Chapter 4   Introduction to Acupuncture

1.  History of Acupuncture & Moxibustion
Before the creation of Chinese characters and at least 3000 years ago; Available data on the history of TCM showed that acupuncture and moxibustion originated at different times, and moxibustion probably came before acupuncture.

2.  Origin and Development of Acupuncture and Moxibustion
1)  Bian Stones: new Stone Age to warring states period (10,000-475 B.C.)
2)  Yin-Yang Theory (475 B.C.)
3)  Warring states times (475-221 B.C.): Huangdi’s Internal Classic
4)  Eastern Han dynasty to three-Kingdom period (25-265 A.D.): Dr. Hua, Tuo, and Dr. Zhang, Zhongjing (‘Treatise on febrile and miscellaneous disease’)
5)  Jin dynasty (265-581): Compiled ‘Systematic Classic of Acupuncture and Moxibustion’
6)  Tang dynasty (618-907): Dr. Sun, Simiao (‘Prescriptions worth a Thousand Gold for Emergencies’); Dr. Wang, Tao (‘Medical Secrets of an Official’)
7)  Song and Yuan dynasty (960-1368): Dr. Wang, Wei-yi (‘Illustrated Manual on the points for Acupuncture and Moxibustion on a New Bronze Figure’); Dr. Hua, Shou (‘Exposition of the Fourteen Channels’)
8)  Ming dynasty (1368-1644): Acupuncture and moxibustion were at their peak.
9)  Qing dynasty (1644-1840): started declining
10)  Acupuncture and moxibustion in China and World

3.  Basic Concepts of Acupuncture and Moxibustion (Classification of Channels & Collaterals)
1)  JING LUO (Meridians/channels and Collaterals): Meridians (Jing); Collaterals (Luo)
A.  This system of meridians and Collaterals includes the twelve regular meridians, eight extra meridians, fifteen Collaterals, twelve divergent meridians, twelve muscle regions and twelve cutaneous regions.
B.  Transmission of needling sensation: Soreness, heaviness or numbness transmits along a certain route to distal areas.  “If an acupoint is accurately punctured, the needling sensation will transmit just as people travel along streets and lanes”
2)  Nomenclature of Twelve regular channels is based on three factors.
LUNG----------------------------Hand –Taiyin (Greater yin)
PERICARDIUM ---------------Hand – Jueyin (Ending or Absolute yin)
HEART---------------------------Hand – Shaoyin (Lesser or Young yin)
LARGE INTESTINE-----------Hand – Yangming (Yang Brightness)
SANJIAO------------------------ Hand – Shaoyang (Lesser yang)
SMALL INTESTINE-----------Hand – Taiyang (Greater yang)

SPLEEN---------------------------Foot – Taiyin (Greater yin)
LIVER-----------------------------Foot – Jueyin (Absolute yin)
KIDNEY--------------------------Foot – Shaoyin (Lesser yin)
STOMACH-----------------------Foot – Yangming (Yang Brightness)
GALL BLADDER---------------Foot – Shaoyang (Lesser yang)
URINARY BLADER------------Foot – Taiyang (Greater yang)
3)  Eight Extra Meridians
Du meridian (Governing or Governor)
Ren meridian (Conception)
Chong meridian (Vital Pass)
Dai meridian (Girdle)
Yang Qiao (Yang Heel)
Yin Qiao (Yin Heel)
Yang Wei (Yang Connecting)
Yin Wei (Yin Connecting) 
• Eight extra meridians have important links with regular channels.
• They supervise functions of meridians.
• They drain and stores blood from main meridians.  They drain when there is excess and supply when deficient.
• Clinically used for the gynecological problems.
4)  Twelve Divergent meridians
They go out from the regular meridians and are named after them.  Organs of yin and yang regular meridians are connected by divergent meridians. They run deep in the body entering the thoracic and abdominal cavities.
Yang divergent meridians enter organs in the abdomen or thoracic cavity from their point of origin on limbs. They resurface on the neck where they join yang channels. Yin meridians go to yang divergents and finally join yang regular meridian.

