This is Chapter 3 from R. C. Schafer, DC, PhD,
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“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
Types and Characteristics of Acupuncture Points
Electrical Analysis

The Human Inch

Major Points: Locations, Primary Indications, and

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


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
B. Nonopioids
 MSH3
II. Enkephalins

III. C–terminally extended
IV. Others

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

[3. 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. and the release of histamine and epinephrine by stimulation of points have all been . [7] For example. since the study and effective application of meridian therapy require some basic knowledge of its theoretical scientific basis. has for all practical purposes been refuted by other investigators. a number of theories have been advanced that generally fall under the headings of "Neural" or "Nonneural" concepts. That is. Also. is a histologic description of elongated tubular cells lying deep in the skin. contraction waves of skeletal muscles. 6] Various other theories have attempted to explain acupuncture and the existence of the meridians. however impressive as it might be. put forth by a North Korean physiologist and acupuncturist. verification for some of the effects of meridian therapy does exist on the basis of these concepts. and the knowledge of the underlying principles behind a particular method of therapy. Han also thinks that a "unique" fluid circulates through these channels. magnetic fields. 4] Han’s theory. Han believes that this fluid travels slowly through the meridians. 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. 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. which contains a high concentration of ribonucleic and other amino acids.has an acceptable explanation and understanding of the biologic mechanisms that are probably involved. discharging of electrical potentials. Kim Bong Han." This theory. the need for this explanation is established. Kellner has shown that some of this theory is based on artifacts occurring in preparation of the histologic slides. In the case of meridian therapy. completing a cycle each 24 hours. [5. quantum mechanics. [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 other attempts at duplicating the work of Han reveal that he was probably describing the lymphatic channels of the body.

Various experimental data tend to support the involvement of a cutaneovisceral reflex. although certain aspects appear to be based on established neurophysiologic concepts. There are many questions. This indicates that some type of nerve conduction occurs. as nerve fibers transmit impulses at an extremely rapid rate through their pathways. that remain unanswered. [9] When an acupuncture point is stimulated. [10–13] Proof for the existence of such a reflex has strong scientific support. along with others.put forth as possible mechanisms. 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. Felix Mann proposed a theory based on the lateral line system in fish. 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. Such a rapid speed of conduction excludes the blood and lymphatic systems as possible mediators of this response. have now been dismissed in favor of one of the neurologic explanations. 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. however. The exact mechanism of this action is not yet fully understood. At one time. Wernoe stimulated a small segment of the skin of fish and amphibians with silver nitrate and. [8] His studies involved the use of radioisotopes. In a series of experiments. 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. These theories. 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. [14–16] In Germany. after a delay of several months. demonstrated . Others have likened the pinprick in the body to the electrical discharge of a condenser.

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

For example. are intersegmental. 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. [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. 34] In contrast. [31. The scratch reflex of a dog is a good example of an intersegmental cutaneomotor reflex. the effects of stimulating the acupuncture points of the head cannot be readily explained. however.example is cardiac ischemia with radiating pain to the left arm. However. 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. 36] Some scientific explanation for this is therefore likely. SEGMENTAL AND INTERSEGMENTAL EFFECTS Most of the reflexes used to explain the effects of acupuncture are segmental and follow specified dermatomal patterns. 32] A possible explanation of this phenomenon is via the long reflex of Sherrington. Qi [pronounced chi]). stimulation of acupuncture points of the foot has been shown to affect organs over 10 dermatomes away. 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. Wernoe stimulated the rectum of a decapitated plaice electrically and found that the skin became pale. but it does not fully or even adequately explain exactly what happens according to the empiric results obtained. 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. [28–30] Others. 26] In this context. those reflexes that fit into the dermatomes are segmental reflexes. . [35. [33. For instance. often referred to as Sherrington’s short reflexes. The scientific proof for these reflexes is important.

