Shi Xue-Min and Xing Nao Kai Qiao Legacy
by Jing Liu and Kun Liu. Translated by Eric Brand
What is Xing Nao Kai Qiao?
According to the World Health Organization, stroke is the third leading cause of death in most countries of the world, surpassed only by heart disease and cancer. By the year 2030, it is expected to be the leading cause of death. In the United States, each year 750,000 individuals suffer a stroke and 150,000 people die from stroke. Each year in China, 5-6 million people suffer from stroke and approximately 1.5 million people die from stroke. Stroke affects three times as many women as breast cancer, and it is an important cause of prolonged disability. Survivors of strokes are often unable to return to work. The economic, social and psychological costs of stroke are enormous. In the U.S., each ischemic stroke costs an average of $140,000.
The "Xing Nao Kai Qiao” (XNKQ) method was created by Dr. Shi Xue-min in 1972, illustrating a new approach to the treatment and rehabilitation of stroke patients. As a result of nearly 40 years of working with stroke patients, the "XNKQ” method has developed into a diagnostic and treatment system. (历经三十余年的临床与基础研究，已经形成以"醒脑开窍”针刺法为主的中风病综合诊疗体系).
The theoretical TCM basis of the "Xing Nao Kai Qiao” method was based on "spirit-arousing” and "spirit-regulating.” Dr. Shi Xue-min put forward a new conception of the etiology and pathogenesis of stroke, based on a deep understanding the theory of "spirit” in TCM combined with the anatomy and physiology of the brain in biomedicine. Dr. Shi posited that fire, phlegm, blood (stasis), and deficiency carried upwards by wind (internal wind) disturbed the lucid orifices and spirit, leading to closure of the orifices and concealment of the spirit, which in turn caused the spirit to fail to guide the Qi, thus stroke occurred. The XNKQ acupuncture method for treating apoplexy/stroke explained the main pathological keys to etiology, pathogenesis, disease location, and manifestations, and created scientific standards of points selection and acupuncture manipulation. A large amount of clinical practice has confirmed that the treatment method is effective, easy, convenient and practical with a strong scientific standard. The XNKQ method is based on activating and regulating the spirit, restoring qi and spirit, regulating yin-yang and qi-blood, calming, dredging the meridians and supplementing the marrow.
The principles of traditional acupuncture treatment in stroke patients include "calming liver-yang and smoothing liver wind” in the acute period. "Smoothing meridians” is the main principle in stable cases and the sequela period. The points chosen were based on the theories of "using three yang meridians to treat wind” and "using Yang-Ming meridians to treat apoplexy.” A comparison of clinical effects and research shows that the traditional acupuncture treatment for stroke patients has a definite effect in stabilizing the disease and improving physical function. However, to improve cerebral circulation and protect the brain cells, the changes in brain function are not obvious. Dr. Shi’s XNKQ mainly uses Yin meridians and the Du meridian to activate the brain and open the orifices and nourish the liver and kidney; smoothing the meridians is supplementary.
The theory of quantitative acupuncture manipulation put forward first by Dr. Shi Xue-min determines a new definition and quantitative manipulation for reinforcing and reducing methods of needle manipulation. Particular attention is given to twirling and rotating, including 4 important factors. The direction of applied force is an important factor in determining reinforcing vs. reducing technique. The reinforcing or reducing nature of twirling and rotating is directly related to the applied force, the best duration of reinforcing or reducing manipulation based on twirling and rotating the needle is 1-3 minutes for each point. Finally, the best interval between two sessions of acupuncture is 3-6 hours, allowing acupuncture therapy to be more reproducible, standardized, and controlled.
Additionally, Dr. Shi Xue-min investigated the most commonly used methods of manipulation for reinforcing and reducing in terms of frequency, range, and direction of applied force. His research on quantification of reinforcing and reducing manipulation techniques resulted in two significant definitions: 1) The twelve channels are positioned with the Ren and Du channels in the center; in regard to the right or left direction of needle rotation, directing the rotation towards the heart is reinforcing and directing the rotation away from the heart is reducing. 2) Rotating the needles within a narrow range with light force is reinforcing; the force is light and the range of rotation is narrow but the frequency is high, the needles are rotated under 90 degrees and the frequency of rotation reaches 120 times per minute. By contrast, a wide angle of rotation, increased force, and relatively less frequent rotation is reducing; the angle of rotation is greater than 180 degrees and the frequency is approximately 50-60 times per minute.
The manipulation and composition of the XNKQ needling method
One of the main reasons for the efficacy of the XNKQ method lies in its strict application of principles, in particular its special specifications in terms of manipulation technique. The principle points in clinical use are the most important because they free and regulate the spirit; this emphasis is one of the most important differences between the XNKQ method and traditional acupuncture.
