One of the things I have noticed in my scant 20 or so weeks of hands-on clinical practice is the great difficulty of accurately locating acupuncture points. At times the body seems an intolerably huge landscape – full of unfamiliar landmarks and confounding convolutions. Yes, at other times the complications diminish and it seems as easy as anything. I find the latter times become more frequent as I go along.
Along with a general increase in my confidence and ability comes a deep interest in REALLY learning the points and channels. Before clinic, acupuncture very obviously played second fiddle in my hierarchy of my interests in Chinese medicine. I have always recognized its power, but simply didn’t feel drawn to study or understand it that much.
Now, with my struggles in clinic, I find myself fascinated by each point and driven to learn more on multiple levels. I am also developing my non-intellectual skills, my ability to feel Qi, to palpate channels and to connect with the patient. I note this because most often when I relate my problems I have people telling me that I need to get out of my head and just “connect” with the energy of the patient. While I recognize the importance of that, it certainly isn’t the whole answer.
Before I talk about how I’ve been working with the points, I’d like to make one small note. I’ve divulged various study methods and tips before on Deepest Health. With the exception of a few suggestions, these have all been methods I’ve used. However, they were methods that I learned directly from others or developed after reading ideas in a book or on a blog. This is a great way to pick up new strategies, and I certainly will continue to use it. On the other hand, the methods I list below are different. They emerged organically to solve particular problems. What I mean is that in response to a particular experience, I desired some particular skill or understanding and worked out the best way to obtain it on my own.
This may seem to be a minor point, and I don’t want to hammer away at it. However, it definitely feels different. I feel more committed to consistently using these methods, and they seem to be more effective. Each new thing I learn inflames my desire to learn even more. A similar thing is happening to me regarding formulas, but the effect isn’t so dramatic since I’ve always been interested in understanding them. I expect clinical practice will create some new developments in that arena, however.
In essence, what I’ve been doing is simply making a list of all the points I use in a given week and then reviewing them in great detail. This is the bulk of my “method.” It has several parts, which I will describe in detail below. However, there are more subtle things that I’ve been doing in the treatment room. I don’t know if I’m quite ready to describe those pieces of the puzzle. One recent development was the return of very focused attention on sensing the layers of the body that the needle is passing through. This is something we learned in our first needling class, as one of our points Professors places a high importance on needling and manipulation in the various layers. I think being in clinic and having to manage so many things at once found me being a little neglectful in this realm – I’m glad I’ve remembered it now.
Anatomy : Descriptions, 2D, 3D, palpation and multiple sources
I’ve never been particularly interested in gross anatomy. In fact, this new revolution in my thinking has helped me to understand that I have an odd detachment from the physical nature of the body in general. Working with the anatomy has helped unravel that personal issue, yet another example of the many benefits of dedication to study. Anyway, we did take anatomy during our first year, but given my general reluctance described already and the fact that I was so enthralled with learning the cosmology and symbolism of Chinese medicine, I frankly didn’t pay much attention. I’ve used various sources to help deepen my understanding of anatomy.
Descriptions: Sometimes a word is worth a thousand pictures. While seeing what things look like on the body is very important, often it has been a stray description of a particular bony landmark in relation to a point that has really solidified its location for me. I use Deadman
as a primary source here.
2-D: Again, Deadman’s Manual of Acupuncture has lovely drawings – including the ones at the back of the book that show points by region of the body. I also use some simple illustrations by Worsley’s group, my Living Meridian Location Charts and some compilations of Chinese sources put together by NCNM Professor Jim Cleaver. Jim has also provided some schematic representations of body areas so its easy to get a feeling for the cun relationships among channels on the same part of the body. I just leaf through these sources at random seeking to really understand where the point is, in general, located.
