Patients are often puzzled when the needles go somewhere other than the place that hurts. “Why aren’t you needling here?” is a question I have heard many times.
There is a reason, and acupuncture point selection follows the same logic as the distinction between treating the cause and relieving the symptom.
In Summary
- Point selection divides by location into two principles: local selection (near the painful site) and distal selection (far from it).
- Local points smooth the circulation of qi in the affected area itself. Distal points resolve the circulatory problem that produced the condition, by stimulating a point some distance away.
- So as a rule: symptom relief tends to be local, root treatment tends to be distal. Both matter; neither is the superior technique.
- Three questions decide the mix — is the cause mostly local, is there a meridian or organ behind it, and is the condition acute or chronic?
- Points work by regulating internal organs and the nervous system through the interaction of acupoint, organ, nerve and musculoskeletal system.
- There is no single correct combination; the KTM physician decides from the patient’s condition. No needle is placed without a reason — ask, and it will be explained.
Two Principles
Where a needle goes divides, by location, into two principles.
Local point selection (近位取穴) — points are chosen near the site that hurts.
Distal point selection (遠位取穴) — points are chosen at a distance from it.
Needling the hand or the foot for a painful knee belongs to the second. From the patient’s chair that is the least intuitive thing that happens in a treatment room, and it is where the principle lives.
What Each One Does
Local selection smooths the circulation of qi in the affected area. It opens the place that is blocked, directly.
Distal selection resolves the problem of qi circulation that produced the condition, by stimulating a point far from it. It works on the system where the cause sits rather than the place where the result appeared.
Which produces this correspondence:
- Needling for symptom relief → usually local
- Needling for root treatment → usually distal
And just as root treatment and symptom relief both matter, needling far from the pain matters as much as needling into it. Neither is the more advanced method.
What Decides the Mix
A KTM physician weighs three things when choosing points:
- Is the cause of the pain or illness mostly a local problem at the site?
- Or is there a meridian and an organ behind it?
- Is the condition acute or chronic?
An acute local problem shifts the weight toward working nearby. Something long-standing, with its root elsewhere, shifts it toward the distal points.
How Points Work
The mechanism is this: stimulating an acupoint regulates the internal organs and the nervous system.
Acupoint, the organs, the nervous system and the musculoskeletal system all act on one another, and needling intervenes in that interaction. This is why stimulating somewhere remote from the pain can change anything at all.
Nor is this a claim unique to Korean Traditional Medicine (KTM), the traditional healing system of Korea also known as Hanbang (한방). The contemporary view that treats the gut as part of the brain points the same way — that stimulating one part of the body can regulate a system some distance from it.
Who Decides
The physician decides, from the state of the patient.
And to be honest about it: there is no single correct optimisation between distal and local. It varies with the theoretical framework a practitioner works from and with their own skill. Two practitioners can treat the same patient with different combinations, and both can be reasonable.
So Ask
If you are curious mid-treatment, ask why a particular point was chosen. You will get an explanation.
There is no needle placed without meaning, and no meaningless point. If nothing is going into the spot that hurts, it does not mean the pain is being ignored — it may mean that, at this moment, the cause is what is being treated.
Related reading: Treat the Cause or Relieve the Symptom? · Pain Is How the Body Distributes Energy
This article reflects the teaching and research of Professor Seungho Baek, Professor of Korean Medicine at Dongguk University College of Korean Medicine, specializing in Pathology and Oncology.
