NAJOM Survey Results

Q7. Describe your criteria for choosing which acu/moxa points to treat?

a) tenderness

b) radiating sensation

c) indurations

d) depressions

e) temperature: warmth/coldness

f) visible markings (based on acupoint indications)

g) acupuncture theory (eg meridian relationships, point categories/combinations, experience)

h) other

​

1. a) tenderness b) radiating sensation c) indurations g) acupuncture theory (eg meridian relationships, point categories/

combinations, experience) h) other

2. All of the above are taken into consideration

3. Tender points, acupoints that react when pressed, indurations, and depressions. These are all reaction points of chi and

blood, so acupuncture points should be selected according to the disease and physical condition of the patient. Even if

an acupoint is estimated by acupuncture theory, if there is no reaction, it is not used.

4. h) other Careful Diagnosis. Pain Analysis. Observing body language and movement.

5. According to the abnormality of the zang-fu (organ) disease, meridian disease, or meridian sinew disease, the selection

of the acupuncture points is made according to the reaction (kyo or jitsu) of the acupuncture points that appear on the

surface of the body.

6. a) tenderness b) radiating sensation c) indurations d) depressions f) visible markings (based on acupoint indications)

7. The selection of the acupoints should be examined comprehensively for cold/heat, deficiency/excess, or depression,

hardness, and tenderness.

8. a) cold, can be b) warm, can be d) “other” in a hard to describe way

9. g) acupuncture theory (eg meridian relationships, point categories/combinations, experience) h) other: If the point

influences distal palpatory findings

10. I choose points based on pulse diagnosis together with acupuncture theory (eg meridian relationships, point

categories/combinations, experience)

11. a) tenderness  b) radiating sensation  c) indurations

12. a), c), d), e) a) tenderness c) indurations d) depressions e) temperature: warmth/coldness

13. a) tenderness

14. a) tenderness c) indurations d) depressions

15. tenderness, indurations, depressions visible markings (based on acupoint indications), acupuncture theory (eg

meridian relationships, point categories/combinations, experience)

16. all of the above

17. g) first and then the rest

18. a b c d e f g h) other: Where treatment is likely to make a difference.

19. g) acupuncture theory

20. a) tenderness b) radiating sensation c) indurations d) depressions e) temperature: warmth/coldness f) visible markings

(based on acupoint indications)g) acupuncture theory (eg meridian relationships, point categories/combinations,

experience) h) other : the ‘qi sensation’ referred to above. Where, if one can feel this sensation, the background hum is

suddenly amplified at a certain spot. If pressing / touching / stimulating this point in some way changes the condition

being treated then it’s used for that treatment.12

21. All of above

22. a b c d e f g

23. a) tender point (kyo pain), d) depression, e) coldness etc. are information about kyo acupoints. a) tender point (jitsul

pain), b) hardening, e） heat sensation, f) bulge, etc. are information about jitsu acupoints. However, since acupoints have

a multilayered structure, in reality, there are cases where these types of information are mixed together in the response.

Also, with regards to reaction points, the movement and flow of qi felt by the fingertips when locating the acupoint is

used to find the center and depth of the treatment point.

24. all the above. but always based on theory.

25. g) acupuncture theory (eg meridian relationships, point categories/combinations, experience)

26. all of a ～ g

27. e), all of the above options because all of them can be a good criteria. it depends on how the point is

28. a) tenderness b) radiating sensation c) indurations d) depressions e) temperature: warmth/coldness f) visible

markings (based on acupoint indications) g) acupuncture theory (eg meridian relationships, point categories/

combinations, experience) SOMETIME

29. a) tenderness b) radiating sensation c) indurations d) depressions e) temperature: warmth/coldness f) visible

markings (based on acupoint indications) g) acupuncture theory (eg meridian relationships, point categories/

combinations, experience)

30. h) determined by hara-, pulse- and meridian palpation followed up by checking for depression with a little hole like

depression in it in the area suggested by the diagnosis.

31. I utilize several criteria A C E F G H- via palpation/sensation

32. h) other: starting with usual point combinations to address hara patterns [in otherwords,g) acupuncture theory] but

informed by patient history i start exploring with pressure to points to see if they change reflexes/symptoms. e.g.

ovarian cyst with history of type 1 diabetes and teeth grinding/TMJ = painful ovary at/about R ST28 treated with (sugar

points) SP3, SP9 and sphenoid adjustment via acupuncture and craniosacral ―> all spontaneous and pressure pain at

ovary/R ST28 resolved

33. a) tenderness c) indurations d) depressions g) acupuncture theory (eg meridian relationships, point categories/

combinations, experience)

34. c) indurations f) visible markings (swollen spot, and changes in skin color)

35. all of above

 

 

Q8. How do acu/moxa points feel to the touch?

a) cold

b) warm

c) no difference to the surrounding tissues

d) “other” in a hard to describe way

​

1. d) “other” in a hard to describe way

2. Points can feel hot, cold, hard, rough, etc... based on the pathological state of the patient. This is used both for

diagnosis and point selection.

3. d) “other” in a hard to describe way: The response of the acupuncture points is important, as the classics say, “the pulse

responds to the hand”. It is the sensation of the fingertips such as tak tak.

4. d) “other” - namely –with variations in Qi frequency.

5. Observe the marked left-right difference, the reaction form that appears from superficial to deep layers, etc.

6. a) cold b) warm d): Tingling, buzzing, wind blowing, sucking, etc.

7. a), b), Where it is kyo feels cold, and where it is Jitsu feels heat.

8. a) cold, can be b) warm, can be d) “other” in a hard to describe way

9. Can be a), b) or c)

10. Like a depression or well (men).

11. no answer

12. d) It’s hard to describe, but it feels different from other places.

13. d) Hard to say. But I can tell when I hit a point that has what I call “juice”. Usually, it’s tender and feels good to press.

14. d) “other” in a hard to describe way

15. d) “other” in a hard to describe way

16. a), b), d)

17. d)

18. a) cold b) warm c) no difference to the surrounding tissues I don’t know the meaning of this question d) “other” Hard,

soft, sickly.

