FINAL SELECTION OF POINTSS
In the last two sections, we saw that points can be selected from therapeutic indices (Cookbook Approach) or by reference to the Laws of AP. (There are other Laws not discussed in this seminar). Ideally one should keep the number of points used in any one session to a minimum. In practice, however, western acupuncturists may use up to 10 or often 20 points in certain cases. Usually, the number would be <10; Master acupuncturists usually use <5 points. The ultimate aim of the Master is to cure with only 1 needle: few western-trained practitioners attain that standard.
There is no hard and fast rule as to the choice of points. Various combinations are possible but all combinations use the Sensitive (AhShi, Trigger etc) Points, when these are present. Examples would be:
ORGAN DISEASES:
Sensitive Points (if present) + Mu + Shu points + points for symptoms
(or) Sensitive points + Yuan + Luo + Xi + points for symptoms
(or) Sensitive points + Earpoints
(or) Sensitive points + Local points + Distant points on the affected Channel
(or) many other combinations.
LOCAL DISORDERS (say elbow pain):
Sensitive points (if present) + Local points + Distant points on affected and related Channels
(or) Sensitive Points + Earpoints for Elbow + Earpoint ShenMen
(or) Sensitive Points + TianYing point + Fore and Aft points
(or) other combinations.
As mentioned earlier, the Cookbook approach, especially when it is based on a comprehensive (cumulative) therapeutic index, may suggest dozens of points in specific conditions. One way to make a final selection is to use only those points which are most frequently recommended and to ensure that two or more of the AP Laws mentioned above are included in making that selection. An example of this method is given below.
Example: In my files, based on a large number of textbooks and other sources, the following points are recommended for the treatment of elbow pain, strain, trauma, arthritis, rheumatism, etc. The various authors are coded (1) to (22). For the purpose of this exercise, only the Channel points are noted.
Author Points Recommended as Effective
1 LU05,06; LI08,11,12,13,14,15; HT03; SI07,08,11; PC03; TH05,15; GB21,34; AhShi
2 LI11; HT03
3 LI10,11; HT03; SI09; BL10,20,23,37; GV04,12,14; LI11; TH05
5 LU05; LI11; TH05;
6 LU05; LI08,11,12,13; SI04,07,11; PC04
7 LU05; LI01,04,11; PC03; TH05,10; AhShi
8 LI11
9 LU05,06; LI08,12,13; SI04,07,11; PC03; TH01
10 LI10,11; BL40
11 LI10,11; SP04; HT04; SI04; PC06; TH01,03,05
12 LU05,07; LI04,06,11; HT01; SI08; PC03; TH10
13 LI04,10,11,12; HT03; TH05,10;
14 LI11,12; HT04; SI04; TH03,05,10; GB34; AhShi
15 LI02,04,05,10,11,13; SI04,08,10,11,12,13,14; BL42,43,44,45; TH04,06,13,14,16; AhShi
16 LI11; GB34; AhShi
17 LU05; LI04,11,14,15; HT03; SI03,06,07,08; TH05,15; GV14; AhShi
18 LI11; TH10
19 LI02,03,04,10,11; TH05; AhShi
20 LI10,11; HT03; GB21
21 LI11; AhShi
22 LU05; LI11; TH05; AhShi
Ranking these points in order of frequency, we find that in 22 text books, LI11 was listed 21 times. Then followed: TH05; LU05; LI10; AhShi points (in local area, shoulder area and neck) 8-9 times; LI03,04,12; HT03; SI04,07,08,11; PC03; TH10 (4-6 times); LU06; LI02,08,14,15; TH01,03,15; GB21,34; GV14 (2-3 times), Mentioned only once were: LU07; LI01,03,05,06; SP04; HT04; SI03,06,09,10,11,12,13,14; BL10,20,23,37,40,42,43,44,45; PC01,04,06; TH04,06,13,14,16; GV04,12.
Looking through these data, we can select the following points as those most frequently recommended:
LI11,10; TH05; LU05; AhShi points. Let us call these the "Primary Points". Further down the list (frequency 4-6/22) we have LI03,04,12; HT03; SI04,07,08,11; PC03; TH10. Let us call these the "Secondary Points". Still further down the list (frequency 2-3/22), we have LU06; LI02,08,14,15; TH01,03,15; GB21,34; GV14. Let us call these the "Tertiary Points". Other points (listed above) are recommended by single authors but for the purpose of the exercise they are ignored.
I would regard the Primary Points as the most important from which to choose the main points. Local and distant points would be chosen from the primary, secondary and (occasionally) tertiary points (or from other sources of information).
In the final prescription for elbow pain, sprain, arthritis, rheumatism etc, we could select the points as follows:
MAIN POINTS (all cases): LI11; TH05 and AhShi points. LOCAL POINTS (depending on the site of pain) from: LU05; LI10,12; HT03; SI09; PC03; TH10. For example, for pain along the biceps tendon: PC03 or LU05 or HT03 would be added to the main points.
