Point selection methods

1
POINT SELECTION METHODS
SELECTING LOCAL POINTS
Local points are those which lie over, on, or in close
proximity to the diseased area. This is perhaps the most
obvious method of point selection, yet one which is of
great importance in acupuncture treatment, and it should
not be dismissed, as it sometimes is, as simplistic or
symptomatic. Examination of the classical combinations
found in this text in fact demonstrates that the use of local
points has always been a fundamental principle of acu-
puncture.
Local points are much used in treating disorders of the
zangfu, the extraordinary fu and the sense organs. Exam-
ples include:
Tianshu ST-25 or Shenque REN-8 for diarrhoea.
Zhongwan REN-12 for nausea.
Shanzhong REN-17 for tightness of the chest.
Guilai ST-29 for diseases of the uterus.
Yingxiang L.I.-20 for diseases of the nose.
Jingming BL-1 for diseases of the eyes.
Tinggong SI-19 for diseases of the ears.
Equally commonly, local points - whether channel points,
extraordinary points or ahshi
1
points - are needled in most
cases of pain, and careful palpation of the affected area, as
well as detailed questioning, should be used to determine
the channels or points affected. The principal exception to
the use of local points is in cases of acute pain or sprain
when the practitioner might require the patient to mobi-
lise the affected area during needling; in this case local
needling is obviously impractical and the selection of
distal points is favoured.
SELECTING ADJACENT POINTS
Adjacent points are points located near the affected area.
Examples include:
Xuehai SP-10, Liangqiu ST-34 or Yinlingquan SP-9
for diseases of the knee joint.
Binao L.I.-14 for diseases of the shoulder.
Jianjing GB-21 or Tianzong SI-11 for diseases of the
breast.
Yangbai GB-14 or Fengchi GB-20 for diseases of the
eyes.
Waiguan SJ-5 for diseases of the wrist joint.
SELECTING DISTAL POINTS
The use of distal points is the most frequently used
method in acupuncture treatment. The Ode to Elucidate
Mysteries refers to the four origins and three ends. The
four origins are the extremities of the limbs, whilst the
three ends are the head, chest and abdomen. Points on the
limbs (the four origins), especially in the area between the
elbows and fingers and the knees and toes, therefore, are
among the most important points on the body, and have
a wide application in treating disorders of the head, chest,
abdomen (the three ends) and additionally the back.
Indeed there is no point distal to the elbow or knee that
does not have an effect on these regions. So important are
the distal points that it is said in relation to the theory of
root (ben) and manifestation (biao) that the root is the
lower and the manifestation is the upper, i.e. in the context
of the channels, the extremities of the limbs are the root,
and the head, shoulder, back and chest are the
manifestation.
The primary principle of selecting distal points is to
choose a point from the involved channel. Thus, for
example, distal points from shaoyang channel (Sanjiao
and Gall Bladder) will be selected for temporal headache,
distal points from yangming channel (Large Intestine and
Stomach) will be chosen for pain of the face and forehead,
distal points from taiyang channel (Bladder and Small
Intestine) will be selected for occipital headache and pain,
and points from the jueyin Liver channel will be selected
for vertex headache. The selection of distal points requires
a good knowledge of the channels, not only the superficial
and deep pathways of the primary channels, but also the
pathways of the luo-connecting, divergent and muscle
channels. For example, Taichong LIV-3 is selected as a
distal point for vertex headache because the internal
pathway of the Liver channel ascends to the vertex to meet
Baihui DU-20. Several distal points of the Liver channel,
which winds around the genitals, can be selected for
genital disorders, but Ligou LIV-5, the luo-connecting
point is favoured due to the pathway of the Liver luo-
connecting channel which also ascends to the genitals.
The point Chengshan BL-57 is much used for haemor-
rhoids due to the pathway of the Bladder divergent channel
to the anus. Points of the Stomach channel are frequently
used to treat disturbance of the spirit, since the Stomach
divergent channel connects with the Heart, and the Stom-
ach primary channel ascends to meet with the Du Mai at
Shenting DU-24 and Renzhong DU-26 and hence affects
the brain.
In the treatment of pain and disorders both of the zangfu
and channels, it is common practice to combine the use of
local, adjacent and distal points. Examples include:
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Point selection methods
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Shuaigu GB-8, Fengchi GB-20 and Xiaxi GB-43 for
temporal headache.
Rugen ST-18, Qimen LIV-14 and Zulinqi GB-41 for
breast diseases.
