Points selection pattern in acupuncture-moxibustion treatment of gouty arthritis: an analysis based on bibliometrics
Li et al. · J Acupunct Tuina Sci · 2018
Evidence Level
MODERATEOBJECTIVE
To analyze patterns of point and meridian selection in the acupuncture-moxibustion treatment of gouty arthritis
WHO
Analysis of 78 clinical studies on gouty arthritis
PERIOD
Literature from 1981 to 2017
POINTS
Taichong (LR-3), Taibai (SP-3), Sanyinjiao (SP-6), Taixi (KI-3), Yinlingquan (SP-9)
🔬 Study Design
Studies analyzed
n=78
Bibliometric analysis of acupuncture-moxibustion protocols
📊 Results in numbers
Most-used point: Taichong (LR-3)
Most-used meridian: Spleen
Total points identified
Meridians involved
📊 Outcome Comparison
Frequency of use of the principal meridians
This study identified the acupuncture points most consistently used to treat gouty arthritis by analyzing decades of research. The findings show that specific points such as Taichong and Taibai are consistently selected by acupuncturists, offering reliable guidance for treating this painful condition.
Article summary
Plain-language narrative summary
This important bibliometric study analyzed 78 clinical investigations published between 1981 and 2017 to identify the most consistently used point-selection patterns in the treatment of gouty arthritis with acupuncture and moxibustion. Gouty arthritis, a metabolic condition characterized by the accumulation of uric acid crystals in the joints, affects between 0.34% and 2.84% of the Chinese population and causes intense pain, redness, and joint swelling. In Traditional Chinese Medicine, this condition is classified as Bi syndrome or joint wind (痹证), resulting from spleen and kidney dysfunctions combined with retention of dampness and phlegm. The methodology involved a systematic search across three major Chinese databases (CNKI, Wanfang, and CQVIP), applying rigorous inclusion criteria that required clinical studies with at least 30 participants per group and acupuncture-moxibustion methods as the primary intervention.
Review studies, dissertations, animal experiments, and research with inadequate methodology were excluded. The findings revealed consistent patterns in meridian and point selection. The five most-used meridians were: Spleen (67 times), Liver (59 times), Stomach (53 times), Kidney (49 times), and Large Intestine (44 times). This selection accurately reflects the principles of Chinese medicine for treating gouty arthritis: tonifying the spleen and kidney, draining dampness, and clearing heat.
The Spleen meridian governs transportation and transformation, the Liver meridian regulates qi (氣) flow, the Stomach meridian facilitates digestion, the Kidney meridian controls the water pathways, and the Large Intestine meridian regulates body fluids. Among the 109 points identified, the five most frequently used were: Taichong/LR-3 (79 times), Taibai/SP-3 (68 times), Sanyinjiao/SP-6 (61 times), Taixi/KI-3 (57 times), and Yinlingquan/SP-9 (55 times). Each point has specific functions aligned with the treatment of gouty arthritis. Taichong, as the Yuan-source point of the Liver meridian, regulates qi movement.
Taibai strengthens the spleen and drains damp-heat. Sanyinjiao, the crossing point of three yin meridians, tonifies the spleen and kidney while draining dampness. Taixi tonifies the kidney and moves qi, while Yinlingquan strengthens the spleen and regulates the san jiao (三焦). Analysis of principal versus auxiliary points showed that the principal points follow the same pattern as those most-used overall, while the auxiliary points include Yanglingquan/GB-34 (31 times), Fenglong/ST-40 (30 times), and Xuehai/SP-10 (29 times) — points that complement treatment by moving blood, dissolving phlegm, and harmonizing qi.
Notably, most points are located in the lower extremities and feet, close to the areas most commonly affected by gouty arthritis, demonstrating application of the local-treatment principle. Regarding treatment methods, acupuncture-moxibustion combination as a standalone modality was most-used (15 studies), followed by acupuncture with herbal medicine (11 studies) and acupuncture-moxibustion with herbal medicine (10 studies). Electroacupuncture also showed significant application, especially when combined with bloodletting (5 studies). The clinical implications are substantial.
The study provides robust evidence for standardized protocols in the treatment of gouty arthritis, based on decades of clinical experience. The identified patterns respect both syndrome differentiation principles and the specific localization of the disease, offering a balanced approach between systemic and local treatment. The consistency of the findings across multiple studies suggests that these protocols are not only theoretically sound but also clinically effective. However, the study also reveals important limitations in current standardization.
