July 9, 2015

Inside the mind of an acupuncturist: how do we choose the acupuncture points?

Our Washington DC acupuncture patients are a cerebral bunch. They get pain relief on the acupuncture table, but their minds want more: they want to know how we choose where to put the needles. Not an easy task, but we sum up our methodology for physical pain here. This article is dedicated to all of our curious patients out there.

What are channels or meridians?

Acupuncture is a highly effective therapy for pain relief, but how do we choose where to put the needles? Let’s start with “meridians”, or “channels” (we will use these two terms interchangeably here.) Traditional Chinese medicine has divided the body into 12 major anatomical sections called meridians or channels  Simply speaking, a meridian or channel refers to a grouping of certain blood vessels, nerves and muscles. Each of these meridians also includes associated acupuncture points (acupoints).

For visual simplicity, the graphic below represents the 12 major acupuncture meridians of the body as lines. The points along the lines are the acupoints associated with each meridian

How we choose acupuncture points - Washington DC acupuncture

The 12 major meridians of the body are named for the organ to which they connect, and are called:

Large IntestineStomachSmall IntestineBladderTriple BurnerGallbladder

How the acupuncturist selects points for pain relief in 3 steps

The acupuncture points that we use for pain relief are selected according to Chinese medical concepts of how different parts of the body are related to one another.  The process can be broken down into 3 steps.


Step 1: Identify the “sick” meridian

To treat any type of painful condition, we must first identify the precise location of the pain. Identifying the location of the pain will show us what meridian is being affected and needs to be focused on for treatment.

Once we’ve established where the pain is located, the acupuncturist can identify the affected meridian(s).  For example, pain in the shoulder and upper back is associated with the Bladder meridian.  The image below from Donald Kendall’s Dao of Chinese Medicine illustrates the muscle groups associated with the Bladder meridian.

Washington DC acupuncture - how acupuncturists choose points - muscles of the bladder meridian

Muscles associated with the Bladder meridian.


Step 2: Identify the meridians that balance the “sick” meridian

Once the acupuncturist identifies the meridian associated with the painful area, we can move on to the next step, which is selecting a meridian that will balance the “sick” meridian.

Each meridian is balanced by 5 other meridians.  These meridian relationships come from the classic Chinese philosophical and medical text called the I Ching.  This text ties together basic philosophical concepts with observations about the natural world and the human body. Dr. Richard Tan, one of Jeremy’s instructors, is one of the foremost teachers of I Ching-based acupuncture in the US.

The table of meridian relationships is summarized here:

System 1System 2System 3System 4System 5
LungSpleenBladderLarge IntestineBladderLiver
Large IntestineStomachLiverLungKidneyStomach
StomachLarge IntestinePericardiumSpleenPericardiumLarge Intestine
SpleenLungSmall IntestineStomachTriple BurnerHeart
HeartKidneyGallbladderSmall IntestineGallbladderSpleen
Small IntestineBladderSpleenHeartLiverBladder
BladderSmall IntestineLungKidneyLungSmall Intestine
KidneyHeartTriple BurnerBladderLarge IntestinePericardium
PericardiumLiverStomachTriple BurnerStomachKidney
Triple BurnerGallbladderKidneyPericardiumSpleenGallbladder
GallbladderTriple BurnerHeartLiverHeartTriple Burner
LiverPericardiumLarge IntestineGallbladderSmall IntestineLung

Step 3: Choose the acupoints

Now that we have identified one or more balancing meridians, we are ready to select acupoints along them. How do we know where on the meridian to treat? Remember, a single meridian has numerous acupoints associated with it. The answer has to do with the Chinese system of “body imaging”.  This system is familiar to many people in the form of foot reflexology, where the whole body is mapped onto the bottom of the foot, and the ailing part of the body is treated by manipulating the associated section of the foot.  In acupuncture, a much broader range of body imaging is used.

Acupuncture body imaging is a correspondence where one part of the body is mapped onto another part of the body.  For example you can “image” the torso onto the arm by transposing an image of the torso onto the arm.  The graphics and charts below illustrate how this imaging is done.

