This paper was written in 1980. For an update, see the attached paper on the Choice of AP points for particular conditions
INTRODUCTION
One may use veterinary acupuncture (AP) by the transposition method (from human to animal) or by the traditional vet method. It follows that the choice of points for therapy can be based on either or both of these methods.
Some of the AP textbooks on man and animals have therapeutic indices (point prescriptions) for specific disease conditions or symptoms. Other texts have not this facility. We have also seen that many different combinations of points may be used in any one clinical condition.
The student is advised to study only a few AP texts initially. However, she/he should know that one text (or even 3-4 texts) does not cover all conditions which may respond to AP. Therefore, over a period of years, the serious student can expect to accumulate and study dozens of different texts. Each of these texts will have to be integrated with material from earlier texts. Therefore the student will need to make out personal prescription lists, using data from many sources.
This paper discusses the choice of AP points based on the human transposition system but first we must consider some differences between orthodox and unorthodox concepts of disease.
DIFFERENCES BETWEEN ORTHODOX AND UNORTHODOX CONCEPTS OF DISEASE
AP is frequently of great value in treating the pain and lameness associated with x-ray evidence of severe osteoarthritis or "intervertebral disc prolapse syndrome", despite the persistence of the lesion. Orthodox practitioners would suggest that this is impossible because they assume that the pain and lameness primarily is caused initially by nerve stimulation from the lesion, but which soon becomes a self-perpetuating system, (i.e., a vicious circle). They claim that if the muscle spasm and tissue oedema is relieved, the locomotor function may be restored despite the persistence of the x-ray lesion.
Severe gastric ulcers, even bleeding ulcers, may respond rapidly to AP, with no change in dietary habits. Orthodox concepts would prescribe change of diet, drug therapy with antacids, gastric sedatives, antispasmodics, Zantac or Cimetidine, etc. However, stimulation of certain AP points, especially NeiKuan (PC06); TsuSanLi (ST36), ChungWan (CV12) and WeiShu (BL21) has powerful effects on the autonomic nervous system (anti-nauseous effects), acid secretion and regenerative power of the gastric mucosa. Thus, AP can combat the symptoms of gastric ulcer and promote the ideal environment for self-healing, by reducing acid-secretion and stimulating the defence systems of the body.
Similarly, AP can help patients who have lost motor function of an arm or leg following a cerebrovascular accident, encephalitis etc. Orthodox medical concepts claim that damaged neurons cannot regenerate. Acupuncturists agree with this but they claim that many types of paralysis are due to functional rather than organic damage, (i.e.) that the motor-neurons are "asleep but not dead", due to inadequate oxygen or blood supply. AP at certain points has marked effect on brain microcirculation and, thus, can restore nerve function in such cases. Also, the nervous system itself has considerable "plasticity" and new circuits can be established to replace the functions of damaged circuits.
Another difference between orthodox and unorthodox concepts is in the importance of the nature of the lesion. Orthodox clinicians would set great importance on the nature of a toe pain (for example). Is it arthritis, sprain, gout, subluxation etc? To an acupuncturist, such questions are of minor importance, as the point combination used covers all responsive conditions of the toe and the Channel-Organ System (COS) related to the toes. For pragmatic purposes, however, it is helpful to establish a firm diagnosis before attempting to treat the condition.
Thus, AP claims to treat or help many conditions which, according to our western training, should be difficult or impossible to treat successfully. How, then, do we go about choosing the best points for therapy?
CONSTRUCTION OF AP POINT PRESCRIPTIONS
As one accumulates textbooks one may wish to construct a cumulative index of the points recommended by the various authors for each condition. Each reference should be coded, in order to avoid confusion as to the source and to avoid mistakes in the location of the points.
As new texts are studied, data can be added to the index, under a new reference code. For example, suppose one were studying Klide and Kung in relation to AP in horses and one were using the Sobin data (p 69 of Klide and Kung), one would find the following data under the various points:
Point Indication
Head & Neck01 Tetanus, encephalitis, encephalomyelitis, encephaloedema
02 Purulent frontal sinusitis, cerebral hyperaemia
03 Cerebral hyperaemia, cerebral anaemia, neck rheumatism
04 Same as HN03
. .
