Tong/Lee Style Acupuncture
Extracts from his book ‘Foundations for Integrative Musculoskeletal Disorders: An East-West Approach’
Tong-style (Tung-style) acupuncture is a style that in part has been passed down within the Tong family (said to be about 300 years old). It is an effective ancillary technique for management of musculoskeletal and other disorders which I learned from Miriam Lee OMD from 1983 through 1985. Tong-style is a system that in part involves older theories relying on early numerological correspondence systems and the needling techniques described in Spiritual Axis that treat points in regions away from the symptomatic areas. It is also said to be related to the Spleen and Stomach school of Li-Dong. The Tong system mainly uses bodily reflections (analogous areas) that relate each body area to another area, mainly on the extremities (These are imaging or somatoreflex systems, e.g., the hand and points of the hand reflect and can be used to treat the head, or the foot, etc.) There are eight (or nine) main imaging systems within Tong-style, the most commonly used being the “same name” upper and lower channels systems (i.e., using Yang-Ming points of the lower limb to treat pain in a upper limb Yang-Ming area).
Few of the principal points used in this acupuncture style are on the Main channels and are often said to be between major muscle groups in the intramuscular “valleys.” Nonregular channel points, i.e., Tong points, are the main points used. Tong points are located within somatoreflex areas that correspond to specific Organ systems. These regions are unique to the Tong-style system but considered less frequently when treating musculoskeletal disorders than when treating internal medical disorders. At the same time, Houxi SI 3 and Wanggu SI 4, for example, are said to be the reaction area of the Kidneys and are used to treat Kidney-deficiency with symptoms such as back pain, sciatica, and tinnitus and therefore the somatoreflex areas may be significant when treating musculoskeletal disorders as well.
The strengths of Tong/Lee-style acupuncture are its simplicity, its use of a minimal number of points on unaffected areas, and its selection of points mainly on a regional and channel basis (i.e., one just needs to match areas of pain or Organic symptoms with their possible reflection in other areas of the body and empirically treat points until a desired effect is achieved). Because it is an acupuncture system, an “herbal” type (Zhong Fu/Organ) TCM diagnosis is not needed. Most Tong-style treatments result in little or no aggravation of symptoms and allow the patient to move the affected joint or area during treatment. Points are also chosen based on master Tong’s clinical experience as suggested by his (or family style) point indications. These however can usually be explained by their location within one of the bodily imaging systems, or by commonly understood relationships between Yin and Yang.
The mobilization of an affected painful joint during an acupuncture treatment, as is attempted in Tong-style, often results in an increased pain-free range of motion. However, functional signs and orthopaedic or osteopathic test results do not always change even when the patient feels less pain. The longevity of such change, when it occurs, is difficult to predict. The effects of the needles are said to last about two or three days, with bleeding techniques having a longer effect. Tong-style acupuncturists therefore like to see patients two or three times per week, with gradually less frequent visits as the patient improves. Occasionally, improvements last for a long time. The author has seen occasional cases in which long-standing pain resolved by a single treatment using distal points. This, however, is an exception. In its discussion of “perverse” diseases, the Spiritual Axis states: “Those headaches which occur from blows or falls which cause the sick Blood to remain inside cannot be treated by acupuncture. With injury of the flesh, where the pain does not cease, one can treat by local needling, but not by using distal points. Headaches which are not affected by acupuncture come from the illness of great Bi syndrome. If they are treated daily, one can effect a minor change, but not an end of the problem”. The Tong system and the usage of remote points are particularly helpful while practicing manual therapy at the same time. The combination of manual therapy and acupuncture has several advantages:
• The patient’s pain is reduced and so is muscle guarding. This allows for better and more accurate evaluation of joint end-feels.
• There is an increased ability to bring joints closer to their dysfunctional end-range during therapy, with less pain or guarding.
• The combination is clinically synergistic.
• The combination may address different aspects of the patient’s symptoms or the root causes of his or her symptoms.
When the practitioner is using remote points, a wave is said to be activated through the channel system (Figure 1).
The practitioner selects from one to four points on the Qi circulation channel system, often as far from the lesion as possible. This results in unblocking the channels and the concentration of Qi at the area of the pain. A second rationale for choosing a contralateral point is that pain (stagnation of Qi and Blood) on one side on the channel results in a Yin/Yang reaction with Emptiness and weakness on the opposite side or at analogous areas. While Dr. Lee often strongly stimulated opposite points when treating pain, master Tong is said to have just inserted the needles and not to have stimulated them.
