The document describes the Active Points Test, a clinical diagnostic tool to evaluate the effectiveness of skin stimulation for treating symptoms. It involves finding the most painful points on the skin corresponding to the location of the symptom. These points are then stimulated manually or with an instrument while asking the patient if it causes any changes to the symptom. Over 260 patient cases demonstrated the test confirmed the temporary therapeutic effects of acupuncture and ear points in 96.15% of cases, showing it is an effective way to identify which points may treat a given symptom before applying therapy. The test was developed in the 1990s and has 4 steps: 1) classifying the symptom, 2) explaining the test, 3) finding painful points, 4) actuating the

1. The Active Points Test
Stefano Marcelli
MD, author, researcher in
Darfo Boario Terme – Galilean Italy
Milan BGY
marcelli@ago.it

2. A friendly “Many Thanks” to all
participants and organizers of all meetings,
conferences and seminars to which for 30
years I was invited to introduce and
disclose The Active Points or the subject of
my most long living clinical diagnostic
instrument and related book.

3. definition

5. The Active Points Test is a clinical
test, both manual and
instrumental, to evaluate the
therapeutic potential of skin
stimulation. It's a quick way to
know if the areas or points of
the skin that we have chosen to
treat a given symptom ARE
REALLY EFFECTIVE or not.
definition

6. The Active Points Test (APT) was conceived
and developed in the 90s [1] and published
in two Italian editions, 1995 [2] and 2010
[3]. In October 2014 the English version
was released by the publisher Singing
Dragon of London [4]. Marco Romoli [5] [6]
adopted the name Needle Contact Test
(NCT) indicating the variant with a light
touch of a needle of acupuncture.
definition

7. 1995

8. 2010

9. 2015

11. In 1986 I began to wonder why therapies so different
from each other could be all effective in combating
pain :
The only element that these therapies have in
common is SKIN, and this because all they cross or
just touch it.
history
Acupuncture, Auricolopuntura, Mesotherapy,
Neural therapy, Infrared Laser/Oxygen Ozone
therapy, infiltration of steroids… All kinds of
massage and manipulation.

12. The only element that these therapies have in
common is SKIN, SKIN, SKIN, SKIN, SKIN…
history

13. At the very beginning of my
studies of acupuncture I had
been particularly impressed to
read, on the most popular
book of Traditional Chinese
Medicine [7], about the point
Tiaokou ST-38 of Stomach
Meridian, the following
statement:
history

14. “Special point for acute shoulder
problems: the needle is inserted in the
direction of Chengshan (BL-57), strong
manipulation is performed and the
patient is requested to move the
shoulder during treatment.”
TIAOKOU ST-38
history

15. history
I applied it in every case of shoulder pain
coming to my medical office, with
inconstant results: from miracle to no
effects at all. I was meditating: “Why?”
LATER I DISCOVERED THAT ONLY THE
SHOULDER PAINS OF PATIENTS
SUFFERING FROM STOMACH/DIGESTION
PROBLEMS WERE CURED BY TIAOKOU
PUNCTURE, AND NOT OTHERS.
The same “strong manipulation” is
suggested also with other points: CV-24
in acute stiff neck, for example. These
manoeuvres recalled me something…
That is…

16. The Control of Pain Gate Theory
of Melzack and Wall [8] [9] that says:
“The pain transmitted to the brain through fine,
slow, unmyelinated A-delta (Aδ), and C fibres, is
inhibited by the transmission of another stimulus,
which could be a needle puncture or an intense
heat, travelling along thicker, faster, myelinated A-
beta (Aβ) fibres (Table 1).”
history

17. Type Diameter Speed Associated Sensory
Receptors
Aβ 6 – 12 μm 33 – 75 m/s
All cutaneous
mechanoreceptors
Aδ 1 – 5 μm 3 – 30 m/s
Free nerve endings for
touch and pressure
Thermoreceptors for
cold
Neospinothalamic tract
nociceptors
C 0.2 – 1.5 μm 0.5 – 2.0 m/s
Paleospinothalamic
tract nociceptors
Thermoreceptors for
warmth
Table 1 Sensory fibers and receptors
history

18. history

19. Furthermore I knew
that the same
statement have
been written in a
simpler form in the
most famous book
of the Father of
Modern Medicine.
history

