Trigger Points (TPs) versus Acupoints (APs) versus Ashi Points

[Guest guest]

Also, Trigger Pts do NOT disappear to distant AP Pt needling, nor do they

disappear with rest or time-off-work. IMO, one MUST work on Trigger Pts

directly

>>>>>>

Phil i do not agree; first, most " myofasical " trigger points are

secondary to other dysfunctions. For example, Ed Styles DO in a

meeting were Simons was present showed how all of the trigger points

Simons identified disappeared by treating the patient with osteopathic

techniques addressing joint restrictions. Second, almost always one

can demonstrate that by injecting an anesthetic to involved joints or

ligaments a myofascial trigger point would disappear (ie become non

tender and loose its referral phenomena) showing it to be a referred

phenomena itself. Third, its fairly rare that one actually cures pain

by addressing only myofascial trigger points. I do agree with you

about the differences in ashi concept and trigger point concept. It is

interesting however that most referred patterns from myofascail

triggers show close relations to the sinew channels.

[Guest guest]

Hi All, esp John, Lonnie & Valerie,

 

John wrote:

 

> Phil, actually the ancients did document and label these points (TPs); they

> called them a-shi points, while some of them do overlap with channel

> points.

 

See my distinction between Ashi Pts and TRIGGER Pts, below.

 

> There is a very comprehensive rebuttal of the flawed and biased study

> done by Melzack and his colleagues by Stephen Birch and Robert Felt

> (Understanding Acupuncture pgs. 158-159) Please read it here:

> http://tinyurl.com/6f8tyj

 

> 1. When they speak of a 71% correlation between acupoints and trigger

> points, Melzack only studied 50 trigger points and found 35 acupoints

> to be within 3 cm proximity to the trigger points. This is called an

> " extreme allowance " by the authors... 3 cm is more than twice the area

> of a 2 cm radius circle, which is that which is proposed for

> standardization of acupoints according to the WHO....please read their

> article. 2. Furthermore, distal points for pain were excluded from the

> study. " Melzack and his colleagues only considered correlations with

> locally painful channel points. This is not only arbitrary, but almost

> perfectly misrepresents what acupuncturists actually do. " 3. Of the 35

> points that were grouped together with the 50 trigger points studied,

> some of the points have " no reputation or traditional indication for

> the treatment for pain. " (mean 20.2 points; 57.7%). " From

> acupuncturists' viewpoint, only 4-9 of the 35 points (11-26%) on which

> Melzack bases his conclusion are even among those that they would

> consider for the treatment of pain. " " The actual correlation level is

> only 23.4% with typically used points and 42.5% with the addition of

> points that are sometimes used. " 4. The implication from this study is

> that 71% of acupoints correlate to trigger points, when in fact 35

> points out of 361 channel points doesn't even constitute 10% of the

> corpus of points, not including extra points. " The more dramatic number

> was accomplished by reversing the expected comparison, thus producing

> an impression that virtually the entire body of acupuncture points had

> been correlated to trigger points " . Please read the last 2 paragraphs

> on pg. 159.

 

IMO that misrepresents what Melzack et al were saying. Though I have not

had time to read the full article, I understand that Melzack et al reported that

35/50 (71%) of the Trigger Pts that they examined wre located within 3cm

with THEIR knowledge of classical locations of AP Pts.

 

Dorsher PT [Can classical acupuncture points and trigger points be

compared in the treatment of pain disorders? Birch's analysis revisited. J

Altern Complement Med. 2008 May;14(4):353-9. Department of Physical

Medicine and Rehabilitation, Mayo Clinic, Jacksonville, Florida 32224, USA.

dorsher.peter ] says:

BACKGROUND: A 1977 study by Melzack et al. reported 100% anatomic

and 71% clinical pain correspondences of myofascial trigger points and

classical acupuncture points in the treatment of pain disorders. A reanalysis

of this study's data using different acupuncture resources by Birch a quarter

century later concluded that correlating trigger points to classical

acupuncture points was not conceptually possible and that the only class of

acupuncture points that could were the a shi points. Moreover, Birch

concluded that no more than 40% of the acupuncture points examined by

Melzack et al. correlated clinically for the treatment of pain (correlation was

more like 18%-19%). OBJECTIVE: To examine Birch's claims that

myofascial trigger points cannot conceptually be compared to classical

acupuncture points and that most (at least 60%) of the classical acupuncture

points examined by the study of Melzack et al. are not recommended for

treating pain conditions, negating their findings of a 71% clinical pain

correspondence of trigger points and acupuncture points. METHODS:

