CHAPTER 3

:
COMMONLY USED MERIDIAN POINTS
This is Chapter 3 from R. C. Schafer, DC, PhD,
FICC's best-selling book:
“Applied Physiotherapy in Chiropractic”
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The Theoretical Basis of Meridian Therapy

Theoretical Concepts
The Nonneural Theories
The Neural Theories
The Cutaneovisceral Reflex
The Viscerocutaneous Reflex
Segmental and Intersegmental Effects
Near and Distant Effects
The Gate Control Theory and Its Clinical Significance
Scientific Evidence
Empirical Evidence

Meridian Trigger points and Their Palpation

Standard Methods of Stimulation
Site Location
Locating Points
Background
Preparation
Types and Characteristics of Acupuncture Points
Electrical Analysis

The Human Inch

Major Points: Locations, Primary Indications, and
Precautions
The
The
The
The
The
The
The
The
The
The
The
The

Lung Meridian
Large Intestine Meridian
Stomach Meridian
Spleen Meridian
Heart Meridian
Small Intestine Meridian
Urinary Bladder Meridian
Kidney Meridian
Heart Constrictor Meridian
Triple Heater Meridian
Gallbladder Meridian
Liver Meridian

The Conception Vessel Meridian
The Governing Vessel Meridian
Alarm Points
Master Points
Association Points
Closing Remarks

References

Chapter 3: Commonly Used Meridian Points
This chapter delineates a few of the many theories attempting to explain the
mechanisms of acupuncture point (acupoint) stimulation and meridian therapy.
Stimulation of specific points on the body as a mechanism for pain control has
achieved great interest in this country in recent years. The majority of studies
center on stimulating endorphin production in the body. See Table 3.1.
Antidotal and clinical evidence as well as patient records from Oriental cultures
point to numerous cases where specific point stimulation has affected visceral
and functional disease processes. In the context of physiologic therapeutics, the
location, primary indications, and precautions associated with the major points
(ie, those most commonly used) are reviewed.

Table 3.1.

Isolated Peptides of the Endorphin Superfamily

I. Peptides of the proopiamelanocortin series
A. Opioid peptides
–endorphin
–endorphin
–endorphin
B. Nonopioids
 MSH
 MSH
 MSH3
II. Enkephalins
Met5–enkephalin
Leu5–enkephalin
Met5-Arg6-Phe7–enkephalin

III. C–terminally extended
enkephalins
Dynorphin
–neoendorphin
–neoendorphin
IV. Others
Kyotorphin
Dermophin
Casei-morphin

After Fields [47]
------------------------------Both Western and Eastern cultures developed systems for treating specific
points on the body. It is hoped that future generations will be able to integrate
the best of traditional Western and Oriental medicine into a single health-care
delivery system for all people. [1]

The Theoretical Basis of Meridian Therapy
Forms of stimulation to specific sites on the skin have been used for at least
3000 years. However, it is only in the last 25 years that comprehensive studies
of acupuncture as an alternative therapy have been seriously undertaken in
this country. The fact that meridian therapy has a beneficial effect on the
control of disease processes seems evident today on the basis of empiric
evidence and clinical studies.

Theoretical Concepts
Although it generally matters little to patients as to why they get well under a
certain therapy, they do, however, expect that the doctor rendering that therapy

Kellner has shown that some of this theory is based on artifacts occurring in preparation of the histologic slides. verification for some of the effects of meridian therapy does exist on the basis of these concepts. That is. however impressive as it might be. completing a cycle each 24 hours. and other attempts at duplicating the work of Han reveal that he was probably describing the lymphatic channels of the body. 4] Han’s theory. has for all practical purposes been refuted by other investigators. Han also thinks that a "unique" fluid circulates through these channels. quantum mechanics. discharging of electrical potentials. [3. Han believes that this fluid travels slowly through the meridians. [5. is a histologic description of elongated tubular cells lying deep in the skin. magnetic fields. contraction waves of skeletal muscles. Also. and the release of histamine and epinephrine by stimulation of points have all been . the patient has a natural tendency to believe that their doctor selects a particular procedure of treatment for their condition on the basis of his or her knowledge of the nature of their problem. Although scientific verification of the concept of "vital energy" as a physiologic probability and the "meridian" system as an anatomical fact have yet to be conclusive." This theory.has an acceptable explanation and understanding of the biologic mechanisms that are probably involved. Kim Bong Han. In the case of meridian therapy. [2] The Nonneural Theories One of the most commonly mentioned nonneural concepts attempts to explain the meridian system by proposing an elaborate conducting system of what is referred to as "Bong Han Ducts and Corpuscles. and the knowledge of the underlying principles behind a particular method of therapy. since the study and effective application of meridian therapy require some basic knowledge of its theoretical scientific basis. [7] For example. These concepts attempt to explain the scientific basis for the biologic effects of meridian therapy in terms of our present understanding of human anatomy and physiology. put forth by a North Korean physiologist and acupuncturist. which contains a high concentration of ribonucleic and other amino acids. 6] Various other theories have attempted to explain acupuncture and the existence of the meridians. a number of theories have been advanced that generally fall under the headings of "Neural" or "Nonneural" concepts. the need for this explanation is established.

