Tung's acupuncture--an introduction

By: McCann, Henry

Abstract

Tung lineage acupuncture represents an ancient divergent approach to acupuncture treatment that has survived to the present day. It is characterised by its unique set of non-channel points, simple needling techniques, ample use of bleeding therapy and extensive use of distal points.

The history and basic characteristics of Tung acupuncture, and a point and two case study examples are presented.

Keywords: Tung Ching Chang, Master Tung, Tung acupuncture, dao ma, dao yin, bleeding therapy

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There is a common misperception that Chinese medicine, including acupuncture, is a unified system that has been handed down in a grand unbroken lineage to the present day. In fact, Chinese medicine is a field that is extraordinarily vast, representing numerous heterogeneous and even conflicting theories and treatment modalities. The seemingly homogenous model of Chinese medicine known as "Traditional Chinese Medicine" (TCM) is the product of a twentieth century synthesis of many approaches to Chinese medicine that was created in response to many factors, including the near decline of Chinese medicine under the Kuomingtang government, the needs of administering inexpensive medical care to a vast Chinese population after the Communist revolution, and the People's Republic of China's (PRC) desire to have TCM mimic modern western scientific models of research design and education (1).

Throughout Chinese history, physicians learned medicine in a wide variety of settings and through many avenues. Some physicians, including many well-respected and famous ones, were self-taught through written texts. At points in China's history various imperial academies existed for training imperial, literate and scholarly physicians. Yet other physicians trained in family lineages of medicine, which, like martial arts lineage traditions, were handed down from father to child, guarded as family treasures and rarely disclosed to outsiders. One positive aspect of the creation of TCM was that some family lineages opened up to outsiders and were absorbed into this new synthesis of Chinese medicine. A downside of the creation of TCM, however, was that such family systems were sometimes taken out of the hands of lineage holders and entrusted to large university-style training programs.

The Tung (2) lineage of classical Chinese medicine is one such old family lineage that has survived into the present day, independent of the TCM movement. Tung's acupuncture is fairly well known in Taiwan, the final home of the last member of the Tung lineage to practise medicine, although it has only recently gained notoriety in the west. This article will serve as a general introduction to the history and unique aspects of Tung's family lineage.

Tung Ching Chang and the History of Tung Acupuncture (3)

The history of Tung's acupuncture is somewhat vague, a phenomenon not uncharacteristic of family systems. According to its own stated history, Tung's lineage was a family system passed down from father to eldest son from the Han (206 BCE to 220 CE) dynasty. All documents related to Tung's acupuncture were lost during China's civil war in the 20th century and thus at this point it may be impossible to achieve a more detailed history.

The last descendant of the Tung family to practise acupuncture was the renowned Tung Ching Chang, known today as Master Tung. Master Tung was born in 1916 in Ping Du County, Shandong Province, Republic of China (4). As a young man Master Tung assisted his father in treating local patients with all sorts of ailments. Due to the chaotic influence of China's warlords on his hometown, Tung was unable to receive a formal school-based education. The Japanese invasion of China during World War II further disrupted life for the Chinese, and Master Tung, a patriotic Shandong native, entered the Nationalist Army to fight the Japanese.

After China's victory over Japan in 1945, the then 29-year-old soldier returned to Ping Du with the intention of opening a private practice. However, by that time the Communists under Mao Zedong had already engaged the depleted and exhausted Nationalist Army in a widespread civil war. During this period Ping Du County was occupied several times by Maoist soldiers and a Russian style collective community was established in most of Shandong Province. Tung, believing it would be impossible to return to a stable life in his beloved Shandong, vowed to work towards the elimination of Maoist Communists in China and returned to military service with the Nationalist Army.

Mao Zedong's forces eventually succeeded in defeating the Nationalists under President Chiang Kai Shek. In 1949 President Chiang, along with many of his followers, including Master Tung, retreated to Taiwan Province and established the current Republic of China (ROC). While in the army, Master Tung treated tens of thousands of his fellow soldiers. In the early 1960s he retired from military service and opened his first acupuncture clinic for the general public in Taipei, where all persons rich and poor could benefit from his unique treatment style. Over his years of practice he was estimated to have performed over 300,000 treatments. Many patients came as referrals from other Chinese medical clinics, and found relief from their ailments only when treated with Tung's family method. Besides the regular patients in his Taipei clinic, Master Tung was known for treating many famous persons including the Defense Minister of the ROC. Tung was especially renowned for his successful treatment of President Lon Nol of Cambodia following a stroke.

