Study indicates that areas of superficial inflammation in animals frequently overlap with acupoints traditionally associated with the relevant disease, and that acupuncture can significantly improve symptoms.

Classic canons of indigenous Chinese medicine, compiled over 2,000 years ago, explained that pathologic changes inside the body are reflected on its surface.1 Scholars and practitioners subsequently continued to examine the influence and interplay of the interior and superficial topographical areas in health and disease, creating foundations upon which current acupuncture point (acupoint) atlases are based.2


In the early days of my acupuncture education, I attempted to reframe the complex and sometimes esoteric historical perspectives of diagnosis and treatment by finding answers in more familiar territory — scouring medical physiology texts and contemporary research articles. The dynamic nature of acupoints transformed from quiescent to active by a wide variety of physiologic stressors began to emerge. The inflammatory soup of neurogenic
inflammation created by release of bioactive substances from excited superficial peripheral
afferent nociceptors explained the changes in sensitivity, temperature, color, and texture noted on examination of some acupoints.3-6 The neighboring position of somatic and visceral afferent cell bodies in dorsal root ganglia, and convergence of their fibers on a common higher order sensory neuron in the spinal cord, not only clarified the origin of referred pain accepted in allopathic medicine (such as when myocardial infarction presents as shoulder or arm pain), but also clarified a connection between viscera and acupoints.7

However, conflicting or contradictory conclusions were made by randomized clinical trials and systematic reviews, ranging from strong support, to noting similar outcomes when acupoints or non-acupoints were treated (sham acupuncture), to the attribution of any benefits to a placebo effect.8-12 As the criteria for the acupoints studied often varied widely, I was left with core questions about the significance of selection: would patient outcomes improve by selecting acupoints that were both sensitized and symptom-indicated? Fortunately, I recently found a unique study that helped clarify some of my questions.13 A brief summary highlighting key findings follows.


In “Acupuncture points can be identified as cutaneous neurogenic inflammatory spots”,
researchers documented the development of sensitive cutaneous spots (which the study’s
authors call “neurogenic spots”) by administering Evans Blue Dye (EBD) to rodents with stress-induced hypertension and colitis. EBD is highly protein bound and leaves a visible blue stain as it extravasates into tissue in areas with increased vascular permeability.14

Stained spots were quantified, their positions cross-referenced with accepted acupoints, and examined via immunohistochemistry. Neurogenic spots had marked increases in CGRP and Substance P (hallmarks of neurogenic inflammation), mechanical hypersensitivity, and electrical conductance.

• In the rodents with stress-induced hypertension, neurogenic spots formed predominantly around the palmar side of the carpus/wrist, and 67% overlapped with traditional acupoint locations on the Heart and Pericardium channels (often used in cardiovascular presentations including stress and hypertension). Acupuncture treatment on neurogenic spots that overlapped with accepted acupoints blocked the elevation of blood pressure but had no effect when performed on non-acupoints stained by EBD, or unstained adjacent acupoints.

• In the colitis model, neurogenic spots appeared primarily on the hind limb, with 70% of spots consistent with acupoints on the Spleen and Stomach channels (often used in acupuncture for gastrointestinal disorders). Rats receiving daily acupuncture on neurogenic spots overlying symptom-indicated acupoints had significant weight gain, faster resolution of diarrhea, and less biochemical and histologic evidence of colonic inflammation when compared to controls or when acupuncture was performed over an area 3 mm to 5 mm away which did not accumulate dye.

• Lastly, in the hypertensive rodents, retrograde dye markers injected into a carpal neurogenic spot and the apex of the heart showed double staining of neuron soma in dorsal root ganglia, indicating the convergence of visceral and somatic afferents on the same sensory neuron.

In summary, this study found that stress-induced hypertension and colitis produced hypersensitive cutaneous spots that frequently overlapped with acupoints traditionally indicated for the associated underlying disease, and acupuncture treatment significantly improved symptoms. It also suggests that patient outcomes may be improved in general if
acupoints selected for treatment have both evidence of neurogenic inflammation (such as tenderness and hyperemia) and are traditionally and/or have evidence-based indications for inclusion based on underlying symptoms or organs involved. and/or have evidence-based indications for inclusion based on underlying symptoms or organs involved.