Where needled
on leg
Pain in areas of
Head & Trunk
 Where needled
on arm
Top of hipTop of headTop of shoulder
Hip jointNeck, jaw, base of skullShoulder
Upper legChest, mid-upper backUpper arm
KneeWaist, L2Elbow
Lower legLower abs, backForearm
AnkleGenitals, bladder, sacrumWrist
FootGenitals, coccyx, lower sacrumHand
ToeTesticles, anusFinger
Imaging: Head/Trunk to limbs

Imaging: Head/Trunk to limbs

The head can also be imaged onto the arms and legs:

Where needled
on leg
 Pain in head
Where needled
on arm
Hip jointTop of headShoulder joint
Upper legForeheadUpper arm
KneeEye, earElbow
Lower legNose levelForearm
Ankle/footMouth levelWrist/hand
Toes   Chin level Fingers
Imaging: Head to limbs

Imaging: Head to limbs

Reverse imaging is another body imaging technique:

Where needled
on leg (reverse) 
 Pain in head or
trunk area
 Where needled
on arm (reverse) 
ToeTop of headFinger
FootHead, base of skullHand
Lower legChest, mid-upper backForearm
KneeWaist, L2Elbow
Upper legLower abs, lower backUpper arm
Hip jointSacrum, genitals, coccyxShoulder
Top of hipTesticles, anusTop of shoulder
Reverse imaging: head/trunk to limbs

Reverse imaging: head/trunk to limbs

As a result of imaging and reverse imaging, acupuncture points can be selected from the knee down and elbow down to treat any pain condition in the body.

We also have the option of imaging one limb onto another limb by using the standard imaging method or the reverse imaging method:

 LegArm Leg Arm - flipped
Imaging: limb to limbReverse imaging: limb to limb

(From Dr. Richard Tan’s Acupuncture 1, 2, 3)


Let’s take a look at a few case studies to see how this all works on a practical level.

A case study as an illustrative example

Case Study: Lower Back Pain

A patient comes into the clinic complaining of pain in his lower back that is worse on the right side.

Step 1: Identify the “sick” meridian

First the acupuncturist asks the patient to identify the exact location of the pain.  The patient points to the low back area on the right side.

Next the acupuncturist identifies what channels are affected.  To do this we need to figure out which muscles are involved.  In the area of the lower back we are mainly looking at the iliocostalis lumborum, quadratus lumborum, erector spinae and the multifidus muscles.  These muscle groups are part of Bladder channel and the Kidney channel.


Washington DC acupuncture - Muscle groups of the bladder channel

Muscle groups of bladder channel.

Washington DC Acupuncture - Muscle groups of the kidney channel

Muscle groups of the Kidney Channel.

Step 2: Choose which channel(s) to treat

Now that we know what channels are being affected, we must choose which channels to needle based on the systems of relationships between channels.  The channels related to the Bladder and Kidney channels according to the different systems are as follows:

System 1:Small intestineHeart
System 2:LungSan Jiao (Triple burner)
System 3:KidneyBladder
System 4:LungLarge intestine
System 5:Small intestinePericardium
System 6:BladderKidney

In this instance, the Kidney channel appears on both lists, so it would be most convenient to choose to needle on the Kidney channel.

Step 3: Choose the acupoints

The Kidney channel traverses the medial aspect of the leg (Shown next to the image chart), so we will transpose an image of the torso onto the leg, imaging the lower back onto the ankle/lower calf area.

Where needled
on leg
Pain in areas of
Head & Trunk
 Where needled
on arm
Top of hipTop of headTop of shoulder
Hip jointNeck, jaw, base of skullShoulder
Upper legChest, mid-upper backUpper arm
KneeWaist, L2Elbow
Lower legLower abs, backForearm
AnkleGenitals, bladder, sacrumWrist
FootGenitals, coccyx, lower sacrumHand
ToeTesticles, anusFinger
Imaging: Head/Trunk to limbs
Washington DC Acupuncture - lower leg area on left side

First we will needle along the Kidney channel in the lower leg area on the left side. Remember, most pain travels along a contralateral pathway, so we will start with needling on the opposite side from the pain.  If the patient does not observe an effect,  we will then needle the Kidney channel on the same side as the pain. At this point, the patient should be noticing an alleviation of the pain.  If no relief is obtained, we will then begin to utilize the channel relationships to choose another channel to place needles on until we get the desired therapeutic result.


