Acupuncture point

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Acupuncture points (also called "acupoints or tsubo"), are, according to the earliest oriental extant medical treatise, the Yellow Emperor's Classic, "holes" on the surface of the body enabling the life force, or qi (ch'i) to pass in an out of the body.[1] Clinically, they are the focus of acupuncture, acupressure, sonopuncture, and laser acupuncture treatments. They are studied using functional magnetic resonance imaging and positron emission tomography of the brain,[2] as well as impedometric measurements[3][4] and "low intensity laser biostimulators"[5] in situ. According to the tradition, there are several hundred acupuncture points, distributed along the meridians, which are believed to link to specific organs, as well as many 'extra points' that are not associated with a particular meridian.

Scientific evidence

Until recently, it was believed that the existence of acupoints could not be scientifically demonstrated because the theoretical system underlying acupuncture was mystical in nature and the practice of acupuncture was alien to the scientific method.

However, neither the theoretical nor the practical context of acupoints could prevent modern research from studying their existence.

In 1998, the groundbreaking study by Lu & al.,(verif+quote needed), published in the US Proceedings of the National Academy of Sciences, showed that a seemingly unimportant area of the fifth toe could cause an activation of the visual cortex, when properly localized and stimulated in accordance with traditional acupuncture theory and practice.

Following this discovery, a host of new researches using state-of-the-art neural imaging techniques obtained results as surprising with other acupoints (but not sham points).

In a 2005 review of 7 intense years of research on this previously neglected aspect of physiology, Lewith & al. appreciate the progress accomplished using modern imaging techniques:

Studies show that specific and largely predictable areas of brain activation and deactivation occur when considering the traditional Chinese functions attributable to certain specific acupuncture points. For example, points associated with hearing and vision stimulates the visual and auditory cerebral areas respectively".[2]

Theory

Acupoints may or may not be in the same area of the body as the targeted symptom. The traditional Chinese medicine (TCM) theory for the selection of such points and their effectiveness is that they work by stimulating the meridian system to bring about relief by rebalancing yin, yang and qi (also spelled "chi"). This theory is based on the paradigm of TCM, not that of science.

Body acupoints are generally located according to their distances from landmark points on the body. Acupoint location usually depends on specific anatomical landmarks that can be palpated. There are nearly 400 basic acupoints on the meridians; many of which are rarely used. Some points are considered more therapeutically valuable than others, and are used for a wide array of health conditions.

Location by palpation for tenderness is also a common way of locating acupoints (see also trigger point). Points may also be located by feeling for subtle differences in temperature on the skin surface or over the skin surface, as well as changes in the tension or "stickiness" of the skin and tissue.

Body acupoints are referred to either by their traditional name, or by the name of the meridian on which they are located, followed by a number to indicate what order the point is in on the meridian. A common point on the hand, for example, is named Hegu, and referred to as LI 4 which means that it is the fourth point on the Large Intestine meridian.

Categories of acupuncture points

Certain acupuncture points are ascribed different functions according to different systems within the TCM framework.