• Strengthen yin-yang relationship.  They connect with organs as well as yin-yang meridians.
• Divergent meridians distribute the body’s Qi to the head.
5)  Fifteen Collaterals:
The fifteen collaterals are the branches arising from the regular meridians and also named after the regular meridians.  Du, Ren, and major Spleen have collaterals.
These branches are distributed superficially over the body.
• They connect yin and yang meridians (Divergent connect organs as they are deep).
• Distribute Qi and blood to the superficial layer of the body, like skin.
6)  Twelve Muscle regions
They are named after regular meridians and also according to hand, foot, yin, or yang. Muscle regions originate from the extremities and ascend to the head and the trunk, but do not reach the Zang-fu organs.
• They connect with muscles, tendons, and ligaments. They extend or flex joints.
• They are used to treat muscular problems such as Bi syndrome, contracture, stiffness, spasm, and muscular atrophy.
7)  Twelve Cutaneous regions
This is the part of the meridian system located in the superficial layers of the body. They connect with the superficial layer of the body, i.e., skin.
These are the sites through which Qi and blood of the meridian is transferred to the body surface.

4.  Cyclical Flow of Qi in Twelve Regular Meridians
Three yins of hand meridians circulate from the chest to hand.
Three yang meridians of hand run from the hand to head.
Three yin meridians of foot circulate from the foot to chest (abdomen).
Three yang meridians of foot run from the head to foot.

Zang organs (Yin meridian)     Fu organs (Yang meridians)
(Interior)        (Exterior)

 Lung (1)-------------------------- (2) Large Intestine

 Spleen (4)------------------------- (3) Stomach

 Heart (5)-------------------------- (6) Small Intestine

 Kidney (8)------------------------ (7) Bladder

 Pericardium (9)------------------- (10) Sanjiao

 Liver (12)--------------------------- (11) Gallbladder

5.  Functions of the Meridians and Collaterals
1)  Transporting Qi and blood and regulating Yin and Yang
2)  Resisting pathogens and reflecting symptoms and signs
3)  Transmitting needling sensation and regulating deficiency and excess conditions

6.  Outline of Distribution of the 14 Meridians
1)  Distribution in the extremities
In general, the medial aspect – Yin; Lateral aspect- Yang

Upper extremities:
a)  Anterior aspect from the radius to ulna. (Medial)
Anterior- Lung (Hand Taiyin)
Middle – Pericardium (Hand Jueyin)
Posterior- Heart (Hand Shaoyin)

b)  Posterior aspect from radius to ulna (Lateral)
Anterior- Large Intestine (Hand Yangming)
Middle- Sanjiao (Hand Shaoyang)
Posterior- Small Intestine (Hand Taiyang)

Lower Extremities:
a)  Medial aspect
Anterior- Spleen (Foot Taiyin)
Middle- Liver (Foot Jueyin)
Posterior- Kidney (Foot Shaoyin)

b)  Lateral aspect
Anterior- Stomach (Foot Yangming)
Middle- Gallbladder (Foot Shaoyang)
Posterior- Bladder (Foot Taiyang)

2)  Distribution in the body/trunk
On the front:
• Ren meridian is on the midline.
• Kidney is the first line lateral to the midline.
• Stomach corresponds to second line.
• Spleen meridian corresponds to the third line
On the back:
• Du meridian is on the midline.
• Bladder meridian is both the first and second lines lateral to the Du meridian.
3)  Distribution in the Head, Face, and Neck
• Stomach and Large Intestine are in the facial region.
• Sanjiao and Gallbladder in the lateral aspect of the head.
• Du meridian goes along the midline of the neck and the head.
• Bladder meridian runs on both sides of the midline in head and neck.

