Lymphatic Drainage

A technique used to drain congestion (both physical and non-physical) from the upper body.

PROBLEMS WHERE IT MAY BE CONSIDERED:

Upper Body               any form of head and facial congestion; some forms of headache; sinus; ears blocked; puffiness in face; glandular swellings; sore throats; infected teeth/gums/acne.

Chest Region                        chest and lung congestions; mucous problems, bronchitis, emphysema, asthma; glandular swellings; breast soreness and lumpiness; mastitis.

Digestive Region      general digestive discomfort; pain and feelings of congestions; general sluggishness; constipation.

General   sadness and feeling flat/stuck/melancholy

Lower Body               Oedema; ascites; infections and swellings; pelvic congestions; gynaecological problems; discharges; tendency to gut/bowel problems of any kind; appendix problems; wanting to lose weight; lack of libido; prostatic congestion; cardiac oedema.

It can be seen by glancing over the list of indications that many health problems can be assisted by the encouragement of movement of body fluids.  You would expect that a person experiencing lymphatic massage would walk out of the clinic feeling lighter and more alive.

Generally speaking, lymphatic drainage will be used when the patient has a mucous condition - remembering the term ‘mucous’ when used in TCM context covers more than just the secretions of the respiratory system.  For the ‘mucous’ to be within the body, the Spleen’s transformation and transportation functions must be impaired.  The presence of this mucous/Phlegm can be either on an acute or chronic basis.

Obviously the underlying cause of the mucous/phlegm/damp must be eliminated – and generally this will involve warming and tonifying the Spleen Yang and Spleen Qi.

The Spleen is said to control the lymphatic system, thus we look beyond the commonly-held concepts of mucous and note congested lymphatics can respond to both physical and energetic treatment directed at it.  Most patients see us in clinics after being unwell for some time; so, as practitioners we see not only energy disturbances, but the actual physical results as ‘problems’, especially the underlying physical congestion. 

Due to the physical nature of this congestion, I have found that in clinic more benefit is gained by working physically with and on the body, rather than expecting timid needle technique, and at best 2 treatments weekly to magically shift what is often quite stubborn energetic and emotionally based physical problems.

Besides administering lymphatic drainage (see instructions below), general treatment aimed at correcting the underlying issue is essential.  What they think is a problem is generally just symptomatic of a lot more.  They keep on reinforcing what is happening also through self medication and general laziness of attitude, so advice regarding lifestyle and diet is highly needed – as most see what is happening as independent of their sometimes very strange habits.

Foods and activities which tax the Spleen Yang especially are to be avoided during a course of treatment involving lymphatic drainage.  Herbal remedies from our context - such as red clover tea, and various herbal tinctures and ointments, in addition to whatever Chinese type medications one would suggest are also applicable.

CONTRAINDICATONS:

1 - Generally, if great pain or discomfort is experienced during the massage, either continuing very lightly or ceasing altogether is indicated.

2 - Perhaps a condition of acute infections, although light lymphatic drainage should assist in clearing the condition.

3 - Possibly lymphatic cancer (it is illegal for natural therapists to be treating a person with cancer anyway).  If they are on a lot of clearing medications – herbal – this may be very necessary to do to assist the processes.

4 - Lower lymphatic drainage during periods or immediately before the period begins is not recommended as there may be a possibility of heavier bleeding, perhaps of haemorrhage.

5 - Lower lymphatic drainage during pregnancy is fine – and needed often – just be careful.  Lower body circulation or with infections and discharges and the massage is performed lightly and very carefully.

UPPER LYMPHATIC:

Moving onto the actual lymphatic massage I find it useful to always work a little on the person’s back first – perhaps some solid massage over acupuncture points that run about  ½” out from the spine, down the length of the back.  Wherever a problem manifests, I have found it useful to attend to the approximate area along the spine that services the area of concern. 

