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Course: Doc: Point Locations II Study Notes – Point Info - Final Date: 3/26/08 Heart Channel of the Hand Shaoyin Pt HT 1 Category HT 2 Loc Depression at center of axilla. Needling Perpendicular 0.5 – 1 cun To locate: Method 1 Find deepest point of armpit (hollow of axilla) Method 2 (more accurate) Find anterior and posterior ends of the axillary fold. Use a measure to get the distance between the 2 and divide it in half. Caution: 1. Avoid the axillary artery. 2. Pnthx with deep medial insert. 3 cun proximal to the medial end of the transverse cubital crease, in the groove between the medial side of the biceps brachii and the humeral shaft. Perpendicular 0.5 – 1 cun To locate: Locate with elbow flexed Find the medial end of the transverse cubital crease. Measure proximally 3 cun using hand measure (or measuring tool, dividing axillary crease end to med cub crease end into 3rds). Locate the point at this line in the groove between the humeral shaft and the medial border of the biceps brachii. Great point for blurry vision due to the cnx between heart and eyes. Note: LU 3-4 and LI 13 are on the lateral border of the biceps brachii. Also, this is generally in line between HT 3 and HT 1, but more important to locate the point in the groove between humerus and biceps. HT 3 He Sea point Medial end of the transverse cubital crease when the elbow is fully flexed. To locate: Elbow slightly flexed: Page 1 of 21 Perpendicular 0.5 – 1 cun Pt HT 4 Category Jing River point Loc Midway between end of cubital crease and the bump of the humeral epicondyle. Elbow fully flexed: Medial edge of the transverse cubital crease. Radial side of the flexor carpi ulnaris, 1.5 cun proximal to HT 7. Needling Perpendicular 0.3 – 0.5 cun To locate, first find HT 7, measure proximally 1.5 cun. Note: Ht 4-7 are all located inline. 1.5 cun total between Ht 4 and Ht 7. HT 5 Luo Connecting point Radial side of the flexor carpi ulnaris, 1 cun proximal to HT 7. Perpendicular 0.3 – 0.5 cun To locate, find HT 7 first, measure proximally by 1 cun. Note: Ht 4-7 are all located inline. 1.5 cun total between Ht 4 and Ht 7. HT 6 Xi Cleft point Radial side of the flexor carpi ulnaris, 0.5 cun proximal to HT 7. Perpendicular 0.3 – 0.5 cun To locate, find HT 7 first, measure proximally by 0.5 cun. Note: Ht 4-7 are all located inline. 1.5 cun total between Ht 4 and Ht 7. HT 7 HT 8 Shu-Stream and Yuan-Source point At the wrist joint on the transverse crease that runs through the pisiform bone. On the radial side of the flexor carpi ulnaris in the depression at the proximal border of the pisiform bone. Perpendicular 0.3 – 0.5 cun Ying Spring point Between the 4th and 5th metacarpal bones where the tip of the pinkie rests when you make a fist. Perpendicular 0.3 – 0.5 cun Usually located between the two transverse palmar creases. Page 2 of 21 Caution: Ulnar nerve and artery lie adjacent to this point. Pt HT 9 Category Jing-Well point Loc Dorsal aspect of pinkie on the radial corner of the fingernail. Needling Perpendicular 0.1 – 0.2 cun Small Intestine Channel of the Hand Taiyang Pt SI 1 Category Jing-Well point Loc Ulnar corner of pinkie fingernail, opposite side from HT 9. Needling Perpendicular 0.1 – 0.2 cun SI 2 Ying-Spring point Ulnar border (where skin changes Perpendicular 0.2 – 0.3 cun color/txture) of little finger in a depression just distal to the metacarpo-phalangeal joint. Make a loose fist and palpate for the depression – it’s usually right at the end of the crease. (You locate LI 2 this same basic way.) SI 3 SI 4 Perpendicular 0.3 – 0.8 cun Shu-Stream point Confluent pt of Du vessel Ulnar border of hand where skin changes color in a big depression proximal to the head of the 5th metacarpal bone. Du = Governing Make a loose fist and it’s easier to find. Yuan-Source point Ulnar border of the hand where the skin Perpendicular 0.3 – 0.5 cun. changes colors in a depression between the base of the 5th metacarpal bone and the triquetral bone. Needle it with hand in a loose fist also. Just distal to triquetral bone. SI 5 Jing-River point On the transverse crease of the wrist in the Perpendicular 0.3 – 0.5 cun depression between the head of the ulna and the triquetral bone. SI 6 Xi Cleft point Dorsal aspect of the head of the ulna in a cleft level with and to the radial side of the high point of the styloid process of the ulna. To locate: 1) lie hand flat on table. 