The bilateral meridians run in a loop. Start anywhere on one meridian and follow it along, into the next one and the next and so on, and eventually you arrive back where you started.
The Conception and Governing channels also form a loop running down the front and up the back. However, there is another tradition which says that they both start beside the anus and finish together inside the mouth. Here, the Conception channel runs up the front, Yin, side, the Governor channel runs up the back, Yang side.
Acupuncturists will argue about anything but both views have validity.
All the other meridians form a loop that relates to an important idea in traditional Chinese acupuncture theory: the idea of energy, or ‘qi’, the Chinese term. (‘Qi’ is pronounced ‘TCHEE!’)
This ‘qi’ is said to flow through the channels, from one acupuncture point location to the next via channels between them.
In relation to the meridian system, the theory is that qi completes the meridian circuit in 24 hours. Knowing the time of day, acupuncturists can tell which meridians are affected by the position of the qi and, furthermore how this may relate to your symptoms.
This then enables acupuncturists to design treatment plans that incorporate the qi circuit. This can be a very effective method of treatment.
It goes further because the acupuncture point locations of the points then become very important when those points have a specific effect on the meridians concerned, because of the timing.
Understanding the relevance of the meridian circuit also explains why acupuncture produces changes over a period of time. For instance, why you could feel the main improvement beginning 24 hours after the actual treatment.
Alternative acupuncture point locations
The accepted acupuncture point location of a number of points has an alternative location used by some acupuncturists instead.
For example, take Hegu, Large Intestine 4. The usual location is in the centre of the web formed between thumb and forefinger. Press your thumb against your forefinger so that the web between them is pushed up into a bulge.
At the highest point of the bulge so formed is usually where Hegu is found. It is quite a powerful point! When an acupuncture needle is inserted here you might feel quite a strong gripping or cramping sensation.
In many people it is slightly painful if you pinch it with the thumb and forefinger of the other hand. (By the way, such pain implies an underlying imbalance in your health, you’ll be interested to know!)
However, because it is so powerful another point nearby is sometimes used. This is in the angle between the base of the first and second metacarpal bones. This point is between 1 and 2 cms proximal to the main Hegu point.
In sensation this point is less powerful, but in action it seems not so different though perhaps less dramatic. In fact this point is preferred by those who practise Japanese acupuncture.
As another example, an alternative acupuncture point location exists for Taixi, Kidney 3. This alternative location is one cun (see below for an explanation of the word ‘cun’) proximal to the usual acupuncture point location for it.
Precise Acupuncture Point Location: ‘Cun’
When texts describe an acupuncture point location, they normally do so by dividing the distance between two recognisable places on the body into a certain number of divisions or ‘cun’. For example, from the wrist crease to the elbow crease is 12 cun.
Wenliu, Large Intestine 7, is 5 cun or 5/12s of the distance from the wrist to the elbow crease on the line connecting Yangxi Large Intestine 5 and Quchi Large Intestine 11.
But no experienced acupuncturist would measure the exact distance and then insert the needle precisely there. She would always feel for the point with her fingers because everyone’s body is different and the text just explains where to look for the point.
In the same way, if you explain to somebody how to find a shop in a row of shops, you’d tell them the name and give its street number or approximate position.
For example you might be told that a shop was “Half way along the street on the North side”.
With this you wouldn’t automatically go into the shop precisely half-way along – you’d walk along and when you got about half-way you’d recognise the shop by its name or description.
Just the same with acupuncturists: you know where the acupuncture point location is supposed to be, and starting from there you look for, or feel for, the exact place.
Even so you might miss the point. Sometimes the actual acupuncture point location can be a millimetre from where you actually insert the needle. You might not get it fully until you re-insert at the right place.
So what is the acupuncturist feeling for? People vary, and so do acupuncturists who describe it in different ways.
Sensation at the precise acupuncture point location
Running her fingers along the meridian, knowing pretty well where to expect it, she encounters a change in how she feels the skin. Somehow it feels different to the skin around.
Either her finger feels as if it is in a small depression in the surface of the skin (and sometimes there really is a small depression there, at the intersection formed between two muscles, for example).
Or the skin at the acupuncture point location feels resistant, sticky, a bit drier than its surrounding. It may feel slightly tingly or attractive, like a magnet.
Usually, recognising this sensation comes with practice and may be less effective if the acupuncturist is tired, cold, indisposed or ill.
Using an infrared camera also exposes the points, but acupuncturists don’t usually have these.
Equally, the electrical resistance at acupuncture point locations is different from the surrounding skin. Some acupuncturists use probes which emit a higher pitched squeak when at the point.
However, using electric probes does distance the acupuncturist from her patient, and therapists overlook the benefits of hands-on touch at their peril. It moves us away from real interaction with our patients towards using intermediate devices instead.
Touch gives enormous advantages if we can recognize what it means and how to use it.
Much modern medicine is so clinical that for some patients human touch and response is a revelation. For many practitioners the use of more senses makes it more enjoyable. So we advise – use your hands!
If an acupuncturist does regular qi gathering work on himself such as Tai Qi, Qigong, yoga or meditation practice, he may also be able to sense the exact acupuncture point location. He does this by holding the tip of the needle just above the surface of the skin until he feels the ‘connection’ between the qi gathering in his hand and the qi gathering beneath the tip of the needle at the acupoint.
Acupuncturists who use this method sometimes describe it like a magnet being pulled: like potential energy awaiting release.
This is rather like what happens during a lightning strike when energy above meets energy below. Fortunately, acupuncture point location is usually rather less dramatic.