DISTANT POINTS (depending on the site of pain) from: LU06; LI02,03,04,08,14,15; SI04,07,11; TH01,03,15; GB21,34; GV14. For example, in pain of the olecranon, distant points (TH03 or SI07 or LI04) could be added to the main points for elbow (LI11; TH05; AhShi) and local points near the olecranon (TH10 or SI08 and LI12).
This approach to the prescription would fulfil at least 3 of the Laws of choosing points and would also choose the most frequently recommended points for the condition. It should be a successful prescription for routine use and would be expected to give better results than if the Cookbook approach alone was used.
The greatest weakness of Cookbook AP is that it is statistical rather than individual therapy. The "best AP" is to adapt the Cookbook to individual cases and to fulfil at least 2 of the LAWS on the choice of points. At the same time, one should also try to see the whole case (not just the elbow pain) and to treat the patient as an integrated individual.
ALTERNATION OF POINTSS
In generalised or systemic conditions, points are often used bilaterally. Thus, if 20 points appeared in the primary and secondary lists, one would have to needle 40 points if all were used!
To limit needles to 6-12 per session, points may be alternated between sessions. For example, primary points in the prescription for diarrhoea are: ST25,36,37; CV04,06,12; SP04,06,09; BL20,25; LV13. One could alternate the points as follows: (bi = bilateral):
Diarrhoea: Session 1: ST25 bi (Local and LI Shu point); CV04 (local and SI Shu point) SP06 bi (symptom point and used in low abdominal disorders); BL20 bi (SP Shu, frequently recommended in diarrhoea). Total 7 needles.
Session 2: ST36 bi (symptom point ); CV06 (Local and in an appropriate neural segment); CV12 (ST Shu; ST is often upset in diarrhoea); SP04 bi (distant point on SP Channel, which traverses affected area and is also appropriate for the symptom); BL25 bi (LI Shu). Total 6 needles.
Session 3: ST37 bi (symptom point); CV04 (SI Mu and local point); SP09 bi (distant point on an appropriate Channel); LV13 bi (SP Mu and on the appropriate Channel). Total 7 needles.
These combinations reduce the number of needles to 7 or 8 per session and meet the major requirements for choosing points. They should be successful. In acute diarrhoea, a response is usually evident after one or two sessions over a 24 hour period. Further sessions are seldom required but may be given over the following days to ensure that the symptoms do not recur.
POINT SELECTION BY PULSEE
In classic human AP, the Laws listed above are used in choosing points. However, the Five Phase Points are said to be very important also. Their choice in each case is based on (a) the symptom picture (which may indicate imbalances between the Phases and within one or more Phases) and (b) the CHINESE PULSE DIAGNOSIS. In Western AP the CHINESE PULSE method is largely ignored, mainly because of lack of expertise. Modern texts from China, Taiwan and Hongkong also ignore it, or give it very brief discussion. Furthermore, high therapeutic success rates are reported by physicians who ignore the Pulse system. However, in skilled hands, Pulse Diagnosis can be extraordinarily accurate but I believe it to be a psychic rather than a physical, objectively demonstrable phenomenon. Those who wish to study Pulse Diagnosis will find details in Wu Wei Ping, Mary Austin or Nguyen van Nghi (see references).
In vet AP, even if one wished to use the PULSE system, this would be impossible to transpose directly because of anatomical differences in the arteries and also because the Five Phase Points are located on those parts of the limbs which show the greatest anatomical differences from Homo sapiens, with his/her five digits. (Some traditional vet texts, including Klide and Kung, report that the CHINESE PULSES may be taken in animals on the carotid or other accessible arteries but few of the vet colleagues whom I know use this system. Other psychic methods of Pulse assessment include taking a "surrogate pulse", possibly one's own or the client's or to use dowsing/divining method (pendulum etc). These methods are rarely used.
CONCLUSIONS
The choice of points in vet AP depends on which system (traditional or transpositional) is being followed. It also depends on one's depth of AP knowledge. Novices usually use the Cookbook Method of point selection but they should try to fulfil some of the Laws and to choose points which help the "whole patient", not just the more obvious symptoms.
In the transposition method a therapeutic index can be consulted in one or more human textbooks, or the student may make a personal cumulative therapeutic index from many sources and may rank the points by citation frequency. This will enable him/her to draw up lists of primary, secondary and tertiary points. From these lists one may select 1 to 12 (occasionally more than 12) points but one should ensure at least 2 of the following Laws are fulfilled in each point combination used:
1. Sensitive points (AhShi, Trigger Points etc). Be careful to examine for sensitive areas on surgical or other scars. If these are related to symptoms, treat the scar. (See the paper on "Methods of stimulating the AP points").
2. TianYing points (focus of a swelling etc).
3. Choose local points along affected Channels or nearby Channels.
4. Choose points along the affected Channels choose points on related Channels
5. Distant points on affected Channels
6. Points on related Channels
7. Some of the MASTER POINTS, especially Mu, Shu, Yuan, Luo and Xi points. Mu and Shu are often combined, as are the Yuan for the affected Channels and the Luo for the Phase-Mate Channel.
