- Identification and Clinical Utilization of Movable Points
Identification and Clinical Utilization of Movable Points
Zong-BaoYANGa,Hai-Xia WUb, Qing YANGc, Bing-Rong ZUOc, Ran-Mi ZHOUa＊
a.School of Xiamen University, Xiamen 361005, Fujian, China
b.TCM Department, Guangzhou Eleventh People’s Hospital 510000, Guangzhou, China
c.University of Traditional Chinese Medicine, Nanchang 330000, Jiangxi, China
Professor. Research fields: acupuncture for neurological disorders; evolutionary medicine.
A Movable Point (MP) is by definition the opposite of a stable point. The term Movable Point is used to describe “acupoints” that can be found all over the body, without a specific name, number or location, which sometimes are invisible and constantly moving. MPs can be detected by simple observation, finger probing, by moxibustion or by electrical identification. A thorough investigation on MPs is necessary in order to reveal their nature and to facilitate their clinical utilization.
“Movable point” (MP) is a completely new concept which was proposed by Professor Weijia in Jiangxi University of TCM, based on his clinical experience of more than fifty years. MP refers to certain acupoints distributed all over the body, without specific names, numbers and location, which are visible or invisible and moving from time to time. It is a concept that is the opposite of “stable points” (SP) which are well defined by name, location and number on the traditional fourteen meridians. The famous acupuncturist Wang Zhizhong, during the Song dynasty, described MP as “a location that is being attacked by patho-factors”. The ancient people thought that “changes inside must bring corresponding changes outside”, which means, when an organ has pathological changes, it can have reflections on the body surface (skin), such as a change in color and gloss, shape or a change in the normal feeling. Therefore, the acupuncturist, by stimulating the “location which is being attacked” can adjust the corresponding organ functions by using this “reflective” system. A MP does not occur randomly. It normally occurs in an area where the organ change is being reflected, and it can be instantly identified. Locating a MP is different from locating a traditional point, due to the typically changing and transferring characteristics which define a MP. A MP has many different expression features, and here we want to make a simple exploration of its identification and clinical utilization.
By a simple observation of the skin where the meridians passes, we can define a specific macula or bleeding as a MP.
It has been observed that a number of diseases, during their development, have significant meridian-skin changes. We can identify those “positive” points and use them as MPs for treatment. “Overview and Essence of Acupuncture” records, “Hordeolum: find the very small and red, sore-like spot on back and puncture it with a needle for a fast cure”. In this case it serves to disperse the accumulated heat in the Taiyang. In “Danxi’s Thoughts on TCM” it says, “One should observe the outside when one wants to understand the changes inside. This is because any inner changes may be reflected outside.” According to this principle, when the inner organ system is being disturbed, a “pathological reflecting area” will form on the surface of body. The doctor, by observing these phenomena and combining them with other clinical manifestations, can make an appropriate judgment in locating the problem and making a qualitative diagnosis.
In the local area of the pathological changes, or in a “remote” area connected through the meridian, we may find signs of different kinds. They can be off-white spots, a blood red rash, brown or light red papule or flecks, and also blue veins, red lines or protuberances. They might be showing or concealed on the skin surface, visible during the disease development but invisible after treatment. These specific points can be used for acupuncture or bleeding. It has been proven in our clinical experience that these points can be even more effective than normal points. Here are some examples: Cervical syndrome patients often have peanut like nodus with regular edges, around the Dazhui point (DU14). Yaofang Liu treated cervical syndrome with “Codonopsis pilosula flower-like” skin changes by using poke therapy and got a 100% effect rate. Yuhua Tan noticed some round or elliptic reactive points between the eighth and ninth rib under the skin on the mid-axillary line. These points can be dark, no higher than skin surface, with a diameter of 1.5 to 2.5 cm and sometimes located on areas with visible veins. These points were used as treatment points. The reported effect rate was 100%.
