by Stephen Rush, L. Ac.
Introduction
The Balance method is comprised of more than ten separate but interrelated systems of acupuncture channel theory. Five systems constitute the "core" systems of the method. While each system is distinct from the others, all of them for the most part can be used interchangeably in the treatment of a particular condition. This interchangeability of systems allows the practitioner using the Balance method a greater degree of clinical flexibility in treatment plans. As I mentioned above, the first two were discussed in some detail in the PCOM article, so here I will briefly review them before proceeding to a discussion of the next three systems. However, in order to make any of the Balance method systems work effectively on a consistent basis, there are a few things to consider. These are: (1) point location, (2) needle technique, (3) treatment time and frequency.
(1). Point Location. The Balance method emphasizes the importance of palpation and ahshi or tender point findings when locating distal points for treatment. The textbook-defined locations of acupoints are not always the optimal location for clinically effective treatment when using the Balance method. Ahshi findings usually yield more effective needling information. Of course, the practitioner needs to draw upon their college anatomy and physiology training and be aware of the underlying anatomical structures while doing so. Another consideration in point location that is sometimes overlooked in discussion is that of point depth. Whenever he lectures, Dr. Tan always emphasizes the concept of the point as a three-dimensional energy field, not simply a dot on the skin. While some research may suggest that the channels and points are most energetic just beneath the level of the skin, Dr. Tan finds that in general the Balance method works best in the clinic when the points are needled to a depth that allows the needle to "stand up" on its own.
In deciding where to look for possible appropriate points, the Balance method frequently makes use of the concept of "Anatomical Image". This concept can be represented in part by the traditional "Liu Ho," or Six Harmonies of classical Chinese anatomy:
the wrist corresponds to the ankle,
the knee to the elbow,
the shoulder to the hip.
Dr. Tan has elaborated upon this concept considerably, but the Six Harmonies should suffice as an example for the purposes of this article.
(2). Needles/Technique. The Balance method does not require an elaborate or complicated needling technique. It does require that the practitioner needle the patient for "Teh Qi" or Chi sensation. The Qi sensation delivers a powerful "signal" to the channel system of the patient, which is very important in making this distal point approach work effectively and rapidly. The degree of Qi sensation that works best with this approach is a moderate one. Along the continuum of acupuncture needle sensations, with "My God, let me out of here!" at one extreme and "I didn't feel a thing!" at the other, the Balance method resides just about in the middle. At our very busy clinic in San Diego. CA, over 95% of all of our patients can tolerate this degree of sensation in their treatment. In fact, entire weeks go by without so much as a single complaint from a patient who will not tolerate the treatment stimulus. Most patients can receive a very adequate stimulus from a #36 gauge Chinese-style needle. The number of needles used in a given treatment can vary from only one to as many as 10-15 in some cases. The average number tends to be around 6-8.
(3). Treatment time and frequency. With any of the Balance method systems, a rapid positive clinical effect is very likely. It is not unusual for patients to report near-instant improvements in symptoms of pain, numbness, diminished range of motion, etc.with this kind of treatment. Regardless of how rapidly the onset of symptom relief may be, treatments with the Balance method should be from 45 minutes to 1 hour in length. By leaving the needles in place for this amount of time, the channel balancing effect is strengthened.
Depending upon several variables, the symptom treated may begin to reassert itself at some time following the treatment. It is important to administer treatments at a frequency rate such that the patient receives subsequent treatment before the symptom or symptoms reassert themselves to the full degree that they presented with prior to the initial treatment session. In this way the clinician can stay ahead of the condition, and each subsequent treatment should be followed by a diminishing return of the original symptom. Initially, treatments are often spaced only a few days apart, with patients sometimes receiving treatment two to three times per week in the beginning. Treatment frequency can be reduced as the symptoms or condition improves and stabilizes.
The first two systems that were discussed previously in the PCOM journal article are the "Anatomical Image" system and the "Bie Jing" or Branching Channel systems, dubbed respectively as systems #1 and 2 of the Balance method.
This system always treats points that are located on the corresponding channel, but on the opposite, diagonal side of the patients' body.
Thus, a patient experiencing pain in the vicinity of their right ankle along the foot Shaoyang or Gall Bladder channel (GB40), would be treated by needling around the left hand Shaoyang or San Jiao channel point SJ 4.
In summary, System #1, the Chinese Anatomical Image system:
1) Diagnose the channel or channels involved and identify by energetic category.( hand or foot, Shaoyang, Taiyang, Shaoyin, etc.).