Tail 114 Over-exertion, heat stroke, common cold, bowel spasm
First, one would go through the data and pick out the complete list of key-words or pathological conditions, mentioned in the text:
Tetanus, Encephalitis, Encephalomyelitis, Encephaloedema, Sinusitis (frontal, purulent), Cerebral hyperaemia, Cerebral anaemia, Neck rheumatism, Overexertion, Heatstroke, Common cold, Bowel spasm etc.
One would then go through the data again and enter the identity of each point under the relevant conditions, giving a code (say) (K-S (for Klide/Kung-Sobin) before each point combination and giving an appropriate alphanumeric code to each point, for example HN01 for Head and Neck 1, T114 for Tail 114.
Bowel spasm (K-S) T114 (T= Tail)
Cerebral hyperaemia (K-S) HN02,03,04
Encephalitis (K-S) HN01
Encephaloedema (K-S) HN01
Encephalomyelitis (K-S) HN01
Tetanus (K-S) HN01
.
.
.
.
etc
If a new reference, for example author X, had points under these headings, they would be added later. For example:
Cerebral hyperaemia (K-S) HN02,03,04....
(X) 99, 112, 115...
Tetanus (K-S) HN01...
(X) 115, 119, 126...
etc
The problem with this system (traditional vet AP) is that there is no standard chart for any one species. It is not possible to relate (K-S) HN02 with (X) 99 etc on the standard chart. Therefore some major integration (referring back to the individual source charts) is necessary either before the cumulative index is attempted or after it is done. Either way, it becomes very time-consuming for the individual practitioner. However, one would expect that research workers interested in vet AP will integrate all existing vet traditional texts into one "standard" text for each species within the next few years.
Meanwhile, integration of human texts is much easier, as they are normally based on a standard chart of the AP points (except for a few instances in which points such as BL36-54 and ST01-8 may have different alphanumeric coding in some texts:
Outer BL Points (IVAS BL40=WeiZhong, mid-popliteal crease)
IVAS 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54
Other 50 51 52 53 54 36 37 38 39 40 41 42 43 44 45 46 47 48 49
Inner line - - - - - --12 13 14 15 16 17 18 19 20 21 22 23 28 30
Codes for ST01-08
(IVAS ST08=TouWei, on temple)
IVAS 01 02 03 04 05 06 07 08
Other 08 07 06 05 04 03 02 01
These differences should be noted and adjusted by the student on the first comparison of his/her "new" text with the reference text.
Thus, studying four texts, such as the Beijing text (2), Hongkong text (3), Taipei text (4) and Barefoot Doctor's Manual (5), the student would prepare a therapeutic index in the same way as above. Then, on checking the points listed for gastritis/gastric ulcer; toothache; sciatica/lumbosacral pain, sprain, etc (for example) he/she would find:
Gastritis/Gastric ulcer
(Pek) ST20,21,25; SP05; CV12,13 (plus Earpoints and other points)
(Hkx) ST21,28,36; SP05; NL20,21; CV12,13 (plus earpoints and other points)
(TX) ST36,44; SP04; BL21; CV12; local points
(Bdm) ST25,36; BL20,21; PC06; CV06,08,12,13
Toothache
(Pek) LI02,03,04,05; ST03,05,06,07,42,44; SI18; Kl03; TH09,20; GB03,05,06,10,12,17; CV24; GV27 (plus earpoints and other points)
(Hkx) LU02; LI01,02,04,05; ST03,05,06,07,42,44,45; SI18; TH09,20,21; GB02,03,05,06,10,12,17; CV24; GV27,28 (plus earpoints and other points)
(TX) LI04,11; ST06,44; TH17
(Bdm) LU09; LI04; ST06,07; SI03; TH17,20
Sciatica, lumbosacral pain, sprain etc
(Pek) BL22,23,24,25,26,27,28,29,30,31,32,33,34,37,39,40,52,53,54,55,
57,59,60,63,64; GB30,31,34,39; GV02,03,04; AhShi, (plus earpoints and other points)
(Hkx) BL27,28,29,30,31,32,33,34,37,39,40,52,54,58,60; GB30,31,32,34,35,40; GV02,03 (plus earpoints and other points)
(TX) BL23,30,40,60; GB34; AhShi
(Bdm) BL23,37,40,52,60; GB30,34; AhShi (plus other points)
In the above examples (Pek), (Hkx), (TX) and (Bdm) refer to the Beijing, Hongkong, Taipei and Barefoot Doctor's Manual Sources respectively.
