Dao Ma Zhen Fa [倒馬針法], or the Dao Ma Needling Technique, is unique to Master Tung’s acupuncture. This technique involves inserting two to six needles along the same line, which can be vertical, horizontal, or diagonal. The Dao Ma needling technique is first mentioned in Tung’s clinical records of his treatment of Cambodian Prime Minister Marshal Lon Nol (Tung, 1971). In his book (Tung, 1973), Tung refers to the technique by a different name, Hui Ma [回馬]. The technique is described twice in the book: once under point 44.03 Shao Ying:

“44.02 Hou Zhui and 44.03 Shou Ying are needled together in a technique called Hui Ma; then the effect is quick and successful,” and again under points 77.05-07 San Zhong: “77.05-07 Yi Zhong, 77.06 Er Zhong, and 77.07 San Zhong are needled together in a technique called Hui Ma to treat the ailments mentioned in the point indications.”

Hui [回] means “to return” and Ma [馬] means “horse.” Therefore, Hui Ma translates to “returning horse.” Given that many of Master Tung’s points include the character “horse,” and horses are known for their speed, Master Tung may have used this character to allude to the rapid effects of the Dao Ma technique.

Why “returning horse”? In Dao Ma, two to six needles are inserted in the same zone. After inserting the first needle, instead of moving to another zone, one returns to the initial zone to insert additional needles.

Today the technique is commonly termed Dao Ma. Dao [倒] means “to reverse” or “to go back,” making Dao Ma potentially translatable as “fallen horse” or “returning horse.”  This reinforces the idea of returning to the same zone to insert additional needles.

Some argue that “fallen horse” is more accurate than “returning horse” because toppling a horse requires removing a leg. Since the Dao Ma needling technique usually involves three needles, these could symbolize a horse’s three fallen legs.

Needling two to six points at one site expands the treatment area. A single needle treats a small area, two needles cover a larger area, and three needles, an even broader area (see Illustration 5).

Master Tung’s acupuncture points are organized into Dao Ma groups along the same line, each representing a channel. Points within a Dao Ma group share the same innervation, and a group’s innervation indicates its channel. For example, consider the Dao Ma group on the thigh (Illustration 6), comprising six points:

All these points, located along a line passing through the center of the thigh, innervate the heart. Therefore, this line represents the heart channel on the thigh. Additional heart channels exist in other zones, such as Xin Ling (33) on the inner forearm and 33.04-06 Shou San Huo on the outer forearm.

In the acupuncture of the 14 primary channels, the channels pass through the upper and lower limbs in a continuous line, ultimately connecting to the internal organs. Master Tung’s channels vary in length, with channels along the fingers as short as one cun and longer channels reaching nine cun. In Master Tung’s acupuncture, the five channels can be found on both the lower and upper limbs. In fact, the channels can be found in nearly all ten zones [1]. These channels do not make up one continuous line but are divided into short lines made up of Dao Ma groups. Also, they do not connect to the internal organs.

Since Master Tung’s acupuncture channels do not have internal pathways connecting to the internal organs, the Dao Ma groups are actually reflex areas. Reflex areas are areas on the body that correspond to internal organs and related systems. Stimulating the reflex area through pressure, needling, or bloodletting can improve the functioning of the associated organs or body systems. In addition, changes can develop in the reflex areas due to impaired functioning of the associated organs and body systems.

Master Tung believed that in chronic illnesses, the connective tissue loses flexibility and vitality, resulting in Bi Zheng [痹证]. Bi [痹] means blockage, and Bi Zheng refers to rheumatism, which is harm to the connective tissue of the muscles, joints, skin, and other organs. Due to pathologies of the organs and associated systems, rheumatism develops in the Dao Ma groups. Dao Ma groups react to pathologies of the organs. In the English-translated version of Master Tung’s book, Paldan Dechen chose to translate the term “innervation” to “reaction area.” (Dechen, 1973) This term is more appropriate because Dao Ma groups react to changes in the organs and body systems related to them. Rheumatism is one kind of reaction that can occur. I will elaborate on other changes that can take place later on.

In summary, Master Tung’s acupuncture channels are distinct from the acupuncture of the 14 primary channels. The channels are reaction (reflex) areas on the surface of the body that can reflect an imbalance or disease of the inner organs and systems related to them. Needling these areas can help the body return to balance and activate its healing capacities.