2) Locate the area(s) along the affected channel(s) where the pain or blockages seem to be.
3) Choose the appropriate diagonal channel ( i.e. L. hand Shaoyang to treat R. foot Shaoyang, etc.)
4) Using the "anatomical image" principle, find ahshi points on the diagonal channel that correspond with the area of pain /blockage.
Taiyin treats Taiyang.
Shaoyin treats Shaoyang.
Jueyin treats Yangming.
Also, as in system #1, Hand channels treat foot channels, and vice-versa.
Following the above criteria:
(1) Hand Taiyin (Lu), would treat foot Taiyang (UB).
(2) Hand Taiyang, (SI) treats foot Taiyin, (Sp).
(3) Hand Shaoyin, (H) treats the foot Shaoyang, (GB).
(4) The foot Shaoyin, (K) treats the hand Shaoyang, (SJ).
(5) Hand Jueyin, (P) treats foot Yangming, (ST).
(6) Foot Jueyin, (Lv) treats hand Yangming, (LI).
In this system contralateral or opposite side treatment is often used, but it is not exclusively employed, as in system #1. A strong Ahshi, or tender point finding at the appropriate site on the same side as the symptom would indicate it for treatment. When looking for points to apply with this system, the "image" concept can also be used to help out.
In the case of the Shaoyang ankle sprain, This system would look for a tender point on the hand Shaoyin or Heart channel. A likely point would be H7.
In summary, the Bie Jing system :
1) Uses Yang channels to treat Yin channels (and vice-versa).
2) Uses Hand channels to treat Foot channels.
3) If the condition treated is one-sided, Bie Jing treats the selected point on the side that elicits the most Ahshi sensitivity upon palpation.
This system involves channel relationships that are easily recognized by any student of TCM, in that they comprise the Zangfu organ pairs taught in all Acupuncture colleges. System 3 employs them in a very interesting way, Differing from systems #1 and 2 in that it treats hand channels with hand channels, foot with foot. Following the Zangfu pair relationship, it treats the paired channel on the opposite side. For example, if the patient complains of a left elbow pain in the vicinity of Lu5, then LI11 on the right side would be the appropriate point to treat. This system works very well in the treatment of sports injuries in their earlier more acute stages.
In fact, this system would probably be a good choice to consider for treating our Shaoyang ankle sprain. If a positive ahshi sensation around the left Lv4 area was found, then it would be indicated for treatment.
This system is also very good for internal types of disorders and pain. For example, to treat many types of abdominal pain, Dr. Tan uses P6 on one side, SJ5 on the other. On the legs he uses Sp9 paired with St36. Actually, these four points, used together to treat abdominal pain , demonstrate the application of both systems #3 and #2. Looking at them in the horizontal, they show the application of system #3:
(L) P6 ----------------> SJ5 (R)
(L) St36 --------------> Sp9 (R).
Looked at in the vertical, they show an application of system #2:
(L) P6 ----------------> St36 (L)
In summary, the internal-external system :
1) Treats opposite side:
2) Treats Yin channels for Yang, Yang channel for Yin:
3)Treats the Zangfu paired channel.
This system also employs the Chinese clock paradigm.The Opposite Clock system does just what its name implies. The affected channel is treated by using the channel directly opposite on the clock diagram. In the Opposite Clock system the channels pair up like this:
1) Heart (H) with Gall Bladder (GB).
2) Small Intestine (SI) with Liver (Lv).
3) Urinary Bladder (UB) with Lung (Lu).
4) Kidney (K) with Large Intestine (LI).
5) Pericardium (P) with Stomach (St).
6) San Jiao (SJ) with Spleen (Sp).
As the reader can see, this system shares in common with system #2, the Bie Jing or Branching Channel system, some specific channel relationships. It also shares with the Bie Jing system the possibility of selecting the same or opposite side for treatment. As with that system, palpation of the possible treatment channels on both sides of the body can determine which side is the best to use for treatment.
This system, like the previous four, is very effective in the treatment of any kind of blockage related to the channel, either internally or externally. Dr. Tan often uses this system as the main approach for the treatment of scapular pain that involves the SI channel. By finding and treating ahshi points on the Liver channel along the lower leg, scapular pain related to the SI channel often reduces or disappears very rapidly. In a typical case anywhere from 1 to 6 such ahshi points on the Liver channel might be detected and treated.
