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.