Despite consistency in the points selected, operational details such as insertion depth, needle retention time, and specific syndrome-differentiation criteria vary across studies, hindering replicability and standardization of treatment.
Strengths
- 1Large database with 78 studies spanning 36 years
- 2Systematic methodology with clear inclusion/exclusion criteria
- 3Consistent identification of point-selection patterns
- 4Alignment with Traditional Chinese Medicine principles
Limitations
- 1Lack of standardization of operational details across studies
- 2Absence of high-quality randomized controlled trials
- 3Variability in syndrome-differentiation criteria
- 4Need for additional multicenter research
Expert Commentary
Dr. Marcus Yu Bin Pai
MD, PhD · Pain Medicine · Physical Medicine and Rehabilitation · Medical Acupuncture
▸ Clinical Relevance
Gouty arthritis represents a recurrent clinical challenge in pain and rheumatology services, especially in patients with chronic hyperuricemia, metabolic syndrome, or low tolerance to conventional anti-inflammatory drugs. This bibliometric work, in consolidating 36 years of literature and 78 clinical studies, delivers something of immediate value: a map of protocols with a reasonable degree of convergence. The clinician who incorporates acupuncture into the management of the gout patient finds here a basis for structuring the point protocol with accumulated empirical support. The profile of dominant meridians — Spleen, Liver, Stomach, Kidney, and Large Intestine — translates a pathophysiologic logic coherent with what we know about urate metabolism and articular inflammation. The preferred localization of points in the lower extremities and feet further reinforces the combination of a systemic approach with local treatment, a strategy the physiatrist already recognizes as a fundamental biomechanical principle in the management of peripheral arthropathies.
▸ Notable Findings
Among the 109 points identified, the frequency concentration in the top five — Taichong, Taibai, Sanyinjiao, Taixi, and Yinlingquan — is notable for its degree of implicit consensus across independent studies conducted over four decades. Taichong emerging as the most-used point, with 79 occurrences, makes sense beyond the traditional nomenclature: its location on the dorsum of the foot, near the metatarsophalangeal joint frequently involved in gout, combines local action with a segmental neuroreflex effect. Sanyinjiao, as a convergence point for three meridians, is particularly versatile for patients with associated metabolic comorbidities. The predominance of the Spleen meridian with 67 occurrences, ahead even of the Kidney, challenges a traditional expectation and suggests that the metabolic-regulation and fluid-management dimension occupies a central position in this protocol. The acupuncture-moxibustion combination leading the therapeutic modalities also warrants clinical attention.
▸ From My Experience
In my practice with gout patients — especially those in the intercritical phase or with contraindications to colchicine and NSAIDs because of borderline renal function — I typically structure the protocol around exactly the points this survey confirms: Sanyinjiao, Taixi, and Yinlingquan as the systemic base, complemented by local points according to the involved joint. Response in a mild acute phase tends to appear by the second or third session, with perceptible reduction of edema and pain intensity. For maintenance and prevention of recurrence, I usually work with cycles of eight to ten sessions, reviewing frequency every three months according to serum urate levels and adherence to dietary measures. I almost always combine nutritional counseling and, when feasible, hydrotherapy. I have observed that patients with concurrent metabolic syndrome respond in a less linear fashion — which makes the selection of points focused on the spleen-kidney axis even more pertinent, as this work endorses.
Full original article
Read the full scientific study
J Acupunct Tuina Sci · 2018
DOI: 10.1007/s11726-018-1025-3
Access original articleScientific Review
Marcus Yu Bin Pai, MD, PhD
CRM-SP: 158074 | RQE: 65523 · 65524 · 655241
PhD in Health Sciences, University of São Paulo. Board-certified in Pain Medicine, Physical Medicine and Rehabilitation, and Medical Acupuncture. Scientific review and curation of every entry in this library.
Learn more about the author →Medical disclaimer: This content is for educational purposes only and does not replace consultation, diagnosis, or treatment by a qualified professional. Some information may be assisted by artificial intelligence and is subject to inaccuracies. Always consult a physician.
Content reviewed by the medical team at CEIMEC — Integrated Centre for Chinese Medicine Studies, a reference in Medical Acupuncture for over 30 years.
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