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StressKM style: Autonomic Nervous Imbalance

The lifestyle in the modern Western world requires a strong and healthy Autonomic NervousSystem (ANS) to cope with society’s stresses and demands. If this system is chronicallycompromised, disease may arise from this imbalance. Exposure to daily stress, coffee, alcohol,lack of vacation time, relaxation and irregular food intake, are all common examples of chronicabuse of the ANS. Over the counter medications, supplements, and herbal preparations canchange the pulse and, with chronic use, disturb the balance of the ANS.

There are two main categories:1. Sympathetic nervous system (SNS) dominance with possible parasympathetic nervous system(PNS) deficiency.2. Sympathetic nervous system deficiency with possible parasympathetic dominance. 1

Sympathetic Nervous System (SNS) DominanceAccording to Master Nagano, stimulating a deficient SNS will regulate an excessive PNS andcalming an overactive SNS will have the effect of stimulating a deficient PNS. Thyroid, pituitaryand estrogen­progesterone imbalances complicate some cases and are termed as autonomicnervous disorders with hormonal problems. Oketsu, immune, adrenal, etc. treatment protocols willnot only alleviate the pressure pain at the diagnostic points associated with the hormonal imbalancebut also most of the pressure pain at the diagnostic points associated with the ANS imbalance. Anexample is given for thyroid gland imbalance: pressure pain at St 9 and treated with K 3, the thyroidpoints behind the ear and LI 15 could also reduce pressure pain at the SCM muscle (which isindicative of an imbalanced ANS). 2

Signs and SymptomsA patient presenting with a SNS dominance most commonly has a rapid pulse and a tight SCM,along with several of the following symptoms: SOB, palpitations, emotional instability, H/A, backpain, decrease in frequency and quantity of urination, insomnia, lack of appetite, dizziness, nausea,eye pain, cold hands and feet.

PalpationK 2 should always be checked for pressure pain since the nature of a SNS dominance presentationis of a Yang and Heat quality. The pulse typically will be rapid and tight. Anti­depressivemedication, tranquilizers, and/or ß blockers, or has a pacemaker, the pulse might not present asrapid but it will still be tight. Check for a pecking pulse indicating Stomach Qi deficiency. Checkboth SCM muscles for size, tension and pressure pain. Patients that present with a sympatheticdominance, commonly have a tighter and more painful SCM only on the right side. Patients withunilateral tension of the SCM may have one­sided presentations of facial twitching and ticks, H/A,

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feeling of a heavy head, general muscle spasms and pain, Bell’s Palsy, motor nerve problems suchas Parkinson’s disease, stroke, or may present with unilateral tension after sports injuries and caraccidents (whiplash). 3

TreatmentFirst step: Reduce pressure pain at K 2.If K 2 is painful upon palpation, treat the Kidney metal and water points: K 7 and K 10. The exactangle and location that reduces the pain pressure at K 2 is required. K 7 is usually where thecalcaneus tendon begins to harden or firm up. It is needled at a 15˚ – 45˚ angle upwards with theflow of the meridian. The angle may have to be adjusted, often toward K 8. K 10 is found betweenthe semitendinosus and semimembranosus tendons at the medial edge of the popliteal crease. Theangle is between 90˚ – 45˚ angle upwards with the flow of the meridian.

If the adrenal sign in the abdomen is also painful upon palpation, add Lu 5 and K 27.

Check for pain pressure on the Fire point of the Lung meridian at Lu 10. Treating Lu 5 and Lu 8should aid the reduction of pressure pain at the adrenal reflection in the Hara. The location of Lu 5may move up to one inch above or below the midline of the cubital fossa and is needled at an angleof 15˚ – 45˚ with the flow of the meridian. Lu 8 is needled with the flow at a 10˚ – 15˚ angle. If Lu 10is still painful, needle GB 25 at an angle of 10˚ – 15˚ from ventral to dorsal following the rib. BL 52is sometimes more helpful in reducing the pressure pain at Lu 10 and is needled downward with theBladder meridian at an angle of 45˚.

Second step: Address the rapid pulse.A non­athlete adult who does not drink coffee has a rapid pulse at 80 beats per minute (bpm) andabove and may also be a few beats slower and have a hurried quality. CV 4 and/or CV 6 calms andrelaxes the patient. If the pulse rate has not changed after treatment, 10˚ – 45˚ insertion of a needleinto GV 2 can often reduce the pulse rate. Treating the Governing Vessel line and/or the Huato Jiajipoints may stimulate the SNS and aggravate the patient’s condition. Exceptions to this rule are GV5, 6, 14, and the sacral points including GV 2. 4

A point behind the third toe on both feet is an important point used to regulate the pulse and bloodpressure and sleeping disorders associated with rapid pulse in a patient with sympatheticdominance presentation. Palpate the crease between the third metatarsal and the phalanx bones. AJapanese #1 needle inserted shallowly into the most sensitive point at this location and stimulatedwith direct, thread­sized moxibustion, especially if the feet are cold. The patient should feel theheat at least seven times. 5

If successful, a magnet can be left at this point at the end of treatment. This magnet is best held inplace by use of a thin micro­pore tape surrounding the toe.

It is very important for the practitioner to teach the patient abdominal breathing.

Rapid pulse and Liver DeficiencyRapid pulse and Liver deficiency is detected when a patient experiences dull or weird sensation atLv 14 on the right side. Treatment is needling the point at Lv 1 on the right where patient is mosttender. The four points are tested against the amount of change obtained at the right Lv 14 area orthe amount of pressure pain reduction at the Huato Jiaji point of C3, then needled with a #1

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Japanese needle and 15 direct, thread­sized moxa stimulations.