19. Where the practitioner feels good to the touch.

20. a) cold b) warm d) “other” in a hard to describe way : could be a ‘bump’ or induration, or even a ‘pocket, or hole’ in

the tissue. They often feel ‘buzzy’ – like some sort of electricity (or qi itself haha) is being conducted.

21. All of above 上の全て

22. a), b), d)

23. a), b), and d), but especially d. In the case of a, it is not only cold, but also feels refreshing. Also, d: the small gap

between the concave surface (kyo) and the hard knot (jitsu) is important.

24. d)

25. d)

26. d)

27. d)

28. d)14

29. d) “other” in a hard to describe way: there is always some information, of many kinds, from an acupuncture point that

needs treatment. Information comes through the palpation.

30. d) they are areas where the tissue lacks tension

31. d)

32. d) “other” = buzzy and inviting in a cleft/space in tissue

33. d) “other” in a hard to describe way: they often feel like holes where I am accessing qi/blood

34. d) When I was inserting the needle, I sometimes felt a tingling sensation in my fingertips.

35. d)

​

​

Q9. Do you incorporate or exclusively use auricular points, scalp points, hand/foot points, etc (i.e. a holographic system)? Please specify.

​

1. I do. Different points, from different styles/teachers

2. I use both auricular and scalp sometimes. All points are related to holographic systems (even all the conventional

acupuncture points) if we really understand Yin-Yang and Five Phase theory. There is no such this as an acupuncture

point that does not have a holographic relationship to the entire body.

3. I use auricular points. The purpose is to reduce weight loss. We do not use other holonic systems very often.

4. I often use hand and/or feet points to help reduce pain/stress at the start of a session

5. Auricular points are not used. Sometime, it is used for reactions during patient’s mental symptoms. The Hokushinkai’s

“spatial theory” (observing where the most prominent direction of qi distortion is based on the reactions around the

GV20, CV8, and GV6) is also used as an indicator.

6. I often use a holographic system especially when I treat pain. I use the method from Yin-Yang crossover based on the

methods of Miu Ci 繆刺 , Ju Ci 巨刺 and Yuan Dao Ci 遠道刺 .

7. no answer

8. not exclusively, but I do incorporate all of the above when indicated

9. I sometimes use ear points.

10. Only rarely use these microsystem points, when classical points are unavailable.

11. yes depend on situation

12. I use ear shinmen almost every time.

13. Sometimes, I use ear, hand and foot points. Depends on what I am treating.

14. Yes,I include them into the system I use. I will use microsystems of ear, abdomen, scalp, and Master Tong when

appropriate.

15. I do use auricular point in supportive treatment and leave pyonex needles on general ear points after treatment for

some days

16. I incorporate microsystems like auricular points, but don’t use them exclusively.

17. A little of all, but too much of a beginner to specify.

18. Auricular acupuncture points are used when symptoms cannot be removed. Scalp points are used for autonomic and

mental symptoms. Acupuncture points on the hands and feet are used when symptoms are present in the hands or

feet, or when other symptoms are unrelieved.

19. I use auricular acu-points15

20. Other than TCM / Kiiko - Nagano / some of Shudo’s Points and some of my own ‘discovery’, I just use some auricular

points

21. I use use auricular points, scalp points

22. ventral ST 44, shi-mian, GV 20, GV 24.

23. I don’t use auricular points, scalp points, hand/foot points, etc (i.e. a holographic system)

24. Sometimes I do scalp and auricular, but not regularly. I rely on the classical channel system mostly.

25. I don’t use auricular points, scalp points, hand/foot points, etc (i.e. a holographic system)

26. I used them after meridian examination of the whole body

27. yes, I do incorporate auricular, scalp, holographic systems

28. I USE ALL POINTS

29. Yes, many points in “holographic” systems: often combined with palpation findings.

30. No

31. Auricular points are incorporated into treatments particularly when working with the head and emotional issues. KHT

has been used for clients’ self-treatment.

32.

I

can use auricular points extensively, but not all the time; very occasionally scalp points (besides the points on regular/

extraordinary meridians that pass through the head)

33. Not often

34. No

35. ear vertigo points, dieting points. The scalp is sometimes used for paralysis.

​

​

Q10. Is there a difference between acu/moxa points on children and adults? Please specify.

​

1. No answer

2. I am still asking myself this question.

3. The difference is the amount of stimulation. Children’s acupuncture points are shallow and responsive, so the amount is

small. Therefore, pediatric acupuncture is sufficient. In the case of Japanese children, their skin changes into adult skin

after the age of 10. Although there are individual differences, once that happens, we end pediatric acupuncture and ink

moxibustion and use adult methods of acupuncture and moxibustion treatment.

4. Depends on the problem. Generally, children’s points react faster than adults, to touch.

5. Since I believe that acupuncture points are not perfected until the age of 6-7 years, we limit myself to skin stimulation

on meridians (shonishin) exclusively.

6. Depending on the age. Newborn to about age 12, I feel the zang-fu, entire meridian system and points are not fully

developed yet. But acu/moxa points can be palpated and felt in the same way as an adult.

7. The response of meridians and acupoints is the same for adults and children. However, children’s qi and blood move

faster and are more sensitive, so stimulation should be taken not to overstimulate them.

8. yes and no. There is the idea that the meridians may be less defined in infants/peds, and their bodies are physically

smaller, and that the in children, qi comes quicker in most cases. Not sure if this is answering your question, but this is

what comes to mind for me.

9. Not really16

10. I only treat greater than 7-year-olds. Their points are the same as adults.

11. no answer

12. I do not know because I do not treat children under 16.

13. Children are a special situation. I never use needles on children. And certainly not moxa. I think psychologically, these

things are frightening to them. I just use my fingers to press and stroke the skin. And because their Qi is so responsive,

only a little stimulation of the right points is enough to produce an effective response. Sometimes, immediately.

14. Generally, pediatric points “feel” less deficient or chronic.

15. More superficial, more etherical, less distinct in location, shonishin treatment overall more meridian based

16. The younger we are, the faster qi moves and the acupoints move and are easily influenced.

17. Not enough experience

18. The position is not particularly different. The child is not good at stillness and needs to finish in a short time. Contact

treatment and moxibustion quickly 1 moxa cone.

