Hua Tuo had several disciples, including Wu Pu, Fan E, and Li Dangzhi, all of whom were excellent physicians. They also practiced qi gong, acupuncture, herbal medicine, and other things learned from Hua Tuo. It is said that Wu Pu wrote an herb guide and that Fan lived to be over 100, thanks to the exercises he practiced regularly.
APPENDIX: HUA TUO ACUPUNCTURE POINTS.
The Hua Tuo acupuncture points, known as Hua Tuo Jiaji (jia = lining; ji = spine), are located in a row along side the spine, bilaterally. The points are attributed to Huo Tuo because it is said that he preferred treating certain conditions with these points. For example, there is a story that a patient having problems with his feet couldn't walk, so he went to Hua Tuo, who applied moxibustion to points on his back along the spine. Soon, the patient was able to walk again. Historical records of these points are few. The Zhenjiu Jicheng (Comprehensive Collection of Acupuncture-Moxibustion; published in 1847) says:
The jiaji treat sudden chaos twisted sinews. Order the patient to lie in prone position and extend their two hands to touch the body. Then use a string to connect the tips of the two elbows. The points are located 1.5 cun bilateral to the spine below the point where the string crosses the spine. Moxa 100 cones and nothing will fall short. This is Hua Tuo's method.
The "twisted sinews" may refer to tendons and muscles that have become stiff or paralyzed, causing one to be unable to walk, and this statement may simply be a reflection of the original story linking these points to Hua Tuo. The initial descriptions refer to use of moxibustion, but needling is emphasized in modern texts.
The general use of points near the spine was eventually organized into a set of 17 specific points in a row (see figure) with specific relation to the vertebrae, but these have been increased to 24 bilateral points by extending the set upward on the neck and downward on the sacrum (8). The points are located between the single row of Governing Vessel points that run directly along the spinal column and the inner set of bilateral Bladder meridian points. The Bladder meridian runs in two lines parallel to the spine; the inner row being 1.5 cun lateral to the spine. The Huo Tuo Jiaji are usually said to be located 0.5 cun lateral to the lower border of each spinous process; some authors locate the points slightly closer to the spine, and others as far as 1 cun from the spine.
The points lie along the interspinous transverse ligaments and muscles. Each point has its related posterior branch of the spinal nerve starting from below the vertebra and the accompanying artery and vein. It is understood that the stimulation of these points will treat problems of the organs and body parts that are located in the same general region. Their functions correspond, roughly, to those of the Bladder-associated shu points. Hence, the points in the upper portion of the thorax are used to treat diseases of the throat, heart, lung, and upper extremities; the points in the lower portion of the thorax are used to treat diseases of the liver, gallbladder, spleen, and stomach; points in the lumbar region are used to treat diseases of the urogenital system, the intestinal tract, lumbosacral region, and lower extremities. From the modern viewpoint, needling the nerves extending from the spinal column to the associated regions could explain these recommendations.
Location of the points, in terms of distance from the spine, has been an issue of some contention. The physician Wang Leting (1894-1990) preferred needling the points slightly closer to the spine (9). He moved the location inward so that the points were just 0.3 cun lateral to the spinous processes. Wang cited the satisfactory needle response as one basis for selecting this location and expressed the view that treating the jiaji would have the effect of simultaneously improving the flow of qi in both the Governing Vessel and Bladder meridian. Such treatment would be of particular benefit for many cases of paralysis; Wang also recommended these points for relieving pain syndromes, including lumbar pain, gastrointestinal disease with pain, herpes zoster, and intercostal neuralgia.
In an article on using the Hua Tuo jiaji points for treatment of summer fever (with weakness in the lower extremities, fatigue, and stiffness in the back), the authors indicate that these points are used to regulate the functions of the internal organs and relieve the stiffness (10). As to location, the authors stated:
Originally, all the points along both sides of the spinal column were designated jiaji, without fixed location. Later, three main ways for location of jiaji points were used according to the clinicians' experiences. The first and most popular way is 0.5 cun; the second way is 1.0 cun, and the third way, 0.8 cun bilateral to the midpoint between each two vertebral spinous processes. From our experience, it is dangerous to apply acupuncture at 1.0 cun bilateral to the spinal column, 0.5 cun is safe but the needling sensation would not be strong enough. Perpendicular insertion of the needles in the third way [0.8 cun] is not only safe, but also more effective because needling sensation would be elicited easily. In regard to the depth, it is common to insert the needle perpendicularly 0.3-0.5 cun deep at the point 0.5 cun lateral to the midpoint between each two spinous processes. But we consider that this depth is not enough, so that no promising needling response could be elicited. Therefore, no good effect could be expected by shallow needling. For this reason we have adopted deep needling [0.5-1.0 cun for upper thoracic points; 1.0-1.5 cun for lower thoracic and lumbar points] to treat summer fever for a better result.
Wang also relied on deep insertion, which was easier to perform and safely done closer to the spine, with 1.5 cun depth except for thin people, who he would needle at 1.0-1.5 cun. He recommended perpendicular needle insertion. In an article on treatment of migraine with Hua Tuo jiaji plus fengchi (GB-20), He Shuhai indicated that needles should be inserted into the points to a depth of 1 cun or a little more or less depending on the fatness or thinness of the patient, using a slight oblique angle of 75 degrees to the skin toward the spine (12).
Thus, it appears that one of the considerations for treatment of this region is to needle close enough to the spine to avoid the danger of puncturing the internal organs (specifically to avoid pneumothorax), while puncturing deeply enough to attain an adequate qi response and therapeutic effect. Yet, the points need to be far enough from established points (those of the Governing Vessel and inner Bladder meridian line) to be considered a separate treatment method. Thus, points are selected at a distance from 0.3-0.8 cun lateral to the spinous processes, with a needling depth of 0.5-1.5 cun, using perpendicular or slight oblique needling angle. Needle retention time is 20-30 minutes, with stimulation by reducing or tonifying method as appropriate to the point (e.g., reducing therapy for liver, tonifying for spleen). The points are mainly used to regulate the internal organs and alleviate stiffness, paralysis, and pain syndromes.
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