Choosing a tandem point

One of the most common questions students and other clinicians ask is: How do you know which acupuncture point to choose as a tandem point? The reality is that a large number of points can be effective for any one problem.

As Peter Deadman wrote: "The insertion of a needle into the body in order to contact the qi will usually produce some changes, whichever the points selected. In current practice throughout the world there is enormous variety in point selection. Indeed this 'fuzziness' is not confined to the Western world. Within modern and classical Chinese traditions there is also enormous variation in understanding and predicting the effects of needling different points, and a great variety of ways to treating different diseases."(6)

Nevertheless the experience of doing Tandem Point therapy over thousands of hours has yielded some insights into which acupuncture points are likely to be most effective in allowing trigger points to release.

The following are good options for tandem points

• points where a patient feels referred pain (must be taken; migraines are a special case--the patient should hold one or two points in the head while the clinician holds points in the feet)
• the insertion and/or origin of the muscle including the trigger point
• xi-cleft points on the same channel as that containing the trigger point or downstream from the trigger point are particularly indicated for pain and acute conditions (and for neck problems or referred pain to the head, Li 6 is particularly indicated and can be taken with a GB point or with Lu 6)
• master points of the eight extraordinary channels, especially early in a session
• shu-stream points on the same channel or on its six divisions partner, especially for yang channels and where there is pain in the joints
• ying-spring points on the same channel or on its six divisions partner, especially when heat is being produced
• points ½ cun distal to the ying-spring points, especially in the feet
• points under the toes, between the head of the metatarsal and the distal interphlangeal joint, usually in the same sagittal plane as a channel
• luo-connecting points on the husband/wife channel
• if the clinician has done a five-element pattern analysis, appropriate tonification/sedation points
• LI 11 if appropriate for the five-element pattern, and LI 10 if not
• source points, especially near the end of a session

Throughout the work, the clinician is feeling for the release in the primary trigger point. Success is releasing that point and allowing the muscle to reach its full length. The clinician can determine if a tandem point is effective based on the response of the primary trigger point. A good tandem point choice will immediately cause a jump in the amplitude of the pulsation in the primary trigger point. Within two seconds the primary trigger point will soften. Frequently it will give off heat.

It is particularly important to eventually clear points upstream and downstream from the trigger point in the Chinese conception of how energy flows in the body.