Zhongwan REN-12, Shanzhong REN-17 and Zusanli
ST-36 for Stomach diseases.
Jianyu L.I.-15, Binao L.I.-14 and Hegu L.I.-4 for disor-
ders of the anterior shoulder.
Naoshu SI-10, Bingfeng SI-12 and Houxi SI-3 for dis-
orders of the posterior shoulder.
There are numerous examples of this method in the
classical combinations given in this text.
SELECTING PROXIMAL POINTS
In disorders of the extremities, there are by definition no
distal points, and in such cases some proximal points may
be used, for example:
Kongzui LU-6, Zhizheng SI-7, Yangxi L.I.-5, Jianyu
L.I.-15 and Waiguan SJ-5 all treat disorders of the fin-
gers and hand.
Feiyang BL-58 treats disorders of the toes.
Xiajuxu ST-39, Chengjin BL-56 and Chengshan BL-57
treat disorders of the heel, feet and soles.
SELECTING POINTS BELOW TO TREAT ABOVE
The principle of selecting points from the lower part of the
body to treat diseases of the upper body shares a common
approach with the method of selecting distal points, and
is one of the key aspects of point selection. The six yang
primary channels either begin or terminate on the face, the
qi of the six yin primary channels reaches the head via
their divergent channels, and the extraordinary channels,
with the exception of the Girdling vessel, all ascend to the
head.
The human body, having the characteristics of warmth,
activity and transformation is yang by nature, and suffers
from a tendency for its qi and yang to rise excessively. The
principle of drawing down excess by selecting points in
the lower body is therefore widely used. This is reflected
in the Yellow Emperors Inner Classic
2
which says When
the disease is above select [points] from below. Without
exception, the points of the twelve primary channels
distal to the elbows and knees treat disorders of the head,
chest and upper back, since the upper jiao is above,
whilst the distal points of the arm and leg channels are
below. Some distal points of the arm channels treat the
middle jiao (for example Neiguan P-6) but these are
exceptions, and it is rather the points that lie below these
regions, those distal to the knee, that generally need to be
selected to treat disorders of the middle and lower jiao
(upper and lower abdomen, mid and lower back). This
basic theory helps to explain one of the apparent
contraindications of acupuncture practice, which is that
few points of the Large and Small Intestine channels treat
intestinal disorders. Since these fu lie in the lower jiao, the
most effective points to treat them lie on the lower limbs,
and the Large and Small Intestines are ascribed lower he-
sea points (Shangjuxu ST-37 and Xiajuxu ST-39
respectively).
SELECTING POINTS ABOVE TO TREAT BELOW
The full quotation from the Yellow Emperors Inner Classic
given above continues ... if the disease is below, select
points above. Whilst also an important principle of point
selection, the use of points in the upper part of the body to
treat disorders below is relatively less common than its
opposite. Examples include:
Dicang ST-4 for atrophy disorder with inability to
walk and swelling of the leg.
Renying ST-9 for vomiting and lumbar pain.
Shuaigu GB-8 for incessant vomiting and cold in the
Stomach.
Fubai GB-10 for pain of the shoulder and arm, inabil-
ity to raise the arm and flaccidity of the leg with
inability to walk.
Fengfu DU-16 for numbness of the legs
Baihui DU-20 for oppression of the Heart, palpita-
tions, rectal prolapse and prolapse of the uterus.
Renzhong DU-26 for stiffness, sprain and pain of the
spine.
Huantiao GB-30 or Biguan ST-31 for disorders of the
whole leg.
Jianyu L.I.-15 for disorders of the whole arm.
SELECTING POINTS FROM THE FRONT TO TREAT
THE BACK AND VICE-VERSA
Yin diseases travel through the yang region and yang
diseases travel through the yin region. The mu points are
situated in the yin region, they may be used to treat yang
disease; the shu points are situated in the yang region,
they may be used to treat yin diseases. Classic of
Difficulties
3
.
When the qi [gathers] in the chest, to prevent [disease use
points on either side of the] breast and the shu point on the
back [Feishu BL-13]; when the qi [gathers] in the abdo-
men, to prevent [disease use] the shu point on the back
[Pishu BL-20] ... . Spiritual Pivot
4
Points on the back (principally the back-shu points) are
commonly selected to treat disorders of the front of the
body, for example Feishu BL-13, Jueyinshu BL-14, Xinshu
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Point selection methods
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BL-15 and Geshu BL-17 all treat pain or oppression of the
chest, points Ganshu BL-18, Danshu BL-19, Pishu BL-20
and Weishu BL-21 all treat abdominal disorders etc.
