Introduction

One of the most uncomfortable moments for many practitioners is when the patient asks the simple, well-intentioned, and reasonable question: “How does acupuncture work?” There are many ways to proceed, but this is not necessarily an easily answered inquiry.

Over the course of 40 years of clinical practice, specializing in acupuncture sports medicine, I have developed a framework for responding to this question, and ones similar in nature. It involves integrating traditional acupuncture with western anatomy, modern physiology, and the principles of orthopedic medicine.

The question is much more easily addressed with this response: “It depends on which point or points we use in the treatment”. I then introduce the patient to the concept of “anatomically significant points”. I explain that each acupuncture point is located in specific tissues of the body that tend to have predictable clinical effects on both structure and function. Certainly this explanation in western anatomy is the basis for a much more easily understood discussion. As we all know, attempting to explain the science of the jing-luo pathways is not always easy and clear.

Discussion

Emphasis on anatomically significant points of the musculoskeletal system opens up a whole new and interesting conversation. Used to treat injury and pain, as well as to harmonize the biomechanics and movement patterns of the body, these are the “access points” in orthopedic and sports acupuncture. Each has some sort of anatomical individuality, such as being located at a muscle-tendon junction or in the region of a major ligament. More examples will be covered below, but for the purpose of this article, these points are based upon surface anatomy. They are structures that we can palpate, muscle test, distract or compress. We are not using the language of neural pathways, reflex arcs, or points that in some studies alter neurotransmitters and other humeral agents. It is not that these physiological responses are insignificant; they just are not always an easy explanation in the clinic room.

We are assuming that many of the traditional acupuncture points have anatomically significant features, giving them a unique set of actions and indications. We don’t know every point, and what its anatomical and physiological characteristics are. With some, we may speculate, and with others, we may make wrong assumptions. Obviously more research is needed. That will all come in time, as acupuncture continues its inclusion into the western medical community.

Examples of Points on the Meridians of the Body:

Points in the belly of the muscle

Bladder 57 Chengshan            

In the belly of the gastrocnemius and soleus muscle group

Bladder 37 Yinmen                 

In the belly of hamstring muscle group

The hamstring, showing the motor points (diamonds) and trigger points (Xs) in the region of Bladder 37.

Points at the tendinous attachment to bone

Bladder 36 Chengfu                

At the superior hamstring tendon attachment to the ischium

Large Intestine 15 Jianyu        

At the supraspinatous tendon attachment to the humerus along with the other muscles of the rotator cuff.

Points at a Muscle-Tendon Junction

Large Intestine 16 Jugu           

At the muscle-tendon junction of the supraspinatous

Large Intestine 10 Shousanli    

At the region of the muscle-tendon junction of the wrist extensors

Motor Points

Small Intestine 12 Bingfeng     

In the region of the motor point of the supraspinatous muscle

Small Intestine 12, located in the belly of the supraspinatous, is the motor point for the muscle.

Trigger Points

Small Intestine 11 Tianzong     

Located in the region of the muscle belly of the infraspinatous, at the common site of multiple trigger points

Points at the “Opening” of a Joint Space

Liver 8 Ququan                      

At the medial joint space of the knee

Points at or Along the Tendon and Tendon Sheath

Bladder 59 Fuyang                 

In the region of the tendon sheath of the achilles

Points Located at or Adjacent to Ligamentous Tissue

Liver 8 Ququan                      

At or just posterior to the medical collateral ligament of the knee

Points Located at Significant Neurological Sites (based upon the anatomical location of the nerve)

Gall Bladder 30 Huantiao

In the region of the gluteus maximus, at or adjacent to the sciatic nerve in the deeper tissues

Bladder 37 Yinmen

In the region of the belly of the hamstring muscle, at or adjacent to the sciatic nerve and its branches, in the deeper tissues

Points Located at Significant Neurological Sites (based upon the course of the nerve as it affects adjacent, distal, or proximal tissues)

Small Intestine 9 Jianzhen

In the region of the posterior shoulder, where a branch of the axillary nerve continues to the posterior shoulder capsule.

Points Located at Significant Neuro-vascular Sites (where the course of the nerve, artery, and/or vein has it affects adjacent, distal, or proximal tissues)

Kidney 7 Fuliu

In the region of the posterior tibial nerve, artery, and vein, superior to structures in the heel and plantar fascia

Examples of Extraordinary Points, as Well as Points and Zones not Defined in the Texts:

Jiankua (posterior to Gall Bladder 29 Juliao) N-LE-55

At the muscle belly or the muscle-tendon junction of the gluteus medius, halfway between the crest of the ilium and the greater trochanter.

Large Intestine 15.5

Halfway between LI 15 Jianyu and LI 16 Jugu, directly over the acromial-clavicular joint space and the acromial-clavicular ligament