19. same

20. 100%!! The points on kids are some much more reactive – in the sense that they require very little stimulation to ‘get

the message across’.

21. Basically, no difference but the acu-point of children are undeveloped, so the amount of stimulation for babies, young

children, and children under the age of 7 is sufficient at around 1% to 10% of adults.

22. Yes, babies don’t have developed meridians.

23. There are differences in the acupuncture points used for adults and children, but this also depends on the child’s age.

Even in the case of very young infants, the main acupuncture points on the abdomen and back are used for treatment

(CV 12, CV 4). Even in the case of children, it is thought that it is difficult to locate the acupuncture points on the

extremities unless you are familiar with them. In contrast, the acupuncture points on the abdomen, back and trunk are

easy to locate, and are used for treatment in the same way as for adults. Because children’s constitutions are basically

inclined towards the yang, treatment that takes into account the speed of the movement of qi and the imbalance of qi

in the front and back is necessary.

24. My perception is that children’s acupuncture channels are not ‘mature’ or completely developed until at least 8 years

old, and ideally 12 or 13, so there are fewer available acupuncture points to treat. Just as the body grows and evolves,

so do the acupoints.

25. no differnces

26. From 7 to 9 years of age, I use contact acupuncture, which is light rubbing, not acupuncture points.

27. Yes, because children’s bodies/systems are still developing

28. For children I use only Teishin, and only a use a few points, less than 5.

29. Definitely a difference in application of treatment to the points: more slow, gentle, brief.

30. No difference, but I tend to use rubbing of the meridian on the lower part of all four limbs for practical reasons.

31. The acu points on children feel lighter softer on children. Typically, meridian treatments are used with children vs a

singular point.

32. Points on children can feel clearer/easier to identify

33. The points on children in my experience are fewer, larger and less defined.

34. We have no children patients.

35. I don’t think there is any difference, but I remember reading that the effect is the same as a single point in GV 12

because pre-pubescent children are protected, and I think that is true in some cases.17

 

 

Q11. How would you compare the reactions created by needles, moxa, non-insertion tools, shiatsu, and others)?

a) the reactions are the same

b) the reactions are different, and how?

c) I have no experience with this

​

1. No answer

2. The reactions are different, and the tools are not all mutually interchangeable. However, this is too complicated a

question to answer shortly.

3. b) All reactions that occur are different. Acupuncture is very effective for pain. Moxibustion is effective for chronic

diseases and there is a lasting effect. Dermal acupuncture and teishin are useful for people who are sensitive to

stimulation. They are especially effective for people and children who are prone to healing reactions. They are

often used when the amount of stimulation is small, and a response can be expected. Shiatsu has effectiveness of

acupuncture and massage. Shiatsu on acupuncture points has the same response as acupuncture. It is effective in

remission of pain. Gentle acupressure also has a relaxing response in the body. Shiatsu is especially good for mental

illness and autonomic nervous system disorders.

4. Shiatsu involves more movement during the session so reactions can be assessed at all stages of the session.

5. a) the reactions are the same

6. b) They are similar but different. With filiform needle and non-insertive needle can still create warmth but different from

the warms of moxa. The filiform needle can create achy and electric like sensations where Tei Shin or other Sesshoku

Shin ( contact needle) create different sensations more like the arrival of qi.

7. The reaction to treatment varies depending on the patient’s illness and constitution. In short, there are no fixed

reactions. Therefore, acupuncture and moxibustion are used differently depending on the finger’s sensations.

8. a) the reactions can be the same, but often are different b)  the reactions are different, and how? depends on the

modality, intention, location, technique

9. b) Every tool is different and elicits a different response from the body. Needles can tonify, move or drain, moxa tonifies

deficiency. Shiatsu and other bodywork works differently. They are very valuable too, but different from acupuncture.

10. a) the reactions are the same but depend on the skill of the practitioner.

11. a) the reactions are the same

12. a). I have much less clinical experience, but I think I can achieve the same effect.

13. Acupuncture reactions seem to come on more gradually. Moxa, often more quickly and Shiatsu more quickly still.

But any of these modalities can produce deeper reactions that are not apparent at first but that also come on more

gradually over time.

14. b) the reactions are different, and how? When treating areas with non-invasive techniques or moxa that is not direct, I’m

focused more on the meridian, looking for skin color or temperature change along the treated area. When needling or

doing rice-grain moxa, the reaction is at the point and maybe ½ cun around.

15. The reactions are different: Teishin: overall soft and gentle reaction. Gold stronger than silver. Silver needle: you need

to be very attentive in treating, effect is very precise. Dosage very manageable. Dosage extra precise with hayate zashi

technique. Moxa: profound deep working on qi and blood, depending on the use (okyu, chinetsekyu, kyotishin), dosage

(rolling of moxa, timing of taking off, repetition)

16. Depending on the reaction of acupoint the appropriate pressure, heat, and invasion by needle varies, and each person

has a different sensitivity.

17. b): the non-inserted needle techniques seem to more deeply calm people if done when you are fine yourself. Though

some people want to feel the pain of needles, it gives them the idea that it works better.18

18. a) the reactions are the same which I expected.

19. same reaction

20. First of all – it depends on whom one is working. Are they weak? Is their condition chronic, or from birth /a very young

age? Some people are by their nature much more ‘in their bodies’ and are able to really participate in the treatment

in the sense that they can communicate what is going on for them physically (“I felt a/b/c reaction at this part of my

body”) as well as emotionally. Some see / hear / smell things that I often take as clues to them and their condition or

as their body & mind’s ‘feedback’ to me. Beyond that – as tools – they can all have strong reactions (in both positive

/ negative senses). Needles in general are more stimulating (getting the message across) but different calibers can

bring the‘message’ in different ways. I find Moxa to be more reinforcing (after the needles and in place of them) and it

also works at a ‘deeper’ level (i.e: Blood level) for more entrenched problems. Teishin work better for sensitive people

(including kids), or people at sensitive spots in their lives But really... “Right Key for the Right Lock” is what I say to my

patients when something works well.