2) Place point of finger on the styloid high point of the ulna. Page 3 of 21 Perpendicular 0.5 – 0.8 cun KNOW: Indicated for— 1) eye degeneration due to aging. 2) Headaches 3) Acute lower back pain 4) Shoulder joint pain Pt SI 7 Category Luo-connecting point Loc 3) Have patient rotate the wrist toward their own body and the finger will fall into a depression. 4) Be sure to locate the point on the distal side of this depression, not the proximal side. Inline with SI-5 and SI-8, 5 cun proximal to SI-5. Needling such as bursitis or tendonitis. Perpendicular 0.5 – 1 cun (5 to 5…just like LI 7 is 5 to 7. Both are 5 cun proximal to transverse crease of wrist.) SI 8 He-Sea point SI 9 SI 10 Meeting of SI and BL with Yin Linking and Yang Motility SI 11 SI 12 Meeting of SI, LI, SJ, GB Funny bone point… In depression between the tip of the olecranon process of the ulna and the tip of the medial epicondyle of the humerus. Perpendicular 0.3 – 0.5 cun 1 cun superior to the posterior tip of the axillary crease when the shoulders are dropped and the arms are at the sides normally. Perpendicular 1-1.5cun Depression directly below the acromion on the lateral side of the scapular spine. This point should be directly above the posterior tip of the axillary crease. Perpendicular 1-1.5cun In a depression on the infrascapular angle line. To find this point: 1. Locate the mid point of the lower border of the scapular spine 2. Locate the posterior border of the scapula. 3. Draw a line between these two points and divide into thirds. SI 11 is located at the meeting point of the upper 1/3 and the lower 1/3. Perpendicular or oblique toward manifestation .5-1.5 cun In the suprascapular fossa at the mid point of the upper border of the scapular spine. Locate the point just above the bone. Perpendicular 0.5-1cun Page 4 of 21 Caution: Ulnar nerve lies deep to the point. “Zap” isn’t Qi here! It’s the ulnar nerve! Pull out a bit, change direction and no damage if you do this quickly. Caution: pnthx Pt SI 13 Category SI 14 SI 15 Loc Depression at the medial end of and superior to the scapular spine. To locate, find the medial border of the scapula. Should be about midway between SI 10 and the spinous process of T2. Needling Perpendicular or oblique toward the scapula 0.5-0.8 cun 3 cun lateral to the lower border of the spinous process of T1 (Du 13) on or near the medial border of the scapula. Oblique scapula 0.5-1 cun 2 cun lateral to Du 14 (lower border of C7 spin process Oblique scapula 0.5-1 cun Caution: Risk of pneumothorax if point is angled to medially. Caution: pnthx Caution: pnthx SI 16 Window of Sky On lateral aspect of neck level with laryngeal prominence. Locate the point on this level on posterior border of SCM. (in horizontal line with ST 9 on anterior border and LI 18 between the two heads of the SCM) Perp 0.3-0.8 cun SI 17 Window of Sky In a depression between the angle of the jaw and the anterior border of the SCM. Point is level with the angle of the jaw/mandible Perp 0.3-0.8 SI 18 Meeting of SI and SJ Directly below the outer canthus of the eye and on the inferior border of the zygomatic bone. Perp 0.3-0.5 cun SI 19 Contra: moxa Meeting of SI, SJ, Just anterior to the tragus of the ear (or the Perp 0.5-1cun GB lower tragus if the pt has 2 of them) and posterior to the condyloid process of the mandible/jaw. Note: with the mouth open there’s a depression. Locate and needle with the mouth open, then pt can close jaw. Page 5 of 21 Bladder Channel of the Foot Taiyang Pt Bl 1 Bl 2 Category Mtg of all Yang but LI with Du, Yin Qiao, Yang Qiao Loc Depression just above inner canthus Needling All “eyeball” acupuncture precautions. Directly above inner canthus at Pinch, transverse insertion supraorbital notch. Usually at medial end either 1) laterally or 2) toward of eyebrow (watch out for unibrow types!) Yuyao extrapoint. 