7.  Introduction to Acupoints
Nomenclature of Acupoints
Acupoints of the fourteen meridians have their definite locations and names, which have their own meaning.

a)  Names bearing analogy to water flow, mountains, and valleys.
Flow of Qi and blood were compared with flow of water.  Mountains and valleys represented prominence and depressions of tendons and bones.
E.g., GB 34-Yanglingquan (Yang mound spring)
LU9- Taiyuan (Great deep pool)

b)  Names bearing analogy to animals, plants, and utensils.
E.g., ST35- Dubi (Ox or calf nose)
LU10- Yuji (Fish border)
ST12- Quepen (Depression basin)

c)  Names bearing analogy to the architectural structure.
E.g., SI19- Tinggong (Hearing palace)
HT7- Shenmen (Spiritual gate)

d)  Names bearing analogy to astronomical phenomena.
E.g., DU23- Shangxing (Upper star)

e)  Points named according to anatomical terms.
E.g., REN 12- Zhongwan (Middle stomach)
ST31- Biguan (Thigh joint)

f)  Points named according their therapeutic properties.
E.g., UB13- Feishu (Lung point)
SP10- Xuehai (Sea of blood)

8.  The Classification of Acupoints
1)  Regular Acupoints
These are the points in twelve regular channels plus Du and Ren meridians. All the regular points can be used to treat disorders according to practical experience.
Nei Jin  160 points
Jin dynasty 349 points
Song dynasty 354 points
Ming dynasty 359 points
Qing dynasty 361 points

The number of the Acupoints in the 14 meridians respectively:
Lung   11
Large Intestine  20
Stomach  45
Spleen   21
Heart   9
Small Intestine  19
Urinary Bladder 67
Kidney   27
Pericardium  9
Sanjiao   23
Gallbladder  44
Liver   14
Du   28
Ren   24

Total   361 Acupoints

2)  Extra points
Extra points are experimental points with specific names and definite locations.  But they are not attributed to regular meridians.  They are effective in treatment of certain diseases and are scattered all over the body.  Some regular points were developed from the extra points.  They clinically supplement regular points.  They increase all the time.
3)  Ashi points
Ashi points are the tender spots or sensitive reflex points.  These sensitive points are present in certain diseases.  They are the primary method of point location without specific names or locations.  They represent early stage of acupoint evolution.  They have neither definite location nor name.
4)  Specific points
The specific points are among the acupoints of the 14 meridians. They have specific therapeutic properties and are grouped under special names.
a)  Five Shu points
Each of the twelve regular meridians has five specific points. These points are located below elbow or knee joint. They are as follows:
Jing = Well (Bubble); Ying = Spring (Gush); Shu = Stream (Flourish); Jing = River (Pouring abundantly); He = Sea (Confluence of river to sea);
Flow of Qi flourishes gradually from these points. They belong to five elements respectively. (Wood-Fire-Earth-Metal-Water-Wood)

Yang meridians      Yin meridians
Metal   Jing-well   Wood
Water   Ying-spring   Fire
Wood   Shu-stream   Earth
Fire    Jing-river   Metal
Earth   He-sea    Water

b)  Yuan-primary points
Each of the twelve regular meridians has a Yuan-primary point, which is located in the extremities near the wrist and ankle joints.  In Yin meridians it overlaps with Shu-stream points while Yang meridians have separate points.

c)  Luo-connecting points
Each of the14 meridians (12+Du and Ren) has a Luo connecting point to link its internal-external related meridians.  Spleen has an extra Luo point.  These points are used to treat meridians.  Luo points treat meridian problems of both its own meridian and its internal-external related meridian.

d)  Xi-cleft points
These are points where the Qi and Blood of meridian are deeply converged.  Each of the twelve regular meridians and four extra meridians have Xi-cleft points.   These are used to treat the acute disorders of the areas supplied by the meridian or pertaining Zang-fu organs.

e)  Back-shu points
Back shu points are located on the back.  They are the specific points where the Qi of the respective Zang-fu organ is infused.  In total, there are 24 back-shu points.   They are located on each side of vertebral column on the Bladder meridian.  They are located 1.5 cun lateral to the vertebral column.