21. Excessive and deficient acupoints respond differently. The excessive point becomes relaxed and gets warm, while the

deficient acupoint becomes strong and feels warm.

22. b), moxibustion is continual application of heat, (various levels depending on type of moxa used), contact needle deals

with manipulation of qi (tonification and dispersion) at that very time, and deals essentially with surface qi; and the

results can be immediate retained needling, can be tonifying or dispersive, but is not continual manipulation of qi by

the practitioner (unless there is electricity involved) and less tactile, shiatsu, while working with the meridians, is also

working directly with the muscles, creating a different relaxed feeling for the patient, is more tactile, and maybe more

soothing. For the patient other tools for scattered needling （散鍼 ) create the continual dispersion and or tonification of

qi that is creating a more total body feeling for the patient.

23. b) The response will differ depending on the treatment tool. For example, the difference between acupuncture and

moxibustion is easy to understand. Moxibustion is a form of thermal stimulation, and is suitable for warming/tonifying

and invigorating qi. As a result, the response of the acupuncture points is often dominated by yang qi (warmth,

redness, slight perspiration). However, the type of moxa used will also affect the response. There are differences in the

amount of heat and depth of heat between indirect moxibustion moxa with a large stimulation area, such as Chosei

Kyu, Kamayami Mini, and Sennen Kyu (all product names), and direct moxibustion moxa, such as Chinetsu Kyu and

Tonetsu Kyu. In addition, while there are cases where the same type of reaction is seen in acupuncture, it is important to

consider that this reaction may vary depending on factors such as the depth of the needle insertion, the purpose of the

acupuncture treatment, and the patient’s physical condition (amount of yang energy). Rather, in acupuncture, reactions

that are in line with the characteristics of acupuncture treatment appear. The characteristic of acupuncture is that it

can affect deep layers that moxibustion cannot reach. For this reason, acupuncture is more likely to produce changes

in the deeper layers (such as the alleviation of hard lumps, the reduction of indentations, the calming of nerves, and

the induction of sleep), and changes with a directionality from the front to the back, from the yang to the yin, can be

seen. On the other hand, depending on the manipulation of the acupuncture, reactions from the back to the front,

such as the externalization and dissipation of the heat beneath the skin, can also be seen. In other words, it seems

that in acupuncture treatment, the movement of qi and changes in the body are more likely to occur along a vertical

axis. When we consider the difference between the filiform needle and contact needle, it is in the nature of the qi that

is targeted. Therefore, in contact needling, which only involves contact, the effects are quick to appear and changes

are also quick to occur. Also, with regard to the response of acupuncture points, it is worth mentioning that in filiform

needling, the pushing hand (Oshide) is used. The pushing hand can obtain information over a wide area, so you can

sometimes feel changes in the area around the acupuncture point immediately after the needle is inserted.

24. Working with one’s hands has a more generalized effect than needles or moxas. The way I describe it to my patients/

students is that acupuncture needles and moxas are more like ‘laser beams’ with more specific therapeutic focus.19

25. b) The reactions are all different. For example? The thickness of the acupuncture needle affects how the pulse

tightens or opens after treatment. For example, the pulse tightens with a fine needle, but not with a thick needle. In

other words, with filiform needles, the qi gathers in the center of the pulse and becomes dense, while with teishin, qi

flows widely throughout meridian.

26. b） Patient response varies depending on the method and dosage.

27. b) the reactions are different because their effects are also different.

28. b) the reactions are different, and how? Needles create more reaction than non-insertion tools, moxa can cause

excessive reactions that must be modulated depending on the pathology.

29. b)  the reactions are different, and how? I am always using two hands, checking for reactions distal/proximal/opposite,

etc. This is easiest with needles, and especially shiatsu. Also, PNST. Reaction depends on intention with the modality,

and how it is applied, almost as much as the modality itself.

30. It depends more on the practitioner than on the tool.

31. They are very distinct in reaction. Typically, I will test the client to see which method the client responds to most

effectively.

32. needling feels like tapping on a river to send signals along the water. i expect change to be perceptible if I have the

right point, but can vary from a ripple to rumble, sometimes reaching very far. teishin feels like creating space between

the molecules of water in the river, reaching more locally and more defined. moxa feels like changing the content of the

river and getting it to enliven and clarify or enrich and calm. Tui na feels like having the river in my hands and interacting

with the shape of its banks. Craniosacral is something else entirely, but similar to tui na when manipulating cranial bones

and similar to teishn when moving CSF.

33. b) the reactions are different, and how? Teishin moves the qi, moxa moves the blood and yang, shiatsu and sotai

impact the larger structures

34. Acupuncture relieves induration of muscle, and moxibustion warms induration and improves blood circulation. We do

not use metal needles.

35. I feel that acupuncture has an immediate effect. Moxibustion gradually takes effect as you keep doing moxa, and I use

non-invasive acupuncture for particularly sensitive people, but I’m not sure about its effectiveness.20

 

 

Q12. Do acu/moxa points have a particular size or shape? Describe.

​

1. No answer

2. They do not - they will vary in size and shape based on the individual patient and underlying pathology.

3. The acupoints are less than 1 mm. Some say 1 cm, but I think that is wrong. You have to be very careful to get the

acupuncture points exactly right. The reaction you feel at your fingertips is everything. There are often acupoints for

stiffness or a depression, but the depression or stiffness is not the acupoint, but a point within it less than 1 mm is the

acupoint.

4. They vary. Some fit a thumbprint. Some are so hidden they require movement and stretching before they emerge from

their Qi caves.

5. I believe that the three dimensional effect is due to the prominence of the reaction, the passage of time, and the spread

of the disease.

6. Acu/moxa points do not have a particular size or shape. The size can be different; even the same point at different time.

Depth may be different, and shape is different. The construction or anatomy of the point differs as well.

7. The acupuncture points can be identified by examination and touch, but the largest ones are about 5 mm in diameter

and the smallest ones are less than 1 mm in diameter. When the acupuncture point is about 5 mm in size, it is less

effective unless acupuncture or moxibustion is applied to the center of the acupuncture point.no I don’t believe this to

be uniform for all acu-moxa points, but for me an effective treatment includes very precise point location.