  • Five Transporting Points system describes the flow of qi in the channels using a river analogy; it describes qi bubbling up from a spring and gradually growing in depth and breadth like a river flowing from a mountain to the sea.
  • Jing-well points are where the qi 'bubbles up'. These are always the first points on the yang channels or last points on the yin channels and with the exception of Kid-1 YongQuan, all are located on the tips of fingers and toes. They are indicated for 'fullness below the heart' (feeling of fullness in the epigastric or hypochondrium regions) and disorders of the zang organs (yang organs).
  • Ying-spring points are where the qi 'glides' down the channel; they are indicated for heat in the body and changes in complexion.
  • Shu-stream points are where the qi 'pours' down the channel; they are indicated for heaviness in the body and pain in the joints, and for intermittent diseases.
  • Jing-river points are where the qi 'flows' down the channel; they are indicated for cough and dyspnoea, chills and fever, diseases manifesting as changes in voice, and for diseases of the sinews and bones.
  • He-sea points are where the qi collects and begins to head deeper into the body; they are indicated for counterflow qi and diarrhea, and for disorders resulting from irregular eating and drinking.
  • Five Phase Points ascribe each of the five phases - wood, fire, earth, metal and water - to one of the Five Transporting points. On the yin channels, the jing-well points are wood points, the ying-spring points are fire, shu-stream points are earth, jing-river points are metal, he-sea points are water points. On the yang channels, the jing-well points are metal, ying-spring are water, shu-stream are wood, jing-river points are fire and he-sea points are earth points. These point categories are then implemented according to Five Phase theory in order to approach the treatment of disease.
  • Xi-cleft points are on the channel where the qi and blood gather and plunge more deeply; they are indicated in acute situations and for painful conditions.
  • Yuan-source points are on the channel from where the yuan qi can be accessed.
  • Luo-connecting points are at the point on the channel where the luo meridian diverges. Each of the twelve meridians have a luo point that diverges from the main meridian. There are also three extra luo channels that diverge at Sp-21, Ren-15 and Du-1.
  • Back-shu points lie on the paraspinal muscles either side of the spine. Theory says that the qi of each organ is transported to and from these points, and can be influenced by them.
  • Front-mu points are close to the respective organ. They have a direct effect on the organ itself but not on the associated channel.
  • Hui-meeting points are considered to have a "special effect" on certain tissues and organs. The hui-meeting points are:
  • zang organs - Liv-13 Zhang Men
  • fu organs - Ren-12 Zhong Fu
  • qi - Ren-17 Shang Fu
  • blood - Bl-17 Ge Shu
  • sinews - GB-34 Yang Ling Quan
  • vessels - Lu-9 Tai Yuan
  • bone - Bl11 Da Zhu
  • marrow - GB-39 Xuan Zhong

Non-meridian points

Additionally, there are microsystems of acupoints that are typically not located on the meridians. For example, auriculotherapy uses the external ear microsystem exclusively, using thousands of points that are not on a meridian, but on the surface of the external ear. The Korean system of hand acupuncture is a microsystem that utilizes acupoints on the hand. There are other common and uncommon acupoints that are called extra points, meaning that they are neither on a meridian nor part of a microsystem. Extra points are referred to more often by name, though some of the more commonly known have a letter/number combination for reference. A popular extra point is Yintang, at the midpoint between the eyebrows.

Scientific research

This section focuses on the efficacy of "distal points', i.e. body acupoints that according to TCM theory are indicated for treating conditions whose symptoms manifest in areas of the body that are distant from the acupoint's location. An example is P6 (Nei guan), located near the wrist and used to treat nausea.

Acupoint P6

The Cochrane Collaboration, a group of evidence-based medicine (EBM) reviewers, reviewed the use of P6 for nausea and vomiting, and found it to be effective for reducing post-operative nausea, but not vomiting [1]. The review included various means of stimulating P6, including acupuncture, electro-acupuncture, transcutaneous nerve stimulation, laser stimulation, acustimulation device and acupressure; it did not comment on whether one or more forms of stimulation were more effective. EBM reviewer Bandolier said that "P6 acupressure in two studies showed 52% of patients with control having a success, compared with 75% with P6 acupressure" [2]. One author of an article in the Scientific Review of Alternative Medicine disagreed [3].

Acupoint BL 67 (Zhi yin)

One randomized controlled trial studied a classical TCM treatment for breech birth (i.e., buttocks-first orientation of the baby, which is much riskier than head-first). The study showed that moxibustion at acupoint BL 67 (aka UB 67), located at the tip of the fifth toe, was more effective than placebo at reducing the incidence of breech birth. An EBM review by Cochrane said that more data were needed before recommendations on effectiveness could be made.

Criticism of TCM theory

Clinical use of acupuncture points frequently relies on the conceptual framework of Traditional Chinese Medicine (TCM), which some scholars have characterized as pseudoscientific. See Acupuncture: Criticism of TCM theory.

