The choice of Acupuncture points for AP therapy

DIAGNOSTIC, THERAPEUTIC AND PROGNOSTIC VALUE OF SENSITIVE POINTS AND THE CHOICE OF POINTS FOR THERAPY

1.SENSITIVE POINTS

It is important to search for sensitive points. Sensitive points include the AhShi, Trigger Points, motor points and any other points which show abnormal tenderness to palpation-probing. After taking the case history, the acupuncturist usually palpates the entire body, probing the muscles, especially in those areas which the case history may suggest as likely to be sensitive. In musculoskeletal conditions of the upper limb and neck one probes especially the muscles of the upper limb, neck and thorax. In conditions of the lumbosacral area and lower limb, these areas will be probed carefully. Occasionally, sensitive points may be found far away from the problem area and a careful examination would include probing of the whole body, irrespective of the more obvious areas likely to be affected. For example, SP06 may be sensitive in menstrual disorder in women; KI03 may be sensitive in renal disorders; GB34 may be sensitive in cholecystitis; L 13 (LanWei = "Appendix Tail") may be sensitive in appendicitis.

Wherever sensitive points are found, their locations are noted carefully for future reference. These points may or may not be codified AP points. Their location can help in the diagnosis and they are also useful in therapy and prognosis. Their disappearance, i.e. return to normal sensitivity, during a course of treatment is taken as a good prognosis.

Sensitive points, when present, are always included in the point prescription. However, occasionally a whole area, such as the rectus abdominis, gastrocnemius or gluteal muscles may be sensitive and to needle all of this would require too many needles. In such cases, one or two of the most sensitive areas in the muscle are chosen. If ultrasound or electrostimulation equipment with a roller-electrode is available, the entire muscle can be treated.

One also probes scar tissue carefully. Wherever scar tissue is found, great care is taken to check whether or not it may be associated with the symptoms (by reflex effects or by blocking the flow of Qi in one or more Channels). Treatment of problem scars is very important. It is discussed in the paper on "Techniques of stimulation of the AP points".

Other areas important to probe include the 66 Command Points (the 60 Phase Points + the 6 Yuan points of the Yang Channels (the Yuan points of the Yin Channels are the same as the Yu points), see paper on the Study of Points and Channels), the front Mu points, the paravertebral Shu Points" (BL13-30), also the outer line of the BL Channel (BL36-40, 41-54)).

Sensitive points excluded from needling treatment include cancers, joint cavities, abscesses, infected wounds, parasitized skin areas and ulcers. In the latter case, the use of TianYing points is permitted in certain conditions (see next section).

In humans, practitioners who use the Earpoints pay particular attention to those points which show abnormal sensitivity.

Point sensitivity can be detected objectively by electronic detectors, as mentioned in an earlier paper.

2.TIANYING POINTS

In certain cases it is permissible to needle abnormal masses, such as goitre, synovial cysts, indurated masses in muscle following intramuscular injections etc. The TianYing point is the point of greatest sensitivity in the mass, cyst etc, It is focus of the problem a swollen or enlarged area such as an inflamed muscle or joint or periosteum. One needle is put into the TianYing point and occasionally, 3 or 4 more needles are placed around this one, from the periphery, as in the diagram (a) and (b) below.

Cyst diagrams (a) and (b):

In the case of varicose leg ulcers, 3-5 needles are sometimes advanced underneath the base of the ulcer as in diagram (c) below. Ulcer diagram (c):

In hip arthritis, for example, point GB30 (HuanTiao) is needled but the needle may also be advanced to peck the periosteum of the femoral neck. The intramuscular lump which sometimes follows injection in the biceps brachii or gluteal muscles can be dispersed quickly by dry-needling the centre of the lump. In "Tennis elbow", the lateral epicondyle of the humerus is often pecked with a needle.

In headache following epidural injection or lumbar puncture, the pain can be relieved by injecting a needle into the original needle track. (A recent paper in a medical journal reported extraordinary success in such cases by injection of 10 ml of the patient's blood back into the puncture site. The author did not acknowledge the Chinese discovered that simple needling of the same area could get the same result).

In general, however, cancer masses, joint cavities, infected wounds and infected abscesses (non-sterile) and parasitised skin areas should not be needled except for biopsy or drainage purposes.

3.LOCAL POINTS

In local problems, such as elbow pain, gastritis, tenesmus etc, one or two local points are included in the prescription. For example, include:

neck pain:GB20; BL10; X 35 (HuaToChiaChi points);

shoulder pain:LI15; TH14;

elbow pain:LI11; HT03;

carpal (wrist) pain:LI05; HT07;

lumbosacral pain:BL23,25; GV03;

hip pain:GB30;

knee (stifle) pain:BL40; GB34; L 16 (HsiYen);

tarsal (hock) pain:BL60 penetrating to KI03;

gastritis:CV12 (CV12 is also the Mu point-for ST);

intestinal disease:ST25, CV04 (these are both local and Mu points for the large and small intestine respectively);

bronchitis:BL13; CV17;

tracheitis:CV22,23.

Other examples of local points are in Table 1 (at the end of the paper).