Patients with piles often have reactive points on the skin of the back. These so-called “piles points” are usually papule like, a little protuberant, like small rice grains, with a little gloss, dark red or brown, with no fading after pressing them and sometimes with a small hair in the middle. Piles points can be found from the seventh cervical to the fifth lumbar level, but usually in the middle part or the lower back. If two points occur at the same time, just select the more apparent one and prick on it. Experience shows that the closer to the spinal column and lower on the back they are found, the better therapeutic effect one gets. Kaizhu Lin et al. used both poking and cupping methods on piles points for 32 cases, and achieved a 100% effect rate. The authors pointed out that if piles points cannot be found, we can prick the point above Chang Qiang (DU1) right close to the end striation of the buttocks and Baliao points (BL31-BL34). Some piles patients have white spots or irregular round small tubercles on the Yinjiao point (DU28), or on the lower part of the frenulum of the upper lip, which can also be used as treatment points. Leshen Liu et al.treated 72 cases of internal hemorrhoids with bleeding by using a three-edge needle to prick on the slight white vegetation on the frenulum of the upper lip, and got an effect rate of 97.20%. Around 60% percent of the piles patients have a slight white, sesame seed like vegetation on the frenulum of the upper lip, and from our experience there have been good results by treating these areas with a poking method.
2.Measuring by fingers
During the progression of a disease, positive reaction points can not only be reflected as skin color changes, but also as tender points, nodules or cord-like lumps under the skin, located around the lesion or somewhere distant but with meridian connections. “Soul Box for Acupuncture·Five methods and their application” records, “Before acupuncture, the practitioner must identify the asthenia/sthenia of the meridian, press and probe, click and clap, and observe the spot with its corresponding reactions, and then use it as the treatment spot”. This text clearly points out the necessity of finding corresponding points with your fingers before the acupuncture treatment. Finger palpation requires the use of the “Body-Cun method” to find out the rough location, and then one probes along the meridian with the finger tips. When you reach some specific points, the patient may experience pain, warmth, numbness, euphoria, a feeling of radiation, etc., and you may also feel resistance, block, reduced plasticity, and nodules of different sizes under skin; - all those points can be used as “movable points”. “The Yellow Emperor's Inner Classics·Cross Needling” states that when there is evil Qi in the Foot Taiyang meridian, we can find the “painful places” when pressing beside the spinal column, and by doing acupuncture on them, the evil Qi will be solved. Through palpating with our fingers we can get some subjective or objective feeling as stated below.
The pain can be divided into “pain when not touching” and “pain when touching”. Some patients complain about a pain they feel somewhere on their body even when not touching the painful part. The pain gets even worse by touching it. We call this “pain when not touching”. The other kind of pain which we call “pain when touching” is when the patient only feels pain while the doctor does finger probing. The doctor can feel the resistance, the block or the reduced plasticity there. While doing acupuncture on these spots, the doctor can also feel resistance, absorbing, or “stasis” under the needles. “Herbal Formulas for Universal Welfare ·Acupuncture” records that when a patient cannot walk, finding the precise place of soreness and doing moxibustion on it, brings about a definite benefit.“Illustration for Classified Yellow Emperor's Classics” records that for hemafecia symptoms, if we find a sore spot around Mingmen (DU4) and do moxibustion on it, the symptoms disappear. “Soul Box for Acupuncture· Complicated Diseases” describes that to treat stomach pain, you need to probe with your finger around the Jin Shuo point (DU8) to find the “pain point” and then needle on it, or probe further to find the positive reaction point and needle on that. All these recordings show that movable points are typically characterized by “moving”, so you need to search with your fingers. Xi Zhang et al.selected positive reaction points by searching for them on the urinary bladder, spleen, liver, heart or pericardium meridians, in order to treat insomnia.
Zhenhua Wang needled on the Xiaojie point and a reaction point around the wrist (look for the point on the inner/lateral side of the wrist when the ankle joint injury is on the inner/lateral side, according to the “same side” correspondence way) for 21 cases of ankle joint sprain. 11 cases got an instant 70% to 80% alleviation and complete healing the next day; 5 cases had their pain disappear after 2 treatments; 3 cases could feel only a slight discomfort while standing after 2 treatments; 2 cases could not get a satisfying effect and discontinued the treatment.
