Revisiting the Zhen Jiu Jia Yi Jing: Differential diagnostic indications related to the LI channel acupoint sequence

Background: Huang-Fu Mi's Jia Yi Jing (JYJ) is regarded as the earliest text (282 AD) on differential diagnosis and clinical acumoxa therapy in Chinese Medicine (CM). Objective: Within this Classical framework, this study examined CM clinical indications for the 20 Large Intestine (LI) channel points for evidence of possible sequence-Associated patterns. Materials and Methods: The JYJ detailed the systematic definition and grouping of all acupoints termed Ruling Points (RPs) in relation to their unique patterns of signs and symptoms (RP indications), rather than as channel-specific lists. The JYJ includes comprehensive descriptions for RP indications for hundreds of clinical patterns for all channel acupoints, systematically categorized across six differential diagnostic books (Seven to Twelve). Two editions of the Zhen Jiu Jia Yi Jing (ZJJYJ) were scrutinized to identify all RPs for the LI channel sequence: the Song Dynasty Chinese edition (1077) and the English translation The Systematic Classic of Acupuncture and Moxibustion (1994) translated by Yang and Chace. RP indications for each acupoint were coded by ZJJYJ diagnostic Book and Chapter Part and examined for relationships between sequence position and diagnostic category of individual RP indications. Results: While no single category of CM indications based on the RP diagnostic system, was common to all 19 points, there were at least seven patterns involving clusters of RP indications associated with sequence positions. Most important were the first 7 acupoints together with LI 11. These contributed 49 of the 61 RPs channel points, with indications drawn from all six diagnostic Books. Overall, the RP indications for the channel focused primarily on the head and neck, as well as on generalized fever and upper-limb pain and weakness. The most frequent diagnostic indications for the channel came from diagnostic Book Twelve (head and neck) with 24 RPs being identified for 12 LI acupoints. Conclusions: The RP attributes and profiles for the sequence of LI points overall reflect a common clinical focus, while position effect concerns the breadth of the signs and symptoms addressed by individual acupoints. Awareness of relevant RPs from other channels could refine the differential diagnosis of complex clinical conditions and their CM treatments further.