Glancing down through the points listed under each condition, one could see some agreement and some alternative point combinations. In choosing points for therapy, the student could pick those which showed the greatest measure of agreement, for example:
Gastritis/gastric ulcer: Choose from CV12,13; ST36; BL21 (listed in 3-4/4 of the texts)
Toothache: Choose from LI04; ST06,07,44; TH20 (listed in 3-4/4 of the texts)
Sciatica/lumbosacral pain: Choose from AhShi; BL23,30,40,60; GB30,34 (listed in 3-4/4 of the texts)
The therapeutic index is obviously a dynamic system, which is extended each time new references are studied. Also, one may add data from the clinical experience of colleagues, articles in the journals etc, as it becomes available.
The above approach is often called "Cookbook AP" by the purists and is regarded (especially by classically trained members) as inferior AP. However, Cookbook AP works very well in clinical situations with only one or a small number of signs or symptoms. Many recent textbooks from China, Taiwan, Hongkong etc make no mention of classic AP in the old sense and they rely very heavily on the Cookbook approach themselves. The Laws of the Five Phases, the classic use of the Phase Points, Yuan-Source, Luo-Passage, Hour Points, the Chinese Pulse Diagnosis etc are not mentioned in detail (if at all) in most of the modern texts from China and its neighbouring countries.
Even if one has access to a comprehensive therapeutic index, one still needs a way to reduce the number of points to a minimum. This is because many comprehensive prescriptions list far more points than are needed to treat the case. In the final choice of points, one usually relies on a few ancient Laws, choosing combinations from the following:
1. Sensitive points
2. TianYing points
3. Local points along affected and nearby Channels
4. Points along the affected Channels
5. Distant points on Channels through the affected area
6. Points on related Channels
7. Master points, including the Five Phase points, Mu/Shu points, Yuan/Luo points and Xi-Cleft points
8. Combination of local and distant points
9. Selection of points according to the symptoms
10. Selection of points according to the innervation
11. Fore and Aft points
12. Earpoints
Cookbook AP can be improved greatly by choosing points from an extensive list (based on many, if not dozens of, authoritative texts) so that at least 2 of the basic Laws of choosing points are fulfilled (see example re elbow pain etc later in this paper).
DIAGNOSTIC, THERAPEUTIC AND PROGNOSTIC VALUE OF SENSITIVE POINTS AND THE CHOICE OF POINTS FOR THERAPY
1. SENSITIVE POINTS
It is important to search for sensitive points. Sensitive points include the AhShi, Trigger Points, motor points and any other points which show abnormal tenderness to palpation-probing. After taking the case history, the acupuncturist usually palpates the entire body, probing the muscles, especially in those areas which the case history may suggest as likely to be sensitive. In musculoskeletal conditions of the upper limb and neck one probes especially the muscles of the upper limb, neck and thorax. In conditions of the lumbosacral area and lower limb, these areas will be probed carefully. Occasionally, sensitive points may be found far away from the problem area and a careful examination would include probing of the whole body, irrespective of the more obvious areas likely to be affected. For example, SP06 may be sensitive in menstrual disorder in women; KI03 may be sensitive in renal disorders; GB34 may be sensitive in cholecystitis; L 13 (LanWei = "Appendix Tail") may be sensitive in appendicitis.
Wherever sensitive points are found, their locations are noted carefully for future reference. These points may or may not be codified AP points. Their location can help in the diagnosis and they are also useful in therapy and prognosis. Their disappearance, i.e. return to normal sensitivity, during a course of treatment is taken as a good prognosis.
Sensitive points, when present, are always included in the point prescription. However, occasionally a whole area, such as the rectus abdominis, gastrocnemius or gluteal muscles may be sensitive and to needle all of this would require too many needles. In such cases, one or two of the most sensitive areas in the muscle are chosen. If ultrasound or electrostimulation equipment with a roller-electrode is available, the entire muscle can be treated.
One also probes scar tissue carefully. Wherever scar tissue is found, great care is taken to check whether or not it may be associated with the symptoms (by reflex effects or by blocking the flow of Qi in one or more Channels). Treatment of problem scars is very important. It is discussed in the paper on "Techniques of stimulation of the AP points".
