BackgroundAcupuncture textbooks, schools, practitioners and clinical researchers designing randomized controlled trials on acupuncture all assume that acupuncture points are small and must be located precisely.MethodSeventy‐one medical doctors with ≥200 h acupuncture training and ≥2 years of clinical experience independently identified 23 commonly used acupuncture points on a male volunteer, using sticky transparent films with an X/Y grid placed asymmetrically around acupuncture points.ResultsFor each acupuncture point, the field covering 95% (68%) of all point locations varied from 2.7 (0.7) cm2 for PC‐6 up to 41.4 (10.2) cm2 for ST‐38. Commonly‐used acupuncture points showed unexpectedly large variance in location: 95% (or 68%) areas were SP‐6: 12.2 cm2 (3.0 cm2), ST‐36: 20.7 cm2 (5.1 cm2), LI‐15: 18.7 cm2 (4.6 cm2), BL‐23: 22.4 cm2 (5.6 cm2) and BL‐54: 22.5 cm2 (5.6 cm2). Points close to anatomical landmarks (forearm, ankle, poplitea; BL‐60, BL‐40, TW‐5, PC‐6) were located with less variance. Precision of point location was independent of length of acupuncture experience, kind of training or medical specialty.ConclusionsIn respect to the high degree of variation in the localization of acupuncture points, we suggest that the term ‘acupuncture field’ is more appropriate than ‘acupuncture points’ to describe the clinical reality; for the design of sham‐controlled acupuncture trials, we recommend a minimum distance of 6 cm between verum and sham points on face, hands and feet, and up to 12 cm for all other parts of the body.

A growing number of clinical trials are testing Chinese acupuncture in the management of headache disorders. Little is known, however, about the relationship between International Headache Society diagnostic criteria and traditional Chinese medicine (TCM) diagnosis in primary headache disorders. We conducted a secondary analysis of the data of the prospective, controlled, blinded German acupuncture trials for migraine and tension-type headache. Data were collected from 1042 headache patients, of whom 633 were diagnosed with migraine and 409 with tension-type headache. We found that the diagnoses of migraine and tension-type headache were mirrored by different patterns of TCM diagnoses, with the patterns Liver Yang Rising, Liver Fire Rising, and Phlegm appearing to be best suited to differentiating between migraine and tension-type headache. Although not unexpected, given that the diagnosis of primary headache disorders in both diagnostic systems is based largely on the nature and quality of patient-reported symptoms, this finding suggests that migraine and tension-type headache are associated with different patterns of TCM diagnosis.

Oxytocin, a polypeptide containing nine amino acids, is produced in the paraventricular and the supraoptical nuclei of the hypothalamus. Oxytocin is secreted into the circulation to produce hormonal effects such as stimulation of milk ejection and uterine contractions. In addition, oxytocin is released from oxytocin containing nerve fibres that reach various areas in the brain, such as other parts of the hypothalamus, the amygdala, the raphe nuclei, the PAG, the striatum and the brainstem centres for control of autonomic function. Thus oxytocin may influence endocrine functions, but also exert anxiolytic and sedative effects, elevate pain threshold, decrease sympathetic nerve activity and increase vagal parasympathetic nerve activity. Taken together oxytocin induces a psycho-physiological pattern consistent with increased social behaviour, anti-stress and promotion of growth. These effects become particularly prominent if oxytocin is given repeatedly. Five daily injections of oxytocin elevate pain threshold for 10 days after the last injection and blood pressure may be reduced for up to three weeks in female rats. When the anti-stress is established it can be maintained by treatment given at longer intervals.The long-term effects of oxytocin and some of the acute effects are mediated by secondary changes in the activity in other transmitter systems. The pain relieving effects involve an increased activity in central opioid systems e.g. in the PAG, whereas the anti-stress effects are mediated by an enhanced activity in the α2 adrenoceptors in various brain areas reached by oxytocin containing nerves. Since these receptors exert an inhibitory effect on noradrenaline (NA) release, the activity in the central NA bundles emanating from the locus coeruleus, which is linked to arousal and aggression, is decreased. At the same time activation of EPI neurons in the brainstem lead to an inhibition of the peripheral sympathetic system, and an increase in the activity of the parasympathetic system, and as a consequence anti-stress and growth promotion is induced.Originally it was assumed that oxytocin was only released during labour and breastfeeding in response to activation of sensory nerves in the mammary gland and uterus. However, it has recently been established that oxytocin can be released in response to touch, warmth and light pressure from all parts of the body. Obviously stimulation of non-noxious somatosensory afferents does not only result in 'a localised sensation of touch', it also results in physical relaxation and a sense of well-being. In a rat model, in which the abdomen is being stroked with a frequency of 40 strokes per minute for 5 minutes, all the effects that can be induced by oxytocin (increased friendly social interaction and the anti-stress effects) are induced. Administration of an oxytocin antagonist inhibits the effects of the massage-like stroking acutely, but also the long-term effects seen after repeated treatments. Interestingly, the massagelike stroking induces more powerful effects if appl...