One of the most fascinating questions regarding the history of acupuncture is the order of its development – did acupuncture points or channels come first? Until 1972, the prevailing belief was that points were discovered initially, and then channels were mapped out to connect them.

However, findings at the archaeological site of Ma Wang Dui [马王堆] in China led to a shift in this perspective. Excavated in 1972, three Han dynasty tombs (206 BCE – 9 CE) yielded medical and philosophical texts on silk, bamboo, and wood. Among seven medical texts found in the third tomb were three silk scrolls, one describing eleven channels, including their pathways and associated diseases, with no reference to acupuncture points. This is the earliest known reference to channels, resulting in a conceptual shift. Nowadays, scholars contend that the concept of channels preceded that of acupuncture points. These books were written before the transition to using needles, when bloodletting and moxibustion were used on different areas along the channels. Later, after needles were already in use, these areas narrowed to points. In the Dao Ma needling technique, we also treat areas, as done in the past. Therefore, using this needling technique in Master Tung’s acupuncture hints at its ancient roots.

The texts from Ma Wang Dui also include another component that resembles Master Tung’s acupuncture. Like in Master Tung’s acupuncture, the eleven channels have no internal pathways connecting to the organs. The areas on the channels where moxibustion and bloodletting were applied are similar to reflex areas in Master Tung’s acupuncture. As acupuncture developed, pathways were likely added as an attempt to explain how these areas influence the internal organs.

To treat changes in the connective tissue, Master Tung used two techniques: needling and bloodletting. Because rheumatism at the site of the Dao Ma groups can develop in a broad area, Master Tung realized that one needle wasn’t enough. Therefore, he developed the Dao Ma needling technique. He found this technique effective for releasing blockages, influencing all the organs in the body, and increasing De Qi [得氣].

Furthermore, if Luo-Connecting Channels appeared along the route of the Dao Ma group, Master Tung would treat them by bloodletting. Luo channels are dark or red veins appearing at the skin’s surface, sometimes in the form of Spider Angioma. When they appear on the routes of Dao Ma groups, they can be treated through bloodletting (see chapter on bloodletting).

In the Dao Ma Needling Technique, the needles can be arranged in two ways. The first, as mentioned earlier, is needling the points along the same line. The second is the triangular arrangement, where the needles are arranged in the shape of a triangle (see Illustration 7). Two of the needles are placed linearly within the same Dao Ma group. The third needle, called the “lead,” is placed at the peak of the triangle, next to the Dao Ma group. This technique allows for covering a broader area. Therefore, the triangular arrangement is used when the affected area is broad.

First, I will elucidate three Chinese philosophical concepts that describe the nature of the cosmos: Wuji, Taiji, and Liangyi.

Wuji [無極] is a nonpolar state. Wu [無] means “without” or “nothing,” and Ji [極] means “extreme,” or “pole” (geography or physics). Wuji is an intangible, formless state with no beginning, no end, no sound, no color, and no name. Wuji represents emptiness containing balance. It is the primordial energy. The term Wuji comes from Chapter 28 of Lao Zi’s Dao De Jing, which states: “Return to the state of boundlessness [復歸於無極]” (Lin 2008). In the modern sense, this is the origin of the universe before the big bang.

Taiji [太極] is absolute polarity. Ji [極] means “extreme” or “pole” (geography or physics) and Tai [太] means “great” or “absolute.”

Taiji is a polar energetic state containing Yin and Yang energy unseparated from the infinite potential. The term comes from the Book of Changes, which states that Taiji exists in changes.  Zhu Xi [朱熹], a philosopher from the Song dynasty, said that Taiji is the main principle of the universe.

Liangyi [兩儀] represents heaven and earth, Yin and Yang. Liang [兩] means “two” or “a few,” and Yi [儀] means “mechanism” or “phenomenon.”

Liangyi describes a state where Yin and Yang are separated (the opposite of Taiji, where Yin and Yang are unseparated). Liangyi describes separate entities – soft and hard, hot and cold, slow and fast, positive and negative.

Taiji is a state between Wuji and Liangyi, connecting the two. All three describe the creation of the universe. Wuji gives birth to Taiji; Taiji gives birth to Liangyi; Liangyi gives birth to the Four Symbols (Sixiang); the Four symbols give birth to the eight trigrams; the eight trigrams give birth to the 64 hexagrams; the 64 hexagrams give birth to ten thousand things (see Illustration 8).