After many years of residence in Taiwan, Master Tung was touched and influenced by President Chiang's Cultural Renaissance Movement [TEXT NOT REPRODUCIBLE IN ASCII]. This was established in 1966 to promote Chinese culture as a direct response to what was perceived as its wholesale destruction in mainland China as a result of Mao's Cultural Revolution. In order to preserve Tung's acupuncture lineage for the benefit of future generations, Master Tung decided to train students. According to his own instructions, upon the master's death in 1975, the names of his 73 disciples were carved on the stone epitaph at his burial site. Master Tung did marry and has a son who is not interested in learning medicine. Tung's disciples however promised to teach his son acupuncture at any time in the future, should he change his mind.

Master Tung was a well-known and highly respected physician in Taiwan. However, when the ROC finally implemented regulation of Chinese medicine and acupuncture, Tung was denied a license, despite the fact that the Taiwanese government had previously promised him a special licensure to thank him for his prominent service to his country. Tung perceived this as a terrible betrayal by the government and it was a humiliating defeat for this proud Shandong native. This rejection had a devastating effect on Master Tung who closed his practice and died from stomach cancer only a short time later.

Before his death, Master Tung was urged by his students to agree to the publication of a book containing reliable information about his family's extra-point-based system. Two years prior to his death, he personally authorised and approved two such works. The original Chinese language edition was written with the help of his disciple Yuan Kuo Pen. At the same time Master Tung requested that his only Tibetan disciple, Dechen Palden (now Dr. Palden Carson), then a medical student at the National Taiwan University, translate and edit the Chinese manuscript into English. In 1988, the English language edition was rewritten by Dr. Carson and republished under the new title Tung's Orthodox Acupuncture.

Characteristics of Tung's acupuncture Tung's Points

The most prominent feature of Tung's acupuncture is the Tung family's set of points, which Master Tung termed "orthodox channel extra (curious) points" (5). While some of these points lie in approximately the same location as some of the conventional points of 14 channel acupuncture, the majority of Tung's points are in unique locations, and even when analogous to conventional points have different point groupings and functions.

The distribution of Tung's points covers the entire body although, unlike 14 channel acupuncture, they are arranged topographically by anatomical zonal concepts rather than by channel. For example, zone number one contains points located on the fingers, zone number two on the hand, and zone number three on the forearm (see Table 1 for a list of zones and number of points found in each zone). Each zone contains points that have a wide-ranging effect over many areas of the body. In fact, each zone can almost be viewed as an independent microsystem (such as ear or scalp systems).

The most commonly used points lie on the extremities and the head, and even though there are ample points on the ventral and dorsal trunk, they are very rarely needled. The fingers and palmar surface of the hand, and the toes and plantar aspect of the foot have a much greater distribution of points than in 14 channel acupuncture. Each point has a specific name and each is also sometimes referred to by a numerical system based on the zone where the point is found. For example, the first point on the fingers, Ta Chien (Da Jian [TEXT NOT REPRODUCIBLE IN ASCII]), is also designated 1.01, i.e. point number one located in zone number one.

Tung's points, instead of being associated with a conventional channel (for example Hegu L.I.-4 belongs to and acts on the arm yangming channel), are described as having a "reaction area" (6) that essentially describes the area of influence of that point or group of points. In some cases a reaction area corresponds to one of the zangfu and in other cases it represents an anatomical area. For example, some points used to treat post-stroke hemiplegia have the reaction area of the "extremities" (7). Certain points also have different reaction areas depending on the depth of needle insertion. Tung's point Ming Huang (8.12 [TEXT NOT REPRODUCIBLE IN ASCII]), located at the centre of the middle line of the medial aspect of the thigh, has a reaction area of the Kidney when needled superficially, the Liver when needled to a medium depth, and the Heart when needled deeply.

In general, Master Tung used his points on the head and hand to treat acute or more recent conditions, and needling these points most often achieves rapid and dramatic reduction of symptoms. Points on the leg, especially those proximal to the knees, are used to treat more chronic and complex conditions. This use of points in particular contrasts dramatically with TCM acupuncture, which utilises points on the thigh infrequently.