Other areas important to probe include the 66 Command Points (the 60 Phase Points + the 6 Yuan points of the Yang Channels (the Yuan points of the Yin Channels are the same as the Yu points), see paper on the Study of Points and Channels), the front Mu points, the paravertebral Shu Points" (BL13-30), also the outer line of the BL Channel (BL36-40, 41-54)).
Sensitive points excluded from needling treatment include cancers, joint cavities, abscesses, infected wounds, parasitized skin areas and ulcers. In the latter case, the use of TianYing points is permitted in certain conditions (see next section).
In humans, practitioners who use the Earpoints pay particular attention to those points which show abnormal sensitivity.
Point sensitivity can be detected objectively by electronic detectors, as mentioned in an earlier paper.
2. TIANYING POINTS
In certain cases it is permissible to needle abnormal masses, such as goitre, synovial cysts, indurated masses in muscle following intramuscular injections etc. The TianYing point is the point of greatest sensitivity in the mass, cyst etc, It is focus of the problem a swollen or enlarged area such as an inflamed muscle or joint or periosteum. One needle is put into the TianYing point and occasionally, 3 or 4 more needles are placed around this one, from the periphery, as in the diagram (a) and (b) below.
Cyst diagrams (a) and (b):
In the case of varicose leg ulcers, 3-5 needles are sometimes advanced underneath the base of the ulcer as in diagram (c) below. Ulcer diagram (c):
In hip arthritis, for example, point GB30 (HuanTiao) is needled but the needle may also be advanced to peck the periosteum of the femoral neck. The intramuscular lump which sometimes follows injection in the biceps brachii or gluteal muscles can be dispersed quickly by dry-needling the centre of the lump. In "Tennis elbow", the lateral epicondyle of the humerus is often pecked with a needle.
In headache following epidural injection or lumbar puncture, the pain can be relieved by injecting a needle into the original needle track. (A recent paper in a medical journal reported extraordinary success in such cases by injection of 10 ml of the patient's blood back into the puncture site. The author did not acknowledge the Chinese discovered that simple needling of the same area could get the same result).
In general, however, cancer masses, joint cavities, infected wounds and infected abscesses (non-sterile) and parasitised skin areas should not be needled except for biopsy or drainage purposes.
3. LOCAL POINTS
In local problems, such as elbow pain, gastritis, tenesmus etc, one or two local points are included in the prescription. For example, include:
neck pain: GB20; BL10; X 35 (HuaToChiaChi points);
shoulder pain: LI15; TH14;
elbow pain: LI11; HT03;
carpal (wrist) pain: LI05; HT07;
lumbosacral pain: BL23,25; GV03;
hip pain: GB30;
knee (stifle) pain: BL40; GB34; L 16 (HsiYen);
tarsal (hock) pain: BL60 penetrating to KI03;
gastritis: CV12 (CV12 is also the Mu point-for ST);
intestinal disease: ST25, CV04 (these are both local and Mu points for the large and small intestine respectively);
bronchitis: BL13; CV17;
tracheitis: CV22,23.
Other examples of local points are in Table 1 (at the end of the paper).
4. POINTS ON THE AFFECTED CHANNEL
Where an organ or function controlled by a Channel is disturbed, one or more points on that Channel are chosen. For example, ST36 in gastritis; LI04 in ulcerative colitis; LU09 in pneumonia; SP06 in diabetes (Spleen- pancreas); HT07 in tachycardia; BL23,28 in bladder disorders (these are also the Shu points for KI and BL respectively); KI points in KI disorders; PC points in PC disorders etc.
Similarly, where aches or pains are located on or near the course of a Channel, points are chosen on the Channel. For example in pain along the lateral thigh, points GB31 or 32 could be included; for pain along the lateral chest, points GB22 or 25; SP17 or 18 or 19 or 20 or 21 could be included; for pain on the inner aspect of the leg, one might include one or two points from: SP05,06,07,08,09; LV05,06,07; KI08,09,10.
5. DISTANT POINTS ON CHANNELS THROUGH THE AFFECTED AREA
In general, the most effective AP points are below the elbow and knee (the areas in which the 66 Command Points lie.
Problems at one end of the body may be treated by points at the other end. For example, disorders of the head and its organs may be helped by points below the elbow or below the knee (stifle). Points on the head may help problems below the waist.
Also, a local problem may be helped by needling a point above or below it on its Channel. For example GB34 in hip, flank or lateral, thoracic pain; TH05 in elbow, shoulder and side of neck pain; BL40 or 60 in lumbar pain; SP04 in genital pain etc.
