‘But where exactly is it?’ – The pitfalls of Teaching and Learning Point Location

This month’s blog is an extract from an article written by our head of Acupuncture Point Location for the current edition of the Journal of Chinese Medicine.

‘But where exactly is it?’ – The pitfalls of Teaching and Learning Point Location

By Paul Johnson, Joint Course Leader and Main Acupoints Tutor

“As someone involved in teaching point location for approaching two decades, I have spent a lot of time telling students whether they have found an acupuncture point correctly or not. But what does that actually mean? Is there such a thing as a correct or incorrect location for an acupuncture point? During my time teaching, I have come to the conclusion that when a novice asks for feedback on where an acupuncture point is, there is no way they can understand how loaded that question is.

Are any locations of points correct? Are any actually wrong? The second question is easier to answer: yes, points can be mis-located. From the traditional acupuncture perspective, points that are located off-channel or on the site of another point can be said to have been found incorrectly. A Manual of Acupuncture (Deadman et al.,1998) is frequently used as the set text for contemporary acupuncture courses in the West, and therefore students on these courses tend to use a similar approach to point location. However, not all traditions see the importance of accuracy in point location in the same way. Felix Mann (2000, p.29), for example, describes a GP colleague who mistakenly located Zusanli ST-36 at Yanglingquan GB-34 for several years with excellent results, and cites this as one of his reasons for abandoning ‘traditional acupuncture’ in favour of ‘scientific acupuncture’ (if such a thing exists – but that is a whole other article).

Is there any reason to be concerned about being able to find points accurately when much contemporary research shows ‘sham’ needling to be almost as effective as ‘verum’ acupuncture?

In an effort to replicate the effects of placebo sugar pills in drug trials, scientists have tried to find what they consider an equivalent inert form of acupuncture needling. Sham acupuncture has taken a number of forms, none of which would be considered inert by anyone with sufficient knowledge about the variety of styles and approaches used by practitioners of traditional acupuncture. Some versions of sham needling involve placing needles close to recognised acupuncture points (but not on them); however, from a traditional perspective these needles inevitably penetrate the cutaneous regions and engage with the jing jin (sinew channels) that cover the entire surface of the body.

Retractable stick-on needles that sit over a point without penetrating have been used to attempt to fool research participants into thinking that they have been needled; however, this is a needling technique similar to that used in the Japanese Toyahari tradition where a needle held over a point engages with the qi to produce physiological changes that can be detected on the pulse. Some studies use sham needling not just adjacent to but far away from traditional point sites altogether. As acupuncturists we appreciate that the body is made up of a complex web of channels that unite the top and the bottom, the left and the right, and the interior and exterior, rendering the body a unified whole. There is no place on or in the body where the channels do not penetrate, and therefore there is no place on (or even close to) the body that is physiologically inert.

Although the evidence is not yet conclusive, some studies utilising fMRI brain scans during needling of recognised acupuncture points in comparison to areas merely close to the point have started to provide neurobiological evidence for the existence of acupuncture point specificity (Na et al., 2009). If acupuncture points have a predictable and reproducible action when needled, being able to find these points accurately becomes a crucial part of a treatment. But what criteria do we use to identify an acupuncture point, and how much agreement is there about their locations…”

The rest of this article and many more can be found in the current edition of The Journal of Chinese Medicine (JCM), the world’s foremost English language journal dedicated to the field of Traditional Chinese Medicine.

Visit them at JCM Latest Issue