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Requesting Input for an Open-Access Repository or Database for Physiological and Anatomical Ontology of Acupoints

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July 08, 2019
Helene Langevin, M.D.

Director
National Center for Complementary and Integrative Health
View Dr. Langevin's biographical sketch

I recently attended the Society for Acupuncture Research’s international research conference in Burlington, Vermont, where I spoke with many researchers keen to pursue rigorous studies on various aspects of acupuncture.

In February, I attended a National Institutes of Health (NIH) workshop on Translating Fundamental Science of Acupuncture Into Clinical Practice for Cancer Symptom Management, Pain, and Substance Abuse, co-organized by NCCIH and the National Cancer Institute. Speakers and participants at that workshop noted that there was a need for a database to deposit, share, and compare anatomical and physiological data associated with acupoints among various studies, as there are no NIH-sponsored databases or resources available to the research community. 
 
The acupuncture research community has generated a substantial amount of anatomical, biochemical, physiological, and behavioral data. However, a lack of consensus on the location and functional significance of specific acupoints (locations on the body that can be stimulated using a variety of methods including, but not restricted to, acupuncture needles) has hampered substantial development of rigorous research evidence on acupuncture’s therapeutic value. To address this issue, NCCIH and our NIH partners are interested in receiving input from the broader research community on the value of an open-access repository or database for acupoints and on key criteria and elements that would make this resource most useful.  

We recently published a Request for Information (RFI): Important Considerations for Potential Creation of an Open-Access Repository or Database for Physiological and Anatomical Ontology of Acupoints.

I encourage you to review the RFI and share your input regarding the creation of this repository/database by August 4, 2019 using our online form: 
https://nccih.nih.gov/rfi-open-access-acupoint-response

We look forward to hearing from you! If you have questions, please leave a comment below or contact us at NCCIHacuptdatabase@nih.gov.

Comments

I hesitate to wade into this, as I cannot see how it both begins and ends in anything but irreconcilable controversy.If I may be so bold to say, my immediate reaction to this project while laudable is that it belongs at perhaps number 4 or 5 or 6 on the list of basic research or “uniformity of practice” priorities. What belongs at number 1 and 2?Whether the “heat, damp, wind, phlegm” language helps or hurts both the efficacy of the clinical encounter and the advancement of the profession (chiefly, collaboration and credibility).Whether the idea that acupoints have specific functions (as opposed to “reaction areas;” that is, a Tan/Tung/British Medical Acupuncture Society understanding vis-a-vis. a TCM/Five Element understanding) helps or hurts (A) our ability to choose an effective point prescription for a given client/patient, (B) our ability to design and conduct research on the effectiveness of acupuncture and (C) the efficiency with which we might perform our craft.As, I believe, SAR board member Richard Hammerschlag observed at the 2014 annual meeting in Ann Arbor, there are in effect NO SHAM ACUPUNCTURE POINTS!! —if only by virtue of the fact that just about any location on the body (A) can be found to be an acupuncture point cataloged within one system or another (I am thinking chiefly here of the Master Tung points, but surely there are others, even the whole idea of Ashi points) and (B) can be reactive via fascial planes or other as yet unelucidated mechanisms/connections. (Here I am thinking of those excellent papers published by Sánchez-Araujo and Luckert-Barela (Acupunct Med 2014;32:62–69) and by Peter Dorsher (Medical Acupuncture 2009;21(2):91-97), as well as Dr Langevin’s own “Paradoxes” paper (Evidence-Based Complementary and Alternative Medicine Volume 2011:1-11).I feel like there was another fantastic paper by Finado & Finado, of Rosyln Park, NY. Via a private conversation with one of them, we both came to the conclusion that the only way forward would be a total overhaul of acupuncture education in the United States, something unlikely to happen at least in our lifetimes, and thus he (and I) have chosen to stay out of this debate!

(Postscript)I find that acupuncture point location both (at least for some points) varies person to person and differs by tradition, training, personal experience. I will provide examples of each:The meridian along a finger breath’s or so distance inferior to the tibial crest, for example, taught and learned as the Spleen channel:An issue with Spleen 9, for example, I would say, is that there exists quite a generous “fair field” for this point; that is, depending on the size of the person, anywhere from a silver dollar to a tea cozy (but probably more oblong) region wherein which needling (are we going to have the depth, manipulation, plastic handle or steel discussion next?) can reproducibly exert a (“central regulating”) effect.Points such as Spleen 6, while traditionally taught to lie “3 fingers’ breadth” superior to the prominence of the medial malleolus (i.e., the breadth of 3 fingers of the patient— not the practitioner) and even Spleen 7 (often used, needled more deeply, to access the motor point in the soleus muscle) are, at least with many experienced practitioners with a rich palpatory experience and practice, located not by measurement (nor by anatomical landmarks) but purely through palpation.Additionally, for frequently used and commonly agreed upon to be systemically active points, Zu San Li (ST36) and Yang Ling Quan (GB34), one can find about as many arguments to where the “right” point lies as one counts clinic supervisors in a (large) school clinic. And again, we haven’t even considered needling technique here: “getting the qi” at ST36 or more of a Japanese/cutaneous insertion— or neither of these; pecking the peroneal tendon at its attachment to the lateral condyle when needling GB34— or not. Finally, with points like Houxi (SI3), commonly used or at least taught to be useful, to open the Governing Vessel /Du Meridian that is taught/learned to run down the midline of the back, a practitioner is very likely to offer the patient/client (or herself/himself) a choice of 2 or more possible “best exact” locations based on sensitivity and/or the patient/client’s reaction to palpation. (To complicate matters further, in Trigger Point acupuncture, a practitioner will palpate and press various possible locations within a very generous range of a given point, asking the patient to report which of those locations exerts an effect (either diminution or aggravation) on the pain— and then that location is chosen for the insertion.)Similar issues exist with Hegu (LI4), with Shenmen (HT7), probably even with Quchi (LI11). While these might be easier to standardize, it’s not at all clear that in this standardization of points we won’t (cue Unintended Consequences soundtrack here) be unwittingly diminishing the potential central regulatory effects of many of these powerful distal points.

I think this is an outstanding idea for accupunturists to share and post the accupoints that may impact the biological and physiological functions of the patients and ultimately a consensus on the accupoints related to functional significance may be reached. 

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This page last modified July 08, 2019