Whilst following the instructions on the printed handout, I find it more important to ‘tune into the person’ and work with the instructions as an outline only.  The general idea is to clear the main drainage channel under the left rib (perhaps sending the wastes to the actual spleen for processing), then clearing the chest/clavicle area, and if necessary clearing the head and neck region.  The degree to which you work is entirely dependent on the individual’s problems.

STEP 2

STEP 3

Follow under clavicle both sides at once and down the sternum broad sweep of the fingers, linking this to the main (left) lymph duct. (x 3)

STEP 4            Drain sinuses and behind, and around mastoid process down throat to top of clavicle, then front of ear, then behind, then in front of ear again. (X 2)

STEP 5            Run pads of fingers down from chin to sternal notch x 2.

STEP 6            Clear the main body again - down left hand side. X2

STEPS 6 – 12  are necessary only if patient has severe chest congestion.

STEP 7            Block T9, bilaterally x2 – Rolfing in reverse.  The skin underneath gradually gives way.

STEP 8            Roll T9 on left hand side only, moving flexed left leg at same time, x 2.

STEP 9            Diaphragm – usually the most painful costal margin.  Very firm pressure under the ribs and hip over the false rib – most movement during expiration.

STEP 10          Drain from zyphoid to navel on exhalation, with other hand on chest as a contact

STEP 11          2 minutes of exercise – running on the spot

STEP 12– Rectus abdomalis – medically RHS first x 2.

Repeat 8 and 10

Repeat in 7 days – only the anterior aspects need doing.

LOWER DRAINAGE:

The basic idea here is also to move any old rubbish through.  It is more comfortable to do some form of warm up first – moxa on the sacrum is best – and /or heavy massage on the lumbar/sacral area, in an outward direction prior to this massage. 

Along with moxa on the sacrum and possibly local needles, GV 1 and many long GB 30’s, I also do deep tissue work to prep the area.  (See also prostatic drainage info)

The speed and depth of your movements is entirely dependent on the person’s condition, and comfort.  Do not do this if she is bleeding or about to.  Is totally indicated to get some of the late pregnancy congestion out of lower body, and also just to alleviate some of the local pressure when heavily pregnant.  Here, perhaps chock up her right hip a little so she is off centre and thus will feel more comfortable lying on her back.

PROSTATIC DRAINAGE

This differs slightly from the lower pelvic drainage as it is an add-on - in that it is a slow actual drainage of the prostate area.  The drainage technique involves the lower work above, and probably local points needled and moxaed first.  Ensure that he has emptied his bladder, as deep pressure will be exerted.

Start about one inch from the midline of the body just above the pubic bone and slanting fingers 45 degrees into the midline, so the fingers reach the midline and about one inch below ‘skin’ level.  A slow dragging outward is then employed.  The process is repeated several times on both sides, and then the usual pelvic drainage is repeated.  If the person has a problem in this area, the technique is painful but usually offers relief.

You may need to start more shallow and work down deeper later.  Slow and methodical is best – without trying to gouge any tubes or whatever out of the way.

ROLE OF ENERGETIC & PHYSICAL OBSTRUCTIONS, SCARS & ADHESIONS.

One area I feel that is practically ignored by people following channel theory is the role of accidental and deliberate (surgical) blockage of these pathways and the consequences of such events.  I believe we need to undo a person’s life before we think about what a text book might direct us to theoretically - what happened to the body on the table in front of us?  Often a lot.

One of the Liver Qi’s roles is that of maintaining the free-flowing movement of qi, and by extension all other energetic and physical substances in the body.  Obviously, if the Liver’s sphere of influence is directly blocked by an internal energy disturbance, this role will be impeded.  Such energy disturbances include:

1 - Lack of qi and blood circulation and production, dependent on the other organ’s system’s functioning.

2 - Constraint of Liver Qi directly due to emotional factors (inherent Liver Qi/Blood deficiency may predispose the person to such a problem giving a primary and a secondary aspect to this.)  Similarly, the blockage of the Liver Qi’s free-flowing function may be due to more outside influences.