A variation of this "Law" is that pain or other disorders at one end of a Channel may be treated by points at the opposite end of the Channel. Examples are: GV20 in haemorrhoids, tenesmus or rectal prolapse; GV26 in low back pain; KI01 in cerebral vascular accident, apoplexy; LI04 in rhinitis, sinusitis, toothache of lower jaw; ST44 in toothache of upper jaw or temporal headache; BL67 or GB37 in eye pain; LU01, HT01 or PC01 in pain in the palm of the hand; TH23, LI20 or SI19 in pain in the dorsum of the hand; SI03, 04 or 05 in tinnitus aurium; LI04, TH05 or SI03 in neck pain.
A Beijing text (9) advises that needles or moxa should not be applied to a wound, an ulcer or scar. The nearest local points should be used instead. This is at variance with two well established techniques: the treatment varicose leg ulcers (in Section 2 above) and the treatment of scar tissue in the paper on "Techniques of stimulation of the AP points").
6. POINTS ON RELATED CHANNELS
The Phase-Mate Channels (Husband-Wife pairs, or Linked Pairs in the same Phase) are: LU-LI; ST-SP; HT-SI; BL-KI; PC-TH; GB-LV. One member of each pair influences the other. Disease along one member of a pair or of the main organ of a pair may be helped by points on the other member of the pair. For example, gastric upsets or pain along the ST Channel may be helped by needling points on the SP Channel. LI points influence LU disorders. LV points are used in GB disorders (see below).
Also, points on nearby (anatomically related) Channels (for example SP, KI, LV in the leg and thigh area; TH, LI, SI on the forearm etc) influence pain etc in the area. Example, pain along LI Channel in the forearm should be helped by local or distal points TH or SI Channels.
7. MASTER POINTS
In Classic AP the Five Phase Points (60 points in total) are very important but these are often ignored in western and modern Chinese AP. They are discussed elsewhere, as are the Master Points of AP.
The most important of the Master Points for therapy are the Shu-Back Association points, Mu-Front Alarm points, Yuan-Source, Luo-Passage and Xi-Cleft points. Whether or not these points are sensitive when their respective organs are upset), these points often are used in therapy.
Combinations of Shu and Mu Points are prescribed frequently when an organ (or its functions/correspondences) is abnormal:
Shu and Mu
BL13 and LU01 in disorders of the Lung
BL25 and ST25 in disorders of the Colon
BL21 and CV12 in disorders of the Stomach
BL20 and LV13 in disorders of the Spleen-pancreas
BL15 and CV14 in disorders of the Heart
BL27 and CV04 in disorders of the Small Intestine
BL28 and CV03 in disorders of the Bladder
BL23 and GB25 in disorders of the Kidney
BL14 and CV17 in disorders of the Pericardium, Circulation-Sex
BL22 and CV05 in disorders of the Triple Heater
BL19 and GB24 in disorders of the Gallbladder
BL18 and LV14 in disorders of the Liver
Combinations of Yuan-Source and Luo-Passage points. In disease of an organ or its Channel, the Yuan point of the affected Channel is used with the Luo point of its Phase-Mate Channel, for example in LU disorders (or disorders of the LU Channel), LU09 (Yuan of LU) and LI06 (Luo of LI) could he used:
affected Yuan and Luo of Mate
in LU disorders: LU09 and LI06
in LI disorders: LI04 and LU07
in ST disorders: ST42 and SP04
in SP disorders: SP03 and ST40
in HT disorders: HT07 and SI07
in SI disorders: SI04 and HT05
in BL disorders: BL64 and KI04
in KI disorders: KI03 and BL58
in PC disorders: PC07 and TH05
in TH disorders: TH04 and PC06
in GB disorders: GB40 and LV05
in LV disorders: LV03 and GB37
The Xi-Cleft points are indicated mainly in acute diseases of their respective Channels or organs. In haemoptysis: LU06 (Xi of LU); in acute colitis: LI07 (Xi of LI); in epigastric pain: ST34 (Xi of ST); in acute lower abdominal pain at menstruation: SP08 (Xi of SP).