f)  Front-mu points 
These are the points located on the front of the trunk.  These are the tender spots when pressure is applied to those specific points; it relieves the pain or the discomfort of the patient.  They correspond to the Zang-fu organs.

g)  Eight confluent points
It refers to the eight points on the extremities.  Through these points, the extra meridians can be activated.  At these points the regular meridian communicates with the extra meridians.  These points are used to treat the disorders of the eight extra meridians.

h)  Crossing or intersecting points
Crossing point is a point where two or more meridians intersect.  Briefly stated, these intersections expand the function of the point by allowing it to affect more than one meridian, e.g., Du14, SP6.

i)  Eight Hui-meeting (influential) points
These are the specific points which have particular effects in the treatment of disorders related to the Zang-fu organs, Qi, blood, tendon, pulse, vessels, bones, and marrow.  Each influential point overlaps other points.  They have systemic effects on a particular tissue or organ.

9.  Method of Locating Acupoints
The location of acupoints is very important as it affects the therapeutic results. At present, basically three methods are used for the location of acupoints.  They are as follows:

1)  Proportional body measurements
Body parts Starting and terminating points and bone measurements
Head 1) Anterior hairline--posterior hairline-----------------------12 cun
2) Yintang—anterior hairline------------------------------------3 cun
3) Dazhui—posterior hairline----------------------------------- 3 cun
4) Between two frontal angles along hairline------------------9 cun
5) Between the two mastoid processes------------------------- 9 cun
Chest and abdomen 1) Sternocostal angle—umbilicus center-----------------------8 cun
2) Umbilicus center---upper margin of pubic symphysis----5 cun
3) Between two nipples-------------------------------------------8 cun
4) Between two midlines of clavicles---------------------------8 cun
Back and waist 1) First thoracic vertebra—fourth sacral vertebra------21 verterbrae
2) Medial border of the scapula—posterior midline----3 cun
3) Lower angle of the scapula is about at the same level of the 7th thoracic vertebra
4) Iliac spine is about at the same level of the 4th lumbar vertebra
Upper limbs 1)   Anterior axillary fold—cubital transverse crease-------------9 cun
2)   Cubital transverse crease—wrist transverse crease---------12 cun
Lower limbs 1) Upper border of pubic symphysis---medial epicondyle of femur—18 cun
2) Lower margin of the medial condyle—tip of the medial ankle---13 cun
3) Tip of the medial ankle---sole------------------------------------------3 cun
4) Greater trochanter of femur—middle of knee----------------------19 cun
5) Buttock crease—popliteal crease-------------------------------------14 cun
6) Middle of knee—tip of the lateral ankle-----------------------------16 cun
7) Tip of the lateral ankle---sole-------------------------------------------3 cun

2)  Anatomical landmarks
Various anatomical landmarks on the body surface are the basis for locating points.  These landmarks fall in two categories.

a)  Fixed landmarks
Fixed landmarks are those that would not change with body movements.  They include hair, nails, nipple, umbilicus, and prominence and depression of bones.  Proportional measurements are based on the anatomical landmarks.  E.g., Ren8 in umbilicus.

b)  Moving landmarks
It refers to the landmarks that will appear only when a body part is kept in a certain position.  E.g., LI11 end of cubital crease; SI6 ulnar process when forearm rotated toward body.

3)  Finger Measurement
The length or the width of patient’s finger is taken as a standard for point location.  The following three methods are used in the clinic.

a)  Middle finger measurement
When patient’s middle finger is flexed, the distance between the two medial ends of the crease of the interphalangeal joints is taken as 1 cun.

b)  Thumb measurement 
The width of the interphalangeal joint of the patient’s thumb is taken as 1 cun.

c)  Four-finger measurement
The width of the four fingers (index, middle, ring, and little) close together at the level of the dorsal skin crease of the proximal interphalangeal joint of the middle finger is taken as 3 cun.