3 - Constraint of Liver Qi due to actual sexual/physical frustration due to inappropriate or inadequate sexual release (think of pathways of the different Liver meridians).

4 - Actual physical blockages from trauma to the pelvic/spinal/abdominal area.

5 - Energy blockages set up by years of holding oneself in certain positions, due to life-style or occupational factors (including the wearing of fashionable high-heels, tight corsets, etc.) or from consciously shutting down the area and its associated ‘naughty’ feelings.

6 - Formation of physical adhesions within the between the pelvic structures due to any of the mentioned factors.

7 - All of the above may set up gross physical manifestations which require surgical intervention, leading on then to actual blockages due to the scar formation, post-operatively on the skin, and internally. And the cold penetration – a circle of misadventure.

Due to the length of time the patient has been aware of the problems in the pelvic area and the probably seemingly hopeless nature of their condition which has lead them to an alternative health practitioner as a last resort, such problems may be quite stubborn, as they represent a body/mind condition, not a named disease as such YET. 

I feel that the usage of ‘pure’ acupuncture techniques only, to be of little value, in the quick resolution of any pelvic blockage.  Perhaps if the patient had consulted an acupuncturist at the beginning of the Stuck Qi manifestations, needle technique and the astute selection of points would have been sufficient.  I doubt our collective abilities to perform at present as master acupuncturists, cum magicians, thus suggest we use a more multi-faceted approach to treatment.

Stuck Qi usually leads to Stuck Blood. Where best to get Stuck Liver Qi?  Sexual contact without orgasm.  Resentment and general relationship hassles fuel it well.

 ‘Stuck Blood’ as a term can cover any number of physical blockages which in normal functioning would not exist.  Fibroids (Stuck Blood encapsulated in membranes) and endometriosis (according to Dr Van Buren a Spleen blockage caused by earth/metal imbalance, along with excess fire of the Kidneys) come instantly to mind.

Manifestations of phlegm-damp, the consequences of infections, the formation of cysts, adhesions and general scarring in the tubal and adjacent areas may be considered as a mixture of Stuck Qi/Blood and phlegm-damp.  Who is factoring in the plethora of alcohol and drug fuelled sexually transmitted diseases that are leaving all with residue on all different levels to attend to in their desperate fertility or bust years?   Any fertility/general gynaecological treatments all would benefit from attention here.

The process of ridding the body of these blockages, plus the externally acquired gross surgical scarring is outlined below.

SUGGESTED “MOVING THE BLOCKAGES” TREATMENT REGIME

Generally, all patients presenting with any gynaecological problem could benefit from receiving extensive massage work, in addition to needing moxa, if applicable, herbal remedies and life-style advice.

1 - A brief back massage, concentration on neck tension and on invigorating the back shu points, is performed.  If required, cups are placed on the upper back to alleviate local tension, chest congestion, or upper spinal problems.

2 - Heavy sacral massage, concentrating on the area around B1 31-34, spreading outwards to the hips and buttocks and along the lower GV points is employed.  In the first treatment the woman may be able to manage only a light version of this, but with subsequent treatments, deeper tissue massage can be accomplished.

3 - Cups off the upper back, and relevant needles placed in that area.

4 - Cups on lower back/buttocks/hip area.

5 - Cups off lower back and relevant needles and moxa applied. The patient then rolls over, and the front of the body receives a workout.

6 - Cupping of navel - or may have been done first, if needed (see below).

7 - Relevant needles to assist the massage techniques and to assist patient relaxation.

8 - Hiatus hernia adjustment and upper lymphatic drainage if needed.

9 - Pelvic drainage techniques, at whatever depth is comfortable to the patient.  If very tense abdomen, use acupuncture points, and then finish the treatment with abdominal massage.