Various combinations of Master Points are possible. For example, in liver disease, or in problems of the eyes or nails (which are controlled by LV), the LV Shu point (BL18, KanShu), the LV Mu point (LV14, ChiMen), the LV Yuan point (LV03, TaiChung) and the LV Xi-Cleft point (LV06 ChungTo) might be combined. In liver and gallbladder disease (or in problems controlled by LV and GB Channels), the Luo points LV05 (LiKou) and GB37 (KuangMing) might be combined with the Mu, Shu and/or Xi-Cleft points for liver and gallbladder (LV14, GB24; BL18, BL19; LV06, GB36).
8. COMBINATION OF LOCAL AND DISTANT POINTS
This is one of the most common methods of choosing points. Examples are:
Face and cheek disorders: local points (ST04,06) plus distant points on Channels to the area (e.g.) LI04, ST44.
Eye disease: BL01; ST01 (local) plus SI06; GB37 (distant).
Ear disease: GB02; SI19; TH17 (local) plus SI03, GB43.
Hip arthritis: GB30 (local) plus GB34 (distant).
Other examples are shown in Table 1 (below).
The "Adjacent" point is another type of point, recommended in recent Chinese texts. This is a powerful point, located 1-20 tsun from the local disorder or problem area. Examples are, GB20 for head and eye; GV20 for forehead; GB25 for lower dorsal area and lumbar area; LV13 in gastric pain. Other examples are given in Table 1 (below).
For best results, "Adjacent" points usually are combined with local and distant points as in Table 1. Example: acute gastritis with gastric pain: ST36; PC06 (remote points on the leg and arm) plus CV12 (local point plus Mu point) plus LV13 ("Adjacent point" and Mu of SP).
9. SELECTION OF POINTS ACCORDING TO SYMPTOMS
Symptomatic points: Certain points are known to be highly effective for common symptoms, such as vomiting, nausea, fever etc. In treating a clinical syndrome, points are chosen for the main problem and others may be added for the symptoms. For example, in gastritis: CV12 and ST36 might be chosen as the main points. If symptoms of nausea and fever were also present, points PC06 and GV14 might be added. The Beijing text (2) lists the following points for the common symptoms:
Cough; CV22; LU07; SP06
Diarrhoea: ST25,36; SP04; CV06
Difficulty swallowing: CV22,23; PC06
Dreams, nightmares: BL15; HT07; LV03
Excess mucus, cough: ST40.
Excessive-perspiration: HT06; KI07
Fever: LI04,11; GV14.
Hiccough, diaphragmatic spasm: BL17; ST36
Insomnia: HT07; SP06; KI03; CV24.
Nausea, vomiting: PC06; ST36.
Night sweats: SI03; HT06; Z 01
Pain in the cardiac area: PC06; CV17
Palpitation: PC06,04
Salivation: ST04; CV24,23
Shock: GV26; CV08,04; PC06,09
Other examples of points specific for symptoms are:
GB34 in acute, traumatic or muscular pain. (This is the pain point par excellence. It is usually combined with one of two local points for the affected area).
ST36 in upper abdominal disorders;
SP06 in lower abdominal disorders;
GV26; KI01 in anaesthetic emergencies (collapse, apnoea, cardiac arrest);
PC06 in disorders of the heart, lungs, thorax;
Earpoint Lung in relieving the symptoms of narcotic or alcohol withdrawal.
10. SELECTION OF POINTS ACCORDING TO NERVE SUPPLY
For diseases in any region (head, neck, limbs, internal organs), one may select points from areas supplied by the same spinal nerves, nerve plexus or nerve trunks as supply the problem area. Often, direct needling of the nerve trunk or plexus is used. In this respect, the paravertebral BL points and the paravertebral X 35 (HuaToChiaChi) points are especially useful for many conditions which do not appear (on casual examination to have anything to do with the back. This may be the explanation for the success of chiropractic and other manipulative systems which concentrate on spinal massage and pressure manipulation. These systems would concentrate on the same areas as the BL and X 35 paravertebral points.
11. SELECTION OF FORE AND AFT POINTS
In local disorders, such as knee pain, arm trauma etc, a combination of Fore and Aft points (in front of and behind) are used. These are almost always local points. Examples are: Knee pain: L 16 (HsiYen) and BL40; Forearm pain: PC06 and TH05. The Mu/Shu combination is also an example.
12. EARPOINTS
Sensitive earpoints, plus other earpoints known to be related to the affected areas or functions are used in Ear AP. The system is highly effective in man but needs much more development before it can be recommended for routine use in animals.