Introduction

Although Ma Danyang’s Heavenly Star Points are the easiest method of bringing acupuncture theory into clinical practice (see The Journal of Chinese Medicine, issue 98, February 2012), the most practical approach to acupuncture in a clinical situation involves the use of ashi points. However, their apparent simplicity of use often means they are discarded by practitioners in favour of treatment based on complex channel and point theory. A story illustrates this point: Twenty years ago a fellow intern in Beijing asked our acupuncture teacher why he did not include distal needling or make use of ying-spring or shu-stream points during treatment. The teacher answered, ‘If something gets into your eye, get it out of your eye’, in order to remind us not to lose sight of the problem being treated due to overthinking the theory. That this comment came from an acupuncturist who had previously lived as a Buddhist monk on Mount Wutai–praying, sweeping and treating the suffering–who was then forced to live in a pig-sty as part of his re-education during the Cultural Revolution, and finally ended up working in a hospital outpatient clinic in the middle of Beijing, made this admonition to remember that theory results from clinical experience–and not the other way around –all the more poignant.

Within Chinese medicine, treating the location of discomfort or pain without addressing its underlying causes is regarded as giving a ‘branch’ treatment instead of fixing the ‘root’ cause of the condition. Because ashi acupuncture frequently involves needling directly into discovered areas of pain, it is easy to mistakenly believe it falls under the heading of a branch rather than a root treatment. As will be seen below, treating the obvious location of pain without looking at the patient holistically–known in Chinese as ‘treating the head when the head hurts, treating the foot when the foot hurts’ (

[TEXT NOT REPRODUCIBLE IN ASCII])–is not how authentic ashi acupuncture is actually practised. Ashi acupuncture involves treating areas causing with pain and dysfunction that are usually unknown to the patient, and which actually constitute the root cause of their physical pain or dysfunction. Adopting ashi acupuncture as the primary treatment method when treating physical pain, numbness, tingling or burning due to inhibited circulation or nerve impingement, as well as a range of motion issues, is critical to clinical success.

The Nei Jing Ling Shu (Inner Classic Divine Pivot) Chapter Xie Qi Zang Fu Bing Xing Pian (Chapter on Illnesses of the Zangfu and Pernicious Qi) clearly states the criteria that should be used to judge the standard of a physician:

Superior practitioners, of ten [patients] nine are cured.

Medium practitioners, of ten, seven are cured.

Inferior practitioners, of ten, six are cured.

The Nan Jing (Classic of Difficulties [TEXT NOT REPRODUCIBLE IN ASCII]) quotes this in the 13th Difficulty, thereby reaffirming it as the accepted standard for medical practitioners. Major texts from each successive dynasty have since included a commentary on these standards, which have not changed or lessened through time or author. These are tough standards by which to judge oneself. I would personally be thrilled to be ranked along with the lowest of practitioners as described in the Nei Jing. However, the complexity of my clients, the weakness of Chinese medicine at this particular time in history, the poor quality of herbs available, the restricted or outlawed use of some ingredients or needling methods, the lack of effort or compliance on the part of patients, and the distractions of my own life, mean that an efficacy rate even of over 50 per cent remains elusive. However, if we narrow the field down to physical injury and rehabilitation, I can confidently state that the majority of my patients will experience extraordinary improvement or cure, and that almost all will experience tangible benefit from seeing me. This is not arrogance, nor a result of any secret techniques passed on by my teachers, but merely the result of the clinical teaching I received that puts ashi work at the core of all injury treatment.

History

Ashi needling is not complicated. In fact, the discovery that injuries improve after massaging a particularly painful spot likely constitutes one of the first and most fundamental discoveries of every medical system on the planet. It is an experience that every human who has tried to help others suffering from pain must have experienced. The first record of using such painful spots as treatment points in the Chinese literature is in Ling Shu’s chapter Jing Jin Di Shi San (Thirteenth Writing: Sinew Channels [TEXT NOT REPRODUCIBLE IN ASCII]): ‘It is [the point of] pain that defines an [acupuncture] point ([TEXTO IRREPRODUCIBLE EN ASCII]).’ The term ashi–literally ‘Ah yes!’–was first coined by Sun Simiao in his Tang Dynasty Qian Jin Yao Fang (Thousand Ducat Formulas): ‘In terms of the method of ashi, in speaking of a person who has a condition of pain, when squeezing, if there is a spot inside [we] do not ask if it is a [recognised] acupuncture point, because [we] located a painful spot and they said, “Ah yes!”. Needling and moxaing [the points] have proven effective in the past, thus they are called ashi points.'([TEXT NOT REPRODUCIBLE IN ASCII])

Ashi points today

Ashi points can be found in various contexts today. In the West, Janet Travell’s pioneering work on what she terms ‘trigger points’ has found its way into Western acupuncture and the professions of sports massage, chiropractic and physical therapy. In modern China Professor Lu Dinghou of the Beijing Physical Education University has tried to scientifically prove the efficacy of ashi work by intentionally injuring his own thigh, then needling the injury whilst monitoring the healing process through repeated biopsy (see Lu, 2000). Japanese shiatsu (dian xue [TEXT NOT REPRODUCIBLE IN ASCII] in Chinese) treatments often find the practitioner leaning deep into tender knots in the muscles that light up entire pathways of pain; Thai massage, Swedish deep tissue massage–the styles of treatment and countries of origin that make use of ashi points are endless. …

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