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Harriet Hall discussed this paper in her Aug. 27 post:
https://sciencebasedmedicine.org/do-acupuncture-points-exist-can-acupuncturists-find-them/

I thought the key points she made were: "If acupoints and meridians were real, wouldn’t they vary in location just as other anatomical structures do? During embryologic development, DNA provides a general recipe but not precise instructions. Just look at the veins on the back of your hands: the location of the veins on your two hands is not identical, and they certainly don’t match the location of veins in other individuals."

and: "Even when you know where a blood vessel is, it can be tricky to get a needle into the right place from which to draw blood...So I find it hard to believe that acupuncturists could get their needles into exactly the right spot at the right depth."



Volume 12, Issue 2, April 2019, Pages 52-66
Journal of Acupuncture and Meridian Studies

Accuracy and Precision in Acupuncture Point Location: A Critical Systematic Review
R.Godson (1,2), Jonathan L.Wardle (3)

1 Academic Department, Honours, Office of the Director of Education, Endeavour College of Natural Health, Brisbane, Australia
2 Department of Chinese Medicine, Endeavour College of Natural Health, Brisbane, Australia
3 Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, Australia

Abstract

A number of studies have examined the accuracy and precision of acupuncture point location across various point location methods. Accuracy of point location is essential for safe, efficacious and reliable treatments and valid reproducible research outcomes. This review aims to identify, summarize, compare and critically appraise available empirical studies relating to the accuracy and precision of acupuncture point location. A comprehensive search of five electronic databases, World Journal of Traditional Chinese Medicine and Google scholar was performed for studies investigating accuracy and precision in acupuncture point location. 771 studies were screened of which 14 studies were identified, including 9 studies that investigated the localization of acupoints and 5 studies that examined the cun measurement system. Considerable variation in localization of acupoints was reported among qualified medical acupuncturists. Variation in point location among qualified non-medical acupuncturists is unknown due to lack of any identified study. The directional method was found to be significantly inaccurate and imprecise in all studies that evaluated the method. Suitability of other methods for clinical and research purposes and influencing factors such as education, training and experience were identified as topics for future studies.

Free full text:
https://www.sciencedirect.com/science/article/pii/S2005290118300530

Excerpts:

"There are three basic methods of locating acupuncture points from which all other methods are derived: the anatomical landmark method, the proportional bone (B-cun or skeletal) method, and the finger–cun (F-cun) method, also known as the directional method [5]. The anatomical landmark method (widely considered to be the most accurate one [5]) is used to locate less than half (n = 164) of the 361 acupuncture points distributed over 14 acupuncture channels. The remaining points require measurement from anatomical landmarks for location. The cun or anatomical Chinese inch is the standard unit of measurement and is based on measurements first mentioned in the classical text 'Lingshu' [2], [5], [6], [7]. Various areas of the body have linear cun measurements ascribed to them [5].

"The directional, proportional, and direct measurement (using a ruler or elastic) methods all rely on the cun system. The directional method uses cun measurements ascribed to areas of the fingers and hand as a standard measurement and applies F-cun to approximate body-cun (B-cun) [5]. The proportional method subdivides the distance between two anatomical landmarks into equal portions according to cun measurements...The limitation of the proportional measurement method is the reliance on the skill of the practitioner to ensure accuracy. Two direct measurement methods—the ruler and elastic methods—are adaptations of the proportional method which are less reliant on skill through the use of standardized measurement tools."

"The directional method was found to be significantly inaccurate and/or imprecise in all eight studies that evaluated the method..."

"Two studies specifically reported on the localization of acupuncture points using the proportional method found this method to be similarly imprecise and/or inaccurate as the directional method, with significant skill-related error in the localization of points..."

"Location by palpation for tenderness was investigated in one study and demonstrated no significant difference between pressure tolerated on genuine acupuncture points versus control points in healthy individuals..."

"One study (by Rivers et al) investigating the anatomical method demonstrated a lack of agreement in the localization of points between participants [20]. However, another study (by Molsberger et al) found that points located in proximity to anatomical landmarks were located with less variance than other points [19]."

"In another study (by Aird et al), localizations by student participants were clustered into quadrants in relation to 'correct locations' as identified by individual lecturers, suggesting that students are influenced heavily by lecturer perceptions of accuracy [14]. However, other studies found a lack of congruence in localization despite similar training of participants [3], [14], [19] or prior calibration sessions [17], [20]."

"Inaccuracies observed in these studies appear large enough to affect clinical and research outcomes. Given the differences in accuracy and reliability in point location methods identified, it is essential that the acupuncture community critically examine and identify the most suitable point location methods for implementation in training and practice. Point location methods, individual practitioner skill, and practitioner education and training are key areas that have been identified as affecting point location accuracy and precision."

"The anatomical method of point location is widely considered to be the most accurate method [5] and benefits from being simple to implement in practice. However, conflicting results in studies that involved the anatomical landmark method challenge this view...Wide variance in the identification of surface anatomical landmarks has also been problematic in other health professions [24], [25], suggesting that this issue may relate to factors beyond acupuncture-specific training.

"The traditional directional (F-cun) method is popularly used by practitioners, most likely due to its ease of use, but may be unsuitable for clinical or research purposes due to its inaccuracy."

"Elastic and ruler methods were more precise but were not well received by participants in this review...Existing measuring tools, such as the 'ACI- or Acu-Locator' expandable ruler, may reduce inaccuracy of the direct measurement method because calculations are not required...Given their unequivocally higher accuracy in our review, ruler or elastic methods [3] should be considered for use as the gold standard for locating acupuncture points as controls in future studies on accuracy in point location and encouraged for implementation in clinical practice.

"The notion that any of the aforementioned methods should be combined with palpation to effect an accurate location [6], [22], [23], [26] is almost universally accepted in clinical practice [26]. However, there appears to be insufficient empirical evidence to confirm the use of palpation as a suitable adjunctive point location method."

"The degree of variance in point localization among practitioners is sufficient to raise concerns regarding safety and efficacy of treatment. A number of acupuncture points lie in close proximity to arteries and other structures prone to damage by needling [1], [5]."

"There is also the possibility of no response or a detrimental response to clinical treatment if a nonpoint or nearby acupoint is inadvertently needled due to inaccurate or imprecise point location. Many acupoints carry specific indications not shared by acupoints in their proximity. HT 6, for example, is indicated for night sweating, whereas nearby acupoints HT 5, HT 7, PC 6, and PC 7 are not [1]."

"The similarity of outcomes in some 'sham' versus 'verum' acupuncture also raises the question about the size of acupuncture points. Some authors have suggested that acupuncture points could be better described as a 'field of fuzziness' and may be an alternate explanation for seemingly nonspecific effects of acupuncture [19]. While this infers that it would be easier to needle an intended acupoint, decreasing the need for accuracy, it would also be easier to needle a nearby acupoint inadvertently, making the need for accuracy even more critical."