  1. X. Y. Zhang and L. G. Ma, The Yellow Emperor’s Canon of Internal Medicine-Miraculous Pivot, Sichuan Science and Technology Press, Chengdu, China, 2008.
  2. A. White, E. Ernst, A brief history of acupuncture. Rheum. 2004; 43(5):662–
  3. Zhang JH, Wang D, Liu M. Overview of systematic reviews and meta-analyses of acupuncture for stroke. Neuroepidemiology. 2014;42(1):50-58. doi:10.1159/000355435
  4. B. Zhu, Systems Acu-Medicine: The Revival of Body Surface Medicine, People’s Medical Publishing House, Beijing, China, 2015.
  5. X. C. Yu, B. Zhu, J. H. Gao et al., Scientific basis for dynamic process of acupoints. J Tradit Chin Med. 2007;48(11):971–973.
  6. B. Zhu, The plasticity of acupoint. Zhongguo Zhen Jiu. 2015;35(11):1203-1208.
  7. Wesselmann U, Lai J. Mechanisms of referred visceral pain: uterine inflammation in the adult virgin rat results in neurogenic plasma extravasation in the skin. Pain. 1997;73:309–317. doi: 10.1016/S0304-3959(97)00112-7.
  8. Linde K, Streng A, Jürgens S, et al. Acupuncture for patients with migraine: a randomized controlled trial. JAMA. 2005;293(17):2118-2125. doi:10.1001/jama.293.17.2118
  9. Hinman RS, McCrory P, Pirotta M, et al. Acupuncture for chronic knee pain: a randomized clinical trial. JAMA. 2014;312(13):1313-1322. doi:
  10. 1001/jama.2014.12660 10Wu XK, Stener-Victorin E, Kuang HY, et al. Effect of Acupuncture and Clomiphene in Chinese Women With Polycystic Ovary Syndrome: A Randomized Clinical Trial. JAMA. 2017;317(24):2502-2514. doi:10.1001/jama.2017.7217
  11. Selva Olid A, Martínez Zapata MJ, Solà I, Stojanovic Z, Uriona Tuma SM, Bonfill Cosp X. Efficacy and Safety of Needle Acupuncture for Treating Gynecologic and Obstetric Disorders: An Overview. Med Acupunct. 2013;25(6):386-397. doi:10.1089/acu.2013.0976
  12. W. He, M. Wu, X. H. Jing, W. Bai, B. Zhu, and X. Yu, Entity of acupoint: kinetic changes of acupoints in histocytochemistry. Zhongguo Zhen Jiu. 2015;35(11):1181-1186.
  13. Kim, DH., Ryu, Y., Hahm, D.H. et al. Acupuncture points can be identified as cutaneous neurogenic inflammatory spots. Sci Rep. 2017; 7:15214.
  14. Wesselmann U, Lai J. Mechanisms of referred visceral pain: uterine inflammation in the adult virgin rat results in neurogenic plasma extravasation in the skin. Pain. 1997;73:309–317. doi: 10.1016/S0304-3959(97)00112-7.
Previous articleGlandular therapies for pets
Next articleChoosing safe chews
Dr. Cheryl Cross is a veteran of both academic and private practice integrative veterinary medicine. While working as an Anatomic Pathologist investigating marine mammal and wildlife disease, a tremendous response as an acupuncture patient began her journey into training and practicing complementary modalities. Her small animal specialty practice incorporates acupuncture, LASER therapy, medical massage and myofascial work, Chinese and Western botanical medicine, and physical rehabilitation. Her veterinary training background includes IVAS, the Chi Institute, Colorado State, CIVT, and the Canine Rehabilitation Institute. She was the first veterinarian to be trained and certified in Japanese style palpation-based acupuncture through Harvard Medical School’s Acupuncture and Integrative Medicine Program and has studied dry needling and biomedical acupuncture with Dr. Yun-Tao Ma. In 2011, she co-founded the Integrative Medicine Service at the University of Tennessee College of Veterinary Medicine and provided student education and clinical service until 2015. Her specialty practice in Knoxville TN aims to provide down-to-earth and evidence-informed care that honors the roots of traditional medicine.


Please enter your comment!
Please enter your name here