This theory has many practical applications in clinical practice. If this were not so. 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. the "gate" is closed). the small fiber system then gains dominance and the patient perceives pain. rapid-conducting. 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. Small diameter. the body would be in a constant state of pain. let us suppose that the "gates" are open and the patient is in severe pain. It is believed that the dermal stimulus depolarizes the cells here. [41] It is by way of this system of inhibitory projections that the full value (ie. the small fiber system is excessively stimulated by some disease process.THE GATE CONTROL THEORY AND ITS CLINICAL SIGNIFICANCE The next consideration is the more recent Gate Theory. and it would be well to summarize it here. it is basically the same as originally proposed. when stimulated. according to Melzack and Wall. which renders them incapable of receiving and transmitting pain signals. relief from pain) can be realized. alpha and beta fibers of the skin conduct impulses via the dorsal columns to the brainstem and from there to the cerebral cortex. however. which is found in the dorsal horn of the spinal cord. painful stimuli are blocked (ie. If. For example. Although this theory. Surgical research on patients with intractable pain has shown that the implantation of a dorsal column stimulator (ie. originally set forth by Melzack and Wall. 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. Thus. 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 . In addition. [37–39] The gate theory holds that the large myelinated nerve fibers of the skin have an inhibitory effect. has been amended to some extent. on the small pain-evoking fibers that enter the same segment of the cord. The stimuli from the dermis specifically produce inhibition in the cells of the substantia gelatinosa of Rolando. as described in Chapter 2.

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

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

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

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

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

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

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

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

stimulation and the indications for treatment as cited by various authorities. 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. that little or no scientific verification has been done in the West to substantiate these projected effects. We must state unequivocally. Thus. The complete validity of the effects described must await further research substantiation. Points on the Lung Meridian .

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

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

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

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

ST-25. 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.Location. This point (Yingxiang) is found at the nasolabial groove on the side of the nasal ala. ST-7. and ST-36. Points on the Stomach Meridian The major points on the stomach (ST) meridian are ST-2. .


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

Points on the Spleen Meridian . 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. 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.ST-36 Location. Because of its location. Several studies have related this point to the cellular elements of the blood. it is also used in the treatment of conditions localized in the lateral aspect of the knee joint. Indications. This point (Dusanli) is another of the seven master points of the body. thus. 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. It is thought to be the major body point for systemic tonification. The depression is located about one finger’s width lateral to the anterior crest of the tibia.

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. 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 .

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

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

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

SI-3 .

Location. make a tight fist and note the small triangular bulge on medial aspect of the supinated hand. In this position. or tinnitus. Indications. the point is located 1 cun above the top of the posterior axillary fold. Precautions: Care must be taken when using a needling procedure to avoid major nerve and vascular structures in this area. 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. SI-9 Location. have the patient hold their relaxed arm at the side. Points on the Urinary Bladder Meridian . 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. Indications. SI-19 Location. This point is treated when patients have pain in the contralateral lower back region and in patients suffering with various types of arthritis. This site is stimulated in various disorders of the ear such as earache. 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. hearing loss. Indications. To locate this point (Houxi).

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



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

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

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

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

This point (Rangu) is found just anterior and inferior to the medial malleolus of the ankle. If an imaginary line is drawn from the midpoint of the foot (midpoint between the front and back).Location. Stimulation of this point is often made when patients show signs of excessively moist skin (ie. Indications. between the 2nd and 3rd metatarsophalangeal joints. Indications. KI-2 Location. 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. hyperhidrosis). The site of this point (Shufu) is found in the depression between the 1st rib and the lower border of the clavicle. this point is one of the best sites to stimulate when a patient has problems related to the feet. Indications. This point is often referred to as the "reset button" by kinesiologists. 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. the point can be located in a depression at the anterior-inferior border of the navicular bone. It is also stimulated in patients with dry skin and complaints of impotence. Although one of the most tender acupuncture sites of the body. KI-27 Location. just lateral to the manubrium of the sternum.

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

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

Indications. This site is the major point of energy balance in the body. The indications for stimulating TH-17 are hearing loss. 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. TH-17 Location. GB-21.Indications. . and earache. tinnitus. Points on the Gallbladder Meridian The major points on the gallbladder (GB) meridian are GB-20. insertion to a depth greater than 11/2 cun is absolutely forbidden. and GB-34. Stimulation of this point is thought to equalize the autonomic nervous system.



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

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

. This point is often stimulated in an attempt to detoxify the body and for the treatment of patients with neurologic complaints. Indications. Some evidence indicates that it is one of the best points on the body for treating patients with migraine. 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.LV-3 Location.

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


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


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

GV-26 Location. Firm manual stimulation of this point is indicated in patients who feel faint. Indications. Alarm Points . 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. The site of this point is found at the philtrum.

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

Alarm Point




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



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



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



Anterior tip of 11th rib



Anterior tip of 12th rib

Large intestine


2 cun lateral to navel

Heart constrictor


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



6 cun above navel, just below xiphoid process



4 cun above navel, epigastrium, midway


between the xiphoid process and navel
Triple heater


2 cun below navel

Small intestine


3 cun below navel



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:



Association Points .

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

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 . between L2 and L3 LI BL 25 1-1/2 cun lateral to spinous processes.

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

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

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