Ashi points

An ashi point (阿是穴) is a site that is needled or heated because it is tender when pressed, wherever on the body that turns out to be. The WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region of 2007 defines it in term 5.1.68, under the English name ouch point, and gives tianying xue (天應穴) as a second Chinese name. By that definition an ashi point has none of the things a catalogue keys on: no name, no fixed place and no code. This page reports where the idea comes from in the classical texts, how it differs from channel and extra points, how trials write it down, what AcuiQ does with it, and the argument over whether ashi points and myofascial trigger points are the same thing.

Where the idea comes from

Chapter 13 of the Lingshu, Jingjin, on the twelve channel sinews, ends the treatment of each sinew with the same instruction: 治在燔鍼劫刺，以知為數，以痛為輸, treat with the heated needle inserted swiftly, needle as many times as it takes to have an effect, and take the painful place as the point. The last clause, yi tong wei shu (以痛為輸), appears in the entry for every one of the twelve sinews. The chapter gives the clause no name and lists no points for any sinew. Channel sinews and divergent channels sets out what the chapter says about the sinews themselves.

The name comes from the Beiji qianjin yaofang (備急千金要方), compiled by the Tang physician Sun Simiao. Its volume 29, the first of two on acupuncture and moxibustion, has a section of examples for moxibustion (灸例第六) which says that moxibustion is widely practised in Wu and Shu and that there is an ashi method there: when a person has pain, the practitioner presses on it, and where the pressure finds the place, without regard to the named points (不問孔穴), the patient feels relief or pain and the place is called a shi. Both moxibustion and needling there are effective, the text says, and so it is called the ashi point.

What the two characters a shi (阿是) meant is not agreed. Jiang and Zhao, in 2016, find three current readings of the word and trace the disagreement to which old texts each reading rests on and how it interprets them. Zhang, in 2013, argues that the ashi method is at bottom a way of locating any point by palpation, older than the name and found throughout the Neijing, and that after the Qianjin yaofang it hardened into a class of point set beside the channel points and the extra points. Channel and extra points came to be located by proportional measurement and ashi points by palpation, a split that Zhang reads as a departure from the classics. Mou and colleagues, in 2025, read the method as a simple folk technique for finding where to relieve pain, used where trained practitioners and supplies were scarce, and write that modern practitioners should use ashi points together with channel and extra points.

How an ashi point differs from a channel point or an extra point

The WHO terminology keeps the classes of point in separate entries. The table gives each entry's definition; a channel point and an extra point both have a name and a location, and an ashi point has neither.

The same terminology lists tender point needling (壓痛点刺鍼, 5.1.227), acupuncture in which tender points are needled for therapeutic purposes, as a technique separate from trigger point needling (5.1.226). Extra points explains how the WHO chose its 48 named extra points, each of which has a code; an ashi point can sit on or beside a channel point or an extra point and still be recorded as ashi, because it is chosen by tenderness rather than by its name.

Not every author accepts the WHO's pairing of the two Chinese names. Zhao, in 2010, separates taking the tender spot as the point, where the affected site is needled or heated directly, from the ashi point, which Zhao reads as a reactive site found in a region; on that reading the tianying point of the classical texts belongs with the first idea and not the second.

How trials record them

A trial that needles ashi points cannot give a code for them. The 2010 revision of the STRICTA reporting standard for acupuncture trials asks, in item 2b, for the names of the points used or their location if they have no standard name, and quotes as an example a trial in which the points were chosen at each session by the patient's pain and by palpation of the neck and thorax for ah-shi points, or local tender points. Papers spell the term ashi, a shi, ah shi and ah-shi.

Some trials name ashi needling as the treatment under test:

• Son, Yun and Choi, in 2010, describe ah shi point acupuncture as needling at painful or pathological sites, and randomised 36 people with acne to general acupuncture points alone or to general points plus ah shi points, 12 sessions over 6 weeks. Both groups improved from baseline, with no significant difference between them.
• Mitidieri and colleagues, in 2020, randomised 35 women with chronic pelvic pain from abdominal myofascial pain syndrome to ashi acupuncture (16) or local anaesthetic injection (19). Pain fell in both groups and did not differ between them. The authors list as limitations the lack of blinding, the absence of a placebo group and different numbers of sessions in the two arms.
• Wang and colleagues, in 2016, reviewed nine trials of ashi point stimulation for shoulder pain. Seven compared it with conventional acupuncture and pooled to an odds ratio of 5.89 for response in favour of ashi points; the authors write that the low methodological quality of the trials prevents a firm conclusion.

How AcuiQ records them

AcuiQ's catalogue gives codes to named points only, so it has no entry for an ashi point. When a paper lists ashi points beside named ones, the extraction keeps the named points and drops the ashi entry, and the protocol reaches the index with its named points only. A few protocols in the index, all from one online list of point prescriptions, still carry the word ashi in the prescription as first recorded: the one for shoulder sprain reads ashi, GB21 (Jianjing) and LI15 (Jianyu), and links only GB21 and LI15. A protocol that relied on tender sites can therefore look, on AcuiQ, like a smaller treatment at named points than the one its source describes. Reading a protocol explains what each field of a protocol records.

Are ashi points the same as trigger points?

The question has been argued since 1977 and the answers range from about one in five to nearly all. Melzack, Stillwell and Fox compared myofascial trigger points with acupuncture points for pain by location and by pain pattern, found a 71% correspondence, and concluded that the two represent the same phenomenon. Birch, in 2003, checked the acupuncture side against texts published since 1977. Birch found that 61% of the acupuncture points in the 1977 comparison are not recommended for pain at all, put the likely correspondence at about 18 to 19%, and argued that the comparison was conceptually impossible because trigger points could only correspond to ashi points, not to channel or extra points.

Dorsher, in 2008, reviewed acupuncture references against Birch's claims and concluded that trigger points and classical points can be compared in treating pain and that their clinical correspondence is likely 95% or higher. Birch answered in the same issue with a commentary on the impossibility of equivalence, and Dorsher replied with a rebuttal later that year. In a 2009 qualitative study, Dorsher grouped trigger point regions by the channel of the acupuncture point each lies on and reported that, for all twelve channels, the summed referred-pain patterns from the Trigger Point Manual matched the course of the channel, particularly in the limbs.

Two later reviews compare the three ideas directly. Lee, Lee and Chae, in 2022, found that trigger points correspond mostly to ashi points among the classes of acupuncture point, and concluded that for muscular pain the two are indistinguishable. Chen and colleagues, in 2017, separate them by anatomy instead: they place the ashi point on the boundary between muscles, the tender point where a muscle attaches to bone and the trigger point at the motor point of a muscle. Dry needling reports the trials of needling trigger points, the dispute over the trigger point model itself and the scope-of-practice disputes that turn on the overlap with acupuncture.

What the sources leave unsettled

The definition itself is not fixed: Jiang and Zhao, in 2017, collected the definitions in textbooks, dictionaries and term standards and found no agreed one. The sources disagree on whether ashi is a class of point, as the WHO entry treats it, or a method of locating any point by touch, as Zhang reads it, and on whether the tianying point is the same idea. The trigger point figures run from 18% to 95% because each study counts a different thing as a match, and none of the four papers examined patients. The trials above are small or of low quality, and none of them compares ashi needling with a sham, so none can separate the choice of a tender site from the effects of being needled at all. In the index, a protocol built on tender sites shows only its named points, and the trial reports themselves do not always say where the tender sites were.