Point specificity remains an important underlying principle used for prescribing acupuncture treatment in traditional Chinese medicine (TCM). According to TCM theory, stimulation of acupoints elicits functional responses that can be used to treat diseases . Practitioners believe that the therapeutic effects of acupoint stimulation primarily work through 12 principal meridians that represent channels through which energy known as Qi flows . Abnormal flow of Qi in meridians is related to disease in principal Chinese organs , and its natural flow is restored by stimulation of the appropriate acupoints . When choosing the acupoints, acupuncturists first examine the patient's symptoms to determine which meridians are involved and subsequently choose a set of acupoints to stimulate along the meridians to evoke the greatest clinical responses . For example, frontal headaches are treated by stimulating acupoints Shangxing (GV23) and Hegu (LI4), while occipital headaches are treated with acupoints Fengchi (GB20), Kunlun (B60) and Lieque (L7) . Patients also are examined for the presence of Ashi points, which are nonspecific pressure points that elicit pain upon palpation and can be used along with the other acupoints to treat local pain . Different acupoints may be stimulated at similar or different frequencies and intensities depending on the patient's conditions .
As TCM has been disseminated worldwide, different versions of acupuncture techniques have been developed, some of which do not follow the TCM principles for acupoint selection. For instance, 'trigger point acupuncture' involves stimulation of only Ashi points, single-point acupuncture uses only one acupoint for treatment and the eclectic approach involves needling anywhere within the region of the pain without any reference to Ashi or traditional acupoints . Despite the various types of new acupuncture approaches, traditional point-specific techniques remain the most common form of acupuncture.
This article reviews clinical and laboratory studies on the role of point specificity. The aims of this article are not only to discuss acupuncture techniques, but also to evaluate the validity of the proposed mechanisms. The article's focus is on studies that incorporated sham controls with traditional needling techniques at non-acupoints or inactive acupoints to evaluate the principle of point specificity. The inclusion criteria take into account sample size and blinding of participants, location of the sham acupoints, needling technique and rationale for choosing both verum and sham acupoints.
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