Introduction: Today we will learn about the significance of meridians and acupuncture point palpation.
Traditional Chinese Medicine (TCM) diagnosis relies on observation, listening, inquiry, and palpation, while Western medicine primarily depends on instrumental examinations. In the early stages of many functional disorders, Western medicine may not detect any diagnostically significant positive results, thus failing to provide targeted treatment. TCM has a significant advantage in this regard, as it still primarily utilizes the four diagnostic methods, especially emphasizing meridian and acupuncture point palpation in acupuncture. In clinical practice, the relationship between syndrome differentiation and treatment is closely related to meridian and acupuncture point diagnosis. Therefore, attention must be paid to surface palpation during diagnosis. For example, in cases of visceral diseases, one should pay attention to corresponding back shu points, Hua Tuo jiaji points, and mu points to find tenderness or sensitive points. Abnormal findings such as tenderness may also be present at the corresponding source points, luo points, sun points, and he points in the limbs. This aligns with what is stated in the “Lingshu: Back Shu” which says, “To verify, press the area; if it is painful in the center, it is the shu point.” The “Lingshu: Nine Needles and Twelve Origins” states, “If the five organs are diseased, they should manifest at the twelve origins, and each origin has its own manifestations. By clearly identifying the origin and observing its response, one can understand the harm to the five organs.”These tenderness or sensitive points, subcutaneous nodules, and abnormal elevations or depressions found during palpation can serve as references for diagnosing diseases and as bases for selecting treatment points. For instance, if there is tenderness at the corresponding jiaji points for the five organs, one should select the jiaji points; if there is tenderness at the corresponding back shu points, one should select the back shu points.Palpation of the shu points can also serve as an objective indicator for evaluating treatment efficacy, allowing for comparisons before and after needling, thereby enhancing the confidence of both the patient and the practitioner in the effectiveness of acupuncture.Depressed points often indicate deficiency, while raised points often indicate excess. The “Suwen: Regulation of Menstruation” states, “The essence of deficiency and excess, I wish to hear its reason… Excess is firm and full externally, cannot be pressed, and pressing it causes pain… Deficiency is due to insufficient qi, pressing it allows qi to warm it, hence it feels comfortable and not painful.”Commonly used palpation points include:1 Lower Limb Region 1. Zu San Li (Stomach Three Miles) Tenderness may appear in gastrointestinal diseases.2. San Yin Jiao (Three Yin Intersection) San Yin Jiao is a commonly used palpation point in gynecology. Conditions of qi stagnation and blood stasis, as well as mixed deficiency and excess pain, such as uterine fibroids, dysmenorrhea, and irregular menstruation, often present with tenderness, nodules, or masses. In severe cases, a three-edged needle may be used for bloodletting, resulting in the outflow of thick, dark purple blood, which returns to normal bright red blood after the stasis is cleared. For example, a female patient with endometrial cancer exhibited significant tenderness and a mass at San Yin Jiao, with daily throbbing pain in that area. If the condition is one of deficiency, this point may feel empty or show no specific manifestations.3. Tai Chong (Great Surge) In cases of liver qi stagnation, this point often feels full and tender; such patients typically experience emotional distress, feel under pressure, and may become depressed or irritable. In cases of significant deficiency, this point may appear slightly depressed.4. Tai Xi (Great Stream) There is usually no excess condition in the kidneys, so this point often appears slightly sunken and rarely exhibits tenderness.5. Lin Qi (Lateral Mound) Tenderness may be present if there is obstruction in the gallbladder meridian. Symptoms may include bilateral headaches, pain in the hypochondriac region, and difficulty opening and closing the jaw.6. Xuan Zhong (Suspended Bell) Tenderness may occur at this point in cases of Shao Yang headache, hypochondriac pain, or liver yang rising.7. Yang Ling Quan (Yang Mound Spring) Tenderness may be present at this point in cases of tendon inflammation, especially when there is pain from pulling on the tendons on both sides of the body.8. Yin Ling Quan (Yin Mound Spring) This point may feel empty and tender in cases of spleen deficiency with water retention or cold damp knee pain.2 Chest and Abdomen In acute cases, pulse diagnosis is preferred; in chronic cases, abdominal examination is emphasized, as advocated by abdominal diagnosis experts throughout history. This means that acute diseases often manifest in the pulse, allowing pulse diagnosis to reveal the nature of the disease (cold, heat, deficiency, or excess); chronic diseases are more apparent in abdominal signs, thus abdominal examination can reveal the underlying cause. The abdomen is generally divided into the upper abdomen, umbilical region, lower abdomen, and small abdomen, with each area corresponding to different meridians and organs. The upper abdomen corresponds to the Tai Yin, the umbilical region corresponds to the Shao Yin, the lower abdomen corresponds to the Jue Yin, and the small abdomen corresponds to the Chong and Ren meridians. Tenderness in the lower abdomen often indicates issues related to the Jue Yin meridian, commonly associated with liver qi stagnation; abdominal pain around the umbilicus or deep-seated masses in the umbilical area often indicate kidney qi deficiency; tenderness or distension in the upper abdomen typically relates to spleen and stomach disorders; and pain or distension in the small abdomen often relates to issues with the uterus or bladder. In menstrual disorders, commonly involved diagnostic areas include the umbilical region, lower abdomen, and small abdomen, which are the primary distribution areas for reproductive organs. The uterus is located in the small abdomen, while the appendages are located in the lower abdomen. For example, if qi accumulates in the zhong region, women may experience chest tightness, or feel pressure and emotional distress