Such a rapid speed of conduction excludes the blood and lymphatic systems as possible mediators of this response. There are many questions. [14–16] In Germany. [9] When an acupuncture point is stimulated. it has been observed that the patient will often experience a change in seconds and this change frequently occurs at the opposite end and contralateral side of the body from the point stimulated. [8] His studies involved the use of radioisotopes. [10–13] Proof for the existence of such a reflex has strong scientific support. after a delay of several months. In a series of experiments. The Neural Theories It is generally conceded that the mechanisms of many effects of acupuncture are similar to but not identical to those of the nervous system. These theories. as nerve fibers transmit impulses at an extremely rapid rate through their pathways. THE CUTANEOVISCERAL REFLEX Acupuncture is founded on the premise that stimulation of the skin has an effect on distant internal organs and functional mechanisms of the body. Wernoe stimulated a small segment of the skin of fish and amphibians with silver nitrate and. demonstrated . Kuntz and Hazelwood stimulated the skin on the back of rabbits and rats and noted changes in various parts of the gastrointestinal tract that were related to the dermatomal segment stimulated. although certain aspects appear to be based on established neurophysiologic concepts. that remain unanswered.put forth as possible mechanisms. along with others. This indicates that some type of nerve conduction occurs. One of the most recent theories has been postulated by Koyo Takase in Japan who concluded that the so-called Qi energy circulating through a "meridian" in acupuncture therapy is actually extravascular sodium. have now been dismissed in favor of one of the neurologic explanations. At one time. Various experimental data tend to support the involvement of a cutaneovisceral reflex. Others have likened the pinprick in the body to the electrical discharge of a condenser. Felix Mann proposed a theory based on the lateral line system in fish. however. The exact mechanism of this action is not yet fully understood.

However. hyperesthesia. [18] Thus. One method is by postulating the viscerocutaneous reflex. For example. by its mediation. it has been established for years that the ear is a hologram of the body as a whole. an acupuncture needle placed in the correct part of the skin is able to influence the related organ or diseased part of the body. [24] The Head-McKenzie Sensory Zone. or hypesthesia. It is often noted clinically that a disease in an internal organ will produce pain. he deduced that vasodilation was mediated by a spinal reflex and that vasoconstriction was mediated by a postganglionic sympathetic reflex. The importance of such a reflex rests in two primary areas: (1) diagnosis and (2) lowering the threshold of stimulation required in treatment with acupuncture. and of the right shoulder in gallbladder disease. It is strongly believed that. [21–23] Diagnostically. certain superficial areas have long been known to relate to an underlying visceral condition such as pain at McBurney’s point in appendicitis. [17] After these experiments. in the left arm in angina pectoris. shows how visceral pain can radiate to certain parts of the skin. as described by Judovich and Bates.vasoconstriction of the part of the intestine dermatomally related. in some area of skin. an explanation of how a visceral problem can relate to areas of the skin should be given. Travell and Rinzler found that complete and prolonged relief resulted when trigger points on the front of the chests of patients with angina pectoris or acute myocardial infarction were infiltrated with procaine or cooled with ethyl chloride. Dale has recently proposed an elaborate hypothesis that most any part of the body is a hologram of the body as a whole. [19] THE VISCEROCUTANEOUS REFLEX Next. etc. tenderness. A familiar . acupuncture points. and/or subluxations. [20] Various researchers have attempted to show that visceral problems may refer to the skin and give rise to trigger points. and this is the basis of auriculotherapy. The viscerocutaneous reflex is thought to be mediated by unknown pathways of the sympathetic chain. the cutaneovisceral reflex is of prime importance in acupuncture. New hypotheses are being brought forth rapidly.

however. NEAR AND DISTANT EFFECTS One of the most perplexing problems is that some of the effects of acupuncture cannot be explained neurologically by either segmental or intersegmental mechanisms. [25. The Chinese for many years have attempted an explanation in the philosophical terms of Taoism with reference to Yin/Yang (law of opposites) and to the circulation of biologic energy (life force. the effects of stimulating the acupuncture points of the head cannot be readily explained. For instance. are intersegmental. For example. SEGMENTAL AND INTERSEGMENTAL EFFECTS Most of the reflexes used to explain the effects of acupuncture are segmental and follow specified dermatomal patterns. stimulation of acupuncture points of the foot has been shown to affect organs over 10 dermatomes away. 32] A possible explanation of this phenomenon is via the long reflex of Sherrington. 26] In this context. [27] It can therefore be readily appreciated that a visceral problem can exhibit in a specific dermatomal segment via a viscerocutaneous reflex and that the stimulation of the skin can have a distinct effect on a related visceral area via a cutaneovisceral reflex. often referred to as Sherrington’s short reflexes. [33. The scientific proof for these reflexes is important. 34] In contrast. but it does not fully or even adequately explain exactly what happens according to the empiric results obtained. [31. some research has shown that a distinct reflex may probably exist between the nose and the heart or between the turbinates and the sexual organs. [35.example is cardiac ischemia with radiating pain to the left arm. He also stimulated areas of the gastrointestinal tract of the eel and cod and noted that in each case the skin became lighter over an area of several dermatomal segments. Qi [pronounced chi]). . [28–30] Others. However. The scratch reflex of a dog is a good example of an intersegmental cutaneomotor reflex. those reflexes that fit into the dermatomes are segmental reflexes. Wernoe stimulated the rectum of a decapitated plaice electrically and found that the skin became pale. 36] Some scientific explanation for this is therefore likely.

This theory has many practical applications in clinical practice. let us suppose that the "gates" are open and the patient is in severe pain. and it would be well to summarize it here. the "gate" is closed). It is then said that the pain gate has been opened by the increased stimulation from the small fibers of the deep somatic and visceral tissues. the body would be in a constant state of pain. It is believed that the dermal stimulus depolarizes the cells here. Small diameter. If.THE GATE CONTROL THEORY AND ITS CLINICAL SIGNIFICANCE The next consideration is the more recent Gate Theory. the small fiber system is excessively stimulated by some disease process. [37–39] The gate theory holds that the large myelinated nerve fibers of the skin have an inhibitory effect. these fast-conducting fibers may also arouse inhibitory responses in the brainstem that produce a downward projection of impulses to various levels of the spinal cord that further inhibit the transmission of pain signals that would normally progress to the brain. [40] The large. has been amended to some extent. rapid-conducting. The stimuli from the dermis specifically produce inhibition in the cells of the substantia gelatinosa of Rolando. Thus. In addition. it is basically the same as originally proposed. alpha and beta fibers of the skin conduct impulses via the dorsal columns to the brainstem and from there to the cerebral cortex. which is found in the dorsal horn of the spinal cord. slow-conducting C fibers convey protopathic or pathologic and traumatic pain signals of the small fibers that arise from the deeper tissues of the body. TENS) can often completely . however. when stimulated. If this were not so. Although this theory. according to Melzack and Wall. relief from pain) can be realized. originally set forth by Melzack and Wall. For example. [41] It is by way of this system of inhibitory projections that the full value (ie. What can be done to relieve this suffering? Studies have shown that the inhibitory effects are enhanced when the large diameter fibers of the skin are sufficiently stimulated and the pain gate in the dorsal horn may be closed. which renders them incapable of receiving and transmitting pain signals. the small fiber system then gains dominance and the patient perceives pain. painful stimuli are blocked (ie. on the small pain-evoking fibers that enter the same segment of the cord. Surgical research on patients with intractable pain has shown that the implantation of a dorsal column stimulator (ie. as described in Chapter 2.

