This new reference book aims to examine the location of acupuncture points from a Western anatomical perspective. The main emphasis of the book is to demonstrate the anatomical structures from the surface to the deep level that underlie the passage of an acupuncture needle. As a teacher of point location, I was interested to see what this book would have to offer, particularly in relation to the existing point location books available.
In the opening section, the author advocates a stronger emphasis on the importance of the western anatomical details of acupuncture points, with examination from the surface level through to tissue structure and down to the cellular level. He indicates that this is the current trend in research of acupoints, but unfortunately gives no references for interested readers to explore this further.
The book begins with a description of the different methods of locating points, including some of the 'short cuts'. This overview is quite helpful on a practical level. The reader is reminded that point location is not an exact science, although overall, the book seems to suggest otherwise.
The rest of the book is devoted to descriptions of 378 acupuncture points with the most commonly used points depicted not only with text, but also with accompanying illustrations. Points are grouped according to regions of the body. However, the groupings are not always particularly logical; for example, Lu 1 zhong fu and Lu 2 yun men are about fifty pages apart! This requires constant cross-referencing to the index at the back of the book, which can be time consuming and a little frustrating. Although each point is named according to its divisional pairing (eg. LI 4, hand Yang Ming large intestine meridian), there is no further information about channel pathways. The classification of the point is given (with the occasional ommision), but the five element correspondences are not. Point functions according to TCM and clinical indications are also included.
The book provides thumbnail sketches of some of the points showing a section of the point's channel pathway on a body. This is the only reference to channel pathways in the whole book. These diagrams are vague enough to be almost superfluous, giving no more than a scant reminder of where the point is on the body. I also detected some inaccuracies (eg. with the label for SI 10 nao shu pointing to SI 12 bing feng).
Under each point that is covered, the anatomical location is given, including useful information on the position in which to locate the point. This is followed by needling and moxibustion methods. Although this information is readily available in existing point location books, more details are given about the depth and direction for needling, with indications about expected needle sensation and the path of radiation. Important warnings and contraindications are also included. In some cases, a variety of depths and directions are indicated for the treatment of particular conditions.
The main strength of the book is the clear and detailed breakdown of the cross-sectional anatomy of the needle passage, from skin to deep structures. Frequent reference is made to the needles reaching nerves. This is not surprising, considering the depths given in many cases are much deeper than those indicated in previous texts. At times it clarifies what to do if this should occur, however, at other times it is unclear if this is the desired effect or not. The main illustrations that accompany the text for the most commonly used points, are cross-sections of the points showing the passage of the acupuncture needle in relation to the anatomical structures it passes through and those surrounding it. As a practitioner with a training in surface anatomy, I found these diagrams quite difficult to interpret and the labelling not always clear. I suspect this might be the case for many lay acupuncturists. The diagrams are based on the needling of corpses which have been frozen before sections have been taken. I question the efficacy of locating points in this manner, as my understanding of the nature of acupuncture points and channels is of something dynamic and integral to life, representing the gathering and flowing of qi in the body. Such an approach seems anathema to this concept and to the spirit of Chinese medicine.
In spite of the inclusion of extensive warnings and detailed information regarding needle depth and possible damage to underlying structures, some depths are alarming. Many of those indicated tend to be deeper compared to other texts. For example, the book indicates needling TH 14 jian liao to a depth of 1.5 - 2.5" through to Ht 1 ji qian and SI 9 jian zhen to a depth of 2 - 2.5" through to the axilla, in a perpendicular direction only, to avoid pneumothorax. I was not entirely reassured when examining some of the diagrams. For example, the diagram for Ht 1 ji qian shows it passing through the radial nerve. In contrast, the needle for Ren 12 zhong guan looks like a 0.5" needle. The diagram also shows the liver directly superior to CV 12, yet indicates a deeper needle insertion at Ren 13 shang guan.
There is a section at the end of the book that covers in extensive detail methods and cautions for needling 'high risk acupoints'. This is particularly useful for practitioners wanting to needle points that might previously have been avoided. It includes information on complications, how to prevent these and treatment should they occur.
My main reservation about this book on a clinical level relates to the depth of needling advocated. I question the necessity for such deep needling and the potential risks it creates. Having recently become more acquainted with the approach to treating chronic pain involving myofascial release by the treatment of tight tender points (as advocated by Mark Seem), understanding the relationship of points to their underlying musculature has taken on a new significance. Interestingly, this technique involves very superficial needling.
I think this book could have a place in the teaching of western anatomy to acupuncture students and serve as a useful resource for cross referencing, particularly since the points are covered according to regions of the body. For students who are learning point location for the first time, this needs to be done within the context of channel pathways, which is not the emphasis of this book. The depths indicated would also not be appropriate for students learning to needle. It is an interesting reference book for practitioners who want to explore in more detail the relationship between particular points and their area of anatomy. In many classical point location descriptions, the point is described in relation to surrounding structures, but without reference to the actual structures the needle is penetrating; this book fills this gap. I would however, only recommend it with caution.
Marian Fixler trained at the London School of Acupuncture and Traditional Chinese Medicine and at Nanjing International College. She teaches at the London School of Acupuncture at the University of Westminster, and practises acupuncture and tuina massage in London privately, on the NHS and in HIV services.