20. history
In fact the 46th (section 2)
Hippocrates’ Aphorism [10] says:
“OF TWO PAINS OCCURRING
TOGETHER, NOT IN THE SAME
PART OF THE BODY, THE
STRONGER WEAKENS THE
OTHER”

21. [11]
history
[12]

22. Eventually, full as my medical student mind
was, with laboratory tests, skin allergy
tests, psychological tests,
tendon reflex tests…
I said myself:
Why not to test the so said
“active” points PRIOR to
insert the needles?”
history

24. actuation
The Active Points Test is a test like any other test:
If we suppose that a given antibiotic is “active” against the
streptococcus, when someone come to office suffering from
hoarse throat and high fever, we could give him some pills of
amoxicillin, but to be sure that amoxicillin is really “active”
we can directly ask the throat with a simple test for the
streptococcus detection.
is to be applied BEFORE THE THERAPY to give it a
stronger immediate evidence.

25. APT consists in stimulating the skin to an appropriate
degree, after asking the patient to notify any change in
perception of the symptom from which he is suffering.
It can be performed both manually and instrumentally, by
pinching between the thumb and the forefinger the skin
corresponding to the chosen point, or by softly pressing on it by
an acupuncture needle tip (NCT), or a pen tip, or an auricular
palpeur, or a glass stick.
Pinching the skin is possible everywhere, except skull,
ear, palm, sole, where APT is applicable only by means
of instruments.
actuation

27. Principal indications of
the Active Points Test
are continuing and
ongoing pains.
Experienced
practitioners can test
also other symptoms
(Table 2).
indications

28. PAIN
somatic
visceral
spontaneous
induced
kinetic
positional
palpatory
ESTHESIC IRRITATIONS
OTHER THAN PAIN
pruritus / burning / stinging sensation
swelling / paresthesias
noise (e.g. tinnitus, creaking of the joints)
FUNCTIONAL
LIMITATION TO
VARIOUS SYSTEMS
respiratory
nasal obstruction, rhinorrhea, cough,
dysphonia, aphonia, hiccups, dyspnoea
digestive
dysphagia, nausea, vomiting, spasms, feeling
of heaviness or knotting
locomotive
muscle contracture, limitation and blockage
of movement, articular noises, sense of
unsteadiness
urogenital dysuria, tension, heaviness
cardiovascular
alterations in rhythm, palpitation, symptoms
of hypotension and hypertension
Table 2 All continuing and ongoing symptoms testable by APT and NCT
indications

29. The Active Points Test is a
diagnostic tool
that is why it does not
pertain exclusively to one
particular methodology, and
may be used usefully in all
manual and puncture
therapies (Table 3).
indications

30. Shiatsu Acupuncture
Tuina Auricular puncture
Physiotherapy Mesotherapy
Applied Kinesiology Neuraltherapy
Chiropractics and Osteopathy Skull acupuncture
Fascia therapy Hand and foot puncture
Rolfing and Dicke intradermal massage Nose, Face, Abdominal acupuncture
Deep-tissue massage Puncture of oral, lingual, nasal mucosa
Other Massages Other techniques of puncture
Table 3 Manual (on left) and puncture techniques (on right) suitable for the Test
indications

31. 4 step procedure

32. The Active Points Test is to be carried out with a precise
sequence of steps:
1. Classification of the symptom
2. Explanations and instructions to patient
3. Looking for painful points
4. Actuation of the Test
4 step procedure

33. Step 1
Classification of the symptom
Given that we can test only a continuing and
ongoing pain or other symptom, fundamentally
we need to know if it spontaneous (patient
need to do nothing to evoke it) or induced by
movement, position and palpation.
This because if pain or other symptom is of induced-type we
must ask the patient to evoke it, e.g. neck ache by turning the
head, by stretching the arm et cetera, while we are performing
the test.
4 step procedure

34. here point tested by an acupuncture needle
spontaneous pain
appears by doing
nothing
4 step procedure

35. Patient must take the position that produces
the symptom before and during the test
kinetic induced pain
appears here—for example—by
raising or stretching the arm
4 step procedure

36. Manual Test
Patient must take the position that produces
the symptom before and during the test
positional induced pain
appears here—for example—by thighs
abduction
4 step procedure