3-D: I have an old version of Qpuncture that has 3D renditions of a needle in various commonly used acupuncture points. While some of the anatomical accuracy has been sacrificed, it is very helpful to see how the needle penetrates with reference to the anatomical markers we cannot see with the eye. I also subject my partner and daughter to infrequent channel palpation and point location (“Is this sensitive? What about this? This?”) which is often very helpful. Of course, while I’m studying the above sources, I palpate my own channels and feel the points on myself.
“Actions”, prescriptions and theory
The point location has been most bothersome for me, mostly because I’m obsessed with being sure that every needle has a real effect. That may seem to be a stupid statement. However, I’ve been needled by many interns and practitioners who don’t seem too interested in actually working with the POINTS – content just to needle anywhere on the body. I gather this from my perception of their lack of intention when needling, the obvious lack of accuracy based on where the needles end up as well as my conversations with them. I do believe that the “points” as they were laid out in ancient times are very special places on the human body that have powerful effects on the human being – I don’t think that “just anywhere” will do.
Despite my obsession with fully knowing where the points are, I haven’t lost sight of the importance of understanding “what they do.” I put “what they do” and “actions” in quotations for a reason. Acupuncture points are not like buttons on a machine. It’s not as if you press the red one and you get a cherry candy, blue one and you get a razzleberry one.
It’s not as if some little ghost in the machine stands behind the point ready to report your instructions via the CNS with exactness and machine-like one-to-one correspondence. If a person asks me for “a point for asthma,” I’m reluctant to report the points we all know to be commonly used in prescriptions for that Western defined condition. It isn’t that points don’t “do something” and it isn’t that I’m afraid to talk about certain points as unequivocally treating some particular pathological state, it’s just that the way we try to simplify things for easy consumption result in overly simplistic ideas about how Chinese medicine works.
I think about acupuncture points like areas where one can access a river. They come in big and large sizes, they have varying ranges of ease of access, some put you in at a furious current, others at gentle pools. The direction you’re heading when you put in at any given point makes a difference, as does your intention when you do so – will you paddle upstream or let the current carry you down? Are you fighting the flow or not? Are you dredging the channel a bit to allow greater flow in a given area? Are you moving boulders that have obstructed your path?
The river metaphor breaks down a bit when we drill down a little more. Each point has its particular characteristics based on its location on the channel, its symbolic power given the part of the body and its physical features as well as a whole range of correspondences that fit the channels and points and the human being in with the consistent patterning of the universe. Thus five elements, yin-yang, six divisions and all their permutations and combinations are peppered throughout the system in remarkably predictable and usable ways.
When we needle a patient, we are not pushing buttons, but mixing colors and flavors, textures and spirits in alchemically beautiful ways with the purpose of influencing the body in particular ways for the creation of health.
You know, no big deal.
All that being said, I’m not just going to abandon myself to studying nature and meditating as a way to understand what KINDS of mixtures are effective in what kinds of situations. I’m not comfortable with that, frankly. Instead, I look to the classics and the theories passed down by the ancients. I use Deadman and some sources given to me by my teachers to understand the Classical point prescriptions. I study closely the theory of the five elements and six conformations as well as point categories to fully comprehend the effect of a given point within a particular clinical context.
All of this is really helping my clinical confidence a great deal and I find that more often than not I am able to recall most of this information when I next encounter a particular point. Sweet! I’ve talked enough about this for now, but I would like to pose a couple of questions. Have you encountered the kinds of troubles I started out this article by describing? If so, how did you get past it? Do any of the methods or ideas above resonate with you? If so, how? If not, why not? I’d really like to hear about others’ experiences. Reply in the comments!
About Eric Grey
Hi - I'm the founder of Deepest Health. When I'm not writing here, you can find me reaching out to the Chinese Medicine community across the web and in my own backyard. I currently teach Chinese herbs at my alma mater, the National College of Natural Medicine. Additionally, I'm the founder of Watershed Community Wellness, a thriving local clinic in Southeast Portland in Oregon. No matter where I'm working, you'll find my focus on the Classical approach to Chinese medicine laced throughout everything I do.