To consider the case of the Shaoyang ankle sprain one last time, here we can see that its treatment would be an example of an overlap with system #2.
In summary, the Opposite Clock system:
1) Is based on the Chinese Clock.
2) Treats Yang channels for Yin channel problems, Yin channels for Yang channel problems.
3) Treats hand channels for foot channel problems and vice-versa.
4) Depending on palpation and ahshi findings, uses either opposite or same side for treatment.
All acupuncture college students are required by curriculum to learn the traditional "Chinese clock", often committing the sequence of organ/channel relationships to memory by rote means without any solid appreciation of their rich potential as a source of clinically effective information. Dr. Tan has based systems # 4 and 5 upon the venerable Chinese clock, and in so doing has generated some channel theory information that is extremely relevant to the clinic.
In the Neighbor Clock system of the Balance method Dr. Tan identifies the channel relationships as being between the neighboring pairs of channels. The pairings are always with the neighbor of the same polarity: Yang with Yang, Yin with Yin.Thus, looking at the diagram of the clock above, the pairings are: (starting with the Hand-Taiyang or SI channel),
(1) Small Intestine (SI), with Urinary Bladder (UB).
(2) Kidney (K), with Pericardium (P).
(3) San Jiao (SJ), with Gall Bladder (GB).
(4) Liver (Lv), with Lung (Lu).
(5) Large Intestine (LI), with Stomach (St).
(6) Spleen (Sp), with Heart (H).
In the Neighbor Clock system the opposite side channel is used. Like the other systems of the Balance method, it is very effective in the treatment of specific channel-related pain and/or blockage and can be indicated for treatment if the channel and points palpated yield a positive ahshi or tender point response. For example, if a patient complains of pain in the vicinity of Lu5 on the left, and palpation of the area around Lv8 on the right side yields a positive ahshi response, then this system could be the best one indicated for treatment.
In the case of the Shaoyang ankle sprain, the treatment in this system would overlap with system #1. SJ4 would be the point to use.
System #5 Summary:
The Neighbor Clock System:
1) Is based on the Chinese Clock.
2) Treats channels of the same polarity.
3) Treats the opposite side.
4) Treats foot for hand, vice-versa.
The channel systems listed above constitute the five core systems of Dr. Richard Tan's Balance method. Together, they represent a simple yet dynamically effective approach to channel theory that requires few needles, simple needle technique, and is easily tolerated by the vast majority of acupuncture patients.
As with virtually every system of acupuncture treatment, there exists the possibility of symptom aggravation. In our clinical experience there is a 10-15% chance that a symptom aggravation may occur either during or soon after a treatment. Since the incidence of symptom aggravation also seems to be higher during the initial treatments, the patient needs to be informed of the possibility of such an event. Actually, Dr. Tan generally interprets the report of a symptom aggravation as a positive sign, since in the great majority of these situations the aggravation clears up within 24-36 hours and the patient reports feeling better than before. In those few cases where the aggravation persists, we almost always find that another factor such as reinjury has occurred. Reinjury often occurs when the patient, feeling no pain or discomfort after the initial treatment or two, mistakenly thinks that the condition has been entirely healed and engages in behavior or activity that results in more damage. Patients should be strongly cautioned against such activity and advised to consult with their practitioner about when it is safe to resume certain activities, and to what degree.
Aside from reading our books, taking the Balance method seminars offered around the country and actually studying with Dr. Tan himself, the best way for the practitioner to become acquainted with the Balance method via this article is to try out one system at a time. Particular attention should be paid to the considerations and precautions mentioned in the introduction section and above. Try to refrain from using all of the systems at once in order to avoid the onset of acute clinical confusion. (In the practitioner, that is). With acupuncture, as with many other things, more is not necessarily better.
However, there is more to the Balance method. As I mentioned briefly at the beginning of this article, there are at least five more functioning systems in the Balance method. As such the Balance method remains very much a work in progress. The five core systems depicted here are very stable and reliable, having been clinically tested over the course of thousands of patient-treatments. Dr. Tan remains as committed to clinical excellence and growth as ever, and continues to refine and develop more Balance material for presentation to the acupuncture community in the near future.
Stephen Rush, L. Ac. is Dr. Richard Tan's senior student, co-author, and longtime friend. He has been a student of acupuncture technique since 1980 and has been a licensed practitioner since 1987. Currently he is working ontheir third book, dealing with the principles of Dr. Tan's Balance theory.
He can be reached via e-mail at : steverushz@earthlink.net.