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

Acupuncture Points of Traditional Chinese Medicine
Acupuncture Points of Traditional Chinese Medicine

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

  1. Lung
  2. Spleen
  3. Heart
  4. Kidney
  5. Pericardium
  6. Liver
  1. Large Intestine
  2. Stomach
  3. Small Intestine
  4. Bladder
  5. Triple Burner
  6. Gallbladder

How the acupuncturist selects acupuncture 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 acupuncture points - muscles of 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.

Table of meridian relationships

Sick MeridianSystem 1System 2System 3System 4System 5System 6
LungSpleenBladderLarge IntestineBladderLiverLung
Large IntestineStomachLiverLungKidneyStomachLarge Intestine
StomachLarge IntestinePericardiumSpleenPericardiumLarge IntestineStomach
SpleenLungSmall IntestineStomachTriple BurnerHeartSpleen
HeartKidneyGallbladderSmall IntestineGallbladderSpleenHeart
Small IntestineBladderSpleenHeartLiverBladderSmall Intestine
BladderSmall IntestineLungKidneyLungSmall IntestineBladder
KidneyHeartTriple BurnerBladderLarge IntestinePericardiumKidney
PericardiumLiverStomachTriple BurnerStomachKidneyPericardium
Triple BurnerGallbladderKidneyPericardiumSpleenGallbladderTriple Burner
GallbladderTriple BurnerHeartLiverHeartTriple BurnerGallbladder
LiverPericardiumLarge IntestineGallbladderSmall IntestineLungLiver

Step 3: Choose the acupuncture points

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 graphic and chart below illustrate how this imaging is done.

Imaging—Head/Trunk to Limbs

Imaging: Head/Trunk to limbs used to demonstrate where to select acupuncture points
Imaging: Head/Trunk to limbs
Where needled on legPain 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 to Limbs

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

Imaging: Head to limbs used to demonstrate where to select acupuncture points
Imaging: Head to limbs
Where needled on leg Pain in head areaWhere 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—Reverse Imaging

Reverse imaging is another body imaging technique.

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

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.


Imaging—Limb to Limb

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

Imaging: limb to limb

Reverse Imaging: limb to limb used to demonstrate where to select acupuncture points

Imaging: limb to limb

Reverse imaging: limb to limb

Reverse Imaging: limb to limb used to demonstrate where to select acupuncture points

Reverse 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 lower back pain case study as an illustrative example

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.

Muscle groups of bladder channel used to demonstrate how to identify meridians
Muscle groups of bladder channel.
Muscle groups of the Kidney Channel. used to demonstrate how to identify meridians
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:

Sick MeridianSystem 1System 2System 3System 4System 5System 6
BladderSmall IntestineLungKidneyLungSmall IntestineBladder
KidneyHeartTriple BurnerBladderLarge IntestinePericardiumKidney

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 acupuncture points

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

Diagram of the Kidney Meridian through the leg and foot
The Kidney channel traverses the medial aspect of the leg
Imaging: Head/Trunk to limbs used to demonstrate where to select acupuncture points
Imaging: Head/Trunk to limbs
Where needled on legPain 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

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:

About the Author

Nadia Bouhdili

Nadia is the co-owner and operations manager of Transformational Acupuncture.

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