[44] Recent studies. however. then. several without a credible basis. ECG readings on heart patients showed improvement after acupuncture treatments. viz. or by means of other modalities most likely work by such a mechanism. by blocking pain signals in or to the brain by projecting inhibitory impulses to the thalamus and/or cerebral cortex and ultimately to the cord. "The ‘body channels’ in their peripheral link are connected with somatic and vegetative conductors running both independently in the form of nerve trunks.block the transmission of painful or protopathic impulses. and finally. [45] In Russia. Macheret and his associates have shown the existence of complex functional relationships between various parts of the human body and the internal organs. local tissue changes may be postulated on the basis of localized vascular changes. 43] SCIENTIFIC EVIDENCE Meridian therapy with needles. Obviously. By extension of this theory. [42. However. electrical stimulation. Therefore. current scientific proof for acupuncture explains in part much of what happens when acupoints are stimulated. have been advocated." According to these researchers. by blocking noxious stimuli through the pathophysiologic reflex and thus producing muscular relaxation. the channels in their central link constitute the conductive pathways of the spinal . In France. The Russians also noted a difference in the skin temperature over acupuncture points. ie. it does not adequately explain any possible localized tissue changes that are known to occur. improvement in the local microcirculation. Much research still needs to be performed. Their findings appear to support the existence of "channels" that are identical to those that the Orientals callmeridians. It appears to be that there are demonstrable entities called acupuncture points. Although the Melzack-Wall theory explains how pain pathways can be blocked. a sensitive stethoscope supposedly noted different sounds over acupoints. it should be noted that acupuncture is veiled in empiric evidence. but scientific verification for chartable meridians connecting these points is still wanting at this writing. and like plexuses that get around the vessels and the muscles and reach the ‘root’ spinal cells and truncus sympathicus nodes from which the corresponding segmental associations pass to the internal organs. according to a 1985 paper from Russia referring to research being conducted at the Department of Neurology of the Kiev Institute for Physicians. moxa.

[53] Meridian Trigger points and Their Palpation . results by itself. behavior modification. primary infertility. episcleritis. he recommends combining it with neural therapy (electrical). induction of labor.3% responded completely to electroacupuncture and 90. the only correct procedure to achieve a therapeutic breakthrough. anxiety and depression. [52] While acupuncture per se has not been as effective in treating disorders of a purely psychic nature." [51] Shafshak compared the effectiveness of electroacupuncture to that of standard physiotherapy in the treatment of tension myositis: 93. Odell reports that when it is used in conjunction with hypnosis and visualization techniques. relief of the symptoms of drug withdrawal. and canker sores (aphthous stomatitis) that responded to acupuncture after failing to respond under Western medical treatment. Fields has shown that acupuncture. is an effective modality in the treatment of pain. He states that "Combining acupuncture with manipulative therapy for a blockage is not only feasible. manipulative therapy (chiropractic). [48] Tseung and Vazharov describe case after case of musculoskeletal disorders. but also in some cases. through the stimulation of endorphins. 50] Kitzinger. and other standard physiotherapeutic modalities when vertebrogenic disorders are treated. it has shown to be a consistent and invaluable tool in a behavioral reprogramming technique. it has been in relieving physiologic disturbances. a medical doctor.9% recovered completely in response to physiotherapy. even spectacular. [47] After treating just one point for acute dysmenorrhea in 10 patients. believes that even if acupuncture may achieve good. [46] EMPIRIC EVIDENCE The volume of recently acquired empiric evidence cannot be denied. Slagoski found complete effectiveness in the resolution of the pain syndrome. chronic asthmatic bronchitis. growth problems. To mention just a few for example. [49.cord and the brain. and stimulating the autoimmune system. impotence.

should be as high as the patient can comfortably tolerate. 4. Stimulating the most painful trigger point contralateral to the patient's pain (eg.Standard Methods of Stimulation Acupuncture points are commonly stimulated by several methods: 1. Using finger or thumb pressure. Using electrical stimulation with any modality designed for this purpose. Using a helium neon or infrared laser (controversial). and microcurrent stimulators. 6. sparks from a hand-held device. The intensity of current. elbow) while the patient moves the involved part has been found effective in rapidly alleviating musculoskeletal pain. A small diameter electrode must be used. when acupuncture sites are stimulated by means of low-volt electric current. Using 30-. 3. The correct frequency must be selected. Other methods of stimulation include use of moxa (a herb that is burned near or on the skin). it is generally believed that a frequency of approximately 5 pulses per second (pps) is ideal for maximal endorphin release. to name a few. 1/2 to 1-1/2-inch stainless steel needles that are carefully inserted at specific preselected sites for durations ranging from a few seconds to 20 minutes or more. several factors should be kept in mind: 1. In summary. The exact site of the point or of its contralateral partner must be stimulated. or 34-gauge. 3. 4. The correct duration must be determined. . 2. 2. Using a specially designed blunt instrument (teishin). Using tiny beads sometimes called acupatches or acu-aids. 32-. When low-volt electric modalities are used in stimulating acupoints. using a small diameter electrode. 5.