before menstruation, which may present with significant tenderness at this point. Therefore, by clearly identifying the affected meridians and organs through palpation, one can provide guidance for clinical syndrome differentiation and treatment. The twelve mu points are also part of the chest and abdominal palpation, as their locations are very close to the corresponding organs, often directly over their surface projection areas. When internal organ diseases occur, local tenderness or sensitivity, nodules, and tension are often observed, such as at the heart mu point (Ju Que), gallbladder mu point (Ri Yue), liver mu point (Qi Men), and stomach mu point (Zhong Wan). Among the twelve mu points, a few are located on the corresponding meridians of the respective organs, such as the lung mu point (Zhong Fu), liver mu point (Qi Men), and gallbladder mu point (Ri Yue). Other points like the large intestine mu point (Tian Shu) belong to the stomach meridian, the spleen mu point (Zhang Men) belongs to the liver meridian, and the kidney mu point (Jing Men) belongs to the gallbladder meridian. The remaining six mu points belong to the Ren meridian. Clinically, when a specific organ is diseased, the corresponding points reflecting the disease are often felt more prominently on one side of the body. For example, visceral surface reflexes for angina pectoris appear on the left side, while liver disease patients often present with more severe symptoms in the right hypochondrium. There are also cases where a specific organ disease reflects on the opposite side or bilaterally, and this diversity in reflexes corresponds to the complexity of the relationships between organs, meridians, and mu points.3 Back Region The back shu points are the acupuncture points where the qi of the organs is transmitted to the back. All back shu points are distributed along the first lateral line of the bladder meridian, which is 1.5 cun lateral to the posterior midline, and their vertical arrangement corresponds to the height of the organs. Back shu points are primarily named based on their proximity to specific organs, such as Lung Shu and Heart Shu. The “Lingshu: Back Shu” suggests that back shu points can treat diseases of the five organs and provides the names and locations of the five organ back shu points, as well as the positive response phenomenon observed when pressing these points, which is described as “pressing the area; if it is painful in the center, it is the shu point.” Clinically, one can observe the subcutaneous tissue at the back shu points for any elevations, depressions, looseness, and variations in skin temperature, to analyze and determine the disease belonging to a specific meridian. One can also seek positive response points near these acupuncture points as a basis for point selection. For example, to treat diseases of the head, face, cheeks, neck, and other organs, one can select the jiaji points from the first to the seventh cervical vertebra; to treat diseases of the thoracic organs and upper limbs, select the jiaji points from the third cervical to the seventh thoracic vertebra; to treat upper abdominal organ diseases, select the jiaji points from the eighth to the twelfth thoracic vertebra; to treat lower back and lower abdominal organ diseases, select the jiaji points from the tenth thoracic to the second lumbar vertebra; and to treat anal and lower limb diseases, select the jiaji points from the second lumbar to the fourth sacral vertebra. Due to the interconnection of yin and yang meridians, the qi of the organs in the abdomen and back communicates, with yin diseases manifesting in yang and yang diseases manifesting in yin. Therefore, in treatment, one should draw yin from yang and yang from yin. In other words, for yin conditions (organ diseases, cold syndromes, deficiency syndromes), one can select back shu points located in the yang area (the back); for yang conditions (fu diseases, heat syndromes, excess syndromes), one can select mu points located in the yin area (the chest and abdomen). Hua Tuo jiaji points, also known as jiaji points or extraordinary points, are located 0.5 cun lateral to the spinous processes from the first thoracic vertebra to the first sacral vertebra, with 17 points on each side, totaling 34 points. Additionally, there are 7 points on each side from the first cervical vertebra to the first thoracic vertebra, totaling 14 points, bringing the total to 48 points. These can also be referred to as cervical jiaji points, thoracic jiaji points, and lumbar jiaji points. For limb or internal organ diseases, the jiaji points are selected based on tenderness. Limb and internal organ diseases usually present with tenderness at the jiaji points or along the governor vessel and back shu points. By pressing with the thumb, the tender points are selected for treatment, which is often effective. If there is tenderness in the intervertebral ligaments, the governor vessel points are selected; if there is tenderness in the paravertebral ligaments, the jiaji points are selected; if there is tenderness at the back shu points, the back shu points are selected. The two meridian lines of the bladder meridian on the back each have their focus; for acute pain conditions, the jiaji points or governor vessel points combined with back shu points are used, while for chronic diseases, points from the second line of the bladder meridian (3 cun from the governor vessel) should be added to enhance efficacy. For example, adding Kidney Shu to Zhi Shi.4 Upper Limb Region 1. Qu Chi (Pool at the Bend) Tenderness may be present at this point in cases of upper limb, shoulder, and back pain, as well as headaches.2. Xie Men (Gate of the Xie) Tenderness may be present at this point in cases of inflammation of the upper esophagus, with a sensation of obstruction.3. He Gu (Union Valley) This point is used for head and facial disorders.5 Head Region 1. Feng Chi (Wind Pool) Effective for treating headaches and eye diseases.2. Shuai Gu (Leading Valley) Effective for treating dizziness and tremors.3. Bai Hui (Hundred Meetings) Effective for treating headaches and dizziness.
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Note: Please follow medical advice for specific treatments and medications! This article is excerpted from “Xi Yongjiang’s Clinical Acupuncture Cases,” edited by Xi Yongjiang, published by Xueyuan Press, March 2009.
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