Shuang Li treated 38 cases of primary sciatica by doing acupuncture on the reaction points of the groin. All the patients had apparent reaction points on the groin of the “diseased” side. When pressing on this point, the patients could feel an instant relieve of the pain of their lower back, thigh or calf on the same side. The treatment lasted from 3 days to 18 days. 23 out of 38 cases got a complete healing after the treatments. 12 of 38 cases got a short-term control, and 3 cases were alleviated after the treatment. All the cured cases reported no recurrence at the follow-up. Decheng Liu treated 202 cases of lumbago by doing acupuncture on Yin-yang points. The method consists of finding the most tender reaction point (here called Yin point) while the patient is postured in the most painful way. Then the doctor looks for another point (Yang point) that when stimulated alleviates the pain from the Yin point. The general effect rate was 98%.
Either the patient feels, or the doctor feels, that some part of the body has a higher temperature than other parts. When the “warm” part is stimulated by pressing on it or being touched by a cold object, the patient can feel an alleviation of the pain that may disappear after removing the stimulation. “Pure Questioning of TCM∙Discussion on Pain” records that pressing on the back until a “warm” feeling comes, is a way to treat back pain induced by an attack of cold. “Soul Box for Acupuncture∙Disease Diagnosis” records that acupuncture on a meridian conduction point, which has a feeling of “warmth”, can treat tooth pain. Sumei Liang treated 86 cases of acute stomach pain by pressing the sensitive points on the corresponding area of the back, and achieved a 99.5% alleviation rate. The sensitive points were generally located on the back between the second and the fifth spinous process of thoracic vertebra (T2～T5). While being stimulated on this particular area, the patient usually felt a comfortable “warm feeling of soreness” along with an alleviation of the stomach pain.
When the doctor presses on local or remote points connected through the meridian, the patient can feel a “sore numbness” in a certain area on the same or on a related meridian. “Ming Tang Classics” records that when pressing the Gaohuang point (BL43) on a patient with a tuberculosis disease, a response consisting of a feeling of numbness on the top of middle finger occurs, and doing moxibustion on that point is “effective for almost everyone”.
When the doctor probes with his finger on the ailing side, the patient may perceive an obvious sore distention or numbness, radiating to the ailing spot. Aiguo Liu selected the sensitive point (Ashi point) on the same side for 132 cases of acute inflammation of the mammary gland and achieved a 90.90% effect rate. The “sensitive point” was determined by pressing on the area around 1 B-Cun above Jianshi point (PC5), The right point was the point where the patient felt that a soreness, a numbness, or a swelling was being conducted to the breast.
2.4Abnormal spots on skin
Doctors may feel a “resistance”, a “hard knot” or a “soft lump” under the skin when examining with the fingers. When they do acupuncture on those spots, they can feel a strong resistance, an absorbing feeling or an aggregating sensation under the needles. Shigang Song did acupuncture on reactive points consisting of cord-like lumps located 1 cm beside the vertebras from C4 to C7 on the neck, for 80 cases of chronic cervical syndrome. 75 cases (93.75%) were cured, 4 cases (5%) got apparent effects and 1 case (1%) got an effect according to corresponding evaluation criteria. Changlai Wang treated 210 cases of insomnia by using intradermal imbedding needles on positive reaction points on the back. The effect rate was 96.10%. The positive reaction points were “hard knots” or “cord-like” lumps located around XinShu (BL15), Sheng Dao (DU11), Jueyin Shu (BL14), Gaohuang Shu (BL43), Gan Shu (BL18), Dan Shu (BL19), Pi Shu (BL20), Wei Shu (BL21) and Shen Shu (BL23). The area of the skin where those points were located was noticeably different from the surrounding normal area, being either elevated, depressed, relaxed or tensed, with a feeling of tenderness, soreness or with a comfortable feeling after pressing. Aiguo Qintreated insomnia by selecting the positive reaction points on the urinary bladder meridian and treating them with a seven-star needle, and got a 100% effect rate. Haiying Maused poking and cupping on the Huatuo vertebrae-clipping points from T1 to T7 where there was apparent pain or lumps under skin. A total of 150 cases were cured with a 100% effect. DehuaZhaiet al. have noticed that insomnia patients of the pathopattern “Yin deficiency with floating fire” easily get a “cord-like”, medium hard knot around GanShu point (BL18) or a round soft knot around Shen Shu (BL23) and Pi Shu (BL20).