Characteristics of treatment and needle technique

Tung's acupuncture is characterised by the use of a minimal number of points in each treatment, usually no more than six. Master Tung favoured the use of large gauge needles (such as 0.40 mm, or 26 guage) and needled freehand, often times through clothing (8). There is a conspicuous lack of complex needle manipulation and there is no use of supplementation (bu fa) or drainage technique (xie fa). Needle depth is varied according to the condition, although Tung made ample use of deep needling (often touching the periosteum of underlying bone) and through-and-through needle techniques to connect multiple points with one needle.

Points are almost always needled distally and contralaterally to the site of disease or dysfunction, and points on the top of the body are used to treat the bottom and vice versa. For example, Tung's points on the plantar surface of the foot generally treat conditions of the head and brain/mind.

Points also treat diseases corresponding to the location of the point. For example, points on the forearm treat pain in the forearm, etc. Unlike conventional 14 channel acupuncture however, these points are not needled locally on the diseased side but rather on the healthy side of the body. Once needles are inserted they are retained for long periods of time, usually in excess of 30 or 45 minutes. Occasionally, throughout the treatment, needles are manipulated with even twirling to strengthen the therapeutic effect.

Point Selection and combination Dao yin needle technique [TEXT NOT REPRODUCIBLE IN ASCII]

One of the benefits of distal acupuncture point stimulation is that it frees up the diseased area for local stimulation (e.g., self-movement or massage). In the dao yin, or 'conducting qi', technique distal points are needled and then the patient is required to mobilise the diseased or painful area. For example, in cases of shoulder pain, point Tse Hua Chong (7.09 Si Hua Zhong [TEXT NOT REPRODUCIBLE IN ASCII]--similar in location to Tiaokou ST-38) is needled contralaterally to the painful side while the patient is asked to mobilise the painful shoulder. In cases where the patient is unable to move, the practitioner can move or manipulate the joint for the patient.

According to Chinese medicine, pain is the patient's subjective perception of stagnant qi and blood in an area. The dao yin needle technique is particularly effective in that it very strongly moves qi and blood in the channels through distal needling and moves qi locally through active physical movement or stimulation.

Dao ma needle technique [TEXT NOT REPRODUCIBLE IN ASCII]

The dao ma 'inverted horse' technique uses combinations of two or three points in a given area, most commonly arranged in a vertical line, to augment needle stimulation. These points are located near to each other, usually no more than two or three cun apart. On the hands and fingers however, these points are much closer together, usually less than one cun apart. In fact many of Tung's unique points are arranged in two or three point sets, meaning that these dao ma groups are always needled in combination rather than as single points.

Dao ma point groupings serve to increase needle stimulation in the treatment target area, thereby achieving more effective and immediate results when needling points distal to the area of disease.

Non-acupuncture therapies of Tung's acupuncture

Triangular needle bleeding therapy [TEXT NOT REPRODUCIBLE IN ASCII]

Bleeding therapy plays a major role in Tung's acupuncture, far more so than in 14 channel acupuncture. Master Tung believed that most chronic disease, painful conditions, and all fatal disease always involve stasis of qi and especially blood. Bleeding therapy in general strongly moves the blood, and the qi via the blood. Thus, bleeding therapy can be used to treat a wide variety of recalcitrant conditions.

In Tung's acupuncture, points over the entire body can be bled. Unlike in 14 channel acupuncture, Tung made frequent use of bleeding points on the trunk. Actually, the majority of Tung's points on both the dorsal and ventral trunk are never needled, only bled. While in Tung's acupuncture points are needled contralaterally to the side of pain or dysfunction, bleeding is typically done ipsilaterally.

Moxibustion and other miscellaneous therapies

The vast majority of treatment in Tung's lineage involves needling acupuncture points or bleeding therapy. Master Tung did, however, utilise other therapies when necessary. Moxibustion, while not performed as frequently as in 14 channel acupuncture, is used to warm and supplement points. For example, Tung's point Huo Fu Hai (3.07 [TEXT NOT REPRODUCBLE IN ASCII], located between the ulna and radius on the posterior forearm 8.5 cun proximal to the wrist joint) is stimulated with moxibustion to treat conditions related to anemia and general vacuity. Like many points treated with moxibustion, the application of moxa to this point is said to increase longevity. Master Tung preferred to have patients use moxibustion as a long-term daily home therapy rather than applying it as short-term treatment in his own clinic.

