Currently, each acupuncturist in North America may locate the same acupuncture points differently, depending on how and where they have been trained. The issue of these point discrepancies may be somewhat of a surprise not only for consumers but also for many acupuncturists and students. The “acupuncture point”, which is supposed to be the most fundamental aspect of this ancient medical treatment, has not been standardized.
Many people have blindly assumed that acupuncture point location is uniform. Despite this assumption, there has, in fact, been a substantial discrepancy among schools in China, Korea and Japan regarding the locations of some acupuncture points. Even for some of the most famous and commonly used points, (such as the ST36 point – a point located below the knee), location differences existed from institution to institution. Although it has not been widely reported here in Canada, it was big public news in Japan and some other Asian countries
Good news however, is that in late 2006, under the auspices of the World Health Organization (WHO), a group of advisors from China, Japan, South Korea, and other countries met in Tsukuba, Japan, and agreed on an internationally standardized set of 361 acupuncture points. It was a historic moment in the acupuncture community. A final version of the book, WHO Standard Acupuncture Point Locations, was just released in May this year.
How will the standardization affect the clinical practice of acupuncture?
It is expected that many accredited acupuncture education programs around the world will soon adopt the new international guideline. However, there will be virtually no impact on the way most acupuncturists practice. Here are the reasons why:
A discussion about standardization of acupuncture point locations under the WHO had begun in 2003. During a series of consequent meetings over the next few years, the consensus was made through discussion and negotiations based on traditions in each country and interpretation of various ancient texts. It was not based on research of clinical efficacy using different point locations.
In reality, the exact location of an “acupuncture point” differs from patient to patient; therefore, during the actual treatment, experienced acupuncturists consider the text book location only as a rough guide. They further determine the exact location based on various factors including information detected through practitioner’s fingers – subtle differences in skin texture or underneath tissues, etc. The procedure requires highly sensitive hands, earned through training and years of clinical experience (This is the reason why many renowned acupuncturists in Japan insist that students train their hands first through massage therapy training). It has been generally understood that acupuncture points are typically within a few millimeters in diameter. Stimulating outside of the parameter potentially has no or much less clinical effect.
So, why is standardization important?
Standardization is especially important in the educational paradigm. With the internationally agreed standard, training can be done in a more systematic manner and basic minimum knowledge of students can be tested with the same guidelines among schools. The international standard can also be useful for research projects and communication among peers. It is certainly an important landmark project for furthering the credibility of acupuncture.
Acupuncture beyond acupuncture points
It should be mentioned that the WHO guideline only states “2 dimensional” locations and does not specify how deep the acupuncture needle should be inserted. Research studies have demonstrated that an acupuncture needle inserted in exactly the same location produced different physiological reactions (opposite response in some cases – this is part of the basis of the multi dimensional meridian structure theory), depending on how the needle was inserted and stimulated, and whether it was superficially into skin or deeply into muscle. Recent studies also indicated that efficacy of acupuncture is also influenced by various other factors including respiration and posture at the time of needle stimulation.
Standardizing the location of acupuncture points took numerous hours of tireless work by many experts; but it has been done (at least on paper). Standardizing the acupuncture procedure is a different story however. Acupuncture is a complex form of medical therapy involving both science and art.
Points of this article
• Exact location of an acupuncture point differs from person to person.
• Finding effective acupuncture points requires knowledge, skills, and experience.
• Acupuncture is not simply inserting a needle into the location specified in the textbook.
Tim H. Tanaka, Ph.D. is director of The Pacific Wellness Institute and visiting research fellow at School of Health Sciences, Tsukuba University of Technology.