The Development of Channel and Point Theory

A Brief Look Into the History of Acupuncture

Jimi Windmills

Throughout the history of Chinese medicine, the theories of the channels and points have been developed, studied, summarised and documented. Through observation and clinical experience, these theories have been changed and moulded, to fit the phenomena of healing associated with the various techniques unique to Chinese medicine. These ever shifting theories, although

transmutable, provide a solid framework for clinical practise. A platform of understanding that, for three thousand years, acupuncturists have been able to rely on, to perform efficacious treatments, and to leap from, with the developments of new theories.

Channel Groups and Pathways

The various channels are divided into groups, and not all were originally present. In the Mawangdui Scrolls (475 – 221 BCE), there were only eleven channels in total. Six channels ran from the feet to the head, and five channels from hands to the chest and head. Only four of these channels were associated with internal organs (McDonald 2006). There were no references to specific points on the channels in the Mawangdui Scrolls (Deadman et al. 2007: 11). By the time of the Huang Di Nei Jing, there were twelve channels, in which Qi and Blood flowed, which were described as flowing in an enclosed 'hydraulic' circuit (Unschuld 1985: 76). Along with the twelve main channels described, the Ling Shu and the Su Wen describe, fifteen Luo Mai, twelve Jing Bie, twelve Jing Jin, and the skin zones. The Nei Jing describes the pathways of the six arm channel that run between the hands and the head, the Hand-yin and Hand-yang. It also defines the three Foot-yin channels from the feet to the chest, and the three Foot-yang channels from the feet to the head (Unschuld 1985: 77). The pathways of these channels have not changed since their original description in the Huang Di Nei Jing. The Beginning and ending locations of the channels are in place, and there are detailed anatomical descriptions that mark the pathways, which can still be used today (Lu & Needham 1980: 92). While the eight extraordinary vessels are mentioned in the Huang Di Nei Jing, it is not until the Nan Jing that the pathways for the eight extraordinary vessels are defined (McDonald 2006). There are two competing theories on the discovery of the channels. It is the age-old argument

of which came first, the channels or the points. Obviously one school of though suggests that the channels came first, and the other school believes the opposite, that the channels developed from playing anatomical joint-the-dots. The points first school advocates the belief that points were discovered through the observation of tender spots that occurred during the course of a disease, and the reduction of symptoms associated with stimulating these points with pressure or heat. With enough points known, they were grouped together with other points that has similar effects, and with the experience of propagated sensation from stimulating the points, came to understand that there were underlying channels (Deadman et al. 2007:11). The channels first school, believes that with the experience of propagated sensation, particularly during massage, and exploration of the body through meditation and qigong, knowledge of the channels developed first, and specific knowledge about individual points came afterward. This channels first theory is supported by the fact that the earliest extant piece of literature dealing with the topic, the Mawangdui Scrolls, tells us about channels, but there is no mention at all of individual points (Deadman et al. 2007: 11).

Channel Pathology

In the Mawangdui Scrolls we find specific symptoms and pathologies associated with the channels, which were considered to be the consequence of either too little of to much Qi in the vessels (Unschuld 1985: 74). In the Nei Jing we see specific channels associated with certain conditions, indicating the use of points to treat pathology of those channels (Lu & Needham 1980: 96). By 300 CE the system of channels as we know them today was completely in place. The Ling Shu describes in chapter 10, the syndromes associated with pathology of the 12 primary channels, caused by external, internal, excess, deficiency, and Qi severance. However, these descriptions are only for the five zang (McDonald 2006). The Ling Shu also describes the course, and signs and symptoms of pathology of the 15 Luo Mai, the 12 Jing Bie and the 12 Jing Jin. McDonald also importantly points out, that while the course of the Jing Bie is described, there are no pathologies, and thus, no treatments associated with these channels (McDonald 2006). Zhang Zhong Jing in the Shang Han Lun, identifies that external pathogens can attack the exterior, and penetrate the channels, and that there were specific syndromes associated with a pathogens attack on specific channels (Lu and Needham 1980: 42). The eight extraordinary channels, for the first time fully laid out in the Nan Jing, receive a full complement of functions, courses, and signs and symptoms of disharmony.

Point Origins

It is obvious that from very early on, points were grouped together, based on proximity, and similarity of function. While the Nei Jing mentions more than 300 places suitable for needling, not all of these are named or precisely located (Unschuld 1985: 97). In the Su Wen, Ling Shu and the Nan Jing we have 160 points named and located. These points are also categorised into some of the historical point categories that we still use. These three books gave us the Back-Shu points for the five Zang, the five Transport points on the distal ends of each channel, the Yuan-Source points, 15 Luo-Connecting points, and Ba Hui (the Eight Meeting/Influential points). This collection expanded in the Zhen Jiu Jia Yi Jing to 349 points, when Huang Fu Mi described the anatomical locations of more points (Lu and Needham 1980:15). He also added new points to old categories, and gave us some new categories altogether. These were six Back-Shu points added for the Fu, Front-Mu points for the Zang (not including Ren17 for the Pericardium), and 16 Xi-Cleft points (McDonald 2006).