Rapid pulse and the Pericardium ChannelCheck Pc 8 for pressure pain. If found, treat by needling Metal and Water points Pc 3 and Pc 5. IfPc 8 is not tender and there is pressure pain on CV 17, then needle Pc 6. Upon firm palpation Pc 8feels very comfortable, it is needled directly with a #1 Japanese needle (Pc 4 can be a substitutefor Pc 8). If CV 17 is painful upon palpation and the patient presents with a rapid pulse, TW 5 andGB 41 should be treated first. GB 41 is needled with shallow insertion and without stimulation. Thelocation and angle of this point are determined by the reduction of pressure pain of the SCM. Aftertwenty minutes of needle retention, the Pericardium Channel is treated as described above. 6

Tension of the SCM: Master Nagano’s Shao­Yang TreatmentThe right SCM muscle tightness is more common in SNS dominance so the Shao­Yang treatmentwould be on the left side. The Shao­Yang treatment is performed on the opposite side of the painfuland tight SCM muscle. However, if the left SCM muscle is tighter and more painful than the right, itis often necessary to treat the Shao­Yang on both sides. Whether the treatment point is TW 5 orabove TW 9, there is usually a groove somewhere in between these two points along this line thatthe finger slips into. It is vital to make sure that the point found on the Triple warmer line willrelease at least some of the tension on the contralateral SCM muscle. This point should bemassaged for about ten seconds. If this successfully reduces pressure pain at the opposite SCMmuscle, it should be needled at 90˚ and gently stimulated. This point should be stimulated everyfive minutes for at least ten seconds during the fifteen to twenty minute time of needle retention.

When combining treatments, such as Oketsu, immune, Stomach Qi, blood pressure or cardiacproblems, reexamination of all reflexes should be performed frequently in order to verify thatpreviously reduced pressure pain does not reappear. 7

Sympathetic Nervous System Deficiency

The PNS will present as dominant in the case of a sluggish SNS. This condition might occur after aprolonged period of sympathetic dominance, long­term intake of medications that affect the ANS, orhead injury. When the PNS becomes dominant, there is a constriction of blood vessels in the brain,excitement of the digestive system and adrenal gland deficiency.

Signs and SymptomsSystemically, adrenal exhaustion may result from an extended period of symptomatic dominanceleading to a later stage complication of parasympathetic dominance. The patient might feel tired,have low back pain, shoulder pain, and muscular tightness in the whole body. Other symptomsmight include lack of sweat (except on the palms of the hands), cold lower back, cold abdomen,and cold extremities. The pulse rate is likely to decline and feel as if it is sinking. So if the patientpresented with a rapid pulse before the deficiency developed, he may now present with a normalpulse.

Locally, patients will complain of low backache, digestive problems such as abdominal pain,cramps, diarrhea, excessive salivation, and gas; upper respiratory conditions such as wheezing,SOB, or coughing; and urinary tract conditions such as contraction of the bladder and relaxedsphincters (frequent urination). 8

Treatment

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The treatment of abdominal points tends to further increase PNS stimulation, so it should beavoided. If necessary, points on the abdomen may be used after the pulse rate has increased andthe pressure pain on the thoracic spine diminished. Bl 27 (Small Intestine Shu) is the best point toincrease the pulse rate. If the sacrum is cold, Kyutoshin moxa should be burned on top of the eightLiao points located at the sacral foramen.

The Governing Vessel at the scapular area is carefully palpated and the most sensitive points areneedled and stimulated with seven or eight direct thread­sized moxa. 30mm Japanese #2 needlesare inserted at a 45˚ angle downward and at a 45˚ angle upwards on the GV line. Huato Jiaji pointsare needled into a hard gummy point at a 45˚ angle toward the spine.

A tight or hard navel, especially at the adrenal gland reflection zone can be reduced with K 6, K 27,and Lu 5. Secondary points to reduce this zone are described in the text on pp. 85­86 should theprimary points not be enough.

If the SCM is tighter or larger on one side, use the Shao­Yang treatment as described earlier.

Active cardiac reflexesThe right Huato Jiaji of GV 4 is needled to reduce pressure pain on the left SI 11 area. Bl 14 and Bl43 are needled at a 45˚ angle downward with the flow of the Bladder meridian.

Breathing problems, especially with constricted tracheaGV 12 is needled at a 45˚ angle upward, Bl 12, Bl 13, and Bl 42 are needled at a 45˚ angledownward.

Headache and symptoms that manifest in the face and neckGV 13 and GV 14 are needled at a 45˚ angle upward. Bl 11 is needled at a 45˚ angle downward.

Tightness below the sternumGV 11 is needled at a 45˚ angle upward, Bl 15 and Bl 44 are needled at a 45˚ angle downward.

Stagnation of blood with a slow pulse (difficulty in reducing Oketsu with Lv 4 and Lu 5)GV 9 is needled with a 45˚ angle upward, Bl 17 and Bl 46 are needled at a 45˚ angle downward.

GV 8 is treated with eight direct, thread­sized moxa stimulations in cases of generalized muscularache, stiff shoulder, fatigue, cold lower back and frequent urination. 9

References:

1. Kiiko Matsumoto’s Clinical Strategies: In the Spirit of Master Nagano, Vol. 1, p. 1052. Ibid., p. 1063. Ibid., p. 1074. Ibid., pp. 108 – 1095. Ibid., p. 1106. Ibid., p. 1117. Ibid., pp. 112 ­1138. Ibid., p. 1159. Ibid., p. 116

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