Acupuncture point

Acupuncture points (also called "acupoints or tsubo") are anatomical locations on the body that are the focus of acupuncture, acupressure, sonopuncture, and laser acupuncture treatments. There are several hundred acupuncture points that are distributed along the meridians as well as numerous other "extra points" that are not associated with a particular meridian. Most of the current research into acupuncture point locations and mechanisms is taking place in China.

Theory
Acupoints used in treatment may or may not be in the same area of the body as the targeted symptom. The TCM theory for the selection of such points and their effectiveness is that they work by stimulating the meridian system to bring about relief by rebalancing yin, yang and qi (also spelled "chi"). This theory is based on the paradigm of TCM, not that of science.

Body acupoints are generally located by a measurement technique that is calibrated according to their proportional distances from various landmark points on the body. Acupoint location usually depends on specific anatomical landmarks that can be palpated. There are nearly 400 basic acupoints on the meridians. Many of these basic points are rarely used. Some points are considered more therapeutically valuable than others, and are used very frequently for a wide array of health conditions.

Location by palpation for tenderness is also a common way of locating acupoints (see also trigger point). Points may also be located by feeling for subtle differences in temperature on the skin surface or over the skin surface, as well as changes in the tension or "stickiness" of the skin and tissue. There is no scientific proof that this method works and some practitioners disagree with the method.

Body acupoints are referred to either by their traditional name, or by the name of the meridian on which they are located, followed by a number to indicate what order the point is in on the meridian. A common point on the hand, for example, is named Hegu, and referred to as LI 4 which means that it is the fourth point on the Large Intestine meridian.

Categories of body acupuncture points
Certain acupuncture points are ascribed different functions according to different systems within the TCM framework.
 * Five Transporting Points system describes the flow of qi in the channels using a river analogy, and ascribes function to points along this flowline according to their location. This system describes qi bubbling up from a spring and gradually growing in depth and breadth like a river flowing down from a mountain to the sea.
 * Jing-well points represent the place where the qi "bubbles" up. These points are always the first points on the yang channels or last points on the yin channels and with exception of Kid-1 YongQuan all points are located on the tips of fingers and toes. The Nan Jing and Nei Jing described jing-well points as indicated for "fullness below the heart" (feeling of fullness in the epigastric or hypochondrium regions) and disorders of the zang organs (yang organs).
 * Ying-spring points are where the qi "glides" down the channel. The Nan Jing and Nei Jing described ying-spring points as indicated for heat in the body and change in complexion.
 * Shu-stream points are where the qi "pours" down the channel. Shu-stream points are indicated for heaviness in the body and pain in the joints, and for intermittent diseases.
 * Jing-river points are where the qi "flows" down the channel. Jing-river points are indicated for cough and dyspnoea, chills and fever, diseases manifesting as changes in voice, and for diseases of the sinews and bones.
 * He-sea points are where the qi collects and begins to head deeper into the body. He-sea points are indicated for counterflow qi and diarrhea, and for disorders resulting from irregular eating and drinking.


 * Five Phase Points ascribe each of the five phases - wood, fire, earth, metal and water - to one of the Five Transporting points. On the yin channels, the jing-well points are wood points, the ying-spring points are fire, shu-stream points are earth, jing-river points are metal, he-sea points are water points. On the yang channels, the jing-well points are metal, ying-spring are water, shu-stream are wood, jing-river points are fire and he-sea points are earth points. These point categories are then implemented according to Five Phase theory in order to approach the treatment of disease.


 * Xi-cleft points are the point on the channel where the qi and blood gather and plunge more deeply. These points are indicated in acute situations and for painful conditions.


 * Yuan-source points are points on the channel from where the yuan qi can be accessed.


 * Luo-connecting points are located at the point on the channel where the luo meridian diverges. Each of the twelve meridians have a luo point that diverges from the main meridian. There are also three extra luo channels that diverge at Sp-21, Ren-15 and Du-1.


 * Back-shu points lie on the paraspinal muscles either side of the spine. Theory says that the qi of each organ is transported to and from these points, and can be influenced by them.


 * Front-mu points are located in close proximity to the respective organ. They have a direct effect on the organ itself but not on the associated channel.


 * Hui-meeting points are a category of points that are considered to have a "special effect" on certain tissues and organs. The hui-meeting points are:
 * zang organs - Liv-13 Zhang Men
 * fu organs - Ren-12 Zhong Fu
 * qi - Ren-17 Shang Fu
 * blood - Bl-17 Ge Shu
 * sinews - GB-34 Yang Ling Quan
 * vessels - Lu-9 Tai Yuan
 * bone - Bl11 Da Zhu
 * marrow - GB-39 Xuan Zhong

Non-meridian points
Additionally, there are microsystems of acupoints that are typically not located on the meridians. For example, auriculotherapy uses the external ear microsystem exclusively, utilizing thousands of points that are not on a meridian, but located on the surface of the external ear. The Korean system of hand acupuncture is a microsystem that utilizes acupoints on the hand. There are other common and uncommon acupoints that are called extra points, meaning that they are neither on a meridian nor part of a microsystem. Extra points are referred to more often by name, though some of the more commonly known have a letter/number combination for reference. A popular extra point is Yintang, located at the midpoint between the eyebrows.