one technique involves systemic palpation (ie. a specific definition of a meridian point should be attempted. BACKGROUND . physical or mental. recent evidence suggests that acupuncture works by means of an extravascular transport mechanism. It is our opinion that an acupuncture point is. Although most pertinent sites are usually tender. Site Location Acupuncture points are usually tender to the touch and located in palpable depressions under the skin. These points will be described later in this chapter. in many instances. we find descriptions of over a thousand of these points. But first. identical to the trigger point described by Travell or the concepts described by Matsumoto and Hiyodo in their writings. This means that the points will be located at a certain depth below the skin surface. Locating Points Of prime importance in meridian/trigger point therapy are the proper palpation and localization of the acupoint. The more common 365 points are located on certain fixed lines or pathways called meridians. there are many situations where a lack of normal tenderness at a site may also be diagnostic. As previously described. of alarm points) of the body at predetermined sites.It should be noted that many of these factors are also important when other methods are used. tender areas are present at certain points on the surface of the body — points that disappear when the illness is cured. He calls these sites acupuncture points. In Chinese literature. Some research studies indicate that stimulation primarily affects the nervi vasorum (autonomic fibers congruent with the blood vessels). In locating important acupoints for treatment and meridian dysfunction. Felix Mann states that in all diseases. and this further lends credence to inserting the needle to a specific depth.

and then transfer the patient to a comfortable cushioned table for examination in the prone and supine positions. a patient with appendicitis will point to McBurney’s point as being exquisitely painful. the patient must first be positioned in a comfortable position. TYPES AND CHARACTERISTICS OF ACUPUNCTURE POINTS . is of utmost importance. they will find it increasingly easier to locate critical sites. sacral. Prior to searching for acupuncture points. Many of the points above the ankles and in the hand and wrist belong to this category. The patient should be disrobed in such a fashion that the points are readily accessible to palpation. For instance. A third type of acupoint is not tender even when moderate pressure is applied. PREPARATION In searching for the acupuncture point. Individuals with headaches often relate a spontaneously tender area on the nuchal line of the occiput.The palpating hands of the examiner contain sensitive nerve endings that are quite perceptive to changes in tissue tone. Many acupuncture points are of this type. As examiners gain experience in point location. Most examiners find it convenient to begin the examination with the patient seated on a low stool. The waist band of the patient should be loosened for comfort and to afford free access to points of the lumbar. Care must be taken in all cases to preserve the modesty of the patient. The fingertips are particularly well supplied with touch and pressure receptors. For these reasons. as always. it is generally best to have the patient undress and then robed in a gown that ties in the back. The examiner’s hands should be thoroughly washed before and after each examination. Personal hygiene. surface humidity. areas will be painful only when pressure is applied. and lower abdominal areas. both the fingertips and the back of the hand should be used during the evaluation procedure. temperature. In other cases. etc. texture. the doctor should remove any jewelry that might scratch or irritate a patient. Acupoints will often be found that are spontaneously tender. As during the routine physical examination. while the dorsal surface of the hand is especially endowed with heat receptors.

These instruments measure skin resistance to an electric current. This area feels like a small node or mass of tissue several millimeters in diameter. ELECTRIC ANALYSIS The examiner might be unable to locate acupuncture points by palpation. In other cases. showing areas where the resistance is altered. In Japan. It is similar to the fibrositic rheumatoid nodules often located at the back of the neck. In these cases. a hard (indurated) area will be found. involved in a complaint). Once a point is localized. Most commonly. It will be tender to pressure and often spontaneously painful. are more conductive than . It is presently thought that sites that are reactive (ie. 3. in the shoulders. [54] which. This system is calledRyodoraku. whether manually or with an electric device.Several types of acupuncture points or lesions might be discovered: 1. or in the lumbar area. the acupuncture point might be characterized as a localized swollen and discolored area or an atrophied area of tissue. Atrophic areas. when translated. means good electroconduction system. 2. Instead of a nodule. Fibrositic nodules. Nakatani mapped out areas of altered skin resistance into pathways that correlate with meridians. especially when we are dealing with a musculoskeletal complaint. the palpator might feel a localized area of tense muscle fibers in a muscle. The fact that an acupuncture point exhibits altered electrical resistance allows an examiner to determine specific sites by using any instrument that measures (objectively with an ohmmeter or subjectively by the intensity of the sound made by an instrument) skin resistance at an isolated point. In many instances. He treats the most altered points. the fibrositic nodule will be the point located. it should be carefully marked with a skin pencil or felt-tipped pen and then charted in the patient’s records so that a comparison can be made from one visit to another. it may be of value to make use of one of the many electric devices available for their detection. Indurated areas.

charted acupuncture points can be located by using a topographic system of anatomical measurement. This sensation is called the deqi (also spelled tae chi). a forearm or leg) is approximately the same whether the patient is young or old. In 1984. American physicians usually call them as trigger points. will be a sensation of tingling or numbness radiating or referred distally from the site stimulated. The unit of measure is called the human inch. Either hand can be used unless one thumb has been deformed by trauma or disease. These points are usually more tender and conduct current more readily (less resistance to an electric current). M. [55] A lack of hyperemia or deqi appears to correlate with poor results. and the system of measurement uses the patient’s own anatomical proportions to establish the parameters to be used in (1) locating points and (2) determining the depth of needle insertion. [56] The Human Inch Besides palpation and measuring electrical resistance. . Also noted.surrounding tissue. surgical. If the correct site is chosen for stimulation. [55] The only exception to this is where obvious growth. the most common reaction will be hyperemia (histamine reaction) around the point stimulated. tsun. Sin showed that acupuncture stimulation not only gave good symptomatic relief in inflammatory disease but also suppressed the underlying progress of the disease. or cun. various portions of the patient’s body may be measured lengthwise or transversely and that measurement may be divided into a certain number of human inches. thus indicating that the proper site was not treated. These points give a higher reading on an ohmmeter and produce a louder sound. tall or short. It can also be determined by measuring the width of the patient’s thumb. Because a human inch is a proportional measurement for a specific individual. or pathologic asymmetries are present (eg. or lean or obese. studies conducted by Y. Once the human inch is known. The human inch for a particular patient can be determined by measuring the distance between the patient’s two joint creases of the volar surface of the middle phalanx of the middle finger when it is flexed. especially when needles are used. the number of cuns on a body part (eg. Chinese physicians refer to these sites asah shi (ouch) points.