10 – Scars addressed – as they block the qi flow. (See below)

11 - Relevant acupuncture points and moxa.  The usage of herbs, red clover tea, castor oil packs, herbal tinctures with flower essences to work on the more emotional /spiritual issues, vitamin and mineral supplements.  Prescription of homeopathic remedies, specific pelvic exercise regime, dietary and lifestyle changes and counselling may all be explained and prescribed during the time it takes to deliver all of the above therapy.

SPECIFIC TECHNIQUES

A – REMOVAL OF COLD - CUPPING THE NAVEL – A technique demonstrated by Dr John Shen in Sydney in 1982. (No doubt an ‘old wife’s tale’, hence not needed in texts for ‘everyone’ knows what to do, before you need to engage a therapist . . . .

1 - Lightly oil the navel area, to avoid friction and dragging.

2 - A penny (or 50c coin) is placed in a tissue and over the navel (to stop leakage of essential energy).

3 - Tissue is ignited and large cup placed over the area.  This cup is left in situation until the drawing feelings ease, or diminish considerably.  The purpose of the exercise is to remove cold from the system. 

Often the patient may experience drawing sensations form the lumbar area inwards, from the feet upwards, and from the surroundings abdominal areas toward the navel.  If only extremely local sensations are experienced, and the patient has little cold symptoms, the treatment is discontinued. 

4 - Depending on the severity of cold symptoms filling the navel with salt after the removal of the cup and burning 3-5 moxa cones on the salt may be necessary.

B - “BRIDGING” SCAR TISSUE - If a scar and its immediate area feel in any way different from the surrounding tissue, this method is strongly recommended.  The scar area feels different because it has modified qi and blood circulation, which in turn, particularly if on a meridian, will cause changes in the flow of that meridian causing repercussions above and below the scar. 

Rather than placing needles at each end of the scar, I tend to adopt a heavy handed approach, depending on the patient’s sensibilities and ability to handle such treatment initially. 

I place needles about 1/3 – ½ inch apart all along the scar’s periphery.  Once the needles are removed (after maybe 10-15 minutes with occasional stimulation) I try to squeeze blood out from the needle-holes as where blood flow, qi follows. 

Light adhesion breaking massage is then advisable around the area.  Suggest the use of comfrey ointment on and around the scar massaged in for 5 minutes, twice daily to continue the energy and physical healing of the scar (regardless of its age).

Dr. van Buren recommends the usage of St 30 bilaterally once a month for an unspecified length of time, after any abdominal or thyroid operation.  As St 30 is a major point on Chong Mai, the de-obstructing meridian, I use it whilst the scar needles are inserted, and any other points I feel will help in the moving of qi through the area.  This may include points immediately above and below the scar’s traverse of a meridian/s.

Please see further info on www.sharpen –up-your-results.com

It will be available for the next two weeks.

With the current rush of C sections – we are starting to see many very damaged women.  They are unlikely to come in for us to reattach them – but we can think preventatively.  There is evidence through research to show that fertility is lessened after a C section, so it may be as simple as restoring pre baby circulation.

POINTS TO USE CONCURRENTLY

GB 41 – Master Point of Dai Mai

Sp 4 – Master Point of Chong Mai

Ki 8 – accumulation point of Yin Qiao Mai

Sp 8 – Accumulation point of Spleen channel.

SP10 – as a major point also of Chong Mai, de-obstructs blood

SP4 – as the MP of Chong Mai, and Luo of spleen – useful also in the draining of lymphatic area.

St25 & Cv7 together are supposed to assist in breaking internal abdominal adhesions.

Zighong and CV3 to work on the uterus.

TH5 as a special uterus point (Dr. van Buren).

Lu7 as MP of Ren and CP of Yin Qiao Mai – to effect changes in stagnancy of qi and blood in abdomen.

Ki 12,13 local points and stimulate ovaries.

St 40 to resolve phlegm and dampness.

Co 11, GB 34 to relax abdominal and muscular tension.

GB 26, 27, 28, 41 to work on unblocking of Dai Mai.