2.5changes of skin elasticity
Doctors noticed that some skin parts with less plasticity, after acupuncture treatment acquired a “concavity” or “intumescence”. He Chun Guang Ding did acupuncture on tense parts on the front of the body (these were usually “Mu points”), for infertility. Pregnancy rate acquired was around 78.00%.
3.Probing by moxibustion
The last decades, moxibustion on heat-sensitive points has become a new diagnosis and treatment method. It is done by holding a lighted moxa-stick above the ailing area and moving it around along the meridian or nerve segment to find the “treatment” spots which may manifest deep heat, heat expansion, heat conduction, remote heat, etc. and trigger a local feeling of soreness, swelling, pain, numbness or cold.
It has been mentioned numerous times in the ancient literature that moxibustion-probing is a good way to find reaction points for treatment for many refractory diseases. “Acupuncture for Life Cultivation” records that back pain can be treated by doing moxibustion on the pain points. “A woman had red and white leucorrhea and asked for acupuncture from me. I did moxibustion for her on the Qihai point (RN6) first, but got no result. The second day I did moxibustion on the Daimai point (GB26)…the disease disappeared…from then on I always selected this point for treatment. Most of the patients can feel soreness when I press. I know this is the correct point for leucorrhea. When I do moxibustion on this point, everybody gets effect”. “Continuation of TCM Wording and Illustration for Classified Yellow Emperor's Classics” also record that intestinal bleeding can be cured by doing moxibustion on Mingmen point (GV4). Numerous experiments also proved that acupoints have “temperature characteristics”, which means, the temperature of acupoints are higher than the normal surrounding area and the temperature of different points vary. When a certain organ gets sick, the corresponding points may have temperature changes as well. Based on this, we can light a moxa stick and probe around to find the “heat-sensitive” points, which will serve as treatment points to adjust the organ functions. This is the so-called “moxa-probing”. This is worthwhile to propagate in the future. Rixing Chen observed 107 cases of myofascial pain syndrome being treated by moxibustion on the “heat-sensitive” points. The results showed an effect rate of 86%, which is significantly higher than the 24% effect rate achieved by acupuncture and cupping (P<0.001), indicating a promising potential of this new treatment.
4.Probing by electricity
By using a specific “meridian measurement” instrument, points of “low resistance” can be detected as movable points, and chosen for treatment. Around 50 years ago, ZhongGu Yi Xiong started to experiment by stimulating the skin with a 9V direct current. He found that the line formed by the low resistance points (good electric conduction point, GECP), was in accordance with the meridian. He also noticed that these GECPs had several times lower resistance than the non-meridian area. He named these meridians “good conduction meridians” due to their characteristics of low resistance. Zhaoliang Han found that the same name meridians on the different sides of the body were in balance during a normal healthy status but in imbalance when there were pathological changes. This further proved that resistance changes are related to diseases. Studies have shown that the resistance of the meridians can be adjusted to a normal range with acupuncture. This might be an explanation to why these points can be used for “adjusting the Qi”, and “balancing the deficiency-excess” in order for the body to recover to a “harmonious” status.
It is easy to be “blinded” by a certain “formula” or “principle” such as “point A at location B, for disease C use point A” in our clinical practice. But things should not be done in a fixed and mechanical way. The limited ways in which we look at things sometimes restrict the needed flexibility of the therapeutic strategy. It is a great benefit if we are aware of the movable points, if we know how to detect them and if we increase their clinical use. By repeated clinical observation, we realized that this “original natural method” can give us instant information and provide a highly individualized treatment strategy, which greatly improves the rate of “striking at the core”, and thus clearly increases the clinical effect.