The principle points of the XNKQ method include Du 26, P 6, Sp 6, Lu 5, Ht 1, and UB 40. Du 26 is a point that was highly regarded historically for emergency situations; it can directly excite and activate the restrained state of the brain cells. It has a special characteristic of increasing the circulation of the carotid artery, which helps the dynamics of blood circulation and improves cerebral circulation. Thus, the use of this point with sparrow pecking stimulation can open the orifices, arouse the original spirit, and regulate the bowels and viscera. P 6 is the luo point of the pericardium channel, it can benefit stroke patients by improving cardiac output and oxygen supply while calming the heart, regulating the blood, and quieting the spirit. Sp 6 supplements the three yin channels, boosts marrow, regulates qi and blood, and quiets the spirit. Ht 1, Lu 5 and UB 40 can dredge the channels, move qi and blood, and improve the function of the limbs. Within these points, Du 26 is the chief, P 6 and Sp 6 are ministers, and Ht 1, Lu 5, and UB 40 are assistants and couriers; together they regulate and brighten the original spirit, balance yin and yang, regulate qi and blood, and free the channels. One treatment course constitutes ten days of twice daily treatments; 3-5 treatment courses are used continuously.
Needle Manipulation Techniques Used in XNKQ
The efficacy of XNKQ is closely related to its strict attention to techniques of needle manipulation. One of the key differences between XNKQ and traditional acupuncture methods is the importance placed upon principle points that arouse the spirit and open the orifices in order to achieve the essential effect of regulating and freeing the original spirit.
The principle points used in XNKQ are DU-26 (ren2 zhong1), PC‑6 (nei4 guan1), SP‑6 (san1 yin1 jiao1), HT‑1 (ji2 quan2), LU‑5 (chi3 ze2), and BL‑40 (wei3 zhong1). Ancient doctors greatly valued DU-26 (ren2 zhong1) as an important point to arouse the brain in emergency situations; it has an excitatory effect on the nervous system and it has an idiosyncratic effect of increasing blood flow in the carotid artery while improving cerebral circulation. Using sparrow pecking technique to drain DU-26 (ren2 zhong1) opens the orifices, arouses the original spirit, and regulates the bowels and viscera.
PC‑6 (nei4 guan1) is the luo-connecting point of the pericardium channel; it is traditionally said to quiet the heart, regulate the blood, and calm the spirit, and it improves the cardiac output of stroke patients and improves the supply of oxygen to the brain. SP‑6 (san1 yin1 jiao1) supplements the three yin channels of the leg and boosts marrow while regulating qi and blood and calming the spirit. HT‑1 (ji2 quan2), LU‑5 (chi3 ze2), and BL‑40 (wei3 zhong1) smooth the channels and network vessels while moving qi and blood to improve movement of the limbs.
DU-26 (ren2 zhong1) is regarded as the sovereign point in the prescription, while PC‑6 (nei4 guan1) and SP‑6 (san1 yin1 jiao1) are ministers. HT‑1 (ji2 quan2), LU‑5 (chi3 ze2), and BL‑40 (wei3 zhong1) are assistants and couriers. This combination regulates the original spirit and brings out brightness. It creates yin-yang balance and rectifies qi and blood to harmonize the thoroughfare (chong) vessel. By freeing the channels, it promotes uninhibited movement. Treatment is given twice per day for 10 days per treatment course, and 3-5 continuous courses of treatment are recommended.
The XNKQ method of needling has a clear effect in stroke patients, with pronounced positive effects in multiple systems. Prof. Shi Xue-Min has studied its clinical effects for over 30 years in numerous systems involving many different disciplines of treatment, prevention, and rehabilitation. He has contributed standards of integration and management for the diagnosis and treatment of stroke, which has been called a unique "chapter on the treatment methods of Master Shi.” It has been shown to reduce mortality and enhance rehabilitation in stroke patients, and is widely regarded as an excellent method of treatment.
Another key aspect of the XNKQ method is the emphasis on manipulation techniques for the principle points. Each point has clear specifications on direction, depth, and hand techniques, which have been assessed with numerous scientific studies. Thus, the needling method is based on established science and standards that enhance clinical results.
After Dr. Shi published his work with the XNKQ needling method, a clinical system of stroke diagnosis and treatment was developed. Altogether, over two million stroke patients have been treated with this system of acupuncture therapy. In recent years, 9005 patients with stroke at various different stages were assessed based on strict, harmonized diagnostic standards and treated principally with the XNKQ method. Based on their specific condition, patients utilized drug therapies including medication for hypertension, infections, and other concerns based on internationally accepted standards of care. Marked results were seen in 95-98% of patients with a variety of different stages and conditions, including acute stages, hemorrhagic stroke, and recovery stages.
Over the past forty years, Dr. Shi Xue-Min’s humble yet highly innovative work has truly entered the history books.