Equally, points on the front of the body may be selected to
treat disorders in the back, for example
Zhongfu LU-1, Qihu ST-13, Burong ST-19 and
Shiguan KID-18 treat pain of the mid or upper back
Shuidao ST-28, Qichong ST-30, Qixue KID-13,
Zhongzhu KID-15, Zhangmen LIV-13, Guanyuan
REN-4, Yinjiao REN-7 and Shuifen REN-9 treat disor-
ders of the lumbar spine.
For this reason, one method of point selection emphasises
combining points of the front and back, often the front-mu
and back-shu points, for example Juque REN-14 and
Xinshu BL-15 for disorders of the Heart, Tianshu ST-25
and Dachangshu BL-25 for disorders of the Large Intes-
tine fu etc.
SELECTING POINTS IN THE CENTRE TO TREAT THE
EXTREMITIES
The selection of points in the centre to treat the extremities
is relatively less common than its opposite. However, a
number of points may be used in this way, for example:
Rugen ST-18 for swelling and pain of the arm.
Daju ST-27 for loss of use of the four limbs and hemi-
plegia.
Daheng SP-15 for inability to raise and move the four
limbs.
Zhangmen LIV-13 for inability to raise the arm.
Yaoyangguan DU-3 for inability to flex and extend
the knee, pain of the outer aspect of the knee and in-
ability to walk.
Mingmen DU-4 for cold painful obstruction of the
hands and feet.
Zhongji REN-3 for exhaustion of the four limbs.
Guanyuan REN-4 for tremor of the hands.
SELECTING POINTS FROM ONE CHANNEL TO TREAT
ITS INTERIORLY-EXTERIORLY RELATED CHANNEL
Examples of this method, most commonly observed in
relation to the luo-connecting points, include:
selecting Hegu L.I.-4 to assist the Lung function of
distributing defensive qi.
selecting Pianli L.I.-6 to promote the Lung function of
regulating the water passages when this is impaired
by exterior wind.
selecting Fenglong ST-40 to resolve phlegm due to
disharmony of the Spleen.
selecting Zhizheng SI-7 to regulate and calm the
spirit when the Heart is in disharmony.
SELECTING POINTS FROM ONE PAIR OF THE SIX
CHANNELS TO TREAT DISEASE OF THE OTHER
Examples include:
selecting Zhigou SJ-6 from the hand shaoyang Sanjiao
channel to treat hypochondriac pain due to disharmony
of the foot shaoyang Gall Bladder channel.
selecting Neiguan P-6 from the hand jueyin
Pericardium channel to resolve stagnation of qi in the
foot jueyin Liver channel in the chest and
hypochondrium.
SELECTING POINTS ACCORDING TO CHANNEL
CONNECTIONS
Examples include
selecting Zhongfu LU-1 to regulate the function of
the Stomach and treat nausea and vomiting, since the
Lung primary channel originates in the middle jiao.
selecting points of the Stomach or Bladder channels
to regulate the spirit since both their divergent chan-
nels pass through the Heart.
selecting Touwei ST-8 to treat headaches of the fore-
head, vertex or occiput because of its status as a
meeting point of the Stomach channel with the Gall
Bladder channel and the Yang Linking vessel (which
itself links all the yang channels of the body includ-
ing the Governing vessel and Bladder channel which
together rule the vertex).
selecting Sanyinjiao SP-6, the intersection of the
Spleen, Liver and Kidney channels, to treat most dis-
eases of the lower abdomen since all these channels
pass through this area.
selecting Dazhui DU-14, the meeting point of the
Governing vessel with all the yang primary channels
to release pathogenic factors from the (yang) exterior.
CROSS NEEDLING
Generally speaking, points are selected unilaterally from
the affected side of the body, or else needled bilaterally,
However, since the channels run bilaterally it is not un-
common to select points from one side of the body to treat
disorders on the opposite side.