The authors declare that they have no competing interests.
We are grateful for the funding support from Jiangxi Provincial Office of Public Health (2011A023） and Jiangxi Provincial Office of Education (GJJ12524）.
1.Yaofang Liu. “Poking therapy for 34 cervical syndrome cases”,Jiangshu TCM Journal 1996;17(7):34.
2.Yuhua Tan, Xiaohong Wang. “Pricking on non name specific points to get bleeding for 23 cases of acute mastitis”,. Chinese Acupuncture 2004;24(4):278.
3.Kaizhu Lin, Guojin He, Jin Shen Yu. “Poking and cupping methods for 32 cases with piles”,ActaofWujingMedical College 2005;14(3):237.
4.ZhenghongXie, Suhe Li. “A Shi point- reaction point and their utilization in acupuncture practice”, Journal of TCM External Treatments 2006;15(3):46-49.
5.Lesheng Liu, Yan Zhang, Wenhui Fang.“Triple-edge needle on poking on Yinjiao point for 72 cases of piles bleeding” Chinese Folk Therapies 2005; 13(2):16.
6.Xi Zhang, Yuhong Zhang, “The influence of dredging fourteen-meridian by positive reaction points on insomnia”, Chinese Folk Therapies. 2009;17(4):54.
7.Zhenhua Wang. “Clinical observation on 21 cases of acute ankle sprain treated by needling Xiaojie point and reaction points around wrist”,New Journal of Traditional Chinese Medicine 2011;43(9):90.
8.Shuang Li. “Acupuncture on reaction point on groin for primary sciatica”,Journal of Qingdao Healthcare 2009;41(4):291.
9.DechengLiu.”Acupuncture on Yin-yang points for 202 cases of lumbago”, Chinese acupuncture 2003;(8):468.
10.Sumei Liang, CaixiaHuo, Yanling Yu. “Pressing on “sensitive points” on back for 80 cases of acute stomach pain”,Chinese Folk Therapies. 1999; (3):12.
11.AiguoLui. “Blocking on Ashi point for 132 cases of acute inflammation of mammary gland”,Medical theory and practice2005;18(7):817.
12.Shigang Song. “Acupuncture on reaction points on lateral neck for 80 cases of chronic cervical syndrome”. Clinical Journal of Acupuncture 1997;13(10):13.
13.Changlai Wang, Xiaoqing Du. “Intradermal imbedding needles for 210 cases of insomnia”,Acta of Chengdu University of TCM. 1998;21(1):25.
14.Aiguo Qin. “Knocking needling of seven-star needles for 70 cases of insomnia”, Chinese Acupuncture 1996;16(12):46.
15.Haiying Ma. “Poking and cupping for 150 cases of acute mammitis”,Chinese Folk Therapies2004;12(3):18.
16.DehuaZhai, LinnaZhai, Jinzhu Liu. “Diagnosis and treatments for insomnia based on clues from meridian”, Henan TCM Journal 2004;24(8):64.
17.Rixing Chen, Mingfei Kang. “Novel therapeutic methods of moxibustion on heat-sensitive points”, Beijing. People’s Health Publishing House. 2006:20-30.
18.Rixing Chen, Mingfei Kang. “Heat-sensitive points for myofascial pain syndrome: a multi-center randomized clinical trial. Chinese Acupuncture”, 2008;28(6):395-398.
19.Zhaoliang Han. “Unbalance of resistance between the same name meridians in different sides and its relationship with diseases”, Journal of Chinese Medical Physics 1999;16(2):112-114.
20.GuiyanPeng. “The essence of meridian, acupoints and acupuncture”,Chinese Journal of Modern Drug Application 2009; 3(6):188-189.
MP: movable point SP: stable point GECP:good electric conductionpoint
* Xiaojie point is a specific point in Dong’s system developed by the famous Taiwanese acupuncturist Jingchan Dong.
YANG ZB,WU HX, YANG Q, et al.Identification and Clinical Utilization of Movable Points.DCM 2017;1(1):1-6.