Inter-Text Comparison of Quality of Operational Definitions of Acupoint Locations, Reliability and Validity of Point Functions and Clinical Indications in Classical and Modern Texts

Background: Acupoint location texts present sources of inconsistencies for point location, function and indications. Aims This study explored inter-text variability among a set of currently available English language point location texts and two Chinese classical sources with respect to acupoint locations and Chinese Medicine (CM) clinical indications for each of the 20 acupoints on the Large Intestine (LI) channel. Methods: Three reference texts used as benchmarks for comparing eight contemporary acupoint location texts included a Song Dynasty edition (circa 1070) of the earliest extant text, the Zhen jiu jia yi jing; the Zhen jiu da cheng (1994 edition) and the 2008 WHO Standard of Acupuncture Point Locations in the Western Pacific Region. Inter-text comparisons included quality of operational definitions of locations, variation in individual acupoint locations; and CM clinical indications for each acupoint using the Zhen jiu jia yi jing diagnostic patterns. Results: Since 94% of all location definitions were complete, generally texts gave reliable descriptions for locating an intended site. However for 14 acupoints, texts defined different locations, including minimal (LI4) or no agreement (LI14). Consensus was limited to six acupoints on the hand and neck. Interestingly, inter-text CM indications for individual points were unaffected by inconsistencies in location. Discussion: There were no common attributes across all 20 acupoints. The most frequent indications involved ear, nose and throat (ENT) conditions (14 acupoints). Importantly, there were definite patterns of change along the sequence from fingers to face. Points on the hand, wrist and elbow regions had the most numerous and varied CM indications; they concerned distal and generalised signs and symptoms and had close relationships between three diagnostic categories: febrile, ENT, and mania and epilepsy. Mid-channel points had limited indications generally related to arm and shoulder pain or weakness. For the final four points indications concerned local signs and symptoms