This principle of contralateral needling is discussed in the
Spiritual Pivot which says Contralateral insertion, that is,
if the left is affected, the right is treated, and if the right
affected, the left is needled
5
. The Treatise on Contralateral
Insertion in the Essential Questions says When evils in-
vade the channels, if the left side is in excess, the disease
occurs on the right side, and vice versa ... for these condi-
tions, contralateral insertion should be used
6
. Among
classical examples of this method, the Great Compendium
of Acupuncture and Moxibustion recommended needling
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Point selection methods
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left Dicang ST-4 for diseases of the right side of the face,
and vice-versa, and needling left Dadun LIV-1 for right-
sided shan disorder and vice-versa, and the Methods of
Acupuncture and Moxibustion from the Golden Mirror of
Medicine by Wu Qian specified that moxa should be
applied to right Tongtian BL-7 for disorders of the left
nostril and vice-versa.
In modern clinical practice, chronic hemiplegia (of over
three to six months duration) is often treated by first
reducing points on the healthy side, then reinforcing
points on the affected side. Contralateral needling is also
commonly used either when the affected side is too pain-
ful to treat, or when, after needling, one wants the patient
to mobilise the painful area. For example in cases of tennis
elbow, the healthy side might be needled whilst the
patient exercises the affected elbow.
Another form of cross-needling emphasised in acute pain-
ful disorders, especially sprain, selects points from the
ankle to treat the opposite wrist (and vice-versa), from the
knee to treat the opposite elbow (and vice-versa) and from
the hip to treat the opposite shoulder (and vice-versa). In
this case, the six channel relationships are called upon, for
example right Qiuxu GB-40, a point of the foot shaoyang
channel on the ankle joint would be selected to treat pain
or sprain of the wrist joint in the area of left Yangchi SJ-4,
a point of the hand shaoyang channel. Among classical
applications of this method, Chize LU -5 at the elbow was
traditionally indicated for cranes knee wind (swelling
and pain of the knee, with atrophy above and below the
joint).
Finally it should be noted that some channels cross the
body. Examples are the Large Intestine primary channel
which crosses to the opposite side of the face at Renzhong
DU-26, and the Large Intestine sinew channel which
crosses over the top of the head to connect with the
mandible on the opposite side. For this reason some
practitioners prefer to needle right Hegu L.I.-4 for disor-
ders of the left side of the face and vice-versa.
SELECTION OF EMPIRICAL POINTS
The classical and modern use of acupuncture points can
frequently be explained by reference to the channel path-
ways and the status of the point (for example jing-well,
shu-stream, xi-cleft, hui-meeting point etc.). Frequently,
however, the selection of distal points is determined by
their historically established empirical effect. Examples of
empirical point applications include:
Naohui SJ-13, Tianfu LU-3 and Binao L.I.-14 are all
used in the treatment of goitre and scrofula. Whilst
all three channels do ascend to the neck or throat re-
gion, there is no simple explanation why these points
on the upper arm, rather than the more powerful and
distal shu-points should have this action.
Tiaokou ST-38 is an important distal point in the
treatment of shoulder pain, even though the Stomach
channel does not pass through the shoulder region.
Lingtai DU-10 is an empirical point in the treatment
of carbuncles and furuncles and clove sores, al-
though there is no obvious theoretical explanation
why this should be so.
Lieque LU-7 has traditionally been emphasised for
the treatment of headache, even though the Lung
channel does not ascend higher than the throat.
Wangu SI-4 is traditionally indicated for jaundice, al-
though there is no obvious theoretical explanation
why this should be so.
Waiqiu GB-36 was indicated for rabies in the Illus-
trated Classic of Acupuncture Points on the Bronze Man .
CHAIN AND LOCK POINT ASSOCIATION METHOD
The chain and lock point association method refers to the
selection of points from the shoulder, elbow and hand or
wrist to treat disorders of the upper limb and from the hip,
knee and ankle to treat disorders of the lower limb. It is
frequently used in the treatment of atrophy disorder and
hemiplegia when points are primarily selected from
yangming channels. Commonly, therefore, Jianyu L.I.-15,
Quchi L.I.-11 and Hegu L.I.-4 are combined to treat the
upper limbs, and Biguan ST-31, Zusanli ST-36 and Jiexi
ST-41 for the lower limb. The method is not, however,
confined to yangming channels, and a similar approach
would combine Naoshu SI-10, Xiaohai SI-8 and Houxi
SI-3 for pain of the posterior shoulder, or Chengfu BL-36,
Weizhong BL-40 and Kunlun BL-60 for pain of the buttock
and posterior leg.