There are other forms of feedback. The patient can usually feel the ‘qi at work’, either at the site of the needle or along the meridian in question, or in a change in her symptoms. (For example, the nose clears, or the headache goes, or the patient feels less depressed.)
What do I mean by the qi at work?
What sensations does the acupuncturist expect her patient to have? People vary, and so do their descriptions, depending on their educational and emotional resources. So where one patient might say he feels a ‘rushing’ another might describe it as a ripple effect, or ‘something going down my leg …’.
Not all acupuncture points have clear sensations expected of them.
Sensations when deqi is obtained have been reported like this:
“Aching, soreness and pressure were most common, followed by tingling, numbness, dull pain, heaviness, warmth, fullness and coolness.” (Characterizations of the “deqi” response in acupuncture. BMC Complement Altern Med. 2007 Oct 31)
What’s going on here, from a scientific perspective?
It is suggested that there is “involvement of a wide spectrum of myelinated and unmyelinated nerve fibers, particularly the slower conducting fibers in the tendinomuscular layers.”(Op cit.)
What happens if you do the same procedure on an acupuncture meridian but away from one of its accepted acupoints?
Theory says that the qi can be contacted anywhere along a meridian, but that the accepted acupoints are where it is most susceptible to interaction.
Finding the point in practice
In practice acupuncturists tend to treat only at the recognised acu-point locations but there’s nothing to stop them inserting needles at other places along the channels, except that the energetic actions of these intermediate points would not be known. But such points, lying between ‘accepted’ points, are often very powerful and act as if they are ‘proper’ points.
Being a little conservative most acupuncturists prefer the identified acu-point locations because we are aware of what they do.
However, acupuncturists often use acupressure along meridians, when they massage or tap or stroke the meridians along their length, often some distance from recognised acupuncture points. So, in effect, they are treating the channel itself, including its many ‘extra’ points.
Of course there are many other points on the body than are found in the 359 points mentioned. Some of these are related to existing meridians through experience and observation, yet haven’t been incorporated; others stand quite clearly in their own right.
Locating them is done as with the meridian points: follow the description of position then feel for the actual acupuncture point location position with your fingertips.
Another benefit of increasing sensitivity in one’s fingertips is that you’ll learn to recognise sore points, previously unmentioned by the patient. This increases trust between patient and practitioner and gives a much deeper awareness of the patient’s condition.
Ah shi points
In addition, many patients have what are called ‘ah shi’ points which become acupuncture points for a while during illness and can be treated as such.
How do you know it’s an acupuncture ‘ah shi’ point?
Answer, by pressing it!
If it’s sore, it’s an ‘ahshi’ point!
Once treated, or after the patient recovers, the point is no longer painful and ceases to be an ‘ahshi’ point.
Also important are points discovered that affect either pain somewhere else in the body, or the functioning of your metabolism.
This can be clever stuff. It takes a bit of training and know-how, but very often, a good acupuncturist can alleviate pain – wherever it may be – by understanding channel theory. By giving it some thought then looking for and treating a point that is very remote from where the pain is.
For instance, a few days before writing this, a patient came in with what had been diagnosed as a herniated disc, giving strong stabbing pains and a sense of pressure down the legs in different places.
She also had an enormous sense of heaviness and constriction in her lower abdomen.
I was able to alleviate the pains and pressure, heaviness and constriction with five needles, variously in wrist, leg, ankle and hand. None of the points used were ‘regular’ acupuncture points.
However, I knew the approximate places to look for them. But the actual place for each of them had to be compared with other points nearby, to find which was best. So I reached each of the points with the use of theory, thought, then testing. So it wasn’t magic, just applied knowledge.
Pain from Stress or Emotional tensions
Not all pain comes from ‘normal’ body pathology. Very often, stress, or what is often diagnosed as Qi Stagnation, is the cause. In fact, if there is Qi Stagnation, the pain will be worse and harder to bear. So this must definitely be treated too. For more, click on Qi Stagnation.
Needle feedback – DeQi, or De Qi
The other way an acupuncturist knows he has reached the right place after inserting the needle (assuming he is in the right place of course), is through feedback via the needle. When a needle is inserted into a non-point, ie a place that is not an acupuncture point, it just feels like fishing in empty water.
But when the needle touches the ‘qi’ in the meridian, the fish bites: the needle is gripped – it becomes slightly harder or stickier to turn. Very often, the musculature in the region also tenses slightly. The effect is that the needle is heavier, more sluggish to move and it feels more ‘alive’. The description of this is ‘de qi’ or ‘holding qi’. This is explained as the needle being gripped by the patient’s qi at that point.
Like a key …
It’s also like when you have a ring of keys.
Only one fits the lock, and you know immediately because it goes in smoothly, is gripped just right and turns, opening the door. All the others are too small or too large.
‘De qi’ is usually a good sign for acupuncture point location. You know you’ve reached the right place!
Your knowledge of the theory of acupuncture then helps you decide what to do with the needle, because just having the needle ‘gripped’ is only the beginning of your work.
Just as a traffic policeman attracts the attention of a driver, the driver looks to the policeman to tell him what to do. (Stop, go, turn left, turn right, wait there for us to discuss your driving behaviour, follow me to jail!…)
The acupuncturist with deqi can then manipulate the energy in the meridian and, importantly, through that the qi of the patient.
However, not all acupuncture traditions require that deqi be obtained. It is, however, very useful feedback.
Japanese and other acupuncture traditions
This site is mainly on Chinese medicine and acupuncture, but other systems of acupuncture also work with different perspectives. I find them hugely important and shall perhaps write about them later.