37. palpatory induced pain
appears here—for example—by palping
once own epigastrium
PC-6 Neiguan
Manual Test
Patient must take the position that produces
the symptom before and during the test 4 step procedure

38. Step 2
Explanations and instructions to patient
It is very important patients understand what exactly is the test!
We will ask, for example: “Dear Mary, now I will give you a quick
test. Your cooperation is very important, as it will let us know in
advance how you will respond to subsequent therapy. Where
does it hurt at this moment?” The patient will answer: “It hurts
here (touching the elbow) when I raise my arm to comb my
hair”. So we will conclude: “Fine, now I’m going to pinch a few
points on your skin and you should tell me when I find a point
which is MORE PAINFUL than the others. Let me know if I cause you
too much pain.”

39. And after found the most painful point we continue…
“Now, while I pinch the point between my fingers (or “I softly
touch the skin by the tip of a needle”), tell me if the pain I’m
causing makes your shoulder pain decrease or disappear. You
should also tell me if it doesn’t change or gets worse. I will try
one point at a time (of the painful points found), and out of all
the points which improve the symptom, you must tell me which is
the most effective.”
4 step procedure

40. Step 3
Looking for the most painful points
Because of the enormous amount of book of
skin points marked as “active” (with very few
evidences), I settled a rational criterion to test
them for the best choice, which should satisfy
any professionals of any therapeutic
methodologies.
4 step procedure

41. Over 1000 classified points,
ordinary (670) and extra (387), of
which at least 50 are
in current use [13].
Approximately 50 energy routes
Regular, Extraordinary Channels,
Luo, Secondary and minor Luo).
At least 10 points endowed
with therapeutic activity
traditionally or “scientifically”
accepted for any affection or
symptom.
4 step procedure

42. 1. LOCAL POINTS – one to two points among the most
painful points detectable on the skin at the symptom site
(e.g. the skin over the elbow in a tennis elbow). GENERALLY
THOSE THAT PATIENTS INDICATE!
2. PARAVERTEBRAL POINTS – the most painful points
detectable on the segmental fields to which the symptom
pertains (e.g. C5-T1 in the tennis elbow).
3. REFLEX POINTS – the most painful corresponding points in
one or more specific reflexology maps (e.g. elbow and
cervical points on ear, skull, nose, hand, foot, oral mucosa).
4. ALL OTHER POINTS – e.g. those scheduled by a TCM
diagnosis, of course the most painful points here too.
4 step procedure

43. The main points to be tested are the most painful ones inside
the chosen area of exploration. They will be identified through
METICULOUSLY PINCHING the skin in accordance with the massage
technique called palper rouler or pincé roulé, which mean
“palpating rolling” and “pinching rolling”, and is performed by
lifting a fold of skin between the thumb, forefinger and middle
finger, first with both hands and then with one. ONCE THE SEARCH IS
OVER, THE SORE POINT TO BE TESTED BETWEEN THUMB AND FOREFINGER OF
ONE HAND MUST BE FOUND
BEWARE: painful point
doesn’t mean active point!
An active points is a point, painful or not, which the Active Points
Test has demonstrated to be able (active) to attenuate or cure the
symptom.

44. “pinch” position of exploring fingers
correct incorrect

45. 4 step procedure

46. 4 step procedure

47. 4 step procedure

48. The most painful point has been found!
Now it can be tested.
Between the fingers pinching the skin
cellulite is evident as a sign of inflammation
4 step procedure

49. Pinching the skin is possible everywhere, except skull, ear, palm,
sole, where APT is applicable only by means of instruments.
We will looking for the most painful points by the classic ear
palpeur, or the tip of ball point pen or by an electrical resistance
detector. The ear zones where we will search the most painful
points will be those corresponding to the local problem and the
relative paravertebral lines (the elbow and the cervical column
C4-T1).

