The Active Points Test

The Active Points Test is a clinical instrument for identifying and selecting the points on the skin that are most effective for treatment. These points may be close to the seat of the disease, for example on the shoulder for periarthritis, or far away, for example on the ear or head for stomach pain or a cough.

Drawing on principles from TCM and Western medicine, Dr Stefano Marcelli sets out the theory of the approach and offers detailed guidance on how to carry out the test and how to interpret the results, as well as explaining how the test can be used in different therapies. The test is based on the discovery that a patient experiencing an ongoing symptom can be made aware of the capacity of a few points on the skin to treat his or her discomfort. The test involves stimulating the skin to the appropriate degree whilst asking the patient to identify whether there is any change in the symptom he or she is suffering, and can be used to treat a wide range of symptoms, from articular pain to migraine, tachycardia, asthenia and depression. Published for the first time in 1995, this substantially updated edition contains the most recent supporting evidence and many new explanatory diagrams and photographs.

Providing a comprehensive and effective system for point selection, this is essential reading for practitioners and students of acupuncture and related reflex and manual therapies, including massage, tuina, Shiatsu and Rolfing.

'The Active Points Test is the result of long experience. It is an original work in which the author shares with us his analytical deductions on the semiological values of clinical functional concordance in acupuncture. We discover that “active points”, either in traditional or auricular acupuncture and in reflex therapies generally, are precisely correlated to the intensity modulation of the symptoms of the pathology to be treated, especially in pain, while the point is being explored… Using a clear, didactic style, appropriate quotes, and very effective iconography, he has given us a treasure in terms of clinical data which will be invaluable for the experienced practitioner and the student at his first practice.'
- from the foreword by David Alimi, Adjunct Professor, Faculty of Medicine, Bobigny, Paris

As a practitioner working with a number of Japanese acupuncture systems, I was interested to read Dr Stefano Marcelli's book -The Active Points Test – in which the author describes a clinical test for identifying and selecting effective points not only for acupuncture but also for related therapies including tuina massage, reflexology and more invasive interventions such as mesotherapy that involve injecting substances including anaesthetics into acupuncture points. Coming from Italy, where acupuncturists have to be medical doctors, Marcelli integrates both a Western and an East Asian medical approach. Alongside acupuncture, he also practises mesotherapy and neural therapy. The system he has devised involves stimulating points either by using a 'pince roule' rolling technique (similar to the niefa-pinching tuina technique), a glass stick or empty ball point pen (not too sure why he does not just use a probe) or shallow needling, to evaluate if such stimulation brings about an immediate change to the presenting symptom. This involves active participation from the patient and a subjective evaluation regarding change to the symptom – either very positive (++), positive (+), neutral (0) or negative (-). Marcelli emphasises the value of involving the patient and describes how to do this. The overall aim is to ensure that effective points are chosen for treatment, rather than choice being based purely on theoretical considerations. This aims to avoid needling of points that may not be therapeutically effective and to thus keep points to a minimum. However, the subsequent treatment involves using five needles to surround the point, which is far from minimalist. Marcello contextualises his approach with reference to other systems such as kinesiology and Akabane testing that work in similar ways. His observations extend to analysing why certain points are more effective than others, with aetiological suggestions regarding the verification of point energetics, such as Tiaokou ST-38 being effective in patients who not only have shoulder problems but also digestive disturbances.

Marcelli also suggests that current symptoms may be an expression of a past illness, that may have been treated with medication which then creates pathology elsewhere at a later date due to the suppression of certain pathogens. Interestingly, he also discusses the possible effect of scars and the disturbance they cause to the energy system and channels, an area of treatment common in many styles of acupuncture. Conversely, he proposes that excess in a channel can result in injury and that this can be as a result of lifestyle factors, for example eating too much meat predisposing one to injuries to the Large Intestine channel.

Alongside explanations that use theories of Chinese medicine, Marcelli also incorporates Melzack and Wall's 'gate control theory' of pain, whereby creating a pain that is greater than the existing pain overrides the original pain. One chapter describes the neurophysiological interpretation of the Active Points Test by way of explanation of how the technique works. Alongside this Marcelli also gives a qi-based interpretation, suggesting that the effectiveness of the points tested is dependent on whether the channel is excess or deficient.

One criticism I have is that Marcelli seems to imply that his approach is unique, yet finding active, 'alive' points is an integral aspect of most Japanese acupuncture systems, in which points are chosen that bring about instantaneous changes. Toyohari uses very light touch to locate the 'alive' point that brings about a positive pulse change. Dr Manaka's system involves finding pressure pain reactions on points that soften reactive abdominal areas after very superficial needling, and in Kiiko Matsumoto-style acupuncture, 'gummy' reactive points that bring relief to pressure pain reactions in other parts of the body are located. This approach of stimulating points prior to treatment to test their effectiveness is not dissimilar, for example, to the technique I employ for locating effective auricular points as part as part of Dr Manaka's isophasal treatment strategy, whereby points are palpated and stimulated to see if they bring about a positive change to the symptoms.

The criteria for applying Marcelli's system are where symptoms are clearly perceptible, i.e. ongoing and continuous, or the symptom may be spontaneous, induced either through movement, in a particular position or through palpation. Interestingly he describes this application not only for musculoskeletal problems but also conditions affecting the zangfu and sense organs.

The subsequent choice of points is based on local reactive points, related paravertebral points and distal acupuncture points, chosen according to the practitioner's preferred system of acupuncture. This allows for this approach to be applied more universally and is not prescriptive in nature. Marcelli describes in detail all the different functional groups of points in order of priority for testing, starting with the Extraordinary vessels. It would of course be impractical to work through all these categories, so the reader would be best placed to apply this method to their own styles of acupuncture if palpation is not already part of diagnosis and treatment. The author also lists an extensive list of conditions and gives suggestions for local and distal points to be tested.

Since the first edition of this book in 1994, Marcelli has been using quantitative evaluation based on the levels of change identified by patients. He gives a breakdown of the treatment of 260 patients for a wide variety of conditions, using classical acupuncture and auricular points, with a very high positive outcome. However, as with many books that are more practical than theoretical, application is dependent on the practitioner developing confidence in their palpatory skills. Such a text would serve best as a resource for those who have been trained in this system of palpation. Practitioners of tuina (familiar with the rolling technique which Marcelli calls 'pince roule') or other forms of massage and acupuncturists already trained to palpate will be better placed to apply these techniques. For practitioners who are less familiar with a hands-on approach to practice, the Active Points Test is an interesting introduction to using palpation to evaluate the potential effectiveness of points prior to needling. However, based on my own knowledge and practice of Japanese acupuncture systems that rely heavily on palpation, these skills take time to develop and are best learnt through demonstration and practice.

Marcelli's style of writing is both didactic and at the same time quite informal -almost conversational. There is a whole chapter of peer review opinions from esteemed colleagues -mainly from Italy -who have tried and tested this approach.

Although there are similarities with Shudo Denmai's Finding Effective Acupuncture Points, which gives detailed descriptions of how to palpate and needle specific empirical points for specific conditions, The Active Points Test proposes a more comprehensive approach to treatment, with the aim of utilising only those points that elicit a verifiable clinically effective change that is evident to both patient and practitioner. Any approach that encourages the practitioner to evaluate the effectiveness of their treatment and uses a dynamic approach in which the patient is actively involved in their treatment is worth examining further.

Marian Fixler