Acupuncture: a very results-oriented  approach to  pain relief

The results of these needle placements are very effective, oftentimes creating immediate pain relief, increased range of motion, and muscle relaxation that is empirically evident to both the patient and practitioner. (Our admin staff enjoys watching patients test out their newfound range of motion at the checkout counter.) In the introduction to his book, Acupuncture 1, 2, 3, Dr. Richard Tan quotes a traditional medical saying regarding the effectiveness of acupuncture: “Li Gan Jian Ying.”  This translates as “Stand a pole under the sun, and you should immediately see its shadow.” This statement reminds us that when the acupuncture point selection is accurate, the results should be obvious and instantaneous.


So how does acupuncture needling actually relieve pain?

The physiological mechanism of action for how acupuncture alleviates pain according to Western anatomy and physiology is understood generally. Acupuncture helps to “retrain” the nervous system and brain, resulting in pain reduction, muscle relaxation and injury healing. Needling certain points is a way to communicate with the brain via the nervous system. Certain points will inform the brain to increase blood flow and a range of healing agents to the ailing area. See our previous article on Acupuncture for Pain Relief for the full story.

The reason specific points work to alleviate pain in specific areas of the body is not yet fully understood and is an area for further research and exploration. As acupuncture integrates further into western culture, our hope is that scientific research will make strides into understanding more precisely how it works.  Our bodies have great potential for healing. Acupuncture is a modality that unlocks that potential, thereby offering a powerful, effective option for lasting pain relief.

What to do if you’re struggling with physical pain

If you live in the Washington DC area and are looking to heal pain naturally, we can help. Here’s what you can do:


17 Comments on “Inside the mind of an acupuncturist: how do we choose the acupuncture points?

Meetings By Mail
June 4, 2017 at 10:37 am

Aweosme post! I just wanted to drop a comment and
let you know how much I enjoy reading your articles. Keep up the good work!
You’ve really put together a great resource here.

October 17, 2017 at 1:03 am

Hi there. I don’t know how to relieve the pain of deltoids, brachialises and brachio radialises using home accupuncture needles. Could you please help me.

Nadia Bouhdili
October 19, 2017 at 3:13 pm

Hi Aaliya, we responded to your query via email – hope that helps!

Helen M. gilmore
October 18, 2017 at 9:51 pm

I am presently going to a wonderful acupuncturist. I have spinal stenosis, severe low back/ sciatica pain , pain leg all the way down to my foot.

I’ve been receiving care twice a week for two months. My last two weeks are my break through of pain , walking improved, feeling like a normal person ,my life back. My sessions begin with needling, followed by cupping & acupressure massage.

This treatment has been my only source of pain relief. I would suggest this treatment to anyone suffering sciatica. PT didn’t help this time & medicine is useless.

I can’t say enough regarding my doctor , she & her staff have helped me Get through the toughest pain I have ever felt. In time I will go on a maintenance schedule.

I live on Long Island , New York & my doctor & her associate are worth their weight in gold to meet.

Thank you for reading my story.

Helen M. Gilmore

Nadia Bouhdili
October 19, 2017 at 3:13 pm

Thank you so much for sharing, Helen. We’re always happy to hear success stories!

Dolli Salinas
December 28, 2017 at 5:50 am

This is such an awesome report. Thank you so much. I recently had acupunture done in Mexico for sciatica. The thereapist applied tiny needle patches to my lower back. He told me to go back in a month. I removed them recently since the tape was really compromised after a couple of weeks. I am in the U. S. now and won’t be able to back. Can I just place them on the lower calf and ankle as you report (I have 5 of them)? Do I put one on inside wrist or outside wrist, on top of forearm or under? Thank you so much.

Jeremy Riesenfeld, M.Ac., L.Ac.
January 29, 2018 at 12:53 pm

Hi Dolli, sorry for the delayed reply. Glad you liked the report! Unfortunately we can’t give advice on specific acupuncture points for your case online. However, we’d be happy to do a Skype consultation with you where we can help you choose acupressure points for your condition. Let us know if you have any further questions.

