Location of the Points
In ancient China the points were considered to be holes of bean-size. As the insertions were very often performed through the clothes, the location of the points differed a great deal. Today the Chinese physicians state that the points are not strictly located, but they can lie within a radius of even 5 mm. The right location is very important and sometimes, when after insertion no reaction is evoked, the insertion must be repeated and the needle must be slightly moved towards another direction. Before insertion the physician must first of all find the right spot and press it with his fingers. With the exception of the points lying in the abdominal region and with the exception of the patients being paralysed, almost all points manifest a reaction and the patient after pressure feels a dull pain.
Although today the anatomical location is quite precisely defined, the old way of measuring in cuns and fens is still being used.
The expression cun and fen have an absolute value only when referring to the depth of the insertion, while as units denoting the distance on the human body their value is only relative. There exist two methods of measuring the distances on the body.
1. Individual cun (1 cun – 10 fens, 10 fens – 1 chi); it is the length between the lines of the first and second joints of the middle finger when bent (with men the left hand is taken and with women the right one). This method is used when measuring the distances between the points located vertically or horizontally on the limbs and horizontally on the back and loins.
2. Proportional cun. This differs according to the constitution of each person and everyone is practically a scale for himself. It means that certain distance is divided into several parts and each of them is so called proportional cun. The following way of measuring is described according to Li Qianxia.
- a) The distance of the frontal and occipital hair border is 12 cuns. In the case the hair border is not distinct, the distance from the middle of the root of the nose to the point dazhui Gv 14 (first thoracic vertebra) is 18 cuns. This is the vertical scale for the head.
- b) The distance between the corners of the eyes is 1 cun. This is the horizontal scale for the head.
- c) The distance between the point tiantu Cv 22 (the middle of the upper border of the jugular incisure) to the point shanzhong Cv 17 lying between the two nipples is 8 cuns. This is the vertical scale for the chest.
- d) The distance between the two nipples is 8 cuns. This is the horizontal scale for the chest and abdomen.
- e) The distance between the xiphoid process to the middle of the navel is 8 cuns. This is the vertical scale for the upper part of the abdomen.
- f) From the middle of the navel to the upper margin of the os pubis is five cuns. This is the vertical scale for the lower abdomen.
- g) The distance between the point dazhui Gv 14 (first thoracic vertebra) to the coccyx is 30 cuns. This is the vertical scale for the back and loins.
As an aid the distance is sometimes given in the width of fingers (for adults the physician uses his own hand, for children the hand of the ill child).
Zhu Lian reprobates the method of the proportional cun and proposes only the precise anatomical localisation.
The Meaning of the Points
In old conception, the points, meridians and organs form a complex inner and outer system. By needling or cauterizing the points the Qi in the meridians is regulated and thus the organs are brought into order. In the view of the ancient Chinese physicians, the meridians are a reflective system of the diseases of the organs and the points are the reflective spots of these meridians. The location of the points is important not only in the healing of the,diseases, it also bears a diagnostic meaning.
Li Qianxia states that the points themselves have no absolute meaning at all. Their effect in treatment is very often rather individual and depends on the patient’s disposition. Thus two patients suffering from gastric pain may have different reactions. After insertion into the point zusanli S 36 patient’s A condition may improve while that of patient B may not. The points zusanli S 36, neiguan Cx 6 and zhongwan Cv 12 are used very effectively for more serious cases of cramps of the diaphragm. It would seem that these three points should be particularly suitable for curing this disease, but it is not so. Zhu Lian cites the following case: in 1956 a worker affected by violent cramps of the diaphragm suddenly fainted. All the three points were used without success. Then the points shixuan EP 11 and shidou SP 17 were used and failed again. But as soon as both yongquan K 1 were needled, the patient regained consciousness and the cramps stopped. After ten days the fainting-fit of the patient was repeated. It would seem that the point yongquan K 1 should be especially efficacious with this patient, but this time the point yongquan failed.
Acupuncture was not invented by one person neither did it come to being suddenly. To state its curing functions one needs experiences and these are very often incomplete. Thus it may happen that some points may but also may not prove effective, and for the same disease many points are given. We can always cite a group of points suitable for a group of diseases.