however. developed a schematic model of the general effects of acupuncture. Major Points: Locations. PhD. and Precautions As the result of millions of observations of patient responses over several centuries. it is thought that any localized point in an area of musculoskeletal pain can be stimulated to inhibit pain in that location. In 1984. Primary Indications. we will attempt to describe the most common sites of . [57] In the following sections. Peter Eckman. MD.disproportionate limb-trunk dwarfism). As a general rule. Oriental physicians have charted over 300 major points on the body and have attributed certain related functions to these locations.

that little or no scientific verification has been done in the West to substantiate these projected effects. We must state unequivocally. Points on the Lung Meridian . however. the reader is cautioned to use every possible diagnostic tool available necessary to evaluate the patient’s complaints and to use this chapter as a reference to those sites used by Oriental physicians. Thus.stimulation and the indications for treatment as cited by various authorities. The complete validity of the effects described must await further research substantiation.

LU-1 Location. approximately 6 cun lateral to the anterior midline of the chest. The site of this point (Zhongfu) is found on the anterior lateral aspect of the chest.The major points on the lung (LU) meridian are LU-1 and LU-7. palpate below the clavicle and seek a tender spot in the space between the first and second rib. . Using your finger.

Indications. especially those exhibiting painful adduction.5 cun from the transverse crease on the volar aspect of the wrist. LU-7 Location. This point (Lieque) may be found just lateral to the radial artery at a spot 1. thus it may be tender in any condition related to the lung meridian. This site is primarily used for chronic respiratory complaints because it is the major point influencing the lungs. proximal to the styloid process of the radius.Indications. LI-11. A slight depression marks the site of LU-7. this is one of the seven master points of the body. Its primary indication is in the reduction of localized edema of musculoskeletal origin. Points on the Large Intestine Meridian The major points on the large intestine (LI) meridian are LI-4. . This point is the alarm point for the lung meridian. Stimulation may also be made at this site for shoulder disorders. According to some authorities. and LI-20.

the point is half way between the proximal and distal aspects of the 2nd metacarpal.LI-4 Location. More specifically. this point is frequently located at the highest spot on the domed muscle bulge between the thumb and index finger. Stimulation of this site with electrodes attached to inserted needles is used to bring about anesthesia in the lower jaw or scalp prior to dental work or during certain surgical procedures. It has been studied most extensively and is stimulated more often than any other site of the body. When the thumb and index finger are brought together. just lateral to its radial side. pain in the upper extremity and anterior . This point (Hoku or Hegu) is another master point. Extensive research has established a connection between stimulation of this site and alleviation of pain in the upper extremity and anterior neck or head. Many authorities feel it is the most powerful acupoint of the upper body. When it is used in combination with the most tender trigger point (Ah shi). Indications. such as when making a fist.

"tennis elbow" syndrome) and is a special point used in the treatment of acute torticollis. The location of this point (Quchi) is located just distal to the lateral end of the transverse crease of the elbow joint when the arm is flexed on the forearm. This site is also contraindicated during pregnancy. except to promote labor or medical abortion. For example: LI-4 + LI-11 — dermatologic complaints LI-4 + ST-36 — gastrointestinal complaints LI-4 + SP-6 — gynecologic complaints. LI-11 Location. We have also found that prolonged stimulation at this site (eg. if the patient complains of weakness. Thus. LI-20 . Precautions: As this is a highly sensitive point. LI-4 may also influence other conditions. or nausea during therapy. it may lower blood pressure and affect the motor aspects of the nervous system.neck or head can be alleviated. it may be useful in the management of dermatologic and allergic nasorespiratory complaints. adverse reactions have been recorded with this site. the treatment should be discontinued. This point is treated for pains associated with lateral epicondylitis (eg. over 15 minutes with needles) will trigger evacuation of the bowels in a patient who is constipated and promote drainage of body fluids. This point is frequently tender. the most frequent of which is syncope. Some studies have also indicated that. When used in combination with other sites. when stimulated bilaterally. Indications. Used in conjunction with LI-4. faintness.

Points on the Stomach Meridian The major points on the stomach (ST) meridian are ST-2.Location. and ST-36. Indications. . Stimulation of this site promotes drainage of the nasal sinuses and may be effective in combination with other focal sites in the treatment of facial paralysis. ST-25. This point (Yingxiang) is found at the nasolabial groove on the side of the nasal ala. ST-7.

.

Stimulation of this point is effective for patient's experiencing painful TMJ dysfunction and may be effective for patients with facial nerve palsy. just in front of the condyloid process of the mandible. 2—3 cun lateral to the midsagittal line. Precautions: Great care must be taken to avoid bruising the sensitive tissues in this area. Indications. This point is the alarm point for the large intestine. Injury may readily lead to subcutaneous hemorrhage (ie. This point (Tianshu) is located at the level of the umbilicus. Palpation of this point should be made when the patient's mouth is closed. . This point (Sibai) is found just below the orbit of the eye at the site of the infraorbital foramen. Indications.ST-2 Location. It is often treated in conjunction with CV-4 and CV-12. at the border of the rectus abdominis muscle. ST-7 Location. This point (Xiaguan) is found in the depression of the inferior border of the zygomatic arch. Stimulation at this site promotes drainage of the maxillary sinuses and is another site that may be used in patients with facial paralysis. a "black eye"). ST-25 Location. Indications. It appears that therapy here is effective in treating many gastrointestinal disorders.

The depression is located about one finger’s width lateral to the anterior crest of the tibia.ST-36 Location. thus. It is thought to be the major body point for systemic tonification. Indications. it has been indicated by some to be effective in the treatment of anemia and to increase the white cell count in patients with infections. Stimulation of this point is often used in conjunction with LI-4 (thought to be the most powerful acupoint of the upper body) in the treatment of chronic gastrointestinal complaints. and many authorities feel it is the most powerful acupoint of the lower body. This point is found in a depression that is 3 cun below the plateau of the tibia. located between and slightly distal to the tibiofibular articulation. Several studies have related this point to the cellular elements of the blood. This point (Dusanli) is another of the seven master points of the body. Because of its location. Points on the Spleen Meridian . it is also used in the treatment of conditions localized in the lateral aspect of the knee joint.

