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7. Selection and combination of acupuncture points
Selection of acupuncture points
Acupuncture treatment consists of the application of a few points at specific places on the body. Thus, the selection and combination of points in an acupuncture treatment is most important. Since selection of points along the channels is guided by the theory of Zang-Fu organs and channels, it is essential for practitioners to have a full understanding of the following so as to be able to choose the correct points:
Selection of points along the course of the channels is one of the basic principles of acupuncture treatment, and is performed according to the theory that disease is related to channels. In practice the points are selected from the channel to which the affected organ is related; or from related channels according to the relations between the Zang-Fu organs and channels; or from several channels.
• Physiology and pathology
• The course of the channels
• The Exterior–Interior relationship of Yin and Yang
• The function, and difference and characteristics of the points.
There are four principles for point selection: local point selection in the vicinity of the pain, distal point selection, special point selection and symptomatic point selection. Each may be used in combination, or independently of the others.
Local point selection
This is the selection of points in the locality of the pain – for instance, pain in the head, forehead, neck or arm can be treated by using the points in the vicinity. In cases of elbow pain, LI-11 Quchi and LU-5 Chize can be selected to promote the circulation of Qi and Blood in that region; CV-12 Zhongwan can be selected to treat epigastric pain; GB-20 Fengchi can be chosen to treat headache and neck pain in the occipital region.
This method also includes selection of adjacent points close to the pain. For instance, ST-21 Liangmen can be used as an adjacent point to CV-12 Zhongwan to treat stomach pain; LI-10 Shousanli can be used as an adjacent point to LI-11 Quchi to treat painful elbow. Adjacent points may be applied independently or in combination with the local points.
Distal point selection
This is the selection of points far from the sides of pain, and usually below the elbow and knees. This method is often used to treat pain caused by disorder of Internal Zang-Fu organs; for instance, ST-44 Neiting and LI-4 Hegu are used to treat toothache due to Stomach-Heat.
Special point selection
Stream points
It was stated 2000 years ago in the Neijing that Stream (Shu) points can be used to joint and limb problems. These points are indicated in painful joints, stiff joints, joint deformity, joint swelling as well as injury in the joints. Also, these points can also be used as inducing points to conduct the treatment to the affected parts of the limbs.
Source points
As the name implies, Source (Yuan) points are the points where the Original Qi resides. On the Yang channels, the Source points are the points just proximal to the Stream points. On the Yin channels, they are the same as the Stream points.
The Source points are said to be responsible for regulation of the Original Qi in both the interior organs and the channels, so they are used for the treatment of diseases that affect the organs, and problems in those channels.
Generally speaking, when they are used to treat pain due to disorder of Interior organs, these points are mostly applied to treat pain resulting from Excessive factors from the Interior organs. When Source points are used to treat the pain due to disorder of channels, these points are mostly applied to treat the pain resulting from the blockage of the channels resulting from Excessive pathogenic factors. In this treatment, they are often applied together with the Connecting points. This is because the channels are subdivided into channels and collaterals, and whereas the Source points can regulate the channels, the Connecting points can harmonise the collaterals, thus both channels and collaterals are treated together.
Connecting points
The place where a Connecting Vessel splits from a main channel is called Connecting (Luo) point. Each channel has its own Connecting point– the 12 regular channels and two of the extraordinary channels, the Governing Vessel and the Directing Vessel – and there is in addition a Connecting point from the Spleen: the Spleen Connecting vessel. So, in total, there are 15 Connecting points.
Classically speaking, the Connecting points have two major applications:
Since these points directly connect to the collateral, in fact they have a third function, which is to harmonise and promote the circulation in the collateral. It is true that not all diseases affect the channels and Interior organs. In a lot of cases, pathogenic factors may attack only the collaterals, especially in cases of pain at the superficial levels.
• They can be used in the treatment of Interior–Exterior coupled organ problems
• They can also be used in the treatment of Connecting Vessel symptoms.
As was mentioned in Source points, when treating pain the Source points and Connecting points are often combined so as to regulate both the channels and collaterals.
Accumulation points
Accumulation (Xi) points (or Cleft points) are the place where Qi and Blood accumulate in the channels. These points are very important in dealing with pain, both in diagnosis and in treatment.
In terms of diagnosis, a sharp or intense pain on pressure, or redness, swelling, hardening, a tingling ‘electric’ feeling or the formation of nodulations indicate Excess, whereas a dull, mild, slight or intermittent pain indicates Deficiency.
In terms of pain treatment, these points are often used to treat stubborn and acute cases. In treating pain, these points are very effective in relieving pain involving the organs, channels or collaterals. Therefore, in some cases they can be punctured first of all with reducing method for a couple of seconds, so as to sedate the pain as soon as possible. However, such treatment can only be considered as symptomatic – that is to say, it doesn’t deal with the cause of the pain. A root treatment should be followed immediately after application of these points. When using this point to sedate severe pain, the Jing-Well point can also be applied so strengthen the therapeutic results.
Eight Gathering points
The following eight points have special functions on the organ or substance for which they are named. They can be applied for pain originating from either Excess or Deficiency. They can in addition be used as the inducing points to lead the treatment to the affected areas.
BL-11 Dashu
This is the Gathering point for the Bones. In case of pain related to bone disorder, use of this point is advisable. For instance, in rheumatoid arthritis there is stabbing finger pain, bone deformity and swelling of the hand. Points should be used that promote circulation of the Blood, smooth the channels and sedate the pain. However, BL-11 should be added simultaneously in order to strengthen the bones. This point is also often applied to treat disorder of bone, such as disc herniation, arthrosis, osteoporosis and bone pain due to bone fracture, etc.
GB-39 Xuanzhong
This is the Gathering point for the Marrow. This point is often applied to treat pain due to deficiency of Kidney-Essence or Blood, since the Marrow produces Blood and Blood and Kidney-Essence benefits mutually. Moreover, since the Marrow nourishes the Bones, this point is often combined with some other points to treat bone problems due to deficiency. For instance, lower back pain in senile people is commonly due to weakness of the Liver and Kidney, thus the points to tonify the Liver and Kidney should be used together with GB-39 in order to strengthen the bones. It is clear to see that this point is indicated only in chronic cases.
GB-34 Yanglingquan
This is the Gathering point for the Tendons. It is effective for treating pain in the Tendons originating from both Excessive and Deficient causes. For instance, in the treatment of sciatica, no matter the cause, this point should be coupled with the local point and distal points to eliminate pathogenic factors and relieve the pain. In treating acute ankle sprain, which is usually caused by stagnation of Blood in the channels, this point should be punctured first to relieve the pain, and then ask the patient to move the affected parts of the body, followed by needling at local and distal points to eliminate Blood stasis.
CV-17 Tanzhong
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