In popular culture

Martial arts applications

There are several types of pressure points, each of which is applied differently, and each one creates different effects:

  • Pain: Some points are painful, because of the prevalence of nerves in the area. For example, being prodded in the throat is painful. The body has a pain withdrawal reflex, whereby it reacts to pain by moving away from it. Martial artists make use of this, sometimes without being aware of it. Applying pressure next to the collar bone, from above, will cause the person to move downwards (away from the pain), whereas poking them in the gap between the jaw and neck (just below the ear) will make their body want to move upwards. Pressure to the shoulder causes that side of the body to move back. A rub to the back down will cause the body to move forth. Some points react more violently to pain from changes in the pressure (rubbing) rather than constant pressure. All pressure points can cause pain.
  • Muscular: Here a direct attack is made on a muscle, which will contract. Examples include: (I) a punch to the solar plexus, which impacts the diaphragm and thus affects the person's breathing ('getting the wind knocked out of you'); and (II) an attack to the outer thigh, which could cause the person to fall as their leg loses power (a 'dead leg' or 'charley horse').
  • Pressure: The baroreceptors in the carotid artery are pressure-sensitive cells that allowing the body to control the bloodflow into the brain. Pressure against this region will 'trick' the brain into thinking that blood pressure is too high, and thus will lower blood pressure - which can cause blackout. Striking veins and arteries can also cause them to shut or tear, both of which will definitely cause black-out and possible death if not treated immediately.
  • Break: There are some areas which are likely to lead to a break if struck properly. This includes the 'loose rib', the philtrum and the top of the skull (soft-spot).
  • Hyper-Extension There are joints that, when struck, can be hyper-extended and even completely torn apart. This is a technique which can cause permanent damage and disfiguration to one's opponent, usually focusing on the elbow and the knee. There are two types:
    • brute force: This takes advantage of the vulnerability of the strike point, thereby causing the damage; and
    • Golgi organs: A relatively gentle strike to the Golgi tendon at the back of the elbow, for example, causes a reflex which immediately relaxes that tendon, allowing the elbow to more easily bend in the wrong direction. If this is immediately followed by a solid strike to the elbow joint, the elbow can be broken with significantly less effort than through brute force.
  • Brain shake: The brain is a very vulnerable organ, which is why it is encased in the skull. The brain floats in fluid and balances on a very flexible spine. Certain techniques can actually shake the brain in a way which causes black out. The most commonly taught technique involves a strike just below the occipital ridge, at the correct angle in the correct direction. Other areas susceptible to such techniques are the temples and the top of the skull.
  • Energy: Some believe there are energy channels which flow around the body through acupuncture meridians, and an attack will impact the flows, and thus impact the body. This is called "chi", "ki" or "qi" in East Asian cultures. These techniques are deadly. If used correctly a strike to an opponents arm or leg can cause black-out and two consecutive strikes along the arm(s) or leg(s) can kill an opponent. A skilled martial artist can master the death touch which is a single strike or grab in the torso or the head and neck that can instantly kill their opponent.

References

  1. Luh CL, Wilson DA (1978) "A Review essay - Acupuncture: Politics and Medicine"] Bulletin of Concerned Asian Scholars, Vol. 10
  2. 2.0 2.1 "(S)tudies show that specific and largely predictable areas of brain activation and deactivation occur when considering the traditional Chinese functions attributable to certain specific acupuncture points. For example, points associated with hearing and vision stimulates the visual and auditory cerebral areas respectively".Lewith GT & al. (Sep 2005). "Investigating acupuncture using brain imaging techniques: the current state of play". Evidence-based complementary and alternative medicine : eCAM 2: 315-9. PMID 16136210.
  3. Pearson S & al. (2007). "Electrical skin impedance at acupuncture points". J Altern Complement Med 13: 409–18. DOI:10.1089/acm.2007.6258. PMID 17532733. Research Blogging.
  4. Ahn AC & al. (2005). "Electrical impedance along connective tissue planes associated with acupuncture meridians". BMC Complement Altern Med 5: 10. PMID 15882468.
  5. Valchinov ES, Pallikarakis NE (2005). "Design and testing of low intensity laser biostimulator". Biomed Eng Online 4: 5. PMID 15649327.

See also