50. Step 4.1
Actuation of the test at BODY POINTS
Note the tissue infiltration (true subcutaneous cellulite) in correspondence of
the point tested manually, on le left, in the same patient.
Manual Test
Instrumental Test (here with a needle)
4 step procedure

51. 4 steps
(with a glass stick)
(with a pen tip)
(with a needle point)

52. 4 step procedure
local point
paravertebral point

53. 4 step procedure

54. Test with the Needle on the point
CV-24 Chengjian in acute stiffneck 4 step procedure

55. Step 4.2
Actuation of the test at EAR POINTS
If the Active Points Test is to be performed with a needle (Needle
Contac t Test), the tip should be perpendicular to the skin when
it makes contact. The patient should be asked to say if the
maneuver induces some changes in his perception of the
symptom. The needle should cause a dimple, resulting from the
balance between the pressure exerted on that point and the
resistance provided by the skin’s elasticity. If the maneuver is
carried out correctly, the patient should experience a light
superficial prick without discomfort. I recommend practitioners
always taking extra care, especially newcomers to this method
and on patients who are afraid of needles and injections.
4 step procedure

56. The most painful point has been found!
Now it can be tested.
4 step procedure

57. Test with the needle contact
4 step procedure

58. Test with the needle causing a dimple
4 step procedure

59. According to the 46th Hippocrates’ Aphorism and
Melzack and Wall’s Gate Control Theory, the
most powerful, most violent, second pain,
effective to weaken the first pain is the NEEDLE
PUNCTURE, as the sensation of it reaches the
brain immediately, flooding the conscience to
ancestral memory of body intrusion, strong
danger of health and even death.

60. Based on the results, the
points which improve the
symptom will be called
POSITIVE (+) and those that
neutralize it will be called
STRONGLY POSITIVE (++).
clinical evidence

61. clinical
evidence

62. Patients with an ongoing, continuous symptom,
through palpation or simple contact without
penetration by the tip of a needle on somatic and/or
ear points, were made aware of their therapeutic
capacity and so pass on an immediate (2 to 5
seconds) improvement (positive points +),
neutralization (strongly positive points +) or
deterioration (negative points -) in the symptom.
260 patients have been studied, 156 of whom were
female F (60%) and 104 male M (40%), with an
average age of about 42 [3][4][5].
clinical evidence

63. Ongoing symptoms at the time of the consultation
were subdivided according to system:
LOCOMOTIVE SYSTEM, 144 cases, 55.38%
DIGESTIVE AND CHEWING SYSTEM, 32 cases, 12.31%
EAR, NOSE, THROAT, RESPIRATORY SYSTEM, 32 cases, 12.31%
CARDIOVASCULAR SYSTEM, 2 cases, 0.77%
NEUROSENSORY SYSTEM, 40 cases, 15.38%
VARIOUS SYSTEMS, 10 cases, 3.85%
clinical evidence

64. Results
The Active Points Test confirmed
its temporary therapeutic activity
(positive + and strongly positive ++) of
classical acupuncture and auricular points
in 250 cases out of 260, equal to 96.15%,
statistically significant.
clinical evidence

65. essential references

66. [1] Marcelli S. Acupuncture Kinesiologic Test (AKT). Giornale Italiano di Riflessoterapia
ed Agopuntura Anno 5-2. Cortina, Torino 1993.
[2] Marcelli S. Il Test dei Punti Attivi. Cortina, Torino 1995.
[3] Marcelli S. Il Test dei Punti Attivi. Hoepli, Milano 2010.
[4] Marcelli S. The Active Points Test, Singing Dragon, London-Philadelphia 2015.
[5] Romoli M. Agopuntura auricolare. UTET, Torino 2003.
[6] Romoli M. Auricular acupuncture diagnosis. Elsevier, London 2009.
[7] Beijing College of Traditional Chinese Medicine. Essentials of Chinese
Acupuncture. Foreign Languages Press, Beijing 1993.
[8] Wall P.D., Melzack R., On nature of cutaneous sensory mechanisms, Brain, 85:331,
1962.
[9] Melzack R., Wall P.D., Pain mechanisms: A new theory. Science, 150:171-9, 1965.
[10] Aphorisms by Hippocrates Translated by Francis Adams, eBooks@Adelaide 2007.
[11] Super Aphorismos Iacobi Fororivensis Et Galeni Super Eismos Commentarios
Venetii Apud Iuntas 1547. Google Book Search and Digitalization of books in the
public domain.
[12] Hippocratis Coi Aphorismi Notationibus Variorum Illustrati. Vol. I. Jo. Chr. Rieger.
Hagae Comitum Apud Petrum Van Cleef 1607. Google Book Search and Digitalization
of books in the public domain.
[13] Low R. The non-meridial points of acupuncture. A guide to their location and
therapeutic use. Thorson Publishing Group, Wellingborough 1988.
essential reference