Master Tung also made use of cupping and scraping (gua sha) therapy as local treatments. Furthermore, while Tung was primarily an acupuncturist, he was well aware of the composition of classical herbal formulae and occasionally prescribed herbs in cases where he thought it was necessary. More commonly than using herbs however, Tung would prescribe simple dietary remedies for patients. A section on dietary recommendations for a variety of disorders is included in Tung's original Chinese language text (9). Thus, Master Tung was not only a talented acupuncturist, but also was an expert in all areas of Chinese medicine.

Classical Daoist (Taoist) therapies

While in the west it is commonly believed that Chinese medicine is synonymous with Daoist medicine, this is not necessarily the case. It is true that many advances in Chinese pharmacology were made by Daoist adepts, yet a great number of Daoist movements actually forbad their members from using herbal therapies or acupuncture in favour of purely religious methods of healing such as prayer, ritual petitions to Daoist deities, and the use of talismanic magic (fu zhou [TEXT NOT REPRODUCIBLE IN ASCII]) (10). Early texts of Chinese medicine, such as Sun Si Miao's Qian Jin Yao Fang, recognised the use of religious healing and included these therapies alongside herbal formulae or acupuncture protocols.

Master Tung was a devout practitioner of the Daoist religion. In his own clinic he occasionally wrote talismans for patients, to treat both physical ailments and social and psychological problems such as marital troubles. Master Tung's familiarity with these ancient shamanistic therapies demonstrates that he was well steeped in classical Chinese medicine before it was purged of therapies the government of the PRC deemed superfluous or superstitious.

Point example: Wu Hu (Five Tigers)

The points Wu Hu (1.27 [TEXT NOT REPRODUCIBLE IN ASCII]) are a commonly used dao ma set in Tung's acupuncture. They are a collection of five points evenly distributed along the radial border of the proximal phalanx of the thumb, located on the demarcation of the red and white skin. The Wu Hu points are associated with the reaction area of the Spleen, and according to Master Tung treat bony swellings, rheumatoid and osteo- arthritis, acute ankle pain, and other acute traumatic ligamentous injuries. Two or three of these points are needled simultaneously, contralaterally to the site of pain, while the patient then mobilises the affected area (an application of the dao yin needle technique combined with the dao ma needle technique).

The Wu Hu points treat conditions of both the upper and lower body. According to one of Tung's disciples, the more distal of the Wu Hu points treat conditions of the upper extremities, while the more proximal of the Wu Hu points treat conditions of the lower extremities (11). Generally, the Wu Hu points are needled perpendicularly with the tips of the needles touching the periosteum of the phalange.

[FIGURES 1-3 OMITTED]

Case study 1: ankle sprain

A 65-year-old patient presented to my office with an acute sprain of the left ankle. She had already been evaluated by her physician, and imaging tests showed no significant physical damage. She complained of pain around the entire ankle, which was quite swollen and hot to the touch. The only treatment she had received was a soft splint and the recommendation that she take analgesics as necessary.

In the office she was asked to sit and elevate her ankle and the soft cast was removed for comfort as well as to allow her to move the ankle slightly. The points for treatment were the three proximal points of the Wu Hu (1.27) set on the right thumb. The three points were needled to a depth of three to four millimetres, until the tip of the needle touched the periosteum of the phalanx, eliciting a heavy sensation. The patient was periodically asked to gently move the painful ankle and the needles were manipulated with a simple even twirling every 15 minutes. The needles were retained for 45 minutes and no other points were used during this treatment.

By the end of the treatment the patient reported a dramatic reduction in pain and could walk again with only a minimal limp. Furthermore by the end of the treatment there was barely any visible swelling of the ankle and on palpation the temperature of the skin had normalised to the same level as the healthy ankle.

