Some medical acupuncturists who favour a non-traditional view base their understanding of the subject mainly or entirely on the TP concept. I think that this may be rather misleading, because quite a lot of acupuncture does not, in fact, make use of TPs. An alternative idea is to speak of “acupuncture treatment areas” (ATAs). An ATA may be defined quite simply as an area on the body at which it is possible to insert a needle and produce a therapeutic effect. On this definition, a TP may be an ATA but an ATA is not necessarily a TP.

The simplest kind of ATA is merely the painful area itself. Some purists refuse to allow that needling a painful area is acupuncture, but this seems to be unnecessary hair-splitting, especially in view of the fact that the method is described in Chinese texts as far back as the seventh century AD. In many cases, however, needling painful areas is ineffective or actually makes things worse, and it is then necessary to look for a distant ATA. Such areas may be found almost anywhere, but as a general rule they are situated proximal or central to the site of pain. They are generally tender themselves when pressed and are then more or less the same as TPs. However, they need not be tender at all. If an ATA is tender needling it is more likely to be effective than if it is not tender but acupuncture at these sites can still work even when there is no tenderness.

ATAs may be quite small (a centimetre or less in diameter) or they may be much larger – for example, the whole leg from the knee down might be an ATA. There are also some special ATAs, such as the ear, which are supposed to have numerous “mini-ATAs” within them. They may exist at any depth within the body; some lie just below the surface, while others are situated more deeply. The periosteum, for example, is often an ATA for painful joints.

Another sort of ATA is able to produce generalized effects. For example, the hands and feet contain ATAs of this kind. Needling these ATAs can affect localized pain in various places, it can influence disorders such as asthma and migraine, and it can improve the patient’s overall feeling of well-being.

Finally, notice that there is a sense in which itthe body as a whole can be thought of as a sort of ATA. In some cases it may make little difference where the needles are inserted! This effect, sometimes called diffuse noxious inhibitory control, is important because it bedevils all attempts to do acupuncture research using so- called “control acupuncture”.

Summary: I use the term ATA to refer to any area in the body that can be needled to produce a therapeutic effect. In most cases ATAs are themselves tender but they need not be. They are found (a) on the basis of descriptions in acupuncture texts and elsewhere, and (b) by looking for tender areas. ATAs overlap considerably with TPs but the two are not always identical.

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