I would claim that introducing the ATA concept has a number of advantages.
䊉 It avoids the danger of getting tied prematurely to any particular theoretical framework, which may need to be modified or superseded as research in acupuncture advances.
䊉 It allows for the introduction of new methods of treatment, since these are not obliged to conform to theoretical expectations.
䊉 I think it is a true reflection of what most modernist acupuncture practitioners are actually doing, because they are generally more flexible in their practice than in their theory. Informal conversations with experienced acupuncturists seem to confirm this view.
The last point seems to me to be particularly important. When one starts out in acupuncture it is quite difficult to avoid thinking of it as a very esoteric subject, and this view is sometimes reinforced by teachers. This isn’t true. Acupuncture itself is relatively simple, given a good knowledge of anatomy. What’s difficult is knowing when to apply it. Provided you have a certain minimum level of manual dexterity, your success rate in acupuncture will be approximately in proportion to your general clinical success rate. If you are getting good results with your existing treatments, especially manual treatments, you will get good results with acupuncture. Acupuncture is of a piece with the rest of clinical practice.
Beginners may get the impression that there is a firmly established body of rather arcane knowledge which must be gradually acquired, so that becoming an expert acupuncturist is largely a matter of learning more and more acupuncture points with their specific properties and effects. As time goes by, however, the aspiring acupuncturist is likely to find that this rather simplistic view of the matter doesn’t correspond to what actually obtains. Different teachers of acupuncture have quite divergent ideas about how to choose which points to needle, as well as about the duration and intensity of needling and other matters. This can create a certain amount of confusion in students’ minds. The remedy, I suggest, is to understand the basic principles and then to apply them without too many preconceptions.
There is a commonly held view about acupuncture which goes something like this. There are hundreds of acupuncture points, which all have specific effects that must be learned; improving your skill depends on learning more and more points, and the more points you know, the better your results will be. If you believe this, acupuncture is inevitably going to appear complex, requiring years of study in order to become expert at it. Experienced acupuncturists, if caught in unguarded moments, will often admit that this isn’t really true; I certainly don’t believe it myself. I think that precision of needling is often, though not always, relatively unimportant. On the other hand, we shouldn’t go to the opposite extreme and say that it makes no difference at all where the needles are placed. So how do we go about choosing where to needle?
First, we recognize that there are certain sites (ATAs) from which radiation of sensations is normally propagated in particular patterns. Needling the ATAs in question can then treat symptoms in the relevant areas. However, we also remember that the patterns described are only averages; individual patients may and do present with different radiation patterns, so it’s important to remain flexible in our thinking. Descriptions of ATAs are guides, not invariable rules; skeleton keys to try in the symptom lock. And new ones will be discovered from time to time; probably every experienced acupuncturist has found some needling sites that have not yet been described in books.
Next, we think about the history and pathology, because these will often give a clue to where to try inserting the needles. For example, I have found an ATA at the back of the thigh which is also a trigger zone and may be activated by sitting on a hard chair which presses on the hamstrings; it refers pain to the front of the thigh above the knee. I haven’t seen this described anywhere (though of course it may be).
Finally, if all else fails, and we still want to try acupuncture, we can use generalized stimulation, which in practice means needling the hands or feet, but especially the feet.
The ATA approach to acupuncture is deliberately not overprescriptive. It is meant for people who don’t necessarily want to be presented with a book of rules to follow blindly but who like to try to understand what they
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are doing and are prepared to think for themselves. In the traditional system enormous importance is generally attached to locating acu- puncture points exactly, and the rather ‘free-style’ approach to acu- puncture I advocate may appear unsettling to some. Newcomers sometimes yearn for firm instructions; they want to be told that in disorder A you should put the needles in points x, y, and z, while in disorder B you should put them in points p, q, and r, and that provided you do this you should get the hoped-for results. But things are not so simple, and confident instructions of this kind really do students a disservice. (Please understand that this applies to postgraduates, who are, or should be, used to thinking critically for themselves; the position might be different if one were teaching acupuncture to undergraduates.)