Thus the points sanyinjiao Sp 6, diji Sp 8, xuehai Sp 10, guanyuan Cv 4, qihai Cv 6, zhongji Cv 3, baliao B 31, B 32, B 33, B 34, shenshu B 23, mingmen Gv 4, zhishi B 47, and pangguangshu B 28 are used for diseases of the male and female reproductive organs and the urogenetic tract; the points zusanli S 36, shangwan Cv 13, zhongwan Cv 12, xiawan Cv 10, weishu B 21, pishu B 20, tianshu S 25, dachangshu B 25 for diseases of the digestive tract. The points lying in the vicinity of the diseasedorgans may be effective for their treatment. For example the points on the head shenting Gv 24, touwei S 8, fengfu Gv 16, baihui Gv 20 are suitable for diseases of the head; the points lying in the vicinity of the eyes, such as jingming B 1, zhongziliao G 1, zanzhu B 2, sizhukong T 23, yuyao EP 4, sibai S 2, yangbai G 14, chengqi S 1 are suitable for the eye diseases; the points ermen T 21, tinggong Si 19, tinghui G 2, yifeng T 17, tianrong Si 17, qimai T 18, luxi T 19, heliao T 22, for the ear diseases; the points heliao Li 19, yingxiang Li 20, suliao Gv 25, juliao S 3, for the nose diseases; the points tiantu Cv 22, liangquan Cv 23, renying S 9, shuitu S 10, qishe S 11, tianding Li 17, futu Li 18, yamen Gv 15, for the laryngopharyngeal diseases; the points on the chest like zhongting Cv 16, shanzhong Cv 17, yutang Cv 18, zigong Cv 19, huagai Cv 20, shufu K 27, shencang K 25, lingxu K 24, qihu S 13, yunmen L 2, kufang S 14, zhongfu L 1, xiongxiang Sp 19, and the points on the back like dazhui Gv 14, taodao Gv 13, shenzhu Gv 12, shendao Gv 11, lingtai Gv 10, dazhu B 11, fengmen B 12, feishu B 13, jueyinshu B 14, xinshu B 15, dushu B 16, fufen B 36, pohu B 37, gaomang B 38, shentang B 39, yixi B 40, for diseases of the heart, lungs and diaphragm; the points in the upper abdomen like juque Cv 14, shangwan Cv 13, zhongwan Cv 12, jianli Cv 11, xiawan Cv 10, shenque Cv 8, youmen K 21, tonggu K 20, yindu K 19, shiguan K 18, shangqu K 17, burong S 19, chengman S 20, liangmen S 21, taiyi S 23, huaroumen S 24, tianshu S 25 and the points in the lumbodorsal region like zhiyang Gv 9, jinsuo Gv 8, zhongshu Gv 7, jizhong Gv 6, xuanshu Gv 5, geshu B 17, ganshu B 18, danshu B 19, pishu B 20, weishu B 21, sanjiaoshu B 22, geguan B 41, hunmen B 42, yanggang B 43, yishe B 44, weicang B 45, huangmen B 46, are suitable for diseases of the stomach; intestines, liver and gall; the points in the lower abdomen like Cv 7, qihai Cv 6, shimen Cv 5, guanyuan Cv 4, zhongji Cv 3, qugu Cv 2, zhongzhu K 15, siman K 14, qixue K 13, dahe K 12, henggu K 11, wailing S 26, daju S 27, shuidao S 28, guilai S 29, qichong S 30, from the fourteenth vertebra downward mingmen Gv 4, yangguan Gv 3, yaoshu Gv 2, changqiang Gv 1, shenshu B 23, qihaishu B 24, dachangshu B 25, guanyuanshu B 26, xiaochangshu B 27, zhonglüshu B 29, baihuanshu B 30 and baliao B 31, B 32, B 33, B 34 are suitable for diseases of the large and small intestines, reproductive organs and the urogenetic tract.
The points on the upper limbs lying on the external surface mostly cure the diseases of the organs of the senses and brain diseases, those lying on the inner surface cure the diseases of the stomach, intestines, organs of the five senses and brain; the points lying on the inner surface of the legs mostly cure the diseases of the reproductive organs and urogenetic tract. In pain or paralysis the needle must beinserted into the affected spot or its environment. The given points should not be viewed as rigid patterns which must produce non-failing effects.