8. no I don’t believe this to be uniform for all acu-moxa points, but for me an effective treatment includes very precise

point location.

9. I don’t know.

10. No. I think all points are like the bull’s eye of a target. the surrounding points are similar but have less of the named

point’s specific efficacy.

11. no

12. I don’t know.

13. I don’t know.

14. This depends on the area they are in and if they are chronic/acute, hot/or cold in nature. Larger muscle groups that

are painful tend to have bigger kori. Smaller muscle groups have smaller ones. Acute tends to feel “puffier” while

chronic can be harder (excess) or a depression (if deficient).

15. For me it feels like a small, round well. Sometimes the borders are less defined, it is bigger, and it feels more swampy.

16. Points vary in size, depth and quality.

17. The intensity and shape and depths seem to differ per person and per day, but the per day change is mostly not as

big than the difference between people.

18. see Q2-18 On a map, you can see lines for the equator, national borders, prefectural borders, lines of atmospheric

pressure, contour lines for mountains, etc., but these lines don’t actually exist. However, we know that these lines

exist functionally. The same is true for acupuncture points. Acupuncture points have various tissues such as skin,

subcutaneous tissue, fascia, muscles, blood vessels, nerves, and bones, and they differ in depth, thickness, and

hardness. However, they are indicated as a single point on the surface. The points where nerves and blood vessels

penetrate into muscles and organs are also acupoints. The position of the acupoint is determined by the posture of the21

patient being treated. Even if I take the acupoint on the surface of the skin, if the patient changes their posture, the

tissues under the skin will move, so I will have to relocate the acupoint.

19. depend on acu-point

20. I would say no – if anything. They have a wide variety of sizes and shapes! Here’s what I’ve ‘found’ off the top of my

head. Pinhole/sesame size; Mung bean sized; Chickpea sized etc.. up to perhaps points the size of an olive or length-

wise like green bean or okra or pole bean sized. Some points are 2-3 mm, large points are 10-15 mm. These points can

‘stick out’ from the surface (kori) but often ‘hide’ behind and under bones or boney ridges (like under the scapula or

behind the tibia. They can also ‘hide’ under tissue (such as the ‘stone at the bottom of the river’ felt around CV5 or 6).

They can feel hard, soft, gummy-like and just ‘weird’.

21. Some points are 2-3 mm, large points are 10-15 mm

22. Yes, I feel LI 4 is very wide, so is ST 36 and GB 34, whereas GB 30 is deep and maybe conical in shape. Lung points

appear shallow.

23. There is no specific size or shape for each acupoint. However, the size of the acupoint varies depending on its

location. For example, the acupoints located on the periphery, such as the “wei-xue, jing well” (peripheral acupuncture

points), are small, but the acupoints located on the trunk, such as the “quan-jiao 環跳 ” (acupuncture points located on

the curved surface), are larger than the peripheral acupoints. In addition, in the case of terminal patients, the “xu” (kyo)

of the acupoints is large, and in some cases, multiple acupoints are connected and their shape changes. In some cases,

even when viewed vertically, the multi-layered structure is lost and the shape becomes like a “simple hole”.

24. Acumoxa points expand and contract and move. In the winter, they are smaller and more contracted, and deeper, in

summer they cover a wider area and are more at the surface.

25. The shape of the acupoints differs depending on the sho-confirmation. The kyo acupoints that require tonification are

sunken, soft, and seeking qi. There is a sensation as if the fingers that are palpating the kyo acupoints are being sucked

in. The jitsu acupoints that require dispersion are hard, rough, and bumpy, and there is a feeling that the disease is

stagnating.

26. It can be a point. I think it’s a very small aspect.

27. No, once they are alive, I would say they have more an area than size or shape

28. no answer

29. Many sizes, but they tend to be roundish, elliptical. There can be points within “points,” or layers.

30. Tsubo are depressions with a little hole like structure in their middle. The hole is the tsubo proper. The tsubo proper is

about the size of a grain of millet - like the head of the teishin.

31. Not to my present understanding. I find the active point and the more specific the better.

32. I experience them largely as rounded impressions that accept my finger pad, and can be from quite slight to a near

crater we could all fall in.

33. Varies on the point― On yin channels often the points feel like deeper holes/indurations and there are often harder

nodule like feelings at points on some yang channels― I’m thinking ST/LI/UB.

34. Depending on the size of the hardening under the acupoint, the needle is not completely removed but is tilted in the

same acupoint and insert needle again in four directions.

35. It depends on the location, but it’s about 1mm to 7 or 8 mm.

​

​

Q13. Have you observed that acu/moxa points respond to colour, sound, types of metal, or other materials?

Please specify.

​

1. no answer

2. With some needles and teishin I do believe the body (the points are just parts of the body) do respond differently

to different materials such as type of metal. The body also responds differently to substances such as moxa or the

topical application of herbal medicines. I don’t believe points respond to sounds or color specifically but the entire body

certainly does. Sometimes during treatment I will have patients use syllables exhaled to influence certain zang-organs (i.e.,

六字訣 ).

3. It is common for different metals of acupuncture needles to react differently. We are also very careful about that. We

use gold acupuncture needles for people who are allergic to metal because they are more likely to strong reaction. We

also use gold acupuncture needle for severe heart disease and severe rheumatism. They are less likely to get tired. We

feel that there is a reaction to color, sound, etc., but we do not know the details.

4. Sometimes colour. Sometimes sound. Depending on the receiver and the situation and environment.

5. Recognized but not clinically used.

6. Qi, the energy is a vibration. Color, temperature and sound also have different frequency of vibration. Metal also has

different energy induction frequency. Higher the induction of the energy, the arrival of qi becomes faster. When I use

warm colors, it tends to show more tonifying effect where cooler color tends to be more sedative.

7. Acupuncture points respond in various ways, but the disease cannot be cured without improving the flow of meridians,

so it is necessary to consider what to choose depending on the sick person. For example, gold needle is good for a

weak person, silver needle for an uplifted person, and stainless-steel needle for a person with stiffness and excess

condition. Sick people may also feel more comfortable listening to music. However, the effect is difficult to sustain. My

clinic always plays classical music in low sound.