SP-6 Location. It can be located by placing the lateral aspect of an ankle on the opposite flexed knee (as in the familiar male seated position) and placing the little finger of your hand (flexed knee side) on the medial malleolus of the .The major points on the spleen (SP) meridian are SP-6 and SP-9. This point (Sanyinjiao) is found on the medial aspect of the ankle on the lower calf.

This point is called the crossroads of the three Yin meridians of the leg because the spleen. Indications. it is often used in the treatment of patients with gynecologic disorders. It is also referred to as the master of the circulatory system as it affects various vascular conditions such as patients with cold extremities or those that bruise easily. This point is primarily stimulated in the treatment of patients with osteoarthritis of the knee or sprains of the medial collateral ligaments. just below the lower border of the medial condyle of the proximal tibia. proximal to the medial malleolus. Indications. Points on the Heart Meridian . This point (Yinlingquan) is located on the medial aspect of the knee joint. liver. and kidney meridians transverse at this site. Due to this fact. The point is located just posterior to the border of the tibia. SP-9 Location.exposed ankle so that the thumb points toward your flexed and rotated knee. As one of the seven master points. The point is located 3 cun up the medial aspect of the calf. the point has multiple indications. especially irregular or painful menstrual complaints and male sexual dysfunctions.

This point (Shaohai) is located when the patient's elbow is flexed. Palpation reveals an extremely tender point.There are two major points on the heart (HT) meridian: HT-3 and HT-7. Indications. golfer's elbow) or . This point is treated in medial epicondylitis (eg. HT-3 Location. It is between the medial end of the transverse antecubital crease and the medial epicondyle of the humerus.

and abnormal forgetfulness. hypertension.other disorders of the medial aspect of the elbow. Points on the Small Intestine Meridian The major points on the small intestine (SI) meridian are SI-3. Exact localization places this point in a depression located just to the radial side of the flexor carpi ulnaris tendon. This acupoint (Shenmen) is located on the ulnar surface of the anterior wrist. anxiety. . Indications. SI-9. Some authorities report success in treating this point in patients with angina-like symptoms. This specific point is stimulated in an attempt to relieve patients with symptoms of nervousness. just medial to the ulnar artery. depression. irritability. insomnia. and SI-19. just proximal to the pisiform bone. HT-7 Location.

SI-3 .

Indications. hearing loss. or tinnitus. Precautions: Care must be taken when using a needling procedure to avoid major nerve and vascular structures in this area. To locate the exact site of this point (jianzhen). The point is located at the end of the transverse crease just proximal to the head of the 5th metacarpophalangeal joint. make a tight fist and note the small triangular bulge on medial aspect of the supinated hand. To locate this point (Houxi). This point (Tinggong) can be found by placing an index finger just anterior to the tragus of the ear and palpating for the gap between the tragus and the temporomandibular joint when the patient opens the mouth. Indications. In this position. SI-9 Location. Indications. Points on the Urinary Bladder Meridian . This site is stimulated in various disorders of the ear such as earache. the point is located 1 cun above the top of the posterior axillary fold. SI-19 Location. This point is stimulated whenever a patient complains of pain when reaching or putting their arm behind their back (extension plus internal rotation) or when a patient exhibits signs of degenerative joint disease of the shoulder joint.Location. have the patient hold their relaxed arm at the side. This point is treated when patients have pain in the contralateral lower back region and in patients suffering with various types of arthritis.

and BL-60. BL-23—25.The major points on the bladder (BL) meridian are BL-10. . BL-51. BL-54. BL31. BL-57.

.

.

: BL-10 Location. and sometimes combined with stimulation of GB30 and/or other points. Indications. Its stimulation may also relieve patients with thoracic outlet syndromes. usually bilaterally. They appear to be related to specific viscera in a manner similar to that described in Meric Analysis where specific spinal segments are related to specific organs.A large portion of the bladder meridian is composed of points called as association or associated points. or torticollis. Qihaishu. This site is thought of as the atlas of acupuncture. respectively. and perhaps. This point (Tianzhu) is located two finger widths lateral to the midline below the occiput in the suboccipital musculature just lateral from the border of the trapezius muscle. and L4—L5. suboccipital headaches. L3—L4. These three points (Shenshu. are located along the medial most aspect of this meridian. BL-31 . BL-24. Stimulation of these points is made in patients with low-back pain. which will be described later in this chapter. and Dachangshu) are found two finger widths lateral to the midpoints of the spinous processes of L2—L3. The choice of specific stimulation in this area depends on the determined level of spinal involvement. and BL-25 Location. Stimulation here is believed to have profound effects on the autonomic nervous system. suboccipital myalgia and tenderness. These points. BL-23. Indications. in the intervertebral depressions between the thoracic transverse processes or lumbar mamillary processes.

Stimulation of this point is made in patients with arthritis of the knee or sciatic pain that radiates to the knee. halfway between the gluteal and popliteal creases. at the split of . at the longitudinal midpoint between the knee and the ankle joints. Indications. Precautions: If needling is conducted. This point (Chengshan) is found halfway down the back of the calf. BL-54 Location. This is an important point in the treatment of IVD syndromes. and other afflictions of the lower back. BL-51 Location. lumbar sprains and strains. Indications.Location. it is best to slightly flex the joint so that tension will be removed from the popliteal tissues. Some reports of experiments with male animals indicate that treatment of this point may elevate sperm quantity. This is an important point in the treatment of low-back pain. Indications. BL-57 Location. This point (Shangliao) is found in the depression of the first sacral foramen. especially when there is sciatic radiation to the thigh. Care must be taken not to pierce one of the many vascular structures in this area. in the center of the popliteal space. This posterior point (Weizhong) is located on the transverse crease of the posterior knee. This point (Yinmen) is found in the longitudinal midline of the posterior thigh.

the gastrocnemius muscle. Indications. BL-60 Location. Points on the Kidney Meridian . at a level of the midpoint of the lateral malleolus longitudinally and halfway between the Achilles tendon and the lateral malleolus transversely. Indications. and sciatic-like pains that radiate from the lower back to the ankle. This point (Kunlun) is found on the external side of the ankle. This site has been found to be of value in patients with generalized body pain. foot problems. Stimulation of this point is indicated in cases of sciatica that manifest pain radiating to the calf.