Point Categories

Back Shu

The first time we see the Back-Shu points is in the Huang Di Nei Jing. Chapter 24 of the Su Wen lists five pairs of points on the bladder channel of the back that correspond to each of the five Yin organs (Zang). It also says that these points can be treated either by needling or with moxibustion. As McDonald points out, The Ling Shu says in chapter 51 that Back-Shu points can be treated with moxibustion for both excess and deficient conditions, but needling them is forbidden (McDonald 2000: 9). Book 3 of the Zheng Jiu Jia Yi Jing, fills in most of the blanks and gives us Back-Shu points for the Diaphragm, Gallbladder, Stomach, Sanjiao, Large Intestine, Small Intestine and Bladder (McDonald 2000: 9). The final addition to this category was BL14 Pericardium Back-Shu, added by Sun Simioa in 682 CE, in his work, Qian Jin Yi Fang (Supplement to Prescriptions Worth a Thousand Gold Pieces). As an aside, Sun Simiao is also credited with the development of needling Ahshi (painful) points, specifically on the back, which were not specific acupuncture points (Lu and Needham 1980: 127).

Front Mu

While the Nan Jing mentions the existence of the Front-Mu points, it does not give any names, locations or indications for their use. The details of the Front-Mu points were not fully elucidated until the Zhang Jiu Jia Yi Jing provided descriptions of each, with the exception of the Front-Mu of the Pericardium given in book 3 chapter 19. Again, it was Sun Simiao that eventually gave the Pericardium a Mu point in the same work just mentioned (McDonald 2000: 9).

Transport Points (Wu Shu)

The transport points were some of the first points to be grouped into a category, based on having common actions. These points had already been allocated by the time of the Nei Jing since they are described and named in the Ling Shu. Wu, in his translation of the Nei Jing tells us:

"the five viscera have five shu acupuncture points each. Five times five is twenty-five points... those points of exit make the jing well points. Those in which there is a flow make the ying spring points. Those in which there is a large flow are the shu stream points. Those in which there is flow make jing river points. Those in which there is entrance in relation to other channels make the he confluence or sea points” (Wu 1993: 4).

It is interesting that there are significant differences in the indications listed in the Nei Jing, and the Nan Jing, for a lot of these points. For instance, the Ling Shu tells us that Jing-Well points are used for diseases of the Zang, while in the Nan Jing they are indicated for fullness below the heart. In the Ling Shu Ying-Spring points are used for diseases that change the colour of the complexion, while the Nan Jing gives us, the perhaps more clinically valuable use, for clearing body heat. Shu-Stream points are used for chronic diseases or intermittent diseases in the Ling Shu, while in the Nan Jing they are used for body heavy, joint pain. The same goes for Jing-River, and He-Sea points (McDonald 2000: 4-6).

Yuan-Source Points

The Yuan-Source points were first identified in chapter 1 of the Ling Shu, where they are indicated for treating diseases of the Five Zang. On the Yin channels, these are the same as the Shu-Stream points, and their use has remained consistent right through the long history of

acupuncture practise, through to modern times (McDonald 2000: 8). Deadman et al. Notes that in this first chapter of the Ling Shu, the Source point for the Heart is given as Daling PC-7, and that it was not until the Zhen Jiu Jia Yi Jing, that the Pericardium and Heart got their own Source points, Daling PC-7, and Shenmen HT-7. The Source points for the Six Fu are given in chapter 2 of the Ling Shu. These are discrete points that are located on the Yang channels between the Shu-Stream and the Jing-River points. The Yuan-Source points on the Yang channels have little ability to regulate or tonify their respective organs, and despite the fact that the Nan Jing says they treat disorders of the Fu, they are better used to expel pathogenic factors and treat channel pathology and pain (Deadman et al. 2007: 39-40).

Luo Connecting Points.

The fist mention of the Luo Connecting points is chapter 10 of the Ling Shu, which describes the location of the Luo channels and the Luo points, where the channels diverge from the primary channels. The points are used in the Ling Shu to treat deficient and excess conditions of their channels (Luomai). In the Zhen Jiu Jia Yi Jing We get another glimpse into the use of the Luo Connecting points. Each Luo point is named, located, its associated with its principle channel. The needling depth, duration, and amount of moxa (in the measurement zhuang) is also given (McDonald 2000: 8). As well as treating the area that the Luomai actaully traverses, Deadman et al. tells us that they also treat conditions of their interior-exterior related channels and Zangfu (2007: 40). This idea is first recorded in the Jin-Yuan Dynasty (1241CE) book by Dou Han Qing named, Zhen Jing Zhi Nan (Guide to the Classic of Acupuncture). The third use ascribed to this category of points by Deadman et al. is treating psycho-emotional complaints (2007:40). I have so far not been able to reconcile this with any classical source. I assume that this is an (perhaps valid) observation made by Deadman et al., based on the individual indications of a number of the Luo points, which do seem to have actions that could be described this way, that the category in general is apt of this description (2007:40).

