Wang Juyi, founder of Meridian Medicine, repeatedly emphasized that the vitality of this system lies in its clinical practicality. Especially for young grassroots TCM practitioners, diagnostic methods must be simple, easy to apply, and effective. The key challenge is achieving accurate pattern differentiation. His innovative Meridian Examination Method provides an objective basis for clinicians to identify affected meridians and select points during treatment, offering direction even for difficult and complicated cases.

I am a newly graduated grassroots physician and an avid reader of Wang Juyi’s “Introduction to Meridian Medicine” and “Wang Juyi’s Case Studies and Lectures on Acupuncture.” Guided by Meridian Medicine, my clinical practice entered the correct path of holistic TCM thinking, leading to increasingly refined clinical skills. This approach enabled me to successfully treat conditions I previously dared not attempt, such as infertility. Below, I share a proven case of acupuncture treatment for infertility.

Case Report:
Patient: Wu, Female, 32 years old.
Date of First Visit: May 19, 2019.
Chief Complaint: Irregular menstruation for 14 years, with amenorrhea (cessation of periods) for the past 5 consecutive months.
Present History: The patient reported irregular menstruation starting 14 years ago after an induced abortion. Each cycle required regulation with ovulation-inducing hormones (specific details unknown). She stopped the medication 5 months ago, and menstruation has not resumed. She sought treatment at a tertiary hospital specialist clinic and was planning for IVF (in vitro fertilization). Tests showed: Ureaplasma positive on vaginal discharge routine. Gynecological ultrasound, sex hormone panel (six items), TORCH screening, infectious disease screening, liver and kidney function tests were all normal.
Presenting Symptoms: General fatigue and lethargy; low mood; irritability and easy anger; accompanied by soreness in the shoulders, back, and waist; excessive sweating, especially on exertion; aversion to wind; variable sleep quality, with intermittent insomnia and difficulty falling back asleep after waking. No cough or sputum, no fever. Normal appetite. Urination 5-7 times daily (nocturia 3 times). Stools alternating between dry and loose.
Past History: One induced abortion at age 18.
Marital/Obstetric History: Married in 2009, no pregnancy since marriage.

Physical Examination: Vital signs normal. Abdominal obesity with slender limbs. Tongue: pale body, greasy yellowish coating. Pulse: Left guan position wiry-thin; chi position deep-thin and forceless. Right cun position slightly floating-tight; right guan position wiry-slippery. Abdominal palpation: entire abdomen cool to touch, soft and weak on palpation, tenderness (+) approximately 3 cun below the umbilicus. Gynecological ultrasound (May 19): Endometrial thickness 9mm.

Meridian Examination: Abnormalities found in the Ren Mai (Conception Vessel), Dai Mai (Belt Vessel), Hand Taiyin (Lung), Foot Jueyin (Liver), Foot Shaoyin (Kidney), Foot Taiyin (Spleen), and Foot Taiyang (Bladder) meridians.

Meridian Differentiation: Disease located in the Taiyin Meridian.
Meridians Selected: Foot Taiyang (Bladder), Hand Taiyin (Lung), Ren Mai (Conception Vessel).
Points Selected: Chize (LU 5), Dazhui (GV 14), Shenque (CV 8) (moxibustion with moxa stick, suspended for 1 hour).
Rationale & Method: According to TCM principles, exterior syndromes should be resolved first. The patient exhibited Taiyin symptoms: “When Qi is abundant and excessive, there is wind pain in the shoulder and back, sweating, frequent but scanty urination” (The Spiritual Pivot · Meridians). Thus, the disease was determined to reside in Taiyin. The initial approach aimed to open the exterior via points. Based on the chapter “Opening, Closing, and Pivoting of the Three Yin and Three Yang Meridians” in Wang Juyi’s “Introduction to Meridian Medicine”: “Hand Taiyin governs the interior opening, dispersing essence and fluids to the body surface. Foot Taiyang governs the opening of the Yang aspect, disseminating defensive Yang Qi to the interstices (cou li).” The dispersion of Lung Qi and the transformation of Bladder Qi work together to ensure body fluids are disseminated to the surface, supplying the skin, muscles, and interstices. Shenque (CV 8) was selected to support upright Qi and expel pathogens.