Wuji, Taiji, and Liangyi influenced the development of Chinese Medicine. There is a saying that goes: “Within the great Taiji, there are countless small Taijis.” In other words, each part of the body can reflect the body as a whole.

This principle can be found in pulse diagnosis, which involves listening to the radial artery, which we divide using three fingers into three parts, each representing one of the three heaters. The cun position closest to the hand reflects the upper heater. Slightly distal to the ulnar styloid process is the guan position, which reflects the middle heater. The third, more proximal, chi position, reflects the lower heater.

According to the Taiji principle, we could have also rested three fingers on the middle of the forearm to reflect the three heaters. However, because the radial artery is deeper and more difficult to feel in the middle of the forearm, the part closer to the hand was chosen, where the radial artery is closer to the surface and easier to feel. The same principle is applied in tongue diagnosis. The tongue is divided into three parts: the upper heater (the tip of the tongue), the middle heater (the middle of the tongue), and the lower heater (the bottom of the tongue).

When we use three needles in the Dao Ma technique, we also treat the three heaters. Therefore, the Dao Ma technique advances free flow among the three heaters and strengthens all the organs. For instance, 88.17-19 Sima, the “four horses,” are three important points for strengthening the lungs. When needling all three points together, we strengthen the lungs while influencing the whole body.

For the most part, the Dao Ma group is organized in groups of three needles, and sometimes we find the words “middle” (Zhong), “upper” (Shang), and “lower” (Xia) in the point names (see Illustration 9). For instance, in the “four horses,” the middle point is called 88.17 Sima Zhong, the upper point is called 88.18 Sima Shang, and the lower point is called 88.19 Sima Xia. The upper point treats the upper part of the lungs, the middle point treats the middle part of the lungs, and the lower point treats the lower part of the lungs. When treating all three together, they treat the lungs as a whole, and simultaneously the three heaters (the whole body). The upper point treats the upper heater, the middle point treats the middle heater, and the lower point treats the lower heater.

The point names can reflect the three heaters in another way: Tian (Heaven) – Di (Earth) – Ren (Human). For instance, in 77.17, 19, 21 Xia San Huang, the “lower three emperors,” the upper point is called 77.17 Tian Huang “Heavenly Emperor,” the middle point is called 77.19 Di Huang “Earth Emperor,” and the lower, 77.21 Ren Huang, “Human Emperor.” Master Tung uses the concept from Chapter 25 of Lao Zi’s Dao De Jing: “Humans follow the laws of Earth, Earth follows the laws of Tao, Tao follows the laws of nature.” (Lin, 2009) The concept of Heaven-Earth-Human can be applied to all the Dao Ma groups using three needles.

The Undefined Point Needling Technique (Buding Xue Zhen Fa [不定穴针法]) is a masterpiece of  Master Tung’s acupuncture, comprising a cornerstone of the method.

Master Tung uses the Undefined Point Needling Technique in one of his treatments for Cambodian Prime Minister Lon Nol, who suffered from hemiplegia and coldness in the leg following a stroke. Master Tung examined the back of his hand and saw a blue vein at the tip of his middle finger. He needled the site of the vein, and immediately afterward, Lon Nol sensed heat from his knee to beneath his foot. The point was unknown until that moment, and afterward, Master Tung named it 11.10 Mu Huo.

This technique exemplifies the flexibility of Master Tung’s approach. Regardless of the severity of the disease, as long as there is disease, there must be healing. Master Tung used to say “Disease is not ingrained in the body. It can be accessed and eliminated. Whoever says disease cannot be healed, has not yet mastered the technique.” (Young, no date)

The Undefined Point Needling Technique utilizes an undefined location, and the points are found by focusing on the external expression of the disease. When Master Tung encountered severe and complicated diseases, he focused for a moment, and when his mind was clear, he sought the undefined acupuncture points, needled or employed bloodletting, and sometimes managed to eliminate the disease (Young, no date).

Chapter 5 of the Basic Questions (Su Wen) states:

“Those who know well how to use the needles… from the exterior they know the interior. By observing the structures of excess and inadequacy, they see the minute and notice the excess. When they apply the [needles], there will be no failure” (Unschuld, Tessenow, 2011).

