Interpretation of acupoint location in traditional Chinese medicine teaching: Implications for acupuncture in research and clinical practice

Acupuncture represents one of the oldest and most respected practices of traditional Chinese medicine, characterized by the insertion of fine metallic needles at specific points on the human body known as acupoints. Over recent decades, this therapeutic modality has evolved from a cultural curiosity into one of the fastest-growing complementary and alternative therapies worldwide, including in the United States. The growing popularity of acupuncture is due to its reported benefits in treating various conditions, such as asthma, headaches, musculoskeletal problems, menopausal symptoms, and chronic pain syndromes. However, a fundamental issue remains a challenge for both researchers and practitioners: the precise location of acupoints.

The study by Yi Zhang of Beijing University of Chinese Medicine had as its main objective the examination of current methods of acupoint location in traditional Chinese medicine and their implications for the teaching, research, and clinical practice of acupuncture. The methodology adopted was a comprehensive narrative review of the existing scientific literature, combined with a critical analysis of traditional and modern methods of acupoint location. The author examined topics ranging from the theoretical foundations of traditional Chinese medicine, including meridian theory and the concept of qi (氣, vital energy), to the latest technologies developed to assist in the precise identification of acupuncture points. The research also included an analysis of the different methods of acupoint stimulation, from traditional manual acupuncture to modern techniques such as electroacupuncture, transcutaneous stimulation, moxibustion, and acupressure.

The main results reveal a worrisome variability in acupoint location among acupuncture practitioners. The most widely used traditional method is the cun measurement system, which includes both the directional method (using fingers as reference) and the proportional method (dividing distances between anatomical landmarks). The study demonstrated that the directional method presents significant inaccuracies and cannot adequately address anthropometric variations related to race, sex, age, or obesity. The proportional method, in contrast, proved more reliable and precise.

The research also indicated that modern technologies, such as ultrasonography, laser-assisted devices, electroencephalography, and functional magnetic resonance imaging, can assist in more precise acupoint location, presenting less variation compared with traditional methods. The concept of "de qi," the sensation experienced during needle insertion that includes tingling, numbness, and a feeling of fullness, remains an important indicator for practitioners to identify the correct acupoint location.

The clinical implications of these findings are significant for both patients and practitioners. For patients, imprecision in acupoint location can result in less effective or inconsistent treatments, raising important ethical questions about the quality of care offered. For practitioners, there is an urgent need for standardization in teaching and acupoint location methods. The study suggests that medical and traditional Chinese medicine educational institutions should place greater emphasis on precise anatomical knowledge during acupuncture training.

More than half of the acupoints have been shown to be sufficiently distant from traditional anatomical landmarks, which further increases the potential for imprecision. Practitioners should also be aware that different methods of acupoint stimulation—from manual needles to magnet therapies and point injections—may have varying efficacy depending on location precision. The growing integration of assistive technologies in clinical practice may help reduce these variations, although time is still needed for practitioners to adapt to these tools.

The study presents some important limitations that should be considered. It is a narrative review based primarily on existing literature, not including new experimental data or controlled studies. The cultural and regional variability in acupuncture practices was also not fully explored, which may limit the generalizability of findings to different international contexts. In addition, although modern technologies show promise in improving acupoint location precision, definitive studies on their clinical efficacy compared with traditional methods are still lacking.

The author recognizes that, despite considerable advances in acupuncture research over recent decades, conclusive results about the specific anatomical or physiological characteristics of acupoints have not yet been obtained. As a final consideration, the study emphasizes the need for future research to develop more reliable tools and more precise methods for acupoint location. Inconsistency among practitioners must be resolved through better training, standardization of techniques, and possibly the adoption of assistive technologies. The author suggests that the transformation from experience-based medicine to evidence-based medicine will be an essential step for the future of acupuncture, ensuring more effective and safer treatments for patients.