Maps of the classical 14 major meridians and their respective points have existed for thousands of years. But what is an acupuncture point? Is there something unique or different about them than other points of the body? That is not as easy question to answer as you might think. First off, there are different kinds of points each having its own nature or characteristics. Even in TCM there are two distinct types of points: Traditional or classical points that have been named and numbered and mostly are found on the meridians, and local “ahshi” points, or points of local tenderness or sensitivity. Even this classical distinction is blurred by the fact that some of the traditional points are ahshi points that have found great practical use clinically and thus became “classical”. One great example of this are the Jiaji points along the spine. They merely “represent” the nerve roots of the spine. They become tender when the nerve roots get irritated and inflamed. The proper needling technique at the point speeds healing and reduces inflammation (I’ll explain why later). Thus, the points become widely known and attain “Classical” status.
I have come to understand that there are mainly two types of points with their own unique characteristics. First off, there are the true “ahshi” points which I define as points of local tenderness due mostly to trauma of some sort. Common points of this type are nerve roots of the spine, attachments of muscle to bone, strained, sprained or torn ligaments or menisci or labrum, degenerative discs, inflamed joints, broken bones, etc. Basically, the tenderness is due to the trauma and identifies the site of the damage. The point itself is usually not usually “special” in any other way. The mechanism of action of these points is mainly through local tissue level responses and not so much through the nervous system.
Then there are the points that are related to some part or function of the body through the nervous system. These points are “unique” in that they have both sympathetic and parasympathetic innervation (See research by doctors Nakatani and Yamashita from Japan2) which appear to be slightly offset from one another (my own observation). The sympathetic innervation is just under the skin and is responsible for the increased tenderness and electrical conductivity when the associated part or function of the body is disturbed in any way. It can be best thought of as a stress reaction sent through the sympathetic nervous system. This is probably controlled by a modified version of the Gate Control Theory3 developed by Melzak and Wall. When needling the point, we are usually needling the parasympathetic innervation which lies deeper (usually in the underlying muscle). This then triggers a response in the body through the nervous system to “treat” the problem area or function (in addition to the more general responses to needling discussed later). This response could be as simple as relaxing a certain muscle group, to increasing or decreasing some autonomic function in the body such as the production of Hydrochloric Acid in the stomach. These points require stimulation of the nervous system (i.e. needling sensation) for their best effect, and to some extent, the stronger the better.
The nature of the stimulation of the point also plays a large role in the type of response the body will have. Regardless of the type of point, the type of stimulation used plays a significant role in the kind of effect stimulating that point will have on the body. The kinds of responses vary from changes in autonomic functioning4, dilation of the vascular bed to increase local blood circulation5, affecting circulation of extracellular fluid which affects the health of the individual cells6, triggering an anti-inflammatory response7, rallying the immune system to the site8, stimulating changes in brain chemistry to affect pain awareness and mood9, to more subtle effects such as influencing the non-local communication system associated with the connective tissues10 etc.
So , when needling a particular point, a practitioner has to ask themselves “What am I trying to do here? Is this the best point or combination of points? What type of stimulation (or even lack thereof at times) will best achieve my goals?” This requires a thorough understanding of the traditional concepts of Chinese Medicine, a thorough understanding of traditional point functions, locations and stimulation techniques and the knowledge, experience and ability to bring it all together into a well thought out and individualized treatment. Only a fully trained acupuncturist has the requisite skill set to do this. No other type of practitioner has the appropriate training or experience to do so. And to be a superior acupuncturist, one needs to be more than a superior diagnostician. You need to know why things work to apply your skills most effectively, especially in unusual conditions where creative application of that knowledge is required to achieve results. It is my hope that this chapter will expand that knowledge and make you a better practitioner.