Live Points
and the Arrival of Qi
Last week I wrote about needle techniques, and mentioned that, for best results, the needle technique should be matched with the process of point location. TCM needling techniques favor points located in areas with deep muscle tissue near larger nerve trunks so the therapist can elicit the characteristic deqi sensation that is considered the standard of successful needling.
But TCM-style needling is not all there is to acupuncture. In Japan, I visited and studied with practitioners who treat hundreds of cash-paying patients every week in a highly competitive urban setting using these very subtle methods of superficial and non-insertive needling and tiny direct moxibustion. Two important components of their treatment style are “Live Points” and “Arrival of Qi”.
Live Point Location
The first principle in point location is the “Live Point” concept. Anatomical locations are just a guideline; real treatable acupuncture points need to be located by palpation. To put it metaphorically, the anatomical location is the street address, but if you want to deliver a package you need to find the door.
Shudo (1990) cites one of the Japanese meridian therapy founders, Okabe Sodo, on five types of changes that are associated with acupuncture points:
1) Induration - a small nodule is felt at the point which may produce a dull pain when pressed
2) Tenderness - a hard area which produces a strong pain when pressed
3) Hyperesthesia - pain felt on the surface of the skin when stroked or lightly pinched
4) Depression - a small area into which the finger falls, often at source or tonification points
5) Congestion - a superficial, slightly bloated, pillow-like stagnation often found on the abdomen
Indurations tend to come in three types: Soft/spongy, medium and hard. The softer indurations are less chronic and easier to treat. If a person has significant amounts of hardened tissue, their prognosis is accordingly much worse.
Depressions and sticky congestions are usually felt when looking for tonification points on Yin channels. Points on Yang channels usually have more tenderness or indurations.
The best way to find Live Points is to begin stroking lightly on the channels about five cm either side of a standard anatomical location. Concentrate on the fingertips and note any changes that you feel. Does your finger stop anywhere along the channel? Examine what you feel if it does -- is there a depression, a sticky feeling, a puffy feeling, or a nodule? Watch the face of the patient -- are they wincing, or has their breathing changed?
You can also monitor the pulse for changes when palpating around acupuncture points, especially tonification points. If the pulse improves while lightly touching the point, then the point should be good for tonification.
Arrival of Qi -- How Do I Know If I’m Doing It Right?
When I was learning needle technique in school, the big idea was “get the qi”. “You have to go deep to get the qi,” was the dogma. But when I took up with the Japanese teachers (while I was still in school), I was taught to just touch the needle to the point and feel for the “arrival of qi”. Quite a paradigm shift: instead of go in and grab it, invite it to come to you.
There is a learning curve here, of course. Since the emphasis is on changes the practitioner feels when needling and not on the patient feeling the deqi sensation, how do we know that the technique is effective? Eventually, the practitioner develops a sense of whether the qi has arrived based on their experience, but for the beginner the following are things to look for:
1) The pulse positions become more evenly balanced, or the pulse quality and Yin/Yang balance becomes more harmonized (pulse moves toward the middle depth, slows down, becomes less scattered, etc)
2) Changes occur on the skin -- not just at the point, but along the channels, abdomen and face. The skin becomes more lustrous, color returns to the cheeks, etc
3) Tender or hard areas become reduced
4) Cold hands or feet begin to warm up
5) The patient begins to breathe more deeply and evenly
6) Abdominal sounds become audible during needling
7) Symptoms are improved, feel “lighter” or disappear
8) The arrival of Qi at the point underneath the finger, tip of the teishin or the left hand supporting the needle
Some of these phenomena are subtle and take a while for the practitioner to recognize. The most obvious are the changes in breathing, abdominal sounds and improvement in symptoms. Look for these first, and when they happen, notice any other changes, such as feelings in your hands when they are contacting the point. Be aware of memorizing any physical sensations associated with good treatments, and you will be better able in the future to judge whether or not your treatments are effective.
References
Shudo, D. (1990). Japanese classical acupuncture: Introduction to meridian therapy (S. Brown, Trans.). Eastland Press. (Original work published 1983)
Note: this newsletter is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.