Dr. Lee uses contralateral (or other nonlocal) points extensively, asking, why punish the painful area? The practitioner finds the source of pain and needles at the same level of “energy” on the channel system as far away from the lesion as possible. For example, if the pain is located on the lateral ankle area (on the Gall Bladder channel or in the Shao Yang region), the practitioner needles at the contralateral wrist Triple Warmer channel or Shao Yang region (i.e., using same-name channels on opposite sides). This system of choosing points is applied as follows:
Small Intestine<—>Urinary Bladder
San Jiao<—>Gall Bladder
For the preceding example (lateral ankle pain) one can also choose a Yin-related point on the Pericardium channel, i.e., the paired arm Jue-Yin channel to San Jiao for pain within a Shao-Yang distribution of the foot. This system of choosing points is applied as follows:
Another system involves pairing left-right Yin/Yang relationships with the Internal/External relationships. A Yang point on the left side is used to treat the paired channel Yin area at the same height, e.g., Yingu K 10 to treat Weizhong UB 40. This system is applied as follows:
Another common association used by master Tong is Tai-Yin to treat Tai-Yang (and vice versa), Shao-Yin to treat Shao-Yang (and vice versa), and Jue-Yin to treat Yang-Ming (and vice versa):
Most of the Tong-style reflection (imaging) systems can be summarized form the “Nine Stars of the Magic Square” as follows (Figure 2).
BOTTOM TO TOP (#1—>#9):
For example, use Neiting ST 44 to treat head; Correct tendons to treat neck and back of head; Flower Bone one (55.02) (Lee 1992) to treat the eyes; Shenmai UB 62, Jinmen UB 63 to treat headaches felt as a band around the head; and Liv-3, 2 to treat the jaw.
TOP TO BOTTOM (#9—>#1):
For example, use State Waters (1010.06) (Lee 1992) to treat low back pain; and Baihui DU 20 to treat the ball of the foot.
OPPOSITE SIDE, BOTTOM TO TOP (#6—>#4).
For example, Beside Three Miles (77.22, 23) (Lee 1992) to treat opposite shoulder/ arm; Fengshi GB 31 to treat opposite elbow.
OPPOSITE SIDE, TOP TO BOTTOM (#4—>#6):
For example, Sanjian LI 3 (1/2) and 4.5 (Ling Gu, Da Bai (22.04, 05)) (Lee 1992) to treat opposite back and leg pain; P-6 to treat opposite knee; Hand Five Thousand Gold (33.08, 09) (Lee 1992) to treat opposite UB channel leg pain; Heart Gate (33.12) (Lee 1992) to treat opposite groin pain; Yangchi (SJ-4) to treat the opposite ankle; Quchi LI 11 to treat opposite side knee pain; Jianyu LI 15 to treat opposite side hip and buttock pain; and Yemen (SJ-2) to treat opposite thigh pain.
SIDE TO SIDE (#4—>#2; #3—>#7; #8—>#6):
For example, Jianyu LI 15 (or shoulder triangle three points 1-2 cun below Jianyu LI 15 in a triangle) for opposite shoulder pain; Quchi LI 11 for opposite Quchi LI 11; Zusanli ST 36, Yanglingquan GB 34; and Yinlingquan SP 9 for opposite knee pain.
ALL DIRECTIONS TOWARDS CENTRE (#3—>#5; #9—>#5; #6—>#5; #1—>#5):
For example, Four Flowers Middle (77.09) (Lee 1992) to treat the chest, Lungs and Heart; Quanliao SI 18, Dicang ST 4 to treat Urinary Bladder burning pain; Water Gold Water Through (1010.19, 20) (Lee 1992) to treat the chest and low back; Xiangu ST 43 to treat opposite abdomen; Flower Bone Three and Four (55.04, 05) (Lee 1992) to treat the sacrum.
UPPER EXTREMITY RELATED TO HEAD AND TRUNK (#3/7/ 4/2—>#9; #3/7/4/2—>#5):
For example, Neiguan PC 6 for chest disease (forearm to treat chest); Quchi LI 11 for navel area (arm/forearm for trunk abdomen); Hegu LI 4 head area (hand to head disease).
LOWER EXTREMITY RELATED TO HEAD AND TRUNK (#8/ 6/1—>#9; #1/3/8/6—>#5):
For example, Zusanli ST 36 to treat naval area (leg to abdomen) and Neiting ST 44 to treat head and throat area (foot to head).