8. tuning forks, essential oils (less so) for me mostly indicated by pulse changes

9. I have some experience using diodes, in the style of master Kawai, and that seems to work. I have also some limited

experiences using magnets and laser. They do something, but needles will always be the basis of what I do.

10. Yellow metals tonify. White metals disperse.

11. no answer

12. I don’t know, I have no clinical experience.

13. No, I have no experience with this.

14. I tend to stick to stainless steel needles and don’t play with sound or color.

15. I have observed that they do respond very different to different materials (more qi coming up, filling the point,

making the point healthier, with more qi). I know they react on colored silk, working with tuning forks, but not by own

experience.

16. Not enough experience; I don’t know.

17. I have felt and have had good results with copper and zinc

18. I don’t pay much attention to it.

19. No observed response

20. I have never tried this, so don’t know. But I also play music and people come up to me after shows and describe the

reactions their bodies and minds had at particular points in songs.23

21. The reaction will also change depending on the type of metal, the type of sound (for example, a tuning fork), or the

color. Even colorless near-infrared rays can have a significant effect on the human body. Moxa ash emits near-infrared

rays, which activate the TPRV channel, and as a result, we can observe an increase in blood flow and an increase in

immune cells and cytokines. In plants, sunlight causes photosynthesis, and in the human body, it causes the synthesis of

vitamin D. Therefore, the human body’s reaction to light should be taken into account.

22. Dashin, listen to sound and feel vibration. Silver and stainless create a different tonification effect. Teishin is able to

produce more wave like movements and feelings in the patient and the practitioner.

23. We have confirmed that the reaction of acupoints can be affected by sounds that are transmitted through space. We

have also confirmed that the pulse diagnosis findings can be affected by light stimulation of acupoints.

24. I used to be able to get solid gold and silver needles, and have used copper/zinc press needles. I noticed a more shen

calming, subtle effect with those materials. I do believe sound and colour have effects, but they are subtle ones.

25. Sometimes the needle will react when it is close to the acupoint that needs to be treated. For example, when the

needle is brought close to the acupoint, it may vibrate slightly and make a faint sound. I think this is probably due to

a resonance between the patient’s qi and the qi of the therapist holding the needle. I cannot perceive the vibration or

sound, but some patients with special senses can detect the vibration or sound of the needle and tell me about it.

26. I have observed some differences between gold, silver and stainless steel. It depends on the dosage, but I feel that

silver is the most suitable for the human body.

27. Yes, as Manaka stated using different ways to show yin/yang balancing using polarity tools.

28. I only use metal and copper needles. I don’t like plastic/metal needles.

29. I have experimented with those methods: but could do more. I often use diodes (semiconductors), applied directly to

the skin.

30. Tsubo responds differently to different metals. A gold teishin helps focus ki better.

31. Yes, Silver and gold spheres work well for reducing pain on metal water points.They can help loosen up the neck

and reduce pain when placed either side of the spine or close to jiaji points. Larger flat gold cover tags work well on

acupoints. I have used them on points close to nerves and on the abdomen. I have also used rhythm and percussion.

Tapping with ontake, a teishin and hammer will loosen tight areas in the meridians. I experiment with tuning forks

from time to time. Osteopathic tuning forks are best for tight areas/acupoints. I have several clients who are metal

specific. One man in particular reacts very well to silver teishin and needles but gold does nothing. Stainless steel is

more effective than gold on this client. I have several female clients that both silver and stainless steel are equally active

but they are very responsive to gold. I don’t think it is a male female issue but unique to each individual. I also use a

thick gold needle in place of a gold teishin. In the rhythm section I tap a teishin occasionally with the hammer but more

frequently it is an enrishin which I use.

32. meh, not really really my thing so never investigated. I do find teishin tools amplify some of what I could detect with

my hands and I’m assuming that’s either because of the metal or because of the fact of more solid/harder surface -

like when information is ‘louder’ against bone.

33. Yes, to various metals with teishin.

34. In the treatment of lower back pain, the area around the insertion point may become red due to the stimulation of the

needle in places where blood circulation is poor.

35. I tried various things because I wanted to experience them, but I don’t really understand.

​

​

Q14. When acupuncture needles are inserted, which hand feels the qi – pressing hand (oshide) or insertion hand (sashide) ― or do you perceive the qi in some other way entirely?

​

1. No answer

2. We don’t feel Qi but rather the changes in the tissue (i.e., heat, cold, roughness, dryness, moisture) that happens in

response to the Qi movement in the individual patient. In this case I use the oshide most of the time to palpate this (unless

it is just physically more appropriate to use the sashide).

3. It is felt with both hands basically. I feel it with my insertion hand (sashide) because I don’t use Oshide (pressing hand)

very often. It is a pity that many acupuncturists cannot feel qi.

4. I dont use needles. My hand, thumb or all four fingers sense Qi – above the point, or on it.

5. The feeling of Sashide is “ 鍼 妙 ”. The Oshide is “hand feeling”, and the coming and going of the qi is observed. The

“obtaining of qi 得 気 ” used in Chinese acupuncture and moxibustion is also referred to. These three methods are

important indicators for observing the coming and going of qi, and Chinese acupuncture and moxibustion focuses

on obtaining qi, traditional acupuncture and moxibustion focuses on 鍼 妙 , and when using Teishin, hand feeling is

emphasized.

6. Oshide senses qi directly from the contact with the skin surface where Sashide senses qi at the tip or under the tip of

needle. Other ways are feeling the qi in practitioner’s body for example at Yin Tang or lower dan tian.

7. When I do needling, I feel qi in both the oshide and sashide. Of course, I also feel it when I hug.

8. oshide when palpating, sashide upon insertion, up right arm to jaw, always has been this way since school, felt stronger

with teishin than other needles

9. I perceive the qi by asking the patient if something has changed in the sensitive spot where my left hand is pushing.

Often I will feel the tissue change under my hand as well: getting softer, more relaxed.

10. Both

11. no answer

12. I feel qi with Insertion hand.

13. The pressing hand feels it more strongly.

14. Both, the arrival of Qi seems to “tighten” the needle and it can be felt in both hands. I used to get sweaty when

needling when I was younger that has passed. I also feel spreading in my oshide when I’m treating an induration.

