung weakness that causes painful sciatica. If after fifteen minutes needling these two points the sciatic pain is gone or greatly reduced, we know the lungs are weak and are causing the sciatica. The pain will come back, however, when the needles are removed. The lungs must be strengthened for effective pain relief in this case” (Dr. Lee, 1992).

Sciatica patient testing his “fix”

A patient in my practice was a heavy smoker with sciatica. After I needled Ling Gu and Da Bai, his sciatic pain completely disappeared. He went home and bench-pressed to test the strength of his lower back after the treatment, as patients sometimes do. The pain immediately returned and was more severe than before, and I was not able to affect it with a second treatment the following day. It is best not to suggest to patients the possibility of cancer; however, I asked him to get a chest X-ray as soon as possible. Unfortunately, he never came back. It is always a good idea to remind patients to rest after their treatments.

Sciatica due to cold invasion

“33.09-33.09 Arm Five/Arm Thousand Gold are useful for treating a specific type of Urinary Bladder channel sciatica that has nothing to do with spinal joint problems but is due to drinking ice water or bathing/swimming in very cold water. The qi of the Small Intestine channel flows into the Urinary Bladder channel.

The Small Intestine channel is of the fire element. If the body becomes cold inside from cold water or cold drinks, then the channel is harmed and constricted. In this case the qi will not pass from the Small Intestine channel into the Urinary Bladder channel, and there will be pain” (Dr. Lee, 1992).

Sciatica - Gallbladder channel (L4-L5):

SI3 Hou Xi, 22.04-22.05 Ling Gu/Da Bai, 22.06-22.07 Zhong Bai/Xia Bai* or SJ5 Wai Guan, needled on the opposite side, with 66.09 Water Curve (GB41) needled on the same side as a Guiding Point.
77.14 Four Flower Outer (Tung’s ST40)*, bled.

Tenacious Gallbladder channel sciatica:

DT.08 or DT.09, bled. Palpate for the most sensitive spots in the area of the back where the arm connects to the torso, close to SI9 and SI10 and extending to the region of the supraspinatus process of the scapula.

Comments: Of diagnostic interest, Gallbladder channel sciatica is especially characterized by pain when getting up from sitting. This type of sciatica originates at L4-L5. Zhong Bai is Tung’s version of SJ3 Zhong Zhu, the Shu-Stream point, so it treats heaviness and pain along the Shao Yang (SJ/GB) meridian, tonifying the qi of the San Jiao. It shares the same connection to the Kidney as A.04 San Cha Three, and also passes through the same area. Both of these points have a very powerful effect on sciatica as well as exhaustion from Kidney deficiency.

Severe and chronic Gallbladder channel sciatica

I have found bleeding DT.08 Essence Branch to be exceedingly helpful in the treatment of stubborn Gallbladder channel sciatica, especially in the area approximately 6.0 cun above the ankle. As a young acupuncturist, I used acupuncture and cupping techniques to treat an elderly woman with severe and chronic Gallbladder channel sciatica. After three weeks of treatment, she was eighty percent better, except for the area between GB39 and GB40. I called Dr. Lee to ask her advice and she told me to palpate the area of DT.08 for an extremely sensitive point. After I bled this point, the last four inches of the patient’s sciatica disappeared immediately. I have never forgotten this case and have used Essence Branch many times successfully over the past thirty years.

Sciatica – Both UB and GB channels:

33.08-33.09 Arm Five Gold/Arm Thousand Gold*, needled on the opposite side with optional same-side UB65 Shu Gu or 66.09 Water Curve (GB41) as Guiding Points.
22.03 Upper White, needled on the opposite side with optional same-side UB65 Shu Gu or 66.09 Water Curve (GB41) as Guiding Points.

Sciatica – Spleen/Stomach channel (groin to front of thigh)

22.04-22.05 Ling Gu/Da Bai, 33.12 Heart Gate (Tung’s SI8)*, all needled on the opposite side. This combination works well without a Guiding Point.
PC6 Nei Guan, needled on the opposite side with same-side LV3 Tai Chong or 66.05 Golden Gate (Tung’s ST43) as a Guiding Point.

Comments: Spleen/Stomach channel sciatica relates to L3-L4. LV3 Tai Chong is an excellent Guiding Point for groin pain. Sciatic pain in the front of the thigh is not common; however, Ling Gu/Da Bai will treat it because these points cover the entire opposite leg and connect to the Stomach channel as Yang Ming. Heart Gate covers the area from the groin to the medial knee (LV/SP/KD), so we can connect LV3 as a Guiding Point, or ST43.

Tailbone or sacral pain:

55.04-55.05 Flower Bone Three/Flower Bone Four*, bilaterally needled, are the best treatment for coccyx pain. On occasion, if the pain is chronic or severe, I also needle 1010.25 State Water.
33.12 Heart Gate (Tung’s SI8)*, unilaterally or bilaterally needled, as we have two elbows and one coccyx; needle or moxa 1010.01 Uprightness Meeting (DU20) or use 1010.05 Anterior Meeting (DU21) with 1010.06 Posterior Meeting (DU19) needled through DU20 to treat tailbone pain. Together, they warm and raise the yang. (Conversely, bleeding the sacrum can relieve pressure in the head and occiput.) Please additional comments, 33.12 Heart Gate.
11.11 Lung Heart*, bilaterally needled.
66.01 Seal may be bilaterally needled, though due to its sensitivity I rarely choose it for this use.

Comments: I have frequently seen that two scenarios cause broken tailbones: elderly patients falling backwards onto cement, and women’s coccyx breaking during labor and delivery. Heart Gate is very effective when combined with 55.04-55.05 Flower Bone Three/Flower Bone Four to treat severe pain or fracture of the coccyx. For coccyx pain from a typical slip and fall, bilateral Heart Gate should be adequate. When we have a one-sided issue, we typically use the opposite side to treat it, but if the issue is on the midline, that gives us the option of using either side or both. If the problem is relatively minor, I may choose only one side, however for a long standing or severe issue, I will likely use both. If the sacral pain has to do with prolapse (urinary bladder, uterine, hemorrhoid, etc.), needle DU19 and DU21 combined, through DU20, or directly moxa DU20.

Over time, I have discovered a few additional toxin areas (similar to DT.01-DT.02), one of which is located at the very base of the coccyx. Though this area is difficult to access, I am certain to apply a small cup to it when the patient is experiencing coccyx pain, especially from an old impact or fracture. (Never cup it within six months of a break.) Surprisingly, on most patients the skin in this area turns black when cupped.

“Heart Gate can also treat inner leg pain and sacral area nerve pain. I use this point a lot with older patients. Most older patients have some heart problems” (Dr. Lee, 1992).