Acupuncture references and literature were reviewed to examine the validity

of the Birch study findings. RESULTS: Acupuncture references support the

conceptual comparison of trigger points to classical acupuncture points in

the treatment of pain disorders, and their clinical correspondence in this

regard is likely 95% or higher. CONCLUSIONS: Although separated by 2000

years temporally, the acupuncture and myofascial pain traditions have

fundamental clinical similarities in the treatment of pain disorders.

Myofascial pain data and research may help elucidate the mechanisms of

acupuncture's effects. PMID: 18576919 [PubMed - in process]

 

See further comments on this, below.

 

Re the discussion on the similarities and differences between the terms

" acupuncture Pt / acupoint (AP Pt) " , " Ashi Pt " and " Trigger Pt " , my

understanding of the terms is:

 

(1) AP Pts are codified loci, described in TCM and modern Oriental (esp

Chinese, Korean & Japanese) medical texts, to which stimuli are applied to

elicit a therapeutic response according to TCM or more modern Oriental

medical theory.

 

Many different classes of AP Pts exist:

 

(a) Channel Pts: 361 codified Pts are described on the 14 Main Channels of

human AP: LU 11, LI 20, ST 45, SP 21, HT 9, SI 19, BL 67, KI 27, PC 9, SJ

23, GB 44, LV 14, CV 24, GV 28; Total 361.

 

(b) Extra-Channel Pts are codified AP Pts that usually lie outside of the Main

Channel System [http://homepage.eircom.net/~progers/pt.htm ]. They

include at least 309 Pts under the category of " Strange Pts " or " New Pts " .

 

Also, at least 376 AP Pts were described by Dr. Dong / Tung

[http://www.acup-chiro.com/englisharticle/TungAcupuncture.htm ]; some of

these correspond with other types of Extra-Channel Pts.

 

However, some " Extra-Channel Pts " lie directly on a Channel between 2

traditional Channel Pts. For example Yintang lies on the GV Channel

between GV24 & GV25.

 

Also, some " Extra-Channel Pts " coincide exactly with traditional Channel

Pts. For example, Waixiyan coincides with ST35-Dubi.

 

© Codified Microsystem AP Pts, include Ear AP Pts, Scalp AP Pt Zones,

Forehead Zone AP Pts, Nose Zone AP Pts, Face Zone AP Pts, Foot Zone

AP Pts, KHA (Korean Hand AP) Pts, ECIWO AP Pts, etc.

 

I have not counted all the AP Pts under categories a, b and c (above), but I

suspect that there are between 1500 and 2500 codified AP Pts. There

probably are MYRIADS of UNCODIFIED (as yet undiscovered /

undocumented) AP Pts.

 

(2) Ashi Pt: The Ashi Pt in TCM is a sensitive Pt. The term " Ashi " refers to

the verbal (and behavioral) response of the subject when an Ashi Pt is

palpated strongly. The Hanzi characters for Ashi can be translated as " Aaah!

Yes " , or " That´s it " or " Ouch! " .

 

There are TWO types of Ashi Pts - LOCAL Ashi Pts and TRIGGER Pts.

These two types differ intrinsically (see (3), below).

 

LOCAL Ashi Pts are only painful locally to palpation, viz, on palpation they

do not refer pain outside of the immediate area. [They may elicit Deqi but

that differs from the Trigger Pt reaction - see below]. LOCAL Ashi Pts are

not as important clinically as Trigger Pts and often disappear to distant or

regional (viz, not direct local) needling.

 

Many Channel & Extra Pts can be sensitive (Ashi) Pts in DysFx of the

related Channel or Zangfu. For example, many women with urogenital /

menstrual problems are very sensitive to palpation of AP Pts on the Leg Yin

Channels, esp SP06. Most appendicitis cases are sensitive to palpation of

ST25 and AP Pts in the lower right quadrant of the abdomen and some also

are sensitive to palpation of Lanwei on the right leg.

 

The Deqi sensation experienced by the subject when neutral AP Pts or Ashi

Pts are probed or needled has parallels with, but (IMO) differs from, the

reactions elicited by probing or needling Trigger Pts.