15. It is somewhere there in the fingers of both hands. Sometimes it in the arms. Or in the chest, the throat. Or in the hara.

16. Both

17. I feel the qi in both hands, but also in my whole body different parts. And I also strongly feel it in a scar on my face.

18. The objectives are different.

19. insertion hand

20. Sometimes I use the method described above, but often I will be ‘listening’ to one part of the body (usually the part

that needs work – Kidney / Shoulder / Neck etc..) while the feeling for the exact right spot of the acupoint I think will be

of benefit. If there is a response – a softening of the tissue usually – then I will needle that point and continue to ‘listen’

to the body’s reaction until I’ve felt a ‘clearness’.. almost like the silt in the stream (turbidity?) has been ‘washed away’

and the flow in that spot is clear again. Then it’s time to move on to the next point – or try another point if there is still ‘silt

in the stream’.

21. Both oshide and sashide.

22. both25

23. When I insert needle, both oshide and sashide feel the ki. The oshide directly touches the acupuncture point, so it

can sense the flow of qi in the meridians that flow under the skin, etc. The sashide senses qi through the acupuncture

needle. Not only the piliform needle, but also the contact needle is felt by sashide. Oshide senses the horizontal flow of

qi, and sashide senses the vertical movement of qi.

24. In different cases, either is possible...qi has its own ‘language’ and presentation, and we need all of our senses and

observations to perceive it correctly.

25. Use your oshide and sashide to feel the chi with your whole body.

26. basically oshide, sometimes both

27. I more often feel the qi doing oshide than sashide. And sometimes I do feel it before touching the skin and that is

confirmed during palpation

28. initially Oshide feels the energy and then during the puncture sashide feels the energy.

29. Both hands, plus through my body reaction, and patient’s body reaction.

30. Oshide and own body

31. I often feel the qi in breath and other body sensations in addition to something going on in the hands.

32. needle hand

33. Both hands feel the qi- oshide when finding the point and sashide when the needle is going in and or being

manipulated

34. I feel qi with oshide stronger than sashide.

35. both

​

​

Q15. Do you close acupoints after needling?

a) always

b) sometimes

c) never

d) Depends on assessment

​

1. c) Almost never

2. d) Depends on assessment

3. I do not find significance in the act of closing acupoints. I hardly ever do it.

4. I do not use needles.

5. We emphasize this in tonifying and dispersing

6. d) Depends on assessment

7. When the acupuncture needle is applied to a deficient area and then removed, the acupoint should be closed. When

acupuncture is applied to an area of the body that is excess, the acupuncture point shouldn’t be closed. This is the

basic rule, but it is usually better to close the acupoints. If the acupoints are not closed even though you think they are

closed, the patient will feel tired after the treatment.

8. d) Depends on assessment, yes and location and particular technique

9. c) never

10. d) Depends on assessment26

11. d) Depends on assessment

12. d) Always close when tonification

13. a) always - yes

14. d) Depends on assessment

15. d) Depends on assessment

16. b) for tonification

17. d) Depends on assessment

18. d) Depends on assessment

19. Always close when tonyfying. But dispersing, do not close.

20. b) sometimes d) Depends on assessment

21. b) sometimes d) Depends on assessment

22. d) Depends on assessment

23. c） In most cases, the acupoint is not closed. The reason for this is that even after the needle is removed, the exchange

of vital energy( 営気 ying qi)and defensive energy( 衛気 wei qi) continues to take place in the area around the acupoint.

However, if the deficiency of the acupoint is severe, the acupoint is closed.

24. d) Depends on assessment

25. d) depend on acupoint, Close after applying tonification, but do not close after applying dispersion.

26. depend on tonification or dispersion

27. b) sometimes

28. a) always

29. b) sometimes

30. a) always

31. b) sometimes

32. c) never - not part of my training

33. b) sometimes

34. a) always

35. c) never, but sometimes depend on acupoint

 

 

Q16. How do you assess the efficacy of a point during and after treatment, in terms of a reaction at the precise point, e.g. by patient reaction, by pulse changes, hara changes, and so on?

 

1. No answer

2. I mostly rely on changes to the pulse as well as patient sensation if there is something like pain being treated (i.e., does

the pain change during needling?).

3. Patient response is everything. We evaluate the patient’s pain relief, smooth walking, headache relief, abdominal pain

relief, etc. by judging the effectiveness of the treatment. As a therapist, I evaluate if the tenderness is gone or if the

abdomen is softening.

4. Hara assessment, also direct acupoint assessment

5. After acupuncture treatment, the pulse and abdominal conditions will change, and these changes after treatment

indicate the flow of qi. We think of this as a guide to the treatment effect.

6. I assess the efficacy of a point by palpating the point. I also assess the entire efficacy of treatment by checking the

pulse and by Fuku Shin (hara diagnose).

7. The effectiveness of the treatment is evaluated by the reduction of the patient’s chief complaint after the treatment.

Even if the chief complaint is not removed, the effect of relaxation, such as feeling more relaxed, is important.

8. Yes, all of the above

9. By palpating the distal diagnostic area (hara, or otherwise), pulse, patient reaction, or the area where the patient

complained of before the treatment.

10. Always by pulse. In addition, I use kinesiology and symptom changes for confirmation.

11. hara changes. patient reaction

12. After the treatment, we check the pulse again to check for changes and observe the patient’s reaction.

13. I usually don’t do this.

14. All of the listed examples-patient report, pulse, and hara.

15. When looking for the point, I stroke the meridian and try to be aware of what is happening at that moment. Also

during and after treating a point, from moment to moment. Sometimes the belly starts to rumble, there is a change

in breathing, a change of the complexion, a change in the hara, a change in the pulse, a change in the tonus of the

muscles, the moistness of the skin, the lustre of the skin, the qi in the room.