8. Combination of local and distant points on relevant Channels
9. Points according to the symptoms
10. Points according to the innervation
11. Fore and Aft points
12. Earpoints
In vet AP, few vets are expert enough to use the classical method of balancing the Channels by using the Five Phase Theory and the 66 Command Points. French colleagues are probably the most expert in this area, as they study the classic concepts in very great depth. Although vets in USA and other countries learn this system, few of them study it deep enough to be really familiar with it. Do not let this deter you!
One old Law of AP states that points on one side of the body may be used to treat problems on the opposite side. This is one aspect of the "Law of Opposites". However, it is more usual to use points on the same side as a local problem unless the problem is in the midline (or near it), in which case points are needled bilaterally.
In certain cases, contralateral points may be used. For example, in motor paralysis, Motor Points (on the Scalp) are needled on the side opposite to the paralysis. In toothache, left LI04 may be used to treat pain in the right jaw (although, more commonly, ipsilateral LI04 is used).
It may be desirable to alternate the points between different sessions if the student is unhappy with his first selection or if the results are not satisfactory.
In other cases of paralysis, contralateral body points (on the "good" limb) are used as well as ipsilateral points. In the Appendix to this paper a list of AP prescriptions is given.
Vets using the traditional AP system may use the therapeutic index in a suitable textbook or may construct their own index from many sources. However, there is a major difficulty of integration of various sources because of differences in point location, nomenclature and alphanumeric coding between various texts and even within texts.
FURTHER READINGG
1 Veterinary AP (1977). by Klide, A.M. and Kung, S.H. University of Pennsylvania Press, 297 pp.
2 Outline of Chinese AP (1975). by Academy of Traditional Medicine. Foreign Languages Press, Beijing, 305 pp.
3 Newest illustrations of the AP points (1973). by Medicine & Health Publishing Co., Hong Kong, 100 pp.
4 Basic AP: a scientific interpretation and application (1977). by Chinese AP Research Foundation. C.A.R.F. Box 84-223 Taipei, Taiwan, 311 pp.
5 Barefoot Doctor's Manual (1977). American translation of official Chinese Manual by U.S. Dept. Health & Education. Running Press, Philadelphia, 948 pp.
6 Chinese Acupuncture (1973). by Wu Wei Ping. Health Science Press, Wellingborough, Northants, U.K., 181 pp.
7 Acupuncture therapy (1972). by Mary Austin. Turnstone Books, London, 290 pp.
8 Pathogenic et Pathologic Energetiques en Medicine chinoise. (1971). by Nguyen van Nghi. Imprimerie Ecole Technique Don Bosco, 78 Rue Stanislas Torrents, 13 Marseille, France, 699 pp.
9 Essentials of Chinese AP (1980). by Beijing, Shanghai and Nanking Colleges of Traditional Medicine, with the Acad. Trad. Chinese Med. Foreign Languages Press, Beijing, 432 pp. Reissued 1993: Essentials of Chinese AP. (Coll. TCM, Beijing, Shanghai, Nanking) Foreign Languages Press, Beijing 432pp.
Table 1
Examples of point selection using Local, Adjacent and Distant points.
Diseased Local points Adjacent Distant points on
area points Thoracic limb Pelvic limb
Head GV20,24; ST08 GB20 LI04; LU07 BL40; ST36
Face/forehead ST08; GV23 GV20; BL10 SI03,09 ST43; BL60
Temple GB08; ST08; Z 09 GB20 TH05; LI04 GB43
Eye BL01; TH23; ST01 GV23; GB20 SI06; LI04 GB37
Ear GB02; TH17; SI19 SI17 TH03 GB41
Nose LI19,20 BL07 LI04,11 ST45
Mouth/cheek/jaw ST04,06 SI17 LI04 ST44
Throat/front of neck CV22,23 GV15 LU11; LI04,11 KI06
Neck and nape GV16; GB20; BL10 BL11 SI03 BL66
Shoulder area SI11; GB21; LI15 LI14 LI11; TH05 BL59; ST38
Upper arm LI11 TH05; LI15
Forearm TH05; LI11 SI03; LI04
Chest area CV17; AhShi T1-T7 ST19 PC06; LU05 GB34; ST40
Ribs/axillary area SP17; LV14 BL18 TH06 GB34
Dorsum, upper GV14; BL43 BL10 SI03 BL60
Dorsum, lower BL18,21 GB25 SI03 BL40
Lumbar area BL18,23 GB25 SI06 BL40
Lumbosacral area GV04; BL25 GB30 SI06 BL40
Hypochondrium GB26,27 LV14 PC06 GB38
Abdomen, upper CV12; AhShi T9-L2 CV16 PC06 ST36
Abdomen, lower CV04; AhShi L2-S4 ST25 TH06 SP06
Rectum GV01; BL35 BL30 BL57
Inguinal area GB26,27 LV14 LV03; GB38
Hip/thigh area GB30,31; BL36 GV03 GB34
Knee area ST36; L 16 GB31 GB39
Ankle area KI03; BL60; ST41; BL59 ST44
GB40