Case study 2: spondylosis

An 80 year-old male presented with a main complaint of back pain. He had a diagnosis of spondylosis and fractured lumbar vertebrae, and presented with a severe kyphosis as well as a scoliosis (he had lost 12 centimetres in height in the last year alone). The pain began about four months prior to his first acupuncture treatment after he underwent chiropractic manipulation. The pain was worse in the morning when getting out of bed and after standing for any period of time, and walking was difficult. His tongue was pale and his pulse was deep and very weak. There were small spider naevi on his face near Chengqiang REN-24. In Chinese medicine terms he presented with a Kidney yang vacuity with local qi and blood stasis in the spine and lumbar area. In Tung's acupuncture the chin is associated with the Kidney and a dark colour or presence of spider naevi in this area shows a vacuity in the Kidney system, further corroborating the tongue and pulse findings.

It was impossible for this patient to lie down for treatment so he was treated sitting upright. The points used for treatment were Shui King (10.20 Shui Jin [TEXT NOT REPRODUCIBLE IN ASCII]), Shui T'ung (10.19 Shui Tong [TEXT NOT REPRODUCIBLE IN ASCII] ), Hou Chui (4.02 Hou Zhui [TEXT NOT REPRODUCIBLE IN ASCII]), Shou Ying (4.03 Shou Ying [TEXT NOT REPRODUCIBLE IN ASCII]), and Shen Kuan (7.18 Shen Guan [TEXT NOT REPRODUCIBLE IN ASCII]). Shui King and Shui T'ung are located on the face. Specifically, Shui T'ung is located 0.4 cun inferior to the corner of the mouth and Shui King is located 0.4 cun medial to Shui T'ung. These points have a reaction area of the Kidney and can be used to treat lumbar pain associated with Kidney vacuity (12). In this patient the points were needled with a 30 gauge 40 mm needle. The needle was inserted bilaterally into Shui King and then inserted through and through subcutaneously to Shui T'ung.

Shen Kuan is a major point in Tung's acupuncture for supplementing the Kidney and is located 1.5 cun inferior to the medial condyle of the tibia (the area of Yinlingquan SP-9) (13). For this treatment Shen Kuan was needled bilaterally with a 28 gauge 50mm needle to a depth of just under two cun. Hou Chui and Shou Ying are part of a dao ma group, and are needled together as a group more commonly than as single points. Hou Chui is located on the posterior arm, 2.5 cun proximal to the olecranon, and Shou Ying is located longitudinally two cun proximal to Hou Chui. As the name suggests, Hou Chui, Back Vertebra, is used to treat problems of the vertebrae. Both Hou Chui and Shou Ying have a reaction area of the spine and are indicated for spinal pain, prolapsed intervertebral disc, lumbar pain and nephritis (14). These two points were needled on the left arm only as the pain was worse on the right side. These two points were also needled with 28 gauge 50mm needles and inserted until the tips of the needles touched the humerus. In total only six needles were used per treatment.

After the first treatment the patient noticed that there was no longer any pain getting out of bed in the morning although there was some pain by the end of the day when he was tired. He was able to stand, however, for much longer periods of time without discomfort. After the second treatment he was able to stand and sit straighter than he had before and the pain relief lasted almost the entire week between treatments. Furthermore, the visible veins on his face were thinner and lighter in colour. To date the patient has had three treatments in all.

Conclusion

Tung's acupuncture represents a rare example of a traditional family lineage of Chinese medicine that has survived into the present day. The uniqueness of Tung's acupuncture challenges and expands knowledge of the basic tenets of acupuncture such as the location of points, their arrangement in channels and their major indications. Tung's approach to acupuncture and Chinese medicine therefore reminds practitioners that it is impossible to point to any one school of thought and practice and believe it is the sole inheritor of the vast ocean of Chinese medicine practised from the days of the Yellow Emperor.

Master Tung was a physician with exceptional generosity, bravery and foresight to teach his family's medical heritage to outsiders for the sake of continuing the lineage and benefiting patients with an exceptionally effective therapy. Perhaps this willingness to share previously 'secret' information will encourage other Chinese medical practitioners, who may still practise family lineages, to open their teachings to outsiders so that they may continue into the future and benefit many more patients than one practitioner alone can treat.

Acknowledgement

Special thanks to Dr. Palden Carson, M.D., president of the World Tung's Acupuncture Association, a personal disciple of Master Tung, and my teacher who has lead me into the wonderful practice of Tung's Orthodox Acupuncture. He was extraordinarily generous in providing information for this article as well as offering corrections and suggestions before publication.