This chapter elucidates the principle that the exterior reflects the interior; that is, the exterior manifestations can provide insights into the state of the internal organs. I believe this principle is central to Master Tung’s acupuncture and refer to it as the “External Expression of the Disease.” This principle is directly related to the Undefined Point Needling Technique and can be applied to every treatment.

Huo Wen Zhi, one of Master Tung’s students, wrote:

“Non-existing points without a location are superior to existing points with a location [無穴無位勝有穴有位].”

Needling a point solely based on its textbook location is less effective than selecting a point through tactile examination and observation. It is essential to assess the body and identify the External Expression of the Disease. While sometimes the needling site will align with the textbook location, other times it will deviate. In this approach, points are chosen more flexibly: we observe, palpate a Dao Ma group, and pinpoint the External Expression of the Disease. If the disease is localized in a small area, one or two points are sufficient. If the external expression spreads over a broad area, two points at opposite ends and one in the middle are typically used. The chosen points may or may not correspond exactly to the textbook locations.

For example, consider the six heart points of the thigh depicted in Illustration 6. Upon examination, a change in the tissue may be detected between 1 cun proximal to Tong Ling (88) and 1 cun proximal to 88.03 Tong Tian. In such cases, needling this area on both sides and a point in the center is recommended. In this example, the middle point coincides with 88.02 Tong Shan (see Illustration 10). Sometimes the changes are localized in a small area, requiring one or two needles, while other times a broader area necessitates a triangular arrangement (see Illustration 7).

The External Expression of the Disease concept can illuminate the discovery of acupuncture points. When the patient arrived, practitioners sought the External Expression of the Disease. By needling or bloodletting these areas and observing improvements, they documented the findings and applied them to subsequent patients. Consistent positive results led to the cataloging and naming of these areas. Over time, additional treatable indications were identified.

Another phenomenon that may have led to the discovery of the connection between points and other body parts involves electrical sensations or tingling at a different location than that of the needle. I encountered this when treating a patient with facial paralysis. Despite previous acupuncture treatments, there was no improvement. I decided to needle 11.25 Zhi Xian, located on the thumb, which treats drooling in children, due to its influence on the mouth region. After inserting the needle, the patient felt electrical sensations at the corner of his mouth and experienced activity there throughout the treatment. Several days later, when returning for another treatment, it was evident that his condition had improved. Although this phenomenon is not common, I have observed it occasionally.

In Chapter 5 of the Basic Questions, it is stated:

“Those who know well how to diagnose, they inspect the color and press the vessels.” (Unschuld, Tessenow, 2011)

The External Expression of the Disease is identified through observation and touch. Practitioners search for veins, skin stains, and changes in tissue. We seek areas of obstruction known as Bi Zheng [痹证]. To identify the External Expression of the Disease, we employ the following observational and tactile techniques:

Inspecting the skin’s surface and searching for stains, pigmentation, and Luo-Connecting Channels. Luo channels are dark or red veins appearing on the skin, sometimes in the form of Spider Angioma.

Applying pressure to areas to detect sensitivity or changes in connective tissue, which may become less flexible and harden.
Palpating for the presence of nodules.

I use the Vascular Autonomic Signal for diagnosis and identifying active Dao Ma groups. This is my application to Master Tung’s Acupuncture; to my knowledge, Master Tung was not familiar with this phenomenon.

Dr. Paul Nogier, a French doctor who taught neurology at a medical school in Lyon, discovered the Vascular Autonomic Signal (VAS) in 1966. His interest in auriculotherapy began in 1957 after witnessing its effectiveness in treating sciatica. Through extensive research, he published his first book on auriculotherapy in 1966, pioneering the field and contributing to its worldwide popularity. Dr. Nogier passed away in 1996, but his work continues to influence practitioners of complementary medicine.

Dr. Nogier’s key discoveries include:

Dr. Paul Nogier practiced chinese medicine and was skilled in pulse diagnosis. He discovered VAS in 1966 while searching for active points in the ear using a detection device that applies mechanical pressure. By simultaneously taking the patient’s pulse, he noticed a change in pulse in active points; he realized that the pulse intensified for several beats before returning to its original state. This phenomenon, observed in many patients, led him to term it Réflexe Auriculo Cardiaque (RAC), or Auricular-Cardiac Reflex. While the pulse speed does not change, Nogier emphasized the importance of considering qualitative changes in the pulse, not just intensity (Angnes, 2000). For instance, sometimes the pulse can become stringy, Xian [弦]. Over time, he observed this phenomenon in all arteries, leading him to change the name to the “Vascular Autonomic Signal.”