The Intensity of Stimulation
The intensity of the stimulation depends on the thickness of the needle, on how fast it turns and how long it remains in the body. The strong stimulation (qiang ciji) is such in which thick needles are used, the needle is inserted into the muscle while turning 180-360 degrees and remains in the body for ten or twenty minutes or sometimes even half an hour. The mild stimulation (qing ciji) is such in which thin needles are used, the needle is inserted into the muscle while turning 90 degrees and after insertion it is immediately extracted. The mild stimulation substitutes the old method of bufa while the strong stimulation takes the place of the method xiefa.
The strong stimulation is mostly used in acute diseases, when the physiological function is hyperactive and with patients of strong constitution, while the mild stimulation, is mostly used in chronic diseases when the physiological functions is hypoactive and with patients of weak constitution, old people and children. It must be, however, borne in mind that these principles are not absolute, because it may happen that some diseases which should be treated by strong stimulation can be cured by mild stimulation and vice versa. In such case individual steps must be taken.
The stimulation is either direct (zhijie ciji), i.e. given at the point where the disease is located, such as with paralysis and neuralgia, which can evoke tonification or sedation or it is indirect (jianjie ciji), i.e. given at a point other than is the affected spot, which brings about reflex or induction. This is applied mainly with hyperemia, various sorts of inflammations in head etc. In such case the points lying on the limbs far from the genuine focus are chosen for treatment.
Combination of Points
In treatment usually several points are used at the same time, one main and one or several secondary points. This combination of points resembles the preparation of drugs in the pharmacy. Sometimes one point can be used too, but usually the combination of more points achieves a better result.
In ancient China the following rule were formulated for the combination of the points: if the illness is in the upper part of the body, insert the needle into the lower part of the body; if the illness is on the right side, insert the needle into the left side; if the illness is in the middle, insert the needle in the upper and lower parts of the body.
Today the following rules essentially prevail:
- 1. Combine points near the focus of the diseases with the points lying far away. This adds to the direct stimulation a valuable indirect one. For example, for headaches combine the taiyang EP 1 on the head with hegu Li 4 on the hand.
- 2. For normal illnesses combine one main point and several secondary ones. Sometimes one spot is sufficient, but a suitable combination of points creates stronger effect. Beginners often think that the more secondary points they use the stronger the effect will be. This is a gross mistake, because the excessive use of points can lead to the collision of reflexes and thus to the lessening of the effect. Moreover, the patient would be worn out considerably.
- 3. With more complicated illnesses, for example with extensive inflammation of the joints when the patient’s whole body is in pain, even twenty needles would not be enough. In such a case the physician treats one or two, of the most affected joints first and then gradually gets to the others. Excessive needling would put the patient into an even worse condition; a weaker person might even suffer from shock.
- 4. With chronic diseases, when treatment has to be given daily or every other day for a period of two or three months (even when the thinnest needles are used), it is understandable that the nerve or the tissue of the muscle which cannot renovate itself so fast becomes injured. Therefore it is necessary to change the points during the treatment. For every illness of this type there is a number of fixed main points which are combined with several secondary points. They are used successively so that the insertion is repeated in the same spot only once a week or once a fortnight according to the time schedule of the insertions.
Li Qianxia introduces the combinations, while Zhu Lian and Cheng Dan’a leave it to the physician to create the combinations himself.
The Depth of Insertion
Almost in every book on acupuncture and moxibustion we find lesser or greater disxrepancies concerning the depth of the insertion. The depth is given for a normal adult person (the depth is greater with adults than with children and with patients of stronger constitution than with those of weak constitution. The main aim is to bring about the stimulation of the nerve, manifested by a tingling sensation, not the depth itself. If according to literature the depth should be one cun but at the depth of 5-6 fens the patient already feels a reaction, the needle should not be inserted deeper. If on the contrary the required depth should be 5-6 fens and the patient does not feel any sensation, the needle can be inserted deeper under the condition that no important organs or arteries exist there.