 

Yes, the ancients used sensitivity (Ashi reactions) at Mu-Shu Pts to aid

diagnosis of Channel or related Zangfu DysFx. They also treated Mu-Shu

Pts for disease of the related Channel or Zangfu systems.

 

(3) TRIGGER Pt: All Trigger Pts are Ashi Pts in that they elicit an " Aaah!

Yes " , or " That´s it " or " Ouch! " response when palpated strongly.

 

However, Trigger Pts differ intrinsically from local Ashi Pts because, though

sensitive / very sensitive to palpation, Trigger Pts ALSO refer pain or

paraesthesia ELSEWHERE, viz to the body area that is troubling the

subject. This has parallels with, but is not the same as, the Deqi reaction.

 

The behavioral / verbal response to palpation / needling Trigger Pts is more

violent than that elicited from LOCAL Ashi Pts. Indeed, when I must needle a

Trigger Pt, some of my human male clients use the F***k word. This is very

rare when I needle other AP Pts or LOCAL Ashi Pts.

 

[in HORSES, I rarely needle LOCAL Ashi Pts because needling distant AP

Pts, " Tan´s Mirror Pts " or regional AP Pts usually removes Ashi Pts in

spastic muscle within seconds].

 

Trigger Pts can exist in any tissue (muscle, periosteum, bone, tendon,

ligament, damaged skin (esp sensitive scar tissue), damaged tooth sockets,

etc.

 

In my experience, and that of several authors of articles on Trigger Pt

therapy, Trigger Pts TRIGGER and / or MAINTAIN symptoms (pain,

proprioceptive DysFx, autonomic DysFx, or ataxia) in areas that can be quite

distant from the Trigger Pt location.

 

Also, Trigger Pts do NOT disappear to distant AP Pt needling, nor do they

disappear with rest or time-off-work. IMO, one MUST work on Trigger Pts

directly.

 

I have seen, or heard of, several cases of chronic pain / autonomic DysFx,

lasting 1 to 15 years before Trigger Pt therapy that had been treated

unsuccessfully with other therapies but responded quickly and dramatically

(and often permanently) to 1 to 3 sessions of Trigger Pt therapy.

 

In summary, my understanding is that:

 

(a) ALL active and latent Trigger Pts are Ashi Pts, but not all Ashi Pts are

Trigger Pts.

 

(b) Not all Ashi Pts are documented AP Pts.

 

© Without needling them directly, LOCAL Ashi Pts often disappear after

needling of distant AP Pts. In my experience, this rarely happens with

Trigger Pts; one MUST needle (or otherwise stimulate) Trigger Pts directly to

release / remove them and get the best clinical outcome.

 

(d) As John said (quoting Birch et al), Melzack´s claim of 71% correlation

between Trigger Pt and AP Pt locations may have been too high because he

allowed a 3cm range between his Trigger Pt and classical AP Pt locations.

 

However, because of his incomplete knowledge of Extra Pts, New Pts,

Strange Pts, ECIWO Pts and as yet undiscovered AP Pts, I believe that

Melzack´s 71% correlation may be much too LOW.

 

IMO, ALL Trigger Pts are potential AP Pts but, because myriads of AP Pts

remain to be discovered. Therefore, the full extent of the relationship is not

resolved yet.

 

There is a saying that " all blackbirds are black but not all black birds are

blackbirds " . However, that saying is incorrect because, though male

blackbirds usually are black, female blackbirds usually are brown or dark

brown. Mutants, such as albino blackbirds, also can occur. The same may

be the case for Trigger Pts and Ashi Pts.

 

Finally, while I accept that the ancients knew of the existence and clinical

usefulness of Ashi Pts, I do NOT agree with John that they knew the

importance of Trigger Pts and their correlation with classical AP. As far as I

know, TP therapy (and a parallel system, Neural Therapy) is a recent

discovery, mainly within Western Medicine.

 

Can John, or others, cite TCM references that mention the concept of

Trigger Pts, or Ashi Pts that actually TRIGGER and / or MAINTAIN

symptoms (pain, proprioceptive DysFx, autonomic DysFx, or ataxia) in areas

that can be quite distant from the Trigger Pt location?

 

I would appreciate further education on the matter.

 

Best regards,