16. Changes in pulse, changes in the abdomen, and indicator points (e.g. pain, tenderness, range of motion)

17. Mostly by pulse and also by the person’s reaction, less the hara.

18. Check to see if the expected changes are being made to meet the objectives.

19. change in pulse

20. Please see my answer to Question 14, number 20.

21. the tissue gets softer, stronger, warmer, or free of left-right differences. If the patient’s face brightens after treatment,

his voice is firm, and his response is clear, then it is good treatment. If the patient only pays for the treatment and

leaves without saying anything, it is not a good treatment.

22. all

23. The most reliable indicator is pulse diagnosis. Rather than simply looking at changes in pulse rate, we check how ying/

wei/qi/blood/fluid is moving within the body trough changes in pulse position, pulse strength and pulse shape.

24. I generally check the pulses during and after treatment….

25. The effects are evaluated through pulse diagnosis, abdominal diagnosis, and meridian diagnosis.28

26. patient’s reaction, pulse/abdomen change.

27. hara and palpation changes and also patient reaction.

28. Usually by the reaction of the patient.

29. Patient reaction; channel changes, hara changes, some pulse.

30. The tsubo fills out, the patient’s facial color becomes better, breathing deeper and pulse, hara and meridian

harmonizes.

31. Changes in skin quality, color of the skin particularly at the site, texture of the skin, tenderness of the point, qi

sensation before, during and after, the patient’s reaction

32. hara change unless patient reaction shows me first. some points I can clearly feel are reactive and appropriate by

the amount of ‘buzz’ or enticement I feel, but always confirmed by repalpating the hara or area of symptoms.

33. Changes at the point in the skin, the pulse and Hara

34. This is the degree of pain reduction. Treatment is continued until the hardening disappears and the pain is reduced to

less than half (10 becomes 5 or less).

35. Patient reaction, changes in pulse

 

​

Q17. Which is more important to you, the needle sensation to the patient, or to the acupuncturist?

 

1. No answer

2. For me needle sensation to the patient is the least important. To the acupuncturist is more important. But the most

important is change in pulse or other palpatory findings, or subjective/objective sensation to the patient. For example,

if I needle a point for painful shoulder, I am more interested in change in pain or range of motion and don’t care about

needle sensation to me or to the patient. I do believe that the definition of De Qi 得氣 as needle sensation felt by the

patient primarily is a mistake. I base my definition of De Qi on Ling Shu chapter 9 (the main chapter in the Neijing where

the word De Qi is defined - and there it is not defined by needle sensation).

3. The patient’s acupuncture resonance is important, but we do not rely on it. We focus on the practitioner’s fingertip

sensation. Many patients do not find the resonance of acupuncture needles pleasant and good. Especially first-

visit patients are afraid of acupuncture needles because they don’t know how they feel. If the acupuncture needles

must resonate in order to be effective, the acupuncturist will ask the patient for clarification and then try to elicit the

acupuncture’s resonance, but this is rare. The acupuncturist must feel the response of the acupuncture points himself

with his fingers in order for the treatment to be effective.

4. Both

5. While the sense of “de qi” is the patient’s sensation, 鍼 妙 (effectiveness of needle) and the sense of hand are the

acupuncturist’s sensations. However, the patient may experience a change in symptoms when a change is confirmed by

fingertip.

6. I think both are important but if I compare, practitioner’s sensation is more important. Patient may not feel anything at

the time of needling, but practitioner should feel at every point at all times.

7. It’s a stupid question. If the acupuncture needles do not feel good to the patient, there is no point in treatment. Even if

the acupuncturist is satisfied, if the patient is not cured, there is no point.

8. both are valuable

9. I try not to get needle sensation, but to get a reaction at a relevant point. It is important that the patient feels a change

at this distant point (so not at the treatment point): it needs to improve, meaning to become more soft, less painful, less

red, less irritated.

10. acupuncturist29

11. sensation to the patient

12. Both are important.

13. Depends on what type of needling. For deep needling, I think ‘de-qi’ of the patient is most important. For super-

superficial needling, the qi sensation of the practitioner is most important.

14. To the acupuncturist- “like a fish taking a hook”

15. I learned to trust what is happening during treatment and do what I have to do. My needle sensation is important, but

I do treat a lot of body workers and mostly times our sensation of needling matches. That helps me trusting what I am

doing is true and right.

16. acupuncturist

17. A question I don’t have an answer to, still figuring out all the sensation I feel everywhere and what to make of it all.

Work in progress. But I do think, that I am the one leading the treatment, so I need to feel and decide when it’s enough.

18. Both

19. acupuncturist

20. Usually it’s the sensation that I – as the acupuncturist – feel. BUT!!! - often the patient will feel a sensation and if they

can begin to describe it in depth (where it went /type of sensation / emotions that ‘come up’ / types of release here

or there) that will provide me with many clues to their ‘puzzle’. Some patients have not developed the habit of ‘being in

their body’ (for whatever reason – no judgement), and are not able to provide that kind of feedback. So being able to

feel sensation myself is very helpful. So, both are equally valuable, and one more than the other depending upon the

circumstances

21. It is important that practitioner and patient both feel the good needle sensation at the same time.

22. both

23. For beginners, it is one way to refer to the opinions of patients. However, as your acupuncture skills improve, it is more

important to rely on your own sensations as an acupuncturist than on the sensations of the patient. This is because

there are individual differences in the sensations of patients. To begin with, patients are in a state of unstable qi/

fluid/blood balance. Therefore, there is a deviation in sensitivity to qi. The practitioner should perform treatment after

considering the characteristics of each individual patient. So, it is essential to perform treatment after grasping one’s

own acupuncture sensation.

24. To the acupuncturist, although of course it is a mutual communication, so that patient response is also significant.

25. If the treatment is effective, the patient’s sensations and the acupuncturist’s sensations will match, so both are

important.

26. practitioner

27. to the acupuncturist

28. Both , it’s a teamwork!

29. More important is the effect of the needling, when sensation is felt by either practitioner or patient.

30. To the acupuncturist.

31. The acupuncturist awareness is more important but I do confirm and check with the client for feedback and

clarification.

32. it’s nice to have patient confirmation, but sometimes that’s just unreliable.

33. Acupuncturist

34. If the patient feels pain, the muscles will tighten. I advise them to tell me if they feel pain or discomfort, while watching

their reactions.

35. patient