How an Acupuncturist Chooses Which Points To Needle, Stimulate, or Bleed

When I treat someone, and they get a needle sensation and ask, “What WAS that?!” I have to laugh a little.  

I laugh because…it’s so hard to explain exactly what that was!

First, the “Qi” sensation is arriving at the needle.  It’s the nerve “waking up” an area of your body.  So, it’s a good sign that we got the right point.

Second, as far as why this point and why not other areas feel this sensation, it’s necessary to look a little more in-depth into Chinese medicine basics.

Acupuncture 101

You have 6 meridians on each arm and another 6 on each leg.  There are 3 yin meridians and 3 yang meridians on each limb.  Then you also have a meridian that runs up the front center of your body and one that runs up the back center of your body.

• The names of the hand / arm yin meridians are: Lung, Heart, and Pericardium.  
• The hand / arm yang meridians are Large Intestine, Small Intestine, and San Jiao (“triple burner” which is not an organ, not the movement of water between the upper, middle and lower “burners” of your torso).  
• The foot / leg meridians yin meridians are Kidney, Spleen, and Liver.  
• The foot / leg yang meridians are Urinary Bladder, Stomach, and Gall Bladder.  
• The “Ren,” and “Du” are the front and back center meridians.  

Based on the position on your limb determines the “amount” of yin or yang on each meridian.

The meridians connect internally with the organ of it’s name, but it's also simply a way of locating where the needles are going.  Meaning, if I tell you I'm needling your Liver meridian, no need to ask, "What's wrong with my Liver?!!"  It's probably nothing to fret over.  

• Tai Yang =  “Sun Yang,” most yang, meaning it gets the most sun!  It’s on the very back of your head, arms, neck, back, and legs.  On your arms it’s the Small Intestine; legs, it’s the Urinary Bladder.  It's considered your "first defense" against a Qi invasion by "Evil Qi" which could lead to arthritis, allergies, etc.  
• Shao Yang = “Middle Yang.”  On your arms it’s the San Jiao / triple burner, on your legs it’s the Gall Bladder.  It's the middle yang, so helpful for navigating changes, emotional or physical.  
• Yang Ming = “Yang Brightness.”  More toward the front of the body where it meets the Tai Yin meridian.   On your arms it’s the Large Intestine, on your legs it’s the Stomach meridian.  This is where the most Qi and Blood reside, so helpful for digestion and mobility.  
• Tai Yin = “Dark Yin.”  On your arms it’s the Lung, on your legs it’s the Spleen.  The most sensitive to outside influences (air, temperature, and food).  
• Jue Yin = “Middle Yin.”  On your arms it’s the Pericardium, on your legs it’s the Liver.  The defensive level for emotions.  
• Shao Yin = “Bright Yin,” where it connects to the Tai Yang.  On your arms it’s the Heart, on your legs it’s the Kidney.  The most important of the organs.  Your Heart is the "Emperor" of the organs; the Kidney is where your Prenatal Qi resides.  Prenatal Qi is what you give to your biological kids and what your parents gave you.  It gradually depletes throughout your life.  

My acupuncture teacher would say we have “light meat and dark meat,” based on how the sun hits the skin.  For example, observe the top of your forearm that extends from your thumb.  You can see where the lighter color meets the darker color.  That’s the change between the Yang Ming and the Tai Yin.

The yin meridians of the arms start on the chest, the yin meridians of the legs start on the foot.  The yang meridians of the arms start on the fingers, the yang meridians of the legs start on your head, in particular around the eyes.

The One Million Dollar Question:  “How do you know where to put the needles???”  I’m going to tell you!

It’s as easy as 1-2-3 as my acupuncture mentor, Richard Tan, used to say.  

1. Where is the problem?  In particular, what meridian(s).  That’s really all I need to know.  “Point to where it hurts.”  

