by Alina Tousseeva MD, RAc
In my blog “What is an acupuncture point anyway?” I discussed anatomical features which make acupoints special: “Medical researchers have noticed these points are associated with nerves and vessels in complex physical areas of potential restriction or transition.”
Now let’s discuss the clinical applications of acupuncture points used as tool for diagnosing pathological conditions.
TCM traditionally crudely divided into really important points and then “the rest”. The most famous ones were called “Heavenly Star Points” (there are dozen or so of them, but that can be reasonably debated), for their divine and superior action, and occurred mainly on the extremities of the arms and legs. Divergent schools of Chinese medicine disagreed on many things regarding on approach and emphasis in using acupuncture, but they mostly agreed on the great utility of these Heavenly Star points for their general impact on the whole body. The rest of acupuncture points were important too, but their effects were often used with a more local focus on whatever part of the body they occurred, and had less general impact on the body as a whole. Modern acupuncture has enough scientific evidence to support categorizing points into primary, secondary, tertiary and others. Recent research performed by Dr. Dung revealed that about 24 points can be classified as primary and they tend to be sensitive or sore when palpated on 75% to 99% of people with any somatic or visceral pain. These include the ancient Heavenly Star points! Surprise!!!
Normally in a healthy state, people’s acupoints are not sore at all to the touch – this is called the latent stage by Dr. Dung. Next he describes the passive or beginning stage of pathology, where acupoints become sensitized and sore when palpated (pressed on firmly with a finger). These particular points Dr. Dung called acu-reflex points or homeostatic points. Homeostasis means the tendency toward sameness or a central balance, and is a unifying concept in all cells, organisms, and ecosystems. The next stage of the sensitization process is the formation of the active points that are sore without touching or pressure. This can be seen with people with fibromyalgia, chronic fatigue syndrome, or long term chronic pathological conditions especially autoimmune diseases, infectious diseases or general inflammatory type problems, severe PMS, or long lasting chronic pain syndromes.
Sensitization can happen at any time as a result of an external insult or an internal imbalance. Conditions which cause sensitization of the sensory nerve receptors at homeostatic acupoints, include physical injuries (including aggressive medical procedures), overuse injuries, postural or neurological imbalances, diet abnormalities , internal pathological conditions, emotional stress and even climate change.
Sensitizing substances that can impact acu-reflex are substance P, bradykinin, serotonin, norepinephrine, TNF, Interleukin1B and others . Accumulation of these chemicals in the soft tissues result in more acidic pH, diminished peripheral microcirculation, subclinical edema and a decreased pain threshold. Eventually this leads to formation of soft tissue adhesions and disturbances of the blood and lymphatic circulations even more, forming a vicious cycle. These active substances can cause significant changes in muscles, ligaments and tendons, as well. The increased fiber tension, shortened sarcomeres(components of a mucle), local ischemia (reduced blood circulation) and eventually cascading into an energetic crisis. These are typical stages of the pathological changes in muscles and related fascial (fibrous) tissues. About 1/3 of primary (homeostatic) acupoints are located on the motor points (where a nerve enters a muscle) and reflect pathology through local muscle soreness. The other 2/3 are located on classic acupuncture points located not in muscles, but in transitory spaces between muscles, layers of tissues, and near joints.
A typical mistake is to see local acu-reflex point soreness as a local problem. Sensitive loci on the body may serve to sensitize homeostatic points as an alarm signal about a disturbance, a postural imbalance or hormonal disharmony. In other words, your sore neck and shoulder may be more than just about local tightness in your trapezius or infraspinatus or supraspinatous muscles. An important thing to watch to differentiate local from a general phenomenon is the symmetry of presentation. Asymmetrical is usually a local muscular tension and pain, whereas symmetry is more common for general a disharmony versus asymmetry.
So I know what you are waiting for now….here are some important acu-reflex points to remember for medical practitioners and health consumers alike! You’re going to have to google these locations if you don’t have a good anatomy textbook. They are located on the motor points of the trapezius, infraspinatus, pectoralis major and gluteus maximus muscles. They also can be found on the attachments of the levator scapulae (inside corner of your scapula), sternocleidomastoid and splenius capitis muscles. Other points are located in the anatomically significant zones where nerves emerge from a deeper layer or in the narrow zones of potential restrictions (foramina or holes in the bone and bone edges) . Examples are locations that touch right on top of tibial, sural, peroneal, supraorbital, infraorbital, cluneal and saphenous nerves. These ones are mostly classical acupuncture points which were used by most divergent acupuncture schools to treat and diagnose a significant number of pathological conditions to support and restore homeostatic balance and health.
Primary acupuncture points can help diagnose pathological conditions during its preclinical stage, before any tests or regular physical examination reveal a pathology. Contrary to the western medicine way of thinking, in oriental medicine we do not diagnose the disease of a particular organ per se, but rather see disharmony and imbalance patterns. The focus becomes on looking at the propensity one has to have a pathology depending on one’s environment and history, predispositions and genetic weaknesses.
Often a disharmony will stay at the “exterior level” in oriental medicine speak, or passive level in Dr. Dung’s way of seeing it, represented as multiple musculo-skeletal complains such as muscular tightness, pain and muscle shortening; joint and spine pathologies and tension headaches.
Apparent exterior pain in the body can be referred directly from the internal organs, and a medical doctor needs to consider this and rule it out every time he/she is presented with a person with muscular pain. These visceral-somatic reflexes and referred hyperalgesia are common findings – like the unique and local abdominal pain of appendicitis, or right shoulder pain associated with a gall bladder attack, the pain of a stomach ulcer, or left shoulder/arm pain associated with heart problems.
But more often than not, a symmetrical type pain on these acu-reflex or homeostatic points are trying to tell you something different than a local effect or a referred pain from an internal organ. Indeed, they may be an general adaptation to tell you to slow down and tend to yourself. Who knows, maybe Dr. Dung’s new way of seeing these ancient points may afford our future society the integration of a more holistic approach in medical diagnosis and treatment?
Acupuncture: An Anatomical Approach, 2nd edition, 2013 CRC press, by Houchi Dung.
Houchi Dung earned a Ph.D. in anatomy from the University of Louisville in 1970. Soon after, he accepted a faculty position in the Department of Anatomy, School of Medicine, at the University of Texas Health Science Center at San Antonio, which he held until his retirement in 2002. His main responsibilities were teaching gross human anatomy to medical and dental students. During his 31-year academic career, he published 24 papers on the field of acupuncture from his clinical experience. He has published several books on acupuncture and pain.