GV 1 to deobstruct and relax spinal and lower abdominal areas.

A selection of relevant ear points may also be used – possibly ovary, pituitary, thyroid, endocrine, internal secretion, muscle relaxant, pelvis, Shen Men.

The scar tissue may benefit from light moxa and/or dermal hammering before or after the bridging, or alternatively between specific scar bridging treatments, to aid the softening of adhesive and scar tissue and for encouraging energy flow.

DISCUSSION

The object of the treatment regime as outlined above is to clear out all blockages.  If you are a male practitioner, this may not be appropriate for you to be doing in clinic without a female assistant.  All of the above may appear to be time consuming, which it is.  I feel that the patient presenting with these problems, requires such an approach as besides the reasons above, the symptoms and resultant past treatment have probably given the patient little sense of liking the pelvic area.

This is before we broach the unwanted sexual advances that may have coloured her life.  Touching the pelvic area may usually only occur during sexual contact, which, as stated elsewhere, may be now a source of low grade trauma, due to other factors. 

During treatment, whilst needles are inserted, asking the patient to practice light abdominal breathing, and perhaps clearing out and energizing the area, may greatly assist the therapy.  Continuance of the breathing and visualisation, perhaps in bed before sleep will aid in unblocking and tonifying between treatments.

HIATUS HERNIA SYNDROME:

Perhaps 80% of patients presenting at a clinic may benefit from this technique.  As with the former techniques, this technique is aimed at speeding up recovery rate and enabling the patient to feel actually physically different (hopefully better) on leaving us, the acupuncturist.  Some patients may present with an actual hiatus hernia.

Most will have some of the following symptoms:

They awaken tired,

Have throat problems – “plumstone throat” or sensation of something stuck there,

They often feel oppression in chest - unable to take a full breath – maybe always sighing.

Suffer from dull frontal headaches,

Complain of an inability to think clearly,

Have a generalised feeling of discomfort in the epigastric region, maybe with burning and indigestion.

If the actual hernia is present, there may be pain in the epigastric region, with regurgitation of food, perhaps involuntarily, esp. when horizontal.  Often have the sensation of burning in epigastrium, extending into throat and perhaps mouth. 

Many these days are on antacid tablets, and freely admit to taking medication that actually reduces their ability to digest – hence a flow-on to all Blood and Jing quality issues. A good chiropractor may be very helpful here also.

Treatment of the patient depends on the severity of the symptoms, and that of the underlying causes.   If the hernia is present, and the patient is in pain, it is unlikely that you will be able to perform the adjustment – after a few acupuncture treatments the area should be sufficiently pacified to permit physical intervention. 

Taking slippery elm powder, (one teaspoon twice daily mixed in with liquid or mashed banana or some such) and food and fluids which will nourish the condition will help.

REASONS FOR THE PRESENCE OF THE SYNDROME:

From a TCM viewpoint there are 2 major causes of the hiatus hernia syndrome. 

They may co-exist.

Spleen qi xu – the Spleen’s function of holding is impaired.  The Spleen controls muscle tone, especially within the abdomen.  Over a period of time, the weakened middle heater, upon a trigger occurrence, will allow the stomach usually to inhabit a higher area of the abdomen, causing upper heater disharmony (inability to take deep breaths etc.).

Stomach yin xu – the burning sensations up the oesophagus typify this condition. 

Once the area is weakened, such events as bellyflops, fetal kicking, punches in abdomen or eating large meals when upset, or before lying down, can give rise to the stomach moving slightly upwards.

Acupuncture treatment varies in accordance with the accompanying signs and symptoms (and hence etiology).  Stomach fire may be quenched.  The reasons behind the stomach fire need investigating – often these are habitual and tied into their life and reactivity.  Dietary, and emotional indiscretions may be outside where they think you are working – but if we do not correct these, the problem will resurface.  (Liver invading Sp/St) etc.