ALTERNATING POINTS
When acupuncture is given frequently, for example in the
treatment of hemiplegia following windstroke, or for any
chronic and intractable disease, it is common practice to
alternate points or point prescriptions to avoid over-
stimulation of or damage to points. Thus, Jianyu L.I.-15,
Quchi L.I.-11 and Hegu L.I.-4 may be substituted by
Jianliao SJ-14, Shousanli L.I.-10 and Yangchi SJ-4 in the
treatment of atrophy disorder of the arm, or Biguan ST-31,
Zusanli ST-36 and Jiexi ST-41 may be substituted by
Huantiao GB-30, Yanglingquan GB-34 and Qiuxu GB-40
for atrophy disorder of the leg. Similarly suitable points
may be divided into two alternating prescriptions, one
from the front and one from the back, for example in cases
of epigastric pain due to attack on the Stomach by Liver qi,
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Point selection methods
5
Zhongwan REN-12, Zusanli ST-36, Qimen LIV-14 and
Taichong LIV-3 may be alternated with Weishu BL-21,
Ganshu BL-18, Yanglingquan GB-34 and Neiguan P-6.
POINT COMBINATIONS
Much space has been given in this text to point combina-
tions from classical texts. Some of these combinations
have a quite modern feel to them, in other words they
might regularly be seen in use in clinical practice today.
Others use what may seem to be obscure and unusual
points from a current-day perspective.
It is well understood in Chinese herbal medicine that
herbs in combination act synergistically, in other words
that the sum effect of their combination is quite different
from the sum of the actions and indications of the indi-
vidual constituents. In the history of acupuncture, it is
clear that a somewhat similar view was held. The majority
of acupuncturists throughout the history of China were
itinerant formula doctors
7
who memorised acupuncture
prescriptions that were handed down in family lineages.
These doctors often tended to specialise in the treatment
of specific complaints, and the great acupuncture classics
(for example the Great Compendium of Acupuncture and
Moxibustion) were in part compilations of such acupunc-
ture prescriptions, collected from the length and breadth
of China. Many of these prescriptions appeared in early
classical compilations and are found repeated in later
classical sources. Some are still famous today, for example
Little sweating: reinforce Hegu L.I.-4, reduce Fuliu KID-7;
much sweating: first reduce Hegu L.I.-4 then reinforce
Fuliu KID-7
8
. Many others have been forgotten. Some
classical prescriptions seem well balanced, mixing local
and distal points from the upper and lower body, for
example Head wind and dizziness: Fenglong ST-40,
Hegu L.I.-4, Jiexi ST-41 and Fengchi GB-20
9
. Others seem
very unbalanced, for example Vomiting with fullness of
the chest: Shencang KID-25, Shufu KID-27, Lingxu KID-24
and Juque REN-14
10
.
Of course, whenever a practitioner selects a number of
points to treat any patient, they by definition use a pre-
scription of points, whether a classical one, a modern one
as found in one of the current acupuncture texts on the
treatment of disease, or one of their own choosing. Many
factors go into the making of such a prescription. Some of
these include:
combining points from the upper and lower body.
combining points from the left and right sides of the
body.
combining points from the front and back of the
body.
combining points to treat the root of the disorder and
points to treat the manifestation.
combining points from yin channels and points from
yang channels.
combining points from one channel with points from
its interiorly-exteriorly coupled channel.
combining points from one channel with points from
its coupled channel according to six channel theory.
In clinical practice, when treating a long-standing disease,
a patient may report that one point prescription, for
example comprising points from the front of the body,
seems to have a better effect than points from the back (or
vice-versa). Sometimes a subtle change of point prescrip-
tion will bring about a significant change or improvement.
There are no hard and fast rules in the making of a point
prescription.
It is the intention of this book to provide the practitioner
with the maximum amount of information on the points
in order to facilitate the best possible point prescription,
and to give consideration and respect to the classical
prescriptions which have stood the test of considerable
periods of time.
NOTES
1 Ahshi points: points of local tenderness found on palpation
which may, or may not, be regular acupuncture points. They
are needled according to the concept that where there is
pain, there is an acupuncture points.
2 Spiritual Pivot Chapter 9 and Essential Questions Chapter 70.
3 Classic of Difficulties 67th Difficulty.
4 Spiritual Pivot Chapter 52.
5 Spiritual Pivot Chapter 7.
6 Essential Questions Chapter 63.
7 According to Bob Flaws in Thoughts on Acupuncture,
Internal Medicine and TCM in the West, The Journal of
Chinese Medicine, Number 38, January 1992.
8 The Great Compendium of Acupuncture & Moxibustion.
9 The Great Compendium of Acupuncture & Moxibustion.
10 Thousand Ducat Formulas.
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