KI-1 .The major points of the kidney (KI) meridian are KI-1. KI-2. and KI-27.

This point (Rangu) is found just anterior and inferior to the medial malleolus of the ankle. This point is often referred to as the "reset button" by kinesiologists. Indications. It is also stimulated in patients with dry skin and complaints of impotence. KI-2 Location. Stimulation of this point is often made when patients show signs of excessively moist skin (ie. hyperhidrosis). Points on the Heart Constrictor Meridian . Manual stimulation of this site is thought to temporarily balance the meridians or to "reset" them before muscle testing or checking for overall energy balance in the meridians. Indications. this point is one of the best sites to stimulate when a patient has problems related to the feet. KI-27 Location. the point can be located in a depression at the anterior-inferior border of the navicular bone. just lateral to the manubrium of the sternum. Although one of the most tender acupuncture sites of the body. If an imaginary line is drawn from the midpoint of the foot (midpoint between the front and back). The site of this point (Shufu) is found in the depression between the 1st rib and the lower border of the clavicle.Location. Indications. between the 2nd and 3rd metatarsophalangeal joints. This point (Yongquan) is found on the plantar surface of the foot in a depression at the junction of the anterior and middle third of the sole.

directly in the midline. Indications. 2 cun from the largest transverse crease of the wrist. intercostal neuralgia. thoracic strain/sprain. rib pain.There is only one major point of the heart constrictor (HC) meridian. HC-6. . Some authorities have reported that stimulation of this site may stop singultus (hiccups). Stimulation of this point is indicated for patients presenting with thoracic pain (eg. It should be noted that this meridian is also referred to just as frequently by many authorities as the pericardium (P) or circulation/sex (CS or CX) meridian. although we have yet to have our first success using this point for hiccups. postherpetic neuralgia. HC-6 Location. and painful disorders of the lungs). This point (Neiguan) is found on the anterior surface of the forearm.

This point (Waiguan) is positioned on the dorsum of the wrist.Points on the Triple Heater Meridian The major points on the triple heater (TH) meridian are TH-5 and TH-17. It is located directly opposite to HC-6. . exactly in the center. TH-5 Location. at a point two cun proximal from the flexure crease of the wrist.

. TH-17 Location. Indications.Indications. Stimulation of this point is thought to equalize the autonomic nervous system. and GB-34. Precautions: If needling is performed. This point (Yifeng) is found posterior to the earlobe in the depression located between the mastoid bone and the angle of the mandible. insertion to a depth greater than 11/2 cun is absolutely forbidden. GB-21. tinnitus. This site is the major point of energy balance in the body. The indications for stimulating TH-17 are hearing loss. and earache. Points on the Gallbladder Meridian The major points on the gallbladder (GB) meridian are GB-20.

.

.

Precautions: Perpendicular needle insertions are discouraged. run your palpating finger from the tip of the acromion halfway up toward the spine. such depth is forbidden. influences the autonomic nervous system. thus. Insertion should be at an angle directed toward the midline. This is probably the best point there is to stimulate patients with muscle spasm in the upper half of the body.GB-20 Location. Precautions: When needling. Indications. in a depression (usually tender) that is located between the sternocleidomastoideus and the trapezius muscles. Do not exceed a depth of 1 cun. Indications. splitting the trapezius down the middle. This point (Fengchi) is found just inferior and medial to the mastoid process. GB-34 . This site. head forward. It is also an excellent point to stimulate in patients with suboccipital headaches. Deep insertion of a needle greater than 1-1/2 cun may trigger adverse effects. With the patient seated. hands folded in the lap. GB-21 Location. as the apex of the lung might be punctured. the line of insertion is directed toward the opposite eye. The site will be found as a tender depression at the halfway point. one of the seven master points. The site of this point (Jianjing) is located midway between the spine and the acromion of the shoulder.

This point appears to be the best site on the body to influence patients with muscle spasm.Location. . Points on the Liver Meridian The major point on the liver (LV) meridian is LV-3. This point (Yanglingquan) is found in a depression located anteroinferiorly to the head of the fibula. especially spasm in the lower half of the body. The point may also be stimulated in patients with pain on the lateral aspect of the thigh and/or leg. Indications.

This point is often stimulated in an attempt to detoxify the body and for the treatment of patients with neurologic complaints. Indications.LV-3 Location. approximately 2 cun from the margin of the web between the toes. . This point (Taichong) is found on the dorsum of the foot between the 1st and 2nd metatarsals. Some evidence indicates that it is one of the best points on the body for treating patients with migraine.

. navel. There are two major points on the conception vessel (CV). and pubis (the conception vessel or Ren meridian). and one on the posterior midline that cuts through the spinous processes (the governing vessel or Du meridian).Points on the Conception Vessel Meridian There are two unilateral meridians on the body: one on the anterior midline that bisects the chin. CV-4 and CV-8.

.

etc). 3 cun below the navel.CV-4 Location. . menstrual pain. Stimulation of this point is thought to affect patients with pelvic disorders (eg. gastroenteritis. GV-14. Treatment may also be given to this point to generally relax the patient. GV-20. Points on the Governing Vessel Meridian The major points on the governing vessel (GV) meridian are GV-3. GV-16. CV-8 Location. This point (Guanyuan) is located in the anterior midline. This point (Shenjue) is found in the center of the navel. and GV-26. Indications. This is a "forbidden" point that should never be needled. polyuria. Indications.

.