The VAS is the neurovascular system’s physiological response to information conveyed to its energetic field. This response creates a “signal” manually detectable as a pulse change. In essence, it is a Fight or Flight Response of the Autonomic Nervous System[2]. While commonly termed “Vascular Autonomic Signal,” the term “response” is more appropriate. The VAS can be sensed in all arteries, but it is most easily felt in the radial artery, near the wrist. Due to the sensitivity of the thumb and the tip of the tongue, the tip of the thumb is placed on the radial artery without pressing on it to feel the VAS. This skill requires practice to develop sensitivity at the tip of the thumb. The VAS guides the practitioner to the exact site of the active point.

There are a number of ways to stimulate the skin on acupoints to check for activity:

The signal’s intensity varies among active points. Some points exhibit strong responses, while others have weaker ones. These differences in intensity allow for selecting the most active and powerful points.

Dr. Paul Nogier introduced an energetic diagnostic device when its underlying science was not fully understood and its potential was not fully realized. While he primarily used VAS to discover active points in the ear, VAS can also be used to identify active acupoints or Dao Ma groups, which are External Expressions of Disease. As Dr. Nogier once said “Perception of the VAS in auricular medicine permits a broad examination of the subject’s physiology and pathology, and even the mechanisms of the illness and recovery.” (Angnes, 2000)

The External Expression of the Disease and the Undefined Point Needling Technique are intertwined, essentially representing the same phenomenon. In the Undefined Point Needling Technique, there is no distinction between the External Expression of the Disease and the chosen point. The goal is to needle the site where the External Expression of the Disease is evident, where we see the changes.

Generally, there are two approaches to point selection: the “scientist’s way” and the “artist’s way.” The scientist relies on clinical experience, embodied by the point indications collected over generations. The “artist’s way” involves searching for the External Expression of the Disease, without relying on intellectual analysis, but through touch and observation.

When I search for the External Expression of the Disease, I combine both approaches. I cannot solely rely on the artist’s way because I don’t have enough time to scan the whole body. To reduce the body scan, I must use the scientist’s way. I base my search on clinical experience, initially focusing on Dao Ma groups with indications that can treat disease symptoms and mechanisms. Subsequently, I use the artist’s way to scan the appropriate Dao Ma groups for the External Expression of the Disease and identify the specific area within that group to needle.

When internal organs and related physiological systems become imbalanced, physical changes in the Dao Ma groups may not be immediately detectable. Initially, the changes are subtle and detectable through the VAS. Over time, as the organs and related systems fail to regain balance, physical changes in the connective tissue of a Dao Ma group may develop, becoming detectable.

The Chinese recognized Nogier as the father of Auricular Medicine and saw Auriculotherapy as an innovation of Traditional Chinese Medicine. While they widely adopted Auriculotherapy, they did not adopt VAS. It’s important to note that Master Tung did not use VAS to find active points. This is my application. Applying VAS to Master Tung’s acupuncture generally improves accuracy in point selection. While it’s possible to find points based on sight and touch, this has limitations, as physical changes may not always be immediately apparent but develop over time.

The use of VAS taught me another important lesson. When I began searching for active points using VAS, I observed subtle changes on the surface of active points that I previously hadn’t noticed. These changes were always present but I had overlooked them. Using VAS changed my way of observing points.

These surface-level changes are another example of the External Expression of the Disease. Various types of changes can be observed on active points:

In addition to surface-level changes, changes can be felt with pressure into the point’s depression. Often, specifically in Zone 88, I have found that the point’s diameter can grow, and sometimes a cluster of nodules within the point, which feels like small bubbles.

Active points are not situated exactly as defined in the books. Therefore, this renewed observation has allowed me to needle a point at a more precise location and to better apply Huo Wen Zhi’s saying: “Non-existing points without a location are superior to existing points with a location.” I believe that Master Tung was also aware of these subtle changes on the points’ pathways, but I cannot be certain.

[1] The ten zones refer to all the zones except for DT and VT.

[2] The Fight or Flight response is an automatic physical response that occurs when a person or animal feels threatened. This response prepares the body to deal with the threat by releasing hormones such as Adrenaline and Cortisol and activating the Autonomic Nervous System.