Criticism of TCM theory
TCM theory is not based on science. Philosopher Robert Todd Carroll deemed acupuncture a pseudoscience because it "confuse(s) metaphysical claims with empirical claims". Carroll states that:
 * ...no matter how it is done, scientific research can never demonstrate that unblocking chi by acupuncture or any other means is effective against any disease. Chi is defined as being undetectable by the methods of empirical science.

A report for CSICOP on pseudoscience in China written by by Wallace Sampson and Barry L. Beyerstein said:
 * A few Chinese scientists we met maintained that although Qi is merely a metaphor, it is still a useful physiological abstraction (e.g., that the related concepts of Yin and Yang parallel modern scientific notions of endocrinologic and metabolic feedback mechanisms). They see this as a useful way to unite Eastern and Western medicine. Their more hard-nosed colleagues quietly dismissed Qi as only a philosophy, bearing no tangible relationship to modern physiology and medicine.

Stephen Barrett, founder of the website Quackwatch.org, writes:
 * ''"Chinese medicine," often called "Oriental medicine" or "traditional Chinese medicine (TCM)," encompasses a vast array of folk medical practices based on mysticism. It holds that the body's vital energy (chi or qi) circulates through channels, called meridians, that have branches connected to bodily organs and functions. ... Most acupuncturists espouse the traditional Chinese view of health and disease and consider acupuncture, herbal medicine, and related practices to be valid approaches to the full gamut of disease. Others reject the traditional approach and merely claim that acupuncture offers a simple way to achieve pain relief. Some acupuncturists ... claim that acupuncture can be used to treat conditions when the patient just "doesn't feel right," even though no disease is apparent.
 * In 1995, George A. Ulett, M.D., Ph.D., Clinical Professor of Psychiatry, University of Missouri School of Medicine, stated that "devoid of metaphysical thinking, acupuncture becomes a rather simple technique that can be useful as a nondrug method of pain control." He believes that the traditional Chinese variety is primarily a placebo treatment, but electrical stimulation of about 80 acupuncture points has been proven useful for pain control.

Ted Kaptchuk, author of The Web That Has No Weaver, refers to acupuncture as "prescientific". Regarding TCM theory, Kaptchuk states:
 * These ideas are cultural and speculative constructs that provide orientation and direction for the practical patient situation. There are few secrets of Oriental wisdom buried here. When presented outside the context of Chinese civilization, or of practical diagnosis and therapeutics, these ideas are fragmented and without great significance. The "truth" of these ideas lies in the way the physician can use them to treat real people with real complaints. (1983, pp.34-35)

According to the NIH consensus statement on acupuncture:
 * Despite considerable efforts to understand the anatomy and physiology of the "acupuncture points", the definition and characterization of these points remains controversial. Even more elusive is the basis of some of the key traditional Eastern medical concepts such as the circulation of Qi, the meridian system, and the five phases theory, which are difficult to reconcile with contemporary biomedical information but continue to play an important role in the evaluation of patients and the formulation of treatment in acupuncture.

Scientific research
See also the main article on acupuncture. This section focuses on the efficacy of "distal points', i.e. body acupoints that according to TCM theory are indicated for treating conditions whose symptoms manifest in areas of the body that are distant from the acupoint's location. Current biomedical knowledge does not predict that such points should be efficacious.  An example is P6, located near the wrist and used to treat nausea.

Acupoint P6 (Nei guan)
The Cochrane Collaboration, a group of evidence-based medicine (EBM) reviewers, reviewed the use of P6 for nausea and vomiting, and found it to be effective for reducing post-operative nausea, but not vomiting. The Cochrane review included various means of stimulating P6, including acupuncture, electro-acupuncture, transcutaneous nerve stimulation, laser stimulation, acustimulation device and acupressure; it did not comment on whether one or more forms of stimulation were more effective. EBM reviewer Bandolier said that P6 acupressure in two studies showed 52% of patients with control having a success, compared with 75% with P6 acupressure. One author of an article published in the Scientific Review of Alternative Medicine disagreed.

Acupoint BL 67 (Zhi yin)
One randomized controlled trial studied a classical TCM treatment for breech birth (i.e., buttocks-first orientation of the baby, which is much riskier than head-first). The study showed that moxibustion at acupoint BL 67 (aka UB 67), located at the tip of the fifth toe, was more effective than placebo at reducing the incidence of breech birth. An EBM review by Cochrane said that that more data were needed before recommendations on clinical effectiveness could be made.