Since ancient times, as can be read in the numerous texts of Traditional Chinese Medicine , Acupuncture has been used in emergency or acute situations in numerous ailments, from infectious diseases to pathologies characterized by strong painful symptoms.

While, with the advent of modern medicine, the indications for the use of acupuncture as primary therapy in infectious diseases have rightly disappeared, other applications, which can be used as an alternative to or alongside conventional therapies, remain absolutely valid and practicable.

From the point of view of Chinese medicine we can distinguish two different situations that require urgent intervention:

1.     Sudden pathological manifestation that occurs in conditions of well-being and a good state of correct energy : it corresponds to the overwhelming penetration of external pathogenic energies or to a sudden alteration of one of the different movements of energy (Qi) for internal, usually emotional, causes.
2.     rapid transformation of a pre-existing pathological process : usually connected to a void of an organ, often associated with a rapid change towards the acute manifestation determined by the formation of pathological products, (such as an accumulation of lasting catarrhs ​​with subsequent stagnation of blood in a certain organ or channel).

Acute diseases are usually to be attributed to what is called “fullness” , but with this difference: in the first case it will be an “absolute fullness” while in the second we will have a “relative fullness” in a picture of emptiness. Faced with an acute manifestation it is essential:
– to quickly orient the diagnosis by applying the eight principles,
– to evaluate the channels involved,
– to start the treatment by first treating the outside (“biao”).
Once the acute phase is over, the diagnosis is resumed, if necessary by specifying it better, and therefore also treating the root of the disease. In treating acute cases it is important to carefully evaluate:
– the patient’s basic state of corrected energy,
– the correct selection of points,
– the stimulation technique.
If the diagnosis is appropriate and these three conditions are present, the effect can be very rapid, often associated with an improvement in both cellular and humoral immune defenses.  
The therapeutic protocol in urgency and acute pathologies

While in chronic pathologies the local points (even the painful ones located outside the meridian , called Ashi ) play a very important role, in the acute ones and in urgency it is the distal points, located downstream of the elbow and knee, that play a fundamental role in the formulation of the therapeutic protocol. The choice of these points usually takes place according to two criteria:
– using the 8 Extra or Extraordinary Vessels ( Dumai, Renmai, Daimai, Chongmai, Yangqiao, Yinqiao, Yangwei, Yinwei ) through the insertion of the 8 Confluent points (SI 3, LU 7 , BL 62, KI 6, TE 5, GB 41, SP 4, PC 6) combining alternatively: o pairs of Yang meridians (Dumai + Yangqiao, Daimai + Yangwei ) between them, with the effect is strongly sedative, both against pain and any psychic disturbances; or pairs of Yin and Yang meridians ( Dumai + Renmai, Daimai + Chongmai, Yangqiao + Yinqiao, Yangwei + Yinwei ), obtaining a harmonizing effect, aimed not only at calming the pain and psychic symptoms, but also at strengthening and rebalancing the organism . The points of the Extra Yang meridians must be energetically stimulated, in reduction, in order to obtain a sedative / analgesic effect, while those of the Extra Yin meridians , when used, must be treated with the strengthening method, in order to tone Yinand Blood.
– Using the   Great Meridians, which brings together the 6 Yang meridians in three pairs, located respectively on the front, side and back of the body ( Yangming, Shaoyang, Taiyang). In this case, the pain area is first identified and associated with the course of a regular meridian. After having chosen the local and adjacent points again on the basis of the localization of the pain, the distal points are selected by combining the affected meridian with its coupled according to the method of the Great Meridians (LI-ST, TE-GB, SIBL). In both cases the distal points are placed at the beginning of the treatment and stimulated in dispersion, to obtain a sedative, analgesic and decontracting effect, useful for relieving the patient’s symptoms and promoting healing of the disease.

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Point categories indicated in urgency and acute pathologies

The ancient Shu points

The system of ancient Shu points of the limbs includes 60 points (66 also considering the Yuan points of the Yang Meridians ) located on the limbs distal to the elbow and knee: starting from the nail ends of the fingers, they proceed in a centripetal direction, sinking at the level of the elbow and knee to reach internal organs.
The Jing -Well
points The 12 points located in the most distal position, in correspondence with the nail corners, are called Jing -Well; according to the allegorical description provided by Chinese Medicine, the Qi at this level, having reached the end of the meridian, changes polarity, passing from Yin toYang or vice versa, for which it is particularly unstable, dynamic and its movement and characteristics can be easily influenced. The effects of the stimulation of the Jing -well points for these reasons gives rapid clinical effects, sometimes spectacular, and is especially effective on the regions located at the opposite end of the meridian. The traditional indications are as follows:

– feeling of suffocation and chest tightness, mental disturbances,

– affections of the internal organs. Initially useful especially in resuscitation, for awakening from coma, in hyperpyrexia and to treat mental disorders, in current clinical practice the rapidity of action recommends the use of some of these points in emergency situations or in acute and sedation , in case of strong agitation and panic, due to their ability to cause rapid changes in mood.