January 29, 2018 at 1:32 am

Sir tell me gow to put needles for footdrop.. i am taking it from past 1 and half month still i am not getting any results so need to tell it to acupuncturist who is coming to treat me.. what will you tell as it is i will inform them to put needles.. please tell me sir..

Jeremy Riesenfeld, M.Ac., L.Ac.
January 29, 2018 at 12:57 pm

Hello – thanks for getting in touch with us. We’re not able to give specific acupuncture advice online. If you’re interested in getting acupuncture in the style that we discuss in this article, I would get in touch with an acupuncturist in your area who does “balance method” or “Dr Tan style” acupuncture. Let us know if you have any further questions, and good luck.

Ashley Maxwell
February 28, 2018 at 10:55 pm

I didn’t know that acupuncture was a form of relieving pain. Thanks for mentioning how the points that they stick needles in are nerves, muscles, and even blood vessels. My aunt is considering getting acupuncture fone because she wants a good stress reliever.

Jeremy Riesenfeld, M.Ac., L.Ac.
June 5, 2018 at 4:51 pm

Thanks Ashley, yes acupuncture seems to work pretty well both for pain and stress. And I would agree, the physiological theories behind why it works are interesting.

Acupuncture Wellness Center
April 21, 2018 at 5:27 am

I’ve always thought acupuncture to be a very interesting practice. I would like to try it some time! I have lots of friends and family members that struggle with depression.
I think it’s cool that acupuncture can help balance energetic disharmonies.

Jeremy Riesenfeld, M.Ac., L.Ac.
June 5, 2018 at 4:37 pm

Thanks for your interest!

Anthony Lim
April 22, 2018 at 10:50 am


Jeremy Riesenfeld, M.Ac., L.Ac.
June 5, 2018 at 4:35 pm

Hi Anthony,

We don’t have a specific protocol for liver spots – sorry we can’t help you with that.

September 25, 2018 at 12:13 pm

Hi, Very interesting but it has left me confused.
Earlier in the article you introduce Dr Richard Tan’s 5 systems. In the case study you reference 6 systems. What is the 6th system?

Also, in Step 2 you say “In this instance, the Kidney channel appears on both lists, so it would be most convenient to choose to needle on the Kidney channel.”

BUT… Doesn’t the Bladder channel also appear in both lists? So Why is the Kidney channel chosen?

As I say very interesting but a bit confusing

Jeremy Riesenfeld, M.Ac., L.Ac.
October 1, 2018 at 11:26 am

Hi Bill,

Thanks for your questions, these are good questions for clarification.

The 6th system is using the same channel to balance itself. So for instance, let’s say a person has pain on the Kidney channel at the ankle. With the 6th system, you’d use the acupuncture points on the same channel (in this case the Kidney channel), but on the opposite ankle. The 6th channel isn’t often used in the Richard Tan system, which is why he generally only talks about 5 systems, but it does exist.

You make a good point about step 2. We could have chosen either the Kidney or Bladder channel based on the criteria mentioned in the article. In practice, in a case like this, where I could choose either the Kidney or the Bladder channel, I would choose to start with one of them. This choice could be influenced by a number of factors. First, there’s consideration of the functions of the channels as described by other systems of acupuncture like TCM or 5 Elements systems. For instance, when a patient has pain, but also fatigue, I can choose the Kidney channel for the channel balancing effect, but there might also be a point on the Kidney channel that is good for fatigue, so by choosing the Kidney channel, I can accomplish two things at the same time. Second, the patient’s body position will also determine which channels can actually be needled. For example, when a patient is lying face up, I can’t access some of the Bladder channel points on the back of the leg, so if I need those particular points, I would choose the Kidney channel instead of Bladder.

After applying needles to the channel, I wait about 10 seconds, which is about the time it takes for the body to have its initial acupuncture response. Depending on the response, I may choose to add more needles to the Kidney channel. If the patient stops improving at some point in this process, I may then choose to use another channel to increase the effects. In this case, I would likely choose the Bladder channel, based on the criteria in step 2.

Hope this helps, and let me know if you have any further questions.



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