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Lauren Burke Bing Yang
In this paper the controversial issue of the effectiveness of distal versus local acupuncture will be discussed. In Chapter 5 of Su Wen the following is stated, “So, an adept doctor of acupuncture always needles the yang part when the yin part is ill, and needles the yin part when the yang part is ill. He adjusts the right to treat the left, and adjusts the left to treat the right. He must know himself to know his patients, and must know the exterior to know the interior.
Detecting a surplus pulse, he must know a deficient one. Seeing the appearance of a disease, he foretells its development. This ensures no delay in treatment.” (Ni, 2005, p.20) This passage tells us the adept doctor does not needle locally at the site of illness. In particular, the discussion of what is more effective (distal or local) is something that has come up frequently at school. There are many different schools of thought in acupuncture and treatment styles such as Dr. Tan’s balance method or Master Tung use distal points to treat the affected area. Orthopedic styles of acupuncture use local points to treat affected areas. Yet, we can see from the classical text that treating locally isn’t necessarily called for.
This is an important topic to think critically about because it is highly disputed. I have heard practitioners say community acupuncture will never be effective because local points aren’t used. I have also heard the opposite of practitioners who use distal points saying it is more effective than local acupuncture. With the correct information, we can make decisions for our patients based on research and anecdotal evidence to help them the best we can. We should be consulting the classics and modern science to determine what is best and not get caught up in debate.
For the side of distal acupuncture being effective here are two citations: “Aupuncture at Tiaokou (ST38) for Shoulder Adhesive Capsulitis: What Strengths Does It Have?” A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Distal “Acupoints Outperform Proximal Acupoints in Treating Knee Osteoarthritis: A Randomized Controlled Trial”. The first study was a systematic review looking at the acupuncture point ST 38 (Tiaokou) and its effectiveness at distally treating Shoulder Adhesive Capsulitis (frozen shoulder). This point is commonly used as a distal empirical point for shoulder pain. The analysis looked at 19 random control trials with 1944 participants. Although some of these studies included local points, most did not. The participants’ results were evaluated by their pain scale as well as their shoulder range of motion. The results are as follows: “the results of our meta-analysis revealed significant differences in acupuncture at Tiaokou (as sole treatment or in combination with shoulder acupoints) versus other therapies (acupuncture at shoulder acupoints, tuina, exercise of the affected shoulder, and oral NSAIDs) for the relief of shoulder pain. What is more, compared with other therapies, acupuncture at Tiaokou appeared to reach a better therapeutic effectiveness in improving the recovery of shoulder joint mobility.” (Yang, 2018) These results show us how distal acupuncture is effective. In the second study effectiveness of distal and local acupuncture points were compared in the treatment of Knee Osteoarthritis. The following conclusion was made: “Both distal and proximal acupoints are effective in treating KOA. However, distal acupoints provide better pain relief and improve ROM compared with proximal acupoints. Following TCM theory, significant changes in spectral energy were observed in the left cun, guan, and chi pulses, indicating pain relief and blood flow improvement after acupuncture.” (Wan-Zhen Yu, 2021) This points again to distal treatment being effective and creating a larger shift in ROM as compared to local proximal points.
For the side for local acupuncture being effective there is a study: “Effect of acupuncture depth on muscle pain”. Although this study does not compare local to distal acupuncture but compares the depth of local acupuncture. Its results find that the stimulation of the muscle itself is what is important for the relief of muscle pain. (Itoh, 2011)
The first two studies that point towards distal points being more effective than local points all in some parts include the usage of local points. I think that what is being proven is also how distal points are an appropriate treatment on their own, and can make local points more effective.
Most patients are expecting to be treated at their site of pain. This expectation may lead to distrust in the practitioner if no local points are used. However, through proper education of the current research and classical texts, the patient can begin to understand how acupuncture works. we can employ both local and distal acupuncture with our patients and fine tune to find what works best for each individual patient.
Resouces
Itoh, K., Minakawa, Y. & Kitakoji, H. Effect of acupuncture depth on muscle pain. Chin Med 6, 24(2011). https://doi.org/10.1186/1749-8546-6-24
Ni, M. (1995). The yellow emperor’s classic of medicine: A new transl. of the Neijing Suwen with commentary. Shambhala.
Wan-Zhen Yu, Chin-Ming Huang, Hui-Ping Ng, Yu-Chen Lee, “Distal Acupoints Outperform Proximal
Acupoints in Treating Knee Osteoarthritis: A Randomized Controlled Trial”, Evidence-Based
Complementary and Alternative Medicine, vol. 2021, Article ID 4827123, 12 pages, 2021.https://doi.org/10.1155/2021/4827123
Yang, C., Lv, T. T., Yu, T. Y., Wong, S., Lu, M. Q., & Li, Y. Z. (2018). Acupuncture at Tiaokou(ST38) for shoulder adhesive capsulitis: What strengths does it have? A systematic review and meta-analysis of randomized controlled trials. Evidence-Based Complementary and Alternative Medicine, 2018, 1-11. https://doi.org/10.1155/2018/4197659
Author information:
Lauren Burke, Nesa Lauren’s lifelong fascination with the human body and medicine, nurtured by her medical family background, led her on a path to becoming a dedicated health and wellness professional. With over a decade of experience in the field, she has specialized in Massage Therapy and Western herbal medicine. In 2023, she achieved her dream of graduating from the New England School of Acupuncture. Now, she’s excited to bring Traditional Chinese Medicine to her home in upstate New York.
Bing Yang, licensed acupuncturist in Massachusetts. She got bachelor and Master degrees of Acupuncture and Chinese Medicine from Beijing University of Chinese Medicine in 1990s and Doctor degree from Massachusetts College of Pharmacy and Health Sciences (MCPHS). Currently she is the associate professor and Director of Chinese Herbal Programs of New England School of Acupuncture, MCPHS. She also maintains a private practice in Boston.