Bibliography

Carson, P. (1988) Tung's Orthodox Acupuncture. Taipei: Lien Ho Press, Co.

Tung, CC. (1973) Tung Shih Chen Chiu Cheng Ching Ch'i Hsueh Hsueh. Taipei: Hsin Ya Publications Ltd.

Yang, WJ. (1999) Dong Shi Qi Xue Zhen Jiu Xue. Taipei: Chih Yuan Bookstore.

Notes

(1) For a more in-depth discussion of both the positive and negative aspects surrounding the creation of TCM see Fruehauf, Heiner. "Science, Politics, and the Making of TCM: Chinese Medicine in Crisis." Journal of Chinese Medicine 61; October 1999.

(2) Tung is the Wade-Giles Romanisation of the Chinese family name. In pinyin Romanisation (the system created by and used currently in the PRC and in most academic circles) the name is Romanised "Dong". Either way, the pronunciation is the same, with a "d" sound at the beginning. Master Tung was a very staunch anticommunist and thus resisted the use of anything related to the communist government of mainland China, including the pinyin system. When Master Tung was alive he himself preferred the spelling "Tung" to represent his name. Thus, in accord with the practice of the World Tung's Acupuncture Association, throughout this article Wade-Giles Romanisation will be used for his name. However in the years since Master Tung's passing, the pinyin system has gradually become the standard academic method of Romanising Chinese, even in Taiwan. Thus all other Chinese medical terms will be given in pinyin. Tung's point names will be given in Wade-Giles first and Pinyin second for those not familiar with the Wade-Giles system.

(3) Historical information was generously provided by Dr. Palden Carson.

(4) Master Tung was very proud of being a native of Shandong. On the cover of his book and on his business cards, Master Tung was listed as "Shandong Tung Ching Chang" (See Tung, 1973) and never referred to himself as either "Taiwanese" or "Mainland Chinese". This is in direct conflict with some texts now being published in Taiwan that claim Master Tung's acupuncture is a form of "Taiwanese acupuncture."

(5) In Chinese [TEXT NOT REPRODUCIBLE IN ASCII]. The term "curious" is the same word used to describe the Eight Extraordinary (Curious) Vessels and the Six Curious Bowels (Fu). (See Tung, 1973).

(6) The original term for "reaction area" in Master Tung's book is Shen Jing ([TEXT NOT REPRODUCIBLE IN ASCII]). This term is usually translated into English as "nerve".

(7) The point Chung Chiu Li (8.25 Zhong Jiu Li [TEXT NOT REPRODUCIBLE IN ASCII]), for example, has a reaction area of the Lung and Extremities. It is located on the median line of the lateral thigh, nine cun above the upper margin of the patella (or at the midpoint of the thigh).

(8) Of course, this directly contradicts standard clean needle technique protocols that acupuncturists are taught today. However, in ancient China (especially in the cold north such as in Shandong province) this was common practice.

(9) Tung, appendix pg. 15-18.

(10) Kohn, Livia. Daoism and Chinese Culture. Cambridge: Three Pines Press, 2001, pg. 75.

(11) Yang, pg. 26.

(12) Carson, pg. 199-200.

(13) Ibid., pg. 125.

(14) Ibid., pg. 62-63.

Henry McCann is a licensed acupuncturist, a licensed Doctor of Acupuncture, and a Diplomate in Oriental Medicine (NCCAOM). He graduated from Oberlin College in Ohio and the New England School of Acupuncture in Massachusetts, and was a Fulbright research fellow to the University of the Ryukyus in Okinawa, Japan. Henry serves on the New Jersey State Acupuncture Examining Board by gubernatorial appointment, and is a member and the New Jersey representative of the World Tung's Acupuncture Association. He can be reached at www.newjerseyacupuncture.com.

Table 1: Point
Distribution
in Tung's
Acupuncture

Zone Location Number of Points

1 Fingers 27
2 Palm and dorsal hand 11
3 Forearm 16
4 Upper Arm 17
5 Plantar aspect of foot 6
6 Dorsal foot 6
7 Leg/Calf 28
8 Thigh 32
9 Ear 8
10 Head 25

Note: There are also more than 160 additional points on the neck, and
both the dorsal and ventral trunk.