The main indications of the Jing -Pozzo points are:
1.     LI1: loss of consciousness, acute odontalgia, sore throat;
2.     TE1: loss of consciousness, tinnitus, sore throat;
3.     SI1: loss of consciousness, stiff neck, agal disease;
4.     LU11: loss of consciousness, pharyngitis, tonsillitis, sore throat;
5.     HT9: loss of consciousness, anxiety, mania, insomnia;
6.     PC9: loss of consciousness, sunstroke, delirium, fever, agitation, mania;
7.     SP1: loss of consciousness, mania, metrorrhagia;
8.     LR1:loss of consciousness, seizures, bleeding, nightmares, insomnia;
9.     KI1: loss of consciousness, stroke, shock, coma, syncope, convulsions;
10.                       ST45: heat stroke, coma, fever, insomnia, agitation, facial pain;

11.                       GB44: orbital headache, tinnitus, conjunctivitis, nightmares, insomnia;
12.                       BL67: nuchal headache, fetal upheaval, uterine dystocia;
13.                       all 12: coma, heat stroke, high fever.

The Xi-fissure points Also in
the territory of the distal Shu points of the limbs, but without being part of the 66 points mentioned above, the 12 Xi points , literally “fissure points”, are finally located. According to traditional Chinese medicine, they represent centers of convergence of energy (Qi, which flows along the meridian and collects in depth) and blood (Xue). In clinical practice they are particularly indicated in acute and urgent situations, for their rapid and direct action on the circulation of Qi and Xue, in the stasis of Qi and Xue, the latter characterized by strong fixed and stabbing / stabbing pains. The points Xithere are 16, one for each meridian and 4 belonging to the Extra Vessels. The latter can be combined with the confluent points, to increase their action. The indications of the Xi points currently most used in clinical practice:

–         SI6: acute pain in the arm and shoulder, acute low back pain;
–         ST34: acute epigastralgia;
–         LU6: asthmatic attack, dyspnoic crisis, cough;
–         PC4: excruciating precordialgia, angor;
–         HT6: excruciating precordialgia, angor, hot flashes with night sweats;
–         SP8: menstrual colic, dysmenorrhea;
–         LR6: dysuria, stranguria;
–         KI9: acute anxiety states, panic attacks.

Problems in the energy flow along the meridians
In case of acute pain along one or more channels, it is necessary to make a diagnosis not only on the basis of the subjective description but also by resorting to direct observation and palpation, in particular of the specific command points, of the xi, of the luo, of the corresponding point right / left and cross high / low on the channel of the same name. It can also be useful to search for the sensitive ear point. As a rule, it is advisable to choose a remote point that frees the canal and, if possible, make the diseased part move; you pass to the local treatment only at a later time.
The specific treatment systems are :
§ cold and wet cold: hot needle, fire needle, moxa, guasha + hot salt or heat-retaining herb pad ( kanlisha );

• heat: scattering needle, bleeding, cup + bleeding, hammer;
• stasis of qi: needle + massage;
• stagnation of blood: bleeding of the luo + hammer.

Particularly effective points at a distance in acute pain:

• shu points of yang channels: LI3, SJ3, SI3 for the top and ST43, GB41, BL65 for the bottom;
• SI3 has an action on the whole taiyang and also on the column (dumai);
• points xi fissure, especially of the yangs;
• LI11 treats the knee;
• luozhen extra point treats the neck;
• yaotongxue EX26 treats the lower back;
• BL1 and BL10 treat acute pains of the long back BL;
• SJ-6 treats pain in the sides (associated with GB34);
• ST-9 treats acute pain in general but is delicate to take;
• BL40 treats all types of lower back pain, can treat acute cases of heat moisture along the canal, such as ocular herpes zooster, usually in bleeding;
• ST38 treats shoulder pain along the stomach meridian;
• GB34 treats hip pain and shoulder pain along the gallbladder canal;
• BL60 treats neck and shoulder pain along the bladder meridian;
• GB39 treats stiff neck;
• ST 44 treats toothache (upper teeth) with LI4 (lower teeth);
• LR3 is a systemic antispastic action point;
• ST34 treats acute stomach pains;
• DU20 treats pain in the anus.

Impairment of the diffusion of qi and chest blood: Asthma
In consideration of the fact that we must move towards an Integrated Medicine, we must however consider the association with the drugs of Western medicine. With Acupuncture, whether it is true fullness or a mixture of empty-fullness, the immediate goal is to restore a normal diffusion of chest qi:
– Lung Meridian: LU5 (transforms catarrhs ​​and purifies the heat of the pomone), LU7 (promotes the lung descent function), LU10 (purifies the lung heat);
– Acupoint EX-B1 dingchuan;
– Dingchuan acupoint of the ear;
– LU6 + LU7 + SI11;
– REN22 + REN17;
– large cup on the navel;
– if necessary add LR3 and PC6. Attention to closely monitor the patient: the asthma crisis can dramatically evolve towards acute respiratory failure. Cough We can use: – ear points: shenmen, lung, trachea, liver; – LU10: irrepressible dry cough from wind heat; – LU6 – LR3: cough with a state of psychic agitation.   Heart disease These are very delicate situations in which the intervention of Traditional Chinese Medicine can only be complementary, for example while waiting for a precise diagnosis. We will use: – PC4 – PC6 – PC5 if there are signs of tan-heat,