Points which may be of use –

B17 – diaphragm shu point

Pc6 – works on upper and middle heaters

Liv14 – local point and harmonizes liver

Liv13 – shu of Sp and influential point of zang

CV14 – local point

Extra point 1 cun below St 36.

If Spleen Qi is a problem, relevant treatment should be directed to strengthen and perhaps warm the Spleen Yang.

Over a period of time, if not corrected, the middle heater’s function of providing nourishment to the body will be impaired, thus allowing the person to become Blood and Qi deficient.

SUGGESTED ROUTINE:

Work on back – massage, possible chiropractic adjustment.  B17, and any other back points, perform adjustment, then Liv14, Cv14, maybe Pc6, other points depending on individual. (ACTUAL TECHNQUE NEEDS DEMONSTRATING)

After care

Advise patient to drink a glass of warm water on arising, and thudding from toes to heels about 12 times for 2 weeks.

ROLE OF THE EIGHT EXTRA MERIDIANS

I feel that a complete understanding of the anatomy, physiology and pathology of this system is vital to an acupuncturist’s assessment and management of any gynaecological problem.  A full study of this topic is outside the scope of the present work, but a brief review is outlined below.

Giovanni Maciocia (taught also by Dr VB) in his two articles in Vol. 2 & 3 of the Journal of Chinese Medicine states that the function of these meridians as a group:

to absorb excess energy at the level of the trunk and back, similar to the luo meridians in the limbs

a reservoir of energy, releasing in times of physical/mental shock

circulate Wei Qi over the central body

regulate charges in life cycle – Ren and Chong Mai

circulate Jing Qi to all parts of the body and the 5 ancestral organs

brain and spinal cord

hepato-biliary system

bone marrow

uterus

blood system

Chong, Ren and Du Mai originate in the kidneys, travel through the uterus (or prostate) to Cv1, then follow different pathways up the body.

            DU- up the spine

            REN – travels up the centre of the abdomen, thorax, and throat

            CHONG – sends one branch to the sacral/lumbar area to Gv 4 – another from

Cv 1 to St 30 and Ki 11, then up abdominal Kidney points to Ki 21.

According to Dr Van Nghi, Chong Mai distributes Jing all over the surface of the body.  After irrigating the skin, it travels to the ting points to join the main meridians and when it arrives at – (1) Ki 6 it beings Yin Qiao Mai

                                                (2) Ki 9 it begins Yin Wei Mai

                                                (3) BI 62 it beings Yang Qiao Mai

                                                (4) BI 63 it begins Yang Wei Mai

                                                (5) GB 26 it begins Dai Mai

DU MAI – the Sea of Yang, influencing all Yang Qi in the body.

REN MAI – the Sea of Yin, influencing all Yin Qi in the body. 

This meridian nourishes the uterus and reproductive organs.

CHONG MAI – the Sea of Blood.  It is called the highway/de-obstructor or regulator of Qi.  It is generally used for the removal of Stagnant Qi and/or Blood.  It links with the Kidneys (source of constitutional energy) and the stomach (source of acquired energy).

With Ren Mai, Chong Main regulates the 7 & 8 year cycles (Western equivalent- hormonal system) (refer to Chapter 1 of Su Wen).

DAI MAI – links all leg meridians, Ren, Chong, and Du Mai and the lumbar areas, plus the liver/GB complex.

YIN QIAO MAI – for moving stagnant Qi/Blood/Yin especially in middle-aged women with gynaecological problems (Giovanni Maciocia).

Wollerton and McLean state this meridian (couple) is indicated in cases of sexual weakness, lack of sexual pleasure, difficult childbirth, toxic pregnancy and post-partum pains and bleeding.

Thus, I feel that working on the sacral/pelvic area with massage techniques designed to unblock energy and its physical manifestations, all gynaecological problems can be helped.  Freeing up energy flow in the Eight Extras, (which act as lakes and reservoirs for the main meridian system) by extension removes stagnation and blockage from the entire system.