Xi-Cleft Points

There are 16 Xi-Cleft points all of which are located near the elbows and knees. Each of the 12 primary channels has a Xi point, as do the Yinqiao, Yangqiao, Yinwei and Yangwei channels (Li 1992: 58). The Xi points did not exist at the time of the Ling Shu, Su Wen and Nan Jing, and thus none of the points are listed in these texts. These points came into usage some time between the writing of the Nan Jing, and the Zhen Jiu Jia Yi Jing (282 CE), where for the first time they are named, and categorised as Xi-Cleft points (McDonald 2000: 8). The Zhen Jiu Jia Yi Jing, however, does not provide us with any theoretical understanding of the indications or actions of these points. The idea of using Xi points to treat acute conditions of their channel or organ comes into practise at a later date, however I could not find a classical source from which this theory might be derived.

Confluent Points for the Eight Extraordinary Vessels

It is interesting that the category of confluent points for the eight extraordinary vessels was not created for a long time after the other categories so far discussed. There is no mention of this category in any of the older classics. Neither the Huang Di Nei Jing, the Nan Jing, nor the Zhen Jiu Jia Yi Jing are able to shed any light on the origins of therapy utilising these points (McDonald 2000: 11). This category, as a group of points to treat the eight extraordinary vessels, first appeared in 1439, in the Zhen Jiu Da Quan (Complete Collection of Acupuncture and Moxibustion) by Xu Feng, who provided a concise description of the application of these points (Matsumoto and Birch: 1986: 5). Before this, these 8 points were grouped together in pairs in the Zhen Jing Zhi Nan (Southward Pointer of Acupuncture classics) by Dou Hanqing, where each pair had specific indications for various conditions. They were also in the same work (Zhen Jing Zhi Nan), listed as an 8 point collection in the Miraculous Turtle Eight Methods (ling gui ba fa), an early theory of time related acupuncture (McDonald 2000: 12). According to Deadman et al. these points can also be used, in accordance with the poem Lan Jiang Fu (Ode of the Obstructed River) which was published by Gao Wu in his work Zhen Jiu Ju Ying Glorious Anthology of Acupuncture and Moxibustion in 1529 CE (2007: 46).

Chart Drawing and Bronze Casting

The first attempts at standardising points were made by those in the Channels and Points Research Schools. In the Sui Dynasty, 6th Centuary Qin Chenzu wrote a number of books, and drew illustrations of the channel pathways. Qin Chenzu was the first to draw the channels of the body from different perspectives. Unfortunately, all of Qin Chenzu's works have been lost. Zhen Quan in the late sui/early Tang Dynasty, wrote Ming Tang Ren Xing Tu (Bright Hall Illustrations of the Human body) (McDonald 2006), a study of the points, after the Zhen Jiu J a Yi Jing. Not long after Zhen Quan's work, Sun Simiao in chapter 29 of his Bei Ji Qian Jin Yao Fang

(Prescriptions for Emergencies Worth a Thousand Gold Pieces), created the first coloured acupuncture charts, detailing 656 points, in 5 colours (McDonald 2006). The first cast bronze statue depicting the locations of acupuncture points was created by Wang Wei Yi in 1026 CE. Wang Wei Yi cast two full size statues with channels and corrected point locations. He wrote an accompanying text named Tong Ren Shu Xue Zhen Jiu Tu Jing (Illustrated Classic of Acupuncture Points on the Bronze Statue (McDonald 2006). Perhaps the most famous cast statue is the Gao Wu Bronze. Gao Wu, also the author of the Zhen Jiu Ju Ying (Glorious Anthology of Acupuncture and Moxibustion) 1529, and Zhen Jiu Jie Yao (Essentials of Acupuncture and Moxibustion) 1537, cast individual life size statues, of a man, woman, and child (McDonald 2006). These attempts at standardising the locations of points probably had varying degrees of success. After each successive iteration, it is likely that the locations of just a few more points solidified in future texts. The process of point location standardisation continues, with the recent attempt by the World Health Organisation (WHO), in collaboration with eminent acupuncturists representing their own regions. Coming together to pin down the exact locations of a remaining handful of disputed points, each with elaborate research tailored to support their assertions that they knew the real locations and everyone else must be wrong. In humorous anecdotes recounted by McDonald, himself a participant in the WHO standardisation process, we find that the politics and fierce protectionism over point location is still very much in vogue. While the HO did manage to publish what was supposed to be the final word in the point location saga, it was eventually retracted, and practitioners in different regions, continue to needle points according to their own traditional regional variations.

References

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