Second Visit (May 20): Patient reported sleeping soundly through the night after treatment, waking feeling refreshed and clear-headed. Shoulder and back soreness decreased. No aversion to wind. Sweating on exertion reduced. No nocturia. Stools loose. Examination: Tongue pale, greasy yellowish coating. Pulse: Left guan wiry-thin; chi deep-thin and forceless. Right guan wiry-slippery. Abdomen cool to touch, soft and weak on palpation, tenderness (+) ~3 cun below umbilicus. Feet cool to touch, not extending above knees.
Meridian Examination: Abnormalities in Ren Mai, Dai Mai, Foot Jueyin (Liver), Foot Shaoyin (Kidney), Foot Taiyin (Spleen), Foot Shaoyang (Gallbladder).
Meridian Differentiation: Disease located in Ren Mai and Dai Mai.
Meridians Selected: Ren Mai, Chong Mai (Thoroughfare Vessel), Dai Mai, Foot Jueyin (Liver), Foot Shaoyin (Kidney), Foot Taiyin (Spleen), Foot Yangming (Stomach), Foot Shaoyang (Gallbladder).
Points Selected: Opening the Four Gates (Hegu LI 4, Taichong LV 3), Guanyuan (CV 4) (warm needle moxibustion for 1 hour), Daimai (GB 26), Tianshu (ST 25), Ligou (LV 5), Xuehai (SP 10), Jiaoxin (KI 8), Huantiao (GB 30) (acupressure only, no needle).
Rationale & Method: Following “Introduction to Meridian Medicine”: “Selecting Hegu (LI 4) and Taichong (LV 3), the source (Yuan) points of the Yang closing and Yin closing meridians respectively, combined. This combination has effects of unblocking Yang, opening orifices, moving Qi, and relieving pain.” Great Compendium of Acupuncture and Moxibustion states: “[Guanyuan treats] vaginal discharge, amenorrhea, infertility, blocked uterine orifice, threatened miscarriage with vaginal bleeding, persistent lochia postpartum.” Therefore, Guanyuan (CV 4) was chosen as the main point. The patient’s abdominal obesity suggested Dai Mai’s (Belt Vessel) binding and supporting function was impaired. Tianshu (ST 25) has a bidirectional regulatory effect, intended to address the alternating dry/loose stools. During meridian palpation, significant tenderness was found near Huantiao (GB 30). Acupressure was applied to relax the gluteus maximus and piriformis muscles. During my internship, an orthopedics/Tuina specialist shared that women with frequent dysmenorrhea or infertility often have tender points near these muscles. Ligou (LV 5), Jiaoxin (KI 8), and Xuehai (SP 10) are commonly used points for regulating menstruation.

Third Visit (May 24): Patient reported menstruation had not started. Fatigue and lethargy improved; felt more energetic. Sleep okay, waking 1-2 times per night but able to fall back asleep. Normal appetite. Urination 3-5 times daily. Examination: Tongue pale, greasy coating. Pulse: Left guan wiry-thin; chi deep-thin but slightly stronger; right guan wiry-slippery. Abdomen: Lower abdomen cool, soft and weak on palpation, tenderness (+) ~3 cun below umbilicus. Feet cool, not above knees.
Meridian Examination: Abnormalities in Ren Mai, Dai Mai, Chong Mai, Foot Jueyin (Liver), Foot Taiyin (Spleen), Foot Shaoyin (Kidney).
Meridian Differentiation: Disease located in Ren Mai, Dai Mai, Chong Mai, Foot Shaoyin (Kidney).
Meridians Selected: Ren Mai, Dai Mai, Chong Mai, Foot Shaoyin (Kidney), Foot Jueyin (Liver), Foot Taiyin (Spleen), Foot Yangming (Stomach), Hand Jueyin (Pericardium).
Points Selected: Shenque (CV 8) (suspended moxa, 1 hr), Daimai (GB 26), Qixue (KI 13), Jiaoxin (KI 8), Xuehai (SP 10), Zusanli (ST 36), Neiguan (PC 6), Ligou (LV 5).
Rationale & Method: Both Chong Mai and Ren Mai originate from the uterus in the lower abdomen. Therefore, Shenque (CV 8) and Qixue (KI 13) were chosen as main points. Neiguan (PC 6) and Ligou (LV 5) were selected based on “Introduction to Meridian Medicine,” commonly used to disperse Jueyin stagnation-heat, treating irregular menstruation, mental fatigue, and listlessness. Other points are commonly used for menstrual regulation.

Visits 4 to 10: Continued with the basic formula, points added or subtracted as appropriate.

Eleventh Visit (June 10): Patient reported menstruation still absent. However, mental state and mood significantly improved. Fatigue and lethargy essentially gone. Sleep quality good, fewer nighttime awakenings, able to fall back asleep quickly. Normal appetite. Urination 3-5 times daily. Stools formed, once daily. Examination: Tongue pale-red, thin white coating. Pulse: Left guan wiry-thin; chi deep-thin but strong on heavy pressure; right guan wiry-slippery. Abdomen: Lower abdominal coolness reduced, moderately soft on palpation, slight tenderness ~3 cun below umbilicus. Feet normal temperature.
Meridian Examination: Abnormalities in Ren Mai, Du Mai (Governor Vessel), Foot Taiyin (Spleen), Foot Shaoyin (Kidney).
Meridian Differentiation: Disease located in Ren Mai and Du Mai.
Meridians Selected: Ren Mai, Du Mai, Foot Shaoyin (Kidney), Foot Taiyin (Spleen).
Points Selected: Guanyuan (CV 4) (ginger-isolated moxa, 1 hr), Yaoshu (GV 2) (ginger-isolated moxa, 1 hr), Xuehai (SP 10), Zhaohai (KI 6).
Rationale & Method: Ren Mai and Du Mai share the same origin and govern the Yin and Yang of the entire body. They are particularly closely associated with regulating reproductive functions, especially menstruation and pregnancy physiology in women. Therefore, Guanyuan (CV 4) and Yaoshu (GV 2) were selected as main points for ginger-isolated moxibustion to warm the uterine palace. Xuehai (SP 10) generates, activates, and moves blood. Zhaohai (KI 6), belonging to the Foot Shaoyin Kidney meridian, dredges Shaoyin and guides heart fire downward. Investigations of Channels and Points records: “Treats difficult urination, dribbling urination in women, irregular menstruation.”