Any of these imaging relationships can be flipped around. For example, the bottom to top imaging can be used as “the foot being related to the head.” Neiting ST 44 is then used to treat head symptoms. The limb can be flipped. Areas of the hip will then relate to the head. Huantiao GB 30 and Fengshi GB 31 can then, for example, be used to treat symptoms in the head. When treating knee pain Chize LU 5, Quchi LI 11 etc., can be used, as the elbow can be related to the knee. If the image is flipped and the wrist joint is related to the knee, the common use of P-6 to treat the knee can be explained. These systems are therefore very flexible and can help guide the practitioner to various areas in the body and to access the channel system in various combinations
In general, points with any of the above channel relationships on analogous areas or systems are palpated for tenderness (although Dr. Lee rarely palpated for tenderness when choosing an imaging system or points). The practitioner uses points which yield the most tenderness, or treats empirically to see which gives the best clinical result. For example, for leg pain (or sciatica) opposite side Hegu LI 4.5 (Ling Gu 22.04), LI-3.5 (Da Bai, 22.05) (Lee 1992) and Shugu UB 65 can be used. A change in the pain is to be expected within a minute or so. If no improvement is seen, another analogous (imaging) area is palpated and needled, such as Hand Five Thousand Gold (33.08, 09) (Lee 1992) for example. Points can be chosen from any of the systems such as left to treat right, up to treat down, anterior to treat posterior, posterior to treat anterior, Yin to treat Yang, Yang to treat Yang, Yin to treat Yin, mid-day to treat mid-night, magic cube combinations, stems branches combinations, Extra channel command points, Source points, Connecting points, Accumulating points, etc. Any of the regular rationales for choosing points can be incorporated at the same time, such as, points Jing/Ting Well points to treat the Sinew channels, Heat and inflammation.
In the Tong method, the names of the Main channel points differ from (and have different functions than) the standard Main channel points. Points are located on body areas that have special functions and relate to Organs in a unique Tong-style methodology. An understanding of the channel system (and early numeric systems) helps in determining the location to be needled but is not mandatory. Most of the body Tong points are found in the valleys between muscle groups, and, therefore, are in close relationships to major nerve trunks and fascial compartments. Tong “channel lines” functions should therefore be understood and accurately located. Points on these lines often share common names and functions.
Bleeding, Cupping, and Moxa Techniques
In addition to needling, Tong-style frequently includes the “bleeding” of blood vessels and Tong’s acupoints. Whereas Tong-style needling is often performed distally, Tong-style bleeding is often performed locally. Points on the back (and on UB channel) are bled often as well. Bleeding is said to have effects of a longer duration than needling.
Dr. Lee used bleeding and cupping to vitalize Blood and to clear Heat and other pathogenic influences. Clearing Heat and pathogenic influences by bleeding is often performed for Deficient patients, especially using Gaohuangshu UB 43. Even though considered a sedating technique, bleeding can be used in Deficient patients because, by eliminating pathogenic influences, the patient is strengthened by a method similar to the attacking method used in herbal medicine. Dr. Lee often bled and cupped Feishu UB 13, Geshu UB 17, and Genshu UB 18 to “increase blood circulation” and to treat extremity pains due to poor circulation, e.g., diabetic neuropathy. Gaohuangshu UB 43 was often bled for knee pain (Figure 3). The retention of cups when used for bleeding is usually around five minutes. For other uses it’s between five and ten minutes (sometimes longer). She also utilized scarping (Gua Sha) techniques, using Wan Hua oil extensively. Dr. Lee used moxa cans (pots) to treat coldness, deficiency, and to build Blood. These were used either to warm the tissues or to “smock” psoriatic lesions.
When Is Tong-style Best Used?
It is my experience that Tong/Lee-style acupuncture, as well as other distal point systems, are best used when local tissue texture abnormalities are not clearly demonstrable (e.g., there are no clear tight-bands with triggers to account for symptoms). There is often palpable tenderness, muscle shortening, and possibly limited and painful movement. It is also helpful when joint pathology is involved. When clear, myofascial tight-bands are palpable I prefer to treat these directly, and then, if needed, to use distal/Tong points (especially in chronic cases). As stated earlier, the use of distal points is very helpful when integrated with other manual therapies. This system is very helpful in acute cases when the patient is in great pain. Tong-style bleeding and cupping techniques can greatly augment the patient’s total care, and their use is encouraged.
In my experience Tong/Lee-Style acupuncture is the most predictable, in terms of analgesic effects, of any of the “traditional” acupuncture systems I use. While as stated above, this system is often not sufficient to resolve the patient’s mechanical dysfunctions and therefore symptoms, this system can be used to reduce the patient’s pain almost immediately and can improve total function. Therefore, it is best to integrate joint and tissue specific diagnosis/examinations, which must be reassessed after the Tong-style treatment to ascertain if further manual therapy is needed. It is not uncommon to have the patient report great improvement in pain (and therefore also show increased range of motion) after Tong-style treatments, but for orthopaedic and joint play tests (especially provocation tests) to still show little improvement. In such cases it is advisable to integrate other therapies; doing so will greatly improve long-term outcome. Another observation is that Tong-style treatments work better when a thicker gauge (30-32) needles are used. 18 gauge hypodermic needles can be used for bleeding with less pain than would be elicited by lancets or traditional bleeding needles. In general, when bleeding, it is more important to look for congested blood vessels than “point location.”
Lee M. (1992). Master Tong’s Acupuncture. An Ancient Alternative Style in Modern Clinical Practice. Boulder: Blue Poppy Press.