局部針灸 vs 遠端針灸
勞倫·伯克 楊冰
本文將討論遠端針灸與局部針灸有效性的争議問題。 《素問》第五章雲：“故善用針者，從陰引陽，從陽引陰，以右治左，以左治右，以我知彼，以表知裏，以觀過與不及之理，見微得過，用之不殆”。這段話告訴我們，經驗豐富的醫生不一定會在病竈部位進行局部針刺。 特别是，關於何種方法更有效（遠端或局部）的討論在學校裏經常出現。 針灸有許多不同的思想流派 以及治療方法，象譚式的平衡法或董氏針灸等使用遠端穴位進行治療；骨科針灸療法使用局部穴位來治療受影響的區域。 從經典中我們可以看出，不一定要局部治療。
這是一個需要批判性思考的重要話題，因爲它存在很大争議。 我有聽到針灸師説社區針灸永遠不會有效，因爲局部穴位没有被使用。 我也聽到過使用遠端穴位的針灸師的相反説法，説遠端取穴比局部取穴更有效。如果有了正確的信息，我們就基於科學研究和經驗證據，盡我們所能幫助患者。 我們應該查閲經典和現代科學來確定哪種方法最好，而不是陷入争論。
對於遠端針灸有效的這一方面，這裏有兩篇文章：“針灸條口穴（ST38）治療肩部粘連性關節囊炎：它有什麽優點?”系統回顧和薈萃分析；另一篇是“遠端穴位治療膝骨關節炎優於近端穴位：隨機對照試驗”。第一項研究是對 ST 38 穴位（條口）治療肩粘連性關節囊炎（肩周炎）療效的系統評價，此穴常用作肩痛的遠端經驗穴。該分析考察了19項隨機對照試驗，共有 1944 名參與者。盡管其中一些研究包括了針刺局部穴位，但大多數没有。參與者的結果是通過他們的疼痛級别以及肩膀的運動範圍來進行評估。結果如下：我們的薈萃分析結果顯示，針灸條口穴治療以緩解肩部疼痛（作爲唯一的治療方法治療或聯合肩部穴位治療）與其他療法（針刺肩部穴位、推拿、患肩部鍛煉和口服非甾體抗炎藥）相比存在顯著差异。更重要的是，與其他療法相比，針灸條口穴在改善和恢復肩關節的活動性方面似乎達到了更好的治療效果。（楊，2018）這些結果向我們展示了遠端針灸的有效性。第二個研究比較了遠端和局部穴位治療膝骨關節炎的療效，得出以下結論：“遠、近穴均對治療 KOA 有效。然而，與取近端穴位比較，遠端穴位可以更好地緩解疼痛並改善膝關節活動範圍。根據中醫理論，左寸、關、尺脈能量光譜發生顯著變化，表明針灸後疼痛减輕和血流狀况有改善。”（於萬振，2021）這再次指出遠端治療與局部針刺相比，有效並能關節活動範圍的變化更爲顯著。
對於局部針灸有效的一面，有一項研究：“針灸深度對肌肉疼痛的影響效果”。盡管這項研究没有比較局部與遠端而是比較局部針灸的深度，其結果發現，刺激肌肉本身對於緩解肌肉疼痛很重要。（Itoh，2011）
前兩項研究表明遠端取穴治療比局部治療更有效, 但在這過程中都包含了局部穴位的使用。我認爲這可以證明遠端穴位可以作爲一種適當的治療方法，并且可以使局部穴位更有效。
大多數患者都希望在疼痛部位得到治療。這種預期可能會導致如果没有使用局部穴位，就會對針灸師産生不信任。然而，通過當前的研究和經典文獻對患者進行適當的教育，患者可以開始瞭解針灸的jili。 我們可以對患者采用局部和遠端針灸，並進行微調以找到最適合每個患者的方法。
參考文獻
Itoh, K., Minakawa, Y. & Kitakoji, H. Effect of acupuncture depth on muscle pain. Chin Med 6, 24(2011). https://doi.org/10.1186/1749-8546-6-24
Ni, M. (1995). The yellow emperor’s classic of medicine: A new transl. of the Neijing Suwen with commentary. Shambhala.
Wan-Zhen Yu, Chin-Ming Huang, Hui-Ping Ng, Yu-Chen Lee, “Distal Acupoints Outperform Proximal
Acupoints in Treating Knee Osteoarthritis: A Randomized Controlled Trial”, Evidence-Based
Complementary and Alternative Medicine, vol. 2021, Article ID 4827123, 12 pages, 2021.https://doi.org/10.1155/2021/4827123
Yang, C., Lv, T. T., Yu, T. Y., Wong, S., Lu, M. Q., & Li, Y. Z. (2018). Acupuncture at Tiaokou(ST38) for shoulder adhesive capsulitis: What strengths does it have? A systematic review and meta-analysis of randomized controlled trials. Evidence-Based Complementary and Alternative Medicine, 2018, 1-11. https://doi.org/10.1155/2018/4197659
作者簡介：
勞倫·伯克一直對人體和醫學感興趣。她的醫學家庭背景的熏陶引導她走上了成爲一名健康和保健專業人士的道路。她在該領域擁有十多年的經驗，擅長按摩療法和西方草藥。 2023年，她實現了從新英格蘭針灸學院畢業的夢想。現在，她很高興能將傳統中醫帶到紐約州北部的家鄉。
楊冰，九十年代畢業於北京中醫藥大學， 獲中醫學學士，碩士學位，後於美國麻省藥科與健康科學大學獲博士學位。現爲麻省藥科與健康科學大學新英格蘭中醫學院教授，中醫係主任，並在波士頓行醫。