Visits 12 to 15: Continued the formula. Ginger-isolated moxibustion every 3 days. Patient instructed to drink plenty of warm water after moxa for rehydration. Points added or subtracted as appropriate.

July 1: Patient called to report menstruation still absent, but a home pregnancy test was positive. Hospital blood HCG test confirmed pregnancy.

Case Analysis:
The patient had a history of abortion in her youth without adequate recovery. Her kidney Qi, not yet fully developed, was further damaged by the procedure, leading to menstrual irregularities. The primary etiology and pathogenesis involve insufficient primordial Qi. The long disease course and persistent menstrual issues affected her emotions, leading to stagnation transforming into fire, manifesting as low mood, instability, irritability, and anger. Thus, the second key pathological factor is Liver Qi stagnation transforming into fire. Combining pulse diagnosis and meridian examination, deep-lying cold and heat pathogens at the Jueyin and Yangming levels were considered. The first visit also showed exterior syndrome signs (shoulder/back pain, excessive sweating), attributed to Taiyin.

Treatment applied Wang Juyi’s Opening-Closing-Pivoting theory. Initially, Taiyin and Taiyang (Du Mai) were opened to regulate Qi movement, promoting dispersion and outward penetration. Symptoms like a cool, soft, weak, tender abdomen, alternating stools, frequent nocturia, and cold lower limbs were attributed to deficiency-cold in the lower jiao uterine palace. Fatigue, lethargy, poor sleep, and difficulty falling back asleep were attributed to Foot Taiyin Spleen and Foot Jueyin Liver meridians. Abdominal obesity with slender limbs suggested impaired binding and supporting function of the Dai Mai.

The pathogenesis was complex—intermingled cold, heat, deficiency, and excess—making treatment principles challenging to establish. However, meridian examination combined with symptom analysis clearly delineated three main pathological mechanisms: 1) Uterine palace deficiency-cold, 2) Jueyin stagnation-heat, and 3) Taiyin dispersion and distribution impairment.

Treatment focused on opening the Four Gates (Hegu, Taichong) to promote Qi movement. Ren Mai, Dai Mai, and Du Mai were selected as primary treatment vessels, coordinated with Foot Taiyin, Foot Jueyin, Foot Yangming, and Foot Shaoyin meridians to improve the body’s Qi-blood nourishment and circulation. Points like Shenque (CV 8), Guanyuan (CV 4), Zhaohai (KI 6), Xuehai (SP 10), Jiaoxin (KI 8), and Zusanli (ST 36) were used to invigorate Yang Qi distribution in the uterine palace, warm the channels, and dispel cold.

Although menstruation did not resume during treatment, the patient’s overall condition improved significantly: energy increased, appetite and sleep normalized, abdominal and lower limb coldness diminished. Just as fertile soil is necessary for life to grow, pregnancy was achieved only after the patient’s overall Qi and blood gradually became abundant and harmonious.

Commentary:
This case involved a clinically difficult condition. Integrating meridian examination for differentiation and targeting the three main pathological mechanisms (uterine deficiency-cold, Jueyin stagnation-heat, Taiyin dispersion impairment) with acupuncture combined with moxibustion yielded excellent results. The shortcoming lies in the selection of too many meridians during visits 3 to 10, which risked dispersing the treatment focus. Clinically, meridians should be selected based on the patient’s current meridian Qi-transformation state, focusing on the 1-2 most abnormally affected meridians. Then, according to the deficiency/excess nature of the condition, and guided by the principle “For deficiency, treat the three Yin; for excess, treat the three Yang,” select meridians that are interiorly-exteriorly related, share the same name, or connect via special pathways (Bie Tong) or generation/control cycles for coordinated treatment. Physicians should strive for accuracy in meridian selection and refinement in point combination. (Chen Lingfeng, Fangchenggang Hospital of Traditional Chinese Medicine, Guangxi Zhuang Autonomous Region; Wang Hongmin, Beijing Tuijinge TCM Clinic)

(Note: Formulas and treatment methods described in the text should be used under the guidance of a physician.)