GV-20 Location. at the base of the occiput. This point is a good point to treat for low-back pain. Stimulation of this point is used in the treatment of suboccipital headaches. and shoulder pain.GV-3 Location. Indications. on a line drawn between the apex of both ears. This point is used in the treatment of thoracic outlet syndromes. This point (Yaoyangguan) is found between the spinous processes of L4 and L5. Indications. Indications. This point (Fengfu) is found directly in the midline just below the external occipital protuberance. This point (Baihui) is located in the midsagittal line of the scalp. It is referred to as a reunion point because it interconnects with other meridians and often takes on the functions of those meridians. neck pain. GV-16 Location. . GV-14 Location. Some studies have indicated a relationship between this point and the endocrines. This point (Dazhui) is found between the spinous processes of C7 and T1.

GV-26 Location. Firm manual stimulation of this point is indicated in patients who feel faint. The site of this point is found at the philtrum. Alarm Points . Indications. Relationships have been drawn between this point and treatment of patients with hemorrhoids and hypertension.Indications. in the angle formed by the nose and the upper lip.

As previously described briefly, there are several reflex points for the meridians
that are located on the anterior surface of the body. Spontaneous pain, pain on
pressure, or excessive electropermeability at one of these points may indicate
that some disorder is present in the associated meridian. For example, it is
empirically claimed that spontaneous pain at LU-1 indicates a problem in the
lung meridian, whose alarm point is LU-1.
All alarm (Mu) points are located on the ventral surface of the thorax and the

abdomen, and each point is associated with one of the 12 main meridians and
its function. Six of the meridian alarm points are located on the conception
vessel meridian, thus they are unilateral. The other six alarm points are
bilateral, giving a total of 18 alarm points in all.
It is thought by Oriental physicians that tenderness or pain elicited by light
pressure on or spontaneous pain at any of these points indicates that the
meridian has excessive energy (Chi). Tenderness only on heavy pressure
indicates that there is a deficiency of Chi. Generally, the alarm points are
associated with the Yin types of diseases; viz, those diseases associated with
cold, depression, and weakness.
Table 3.2 lists the alarm points for the 12 meridians and gives the
anatomical location of each.

Table 3.2. Alarm Points of the Body
Meridian

Alarm Point

Location

BILATERAL POINTS
Lung

LU-1

1 cun below clavicle, lateral interspace of 2nd
—3rd ribs

Liver

LV-14

On vertical nipple line, between 6th—7th ribs

Gallbladder

GB-24

On vertical nipple line, between 7th—8th ribs

Spleen

LV-13

Anterior tip of 11th rib

Kidney

GB-25

Anterior tip of 12th rib

Large intestine

ST-25

2 cun lateral to navel

Heart constrictor

CV-17

Midsternal, nipple level, 3/4ths down from
episternal notch

Heart

CV-14

6 cun above navel, just below xiphoid process

Stomach

CV-12

4 cun above navel, epigastrium, midway

MIDLINE POINTS

between the xiphoid process and navel
Triple heater

CV-5

2 cun below navel

Small intestine

CV-4

3 cun below navel

Bladder

CV-3

4 cun below navel

Master Points
The seven master points are the primary points of the body, and, according to
some authorities, they are used more frequently than other points. Generally,
they will all be tender to the touch and the effects from stimulating them are
usually pronounced. These points, in review, are:

LI-4
SP-6
BL-54
LU-7

ST-36
GB-20
LV-3

Association Points .

3. between T3 and T4 HC BL 14 1-1/2 cun lateral to spinous processes. This point is located along the back on the medial course of the bladder meridian. An association point (or associated point. between T12 and L1 TH BL 22 1-1/2 cun lateral to spinous processes. Table 3. Generally. Associated Points Meridian Association Point Location LU BL 13 1-1/2 cun lateral to spinous processes. between T9 and T10 GB BL 19 1-1/2 cun lateral to spinous processes. on either side of the vertebral column. between T6 and T7 LV BL 18 1-1/2 cun lateral to spinous processes. between T11 and T12 ST BL 21 1-1/2 cun lateral to spinous processes. See Table 3.3. between . it allegedly becomes tender when the meridian’s Chi is abnormally disturbed. between T10 and T11 SP BL 20 1-1/2 cun lateral to spinous processes. all association points may be found approximately two finger widths lateral to the midline of the spine. There are also associated points that do not correspond with a specific meridian. That is. as it is sometimes called) is a reflex site for an affiliated meridian. All meridians have an associated point.Associated points were briefly described with the bladder meridian. between T5 and T6 GV BL 16 1-1/2 cun lateral to spinous processes. between T4 and T5 HT BL 15 1-1/2 cun lateral to spinous processes. 1-1/2 cun from the spinous processes.

between L2 and L3 LI BL 25 1-1/2 cun lateral to spinous processes.L1 and L2 KI BL 23 1-1/2 cun lateral to spinous processes. between L4 and L5 SI BL 27 At the level of the S1 foramen BL BL 28 At the level of the S2 foramen .

when tender." Some authorities contend that these association points.In this context. This point is located on the anterior surface of the body and supposedly acts as an associated point for the entire series. are the . a special point to be noted is KI-27. It is sometimes referred to as the "home of all associated points.

the skillful use of penetrating techniques requires specialized instruction beyond the scope of this discourse.best points to treat for tonification or sedation of the affiliated meridian because of a lesser possibility of an adverse reaction or side effects. are used in Yang diseases such as those associated with fever and/or overexcitation. 4. because of their general calming effect. However. Sedation of an association point in turn causes sedation of the meridian preceding it and the meridian that follows it. 3. Jayasuriya A: Medicina alternative strategy for the integration of healing methods. they are points of sedation. Association points also serve well as points of tonification. this information as presented will be of extreme value when non-needling techniques (eg. 2(1):7–14. The associated points have certain characteristics in contrast to the alarm points. These points. March 1985. 2. electric stimulation) are used in adjunctive therapeutics. . Classically. nternational Journal of Chinese Medicine. Closing Remarks Although needling procedures are frequently described in this chapter. according to Felix Mann: 1. This is typically the reverse of what occurs when alarm points are stimulated. Chinese osteopathy uses these points in the correction of minor displacements of the vertebrae. References 1.

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