There's no such thing as “regular back pain,” or “regular sciatica.”  Someone could have back pain on the Du meridian (straight on the center of the spine), on the Bladder meridian (just to the side of the spine) or on the Gall Bladder meridian (lateral side of the hip and leg), or any combination of those.  It could even wrap around to the meridians on the front of the body!  Plus, the pain could be moving in a line on any of those meridians, or it could be in one spot, or it could move to different areas.

2.  What meridians balance the “problem meridian?”  

A. On the Chinese medical clock, there is a 2-hour segment for each meridian.  More Qi circulates on that meridian at those times.  The “neighboring” meridians balance each other and the opposites of the clock balance each other.

B. Tai Yin of the hand balances Tai Yin of the foot and so on and so forth.

C. Tai Yin can balance Tai Yang; Shao Yin balances Shao Yang; and Jue Yin balances Yang Ming.

D. A meridian can balance itself.

E. Yin meridians balance Yang meridians.  For example, Tai Yin and Yang Ming are considered “paired” meridians and balance each other.  Lung balances Large Intestine; Spleen balances Stomach; etc…

3.  Choose the points based on mirror imaging.  

The mirror image is, for example, treating the head (like for headaches) by using your hand and using your wrist to treat the neck area.  It’s like your arm turns into a puppet, with the elbow being the abdomen area.  You can also mirror image the whole body onto a smaller part, like your fingers, with the tip being the head and the base of the finger being the torso!  Or you can “expand” an area, like using the whole leg to image the neck, like a magnifying glass.  

But it’s not always that easy.  

For example, what meridian is diabetes on?  What meridian is depression on?  

Trick question:  they’re not on a meridian!  

In that case, we do overall balancing, like one needle in each meridian, or we use more of the internal function of the meridians and their corresponding organs.  

For example, if I treat someone with allergies by needling the Spleen meridian, they may feel a tender spot, and I can explain that it’s for their immune function.  For stress, we may use the Liver or Pericardium meridian.  

Most people have more than one problem going on. 

As an example, let’s use the Spleen meridian again.  

It balances the Stomach meridian (Yin – Yang combination), which can treat your chest, throat, or eyes.  

The Spleen meridian also balances the Heart meridian (meridian clock neighbors) which could be:  problems in / with the armpit area; wrist or elbow pain on the Heart meridian (arm Shao Yin) or pinky finger.  It also balances the Small Intestine meridian (Tai Yin / Tai Yang) and San Jiao meridians (Chinese clock opposites).  

The Spleen also balances itself!  

Plus, I use it for its internal function of water regulation, for edema (water retention or swelling,) blood regulation and bleeding, digestive problems or immune systems weakness and fatigue.  

When I choose the right points, I try to narrow down the number of needles and the number of meridians to the bare minimum necessary to achieve the treatment goals and total balance.  

So, I may needle someone on the Spleen meridian for several things at once:  digestive problem, wrist pain, and shoulder tension, for example.  So when they ask, “What is that?!”  You see how it’s hard to answer… 

It’s a matter of finding the best meridian for treating what the patient has going on.  

Then:  finding the right points.  

The more tender the area, the more likely it is to balance the “sick meridian(s).”  

So I may palpate along a meridian to find those slightly sore points.  Those are the best points to remove “stuck qi.” 

Another good way to find points are areas with lots of surface veins that we can bleed (yes, just like the old timey notion of "blood-letting").  

Or old scars.  The older the scar, the more dismissive people get about it, but actually, that makes it all the more important to undo the damage to your nervous system in that area. 

 "Global balance" is when the meridians needled on each limb balance the needled meridians on all the other limbs.  

We want at least 4 connection points of balance before the treatment is considered “done” or “good.”  What that means, is that if I choose, again, the Spleen on one leg, on the other leg I may do Stomach points to balance.  Then, on one limb I will choose let’s say the Heart meridian, because it balances Spleen, and on the other arm do Large Intestine because it balances the yang leg (Stomach).  

Yes, it's a lot.  

So, how do I know where to put the points? 

Answer:  going to school for 4 years to learn the basics, studying with Masters of the art, and then spending the next 20 years practicing.  :)