0.3 – 1 cun -or – Prick to bleed Bl 3 Directly superior to BL 2/inner canthus, ½ cun into the anterior hairline and level with Du-24 Upward toward vertex or downward toward eye, depending on whether the patient is prone or supine. Transverse ½ - 1 cun into 4th layer. Contra to moxa Bl 4 ½ cun into anterior hairline and level with BL 3, following hairline. 1½ cum lateral to Du 24/midline. Transverse (15-30°), 0.3 – ½ cun Can also be measured laterally as 1/3 of the distance between ST 8 and DU 24. Bl 5 1 cun into anterior hairline, inline between Transverse (15-30°), 0.3 – ½ BL 4 and BL 8. 1½ cun lateral to midline. cun Contra to moxa Bl 6 2.5 cun into anterior hairline, inline between BL 4 and BL 8. 1½ cun lateral to midline. Transverse (15-30°), 0.3 – ½ cun Contra to moxa Bl 7 4 cun into anterior hairline, inline with BL 4 and BL 8. 1 ½ cun lateral to midline. Transverse (15-30°), 0.3 – ½ cun Use Du 20 as a reference at 5 cun into hairline and on the midline. Contra to moxa Page 6 of 21 Pt Bl 8 Category Loc 5.5 cun into anterior hairline on same line as BL 4 – BL 47 Needling Transverse (15-30°), 0.3 – ½ cun Use Du 20 at 5 cun into hairline and on midline as a reference. Bl 9 1.3 cun lateral to DU 17 (which is located in the dperession just superior to the occipital protuberance on the midline) in a depression. Transverse (15-30°), 0.3 – ½ cun To locate: 1. Slide finger up back of neck at midline. 2. Feel base of skull and go up to “shelf” 3. Just over the shelf is a depression and Du 17 4. Go lateral to Du 17 by 1.3 cun and feel for the depression for BL 9 In vertical line with BL 10 also. Bl 10 Window of Sky At insertioin of trapezius muscle on the back of the neck ½ cun superior to the back hairline. It’s about 2 cun down from BL 9 and at the same lateral level, about 1.3 cun from midline. Perp, ½ - 0.8 cun. 1st (1.5 cun lat) and 2nd (3 cun lat to mid) Bladder lines begin here. All are level with the tip of the lower border of the spinous processes, also level with the Du points. Bl 11 Hui Meeting point of Bone Level with T1, 1½ cun lateral to midline. Trans/obl spine, ½ - 1 cun. Caution: pnthx Bl 12/41 (wind gate, but not really a category) BL 12: Level with T2, 1½ cun lateral to midline. Bl 12: Trans/obl spine, ½ 1 cun. BL 41: Level with T2, 3 cun lateral to midline Bl 41: Trans/obl scapula, 0.3 – ½ cun Caution: pnthx Page 7 of 21 Pt Bl 13/42 Category Back Shu of Lung Loc BL 13: Level with T3, 1½ cun lateral to midline. Needling BL 13: Trans/obl spine, ½ to 1 ½ cun BL 42: Level with T3, 3 cun lateral to midline BL 42: Trans obl scapula, 0.3 – ½ cun Caution: pnthx Bl 14/43 Back Shu of Pericardium BL 14: Level with T4, 1½ cun lateral to midline. BL 14: Trans/obl spine, ½ to 1½ cun BL 43: Level with T4, 3 cun lateral to midline. BL 43: Trans/obl scapula, 0.3 – ½ cun Caution : pnthx Bl 15/44 Back Shu of Heart BL 15: Level with T5, 1½ cun lateral to midline. BL 15: Trans/obl spine, ½ - 1½ cun BL 44: Level with T5, 3 cun lateral to midline BL 44: Trans/obl scapula, 0.3 – ½ cun Caution: pnthx Bl 16/45 BL 16: Level with T6, 1½ cun lateral to midline. BL 16: Trans/obl spine, ½ - 1½ cun BL 45: Level with T6, 3 cun lateral to midline. BL 45: Trans/obl scapula, 0.3 – ½ cun Caution : pnthx Bl 17/46 Hui Meeting of Blood BL 17: Level with T7, 1½ cun lateral to midline BL 17: Trans/obl spine, ½ - 1½ cun Back Shu of Diaphragm BL 46: Level with T7, 3 cun lateral to midline BL 46: Trans/obl scapula, 0.3 – ½ cun Caution: pnthx Bl 18/47 Back Shu of Liver BL18: Level with T9, 1½ cun lateral to midline BL 18: Trans/obl spine, ½ - 1½ cun BL 47: Level with T9, 3 cun lateral to midline BL 47: Trans/obl lateral, 0.3 – ½ cun Caution: pnthx Page 8 of 21 Pt Bl 19/48 Category Back Shu of Gallbladder Loc BL 19: Level with T10, 1½ cun lateral to midline Needling BL 19: Trans/obl spine, ½ - 1½ cun BL 48: Level with T10, 3 cun lateral to midline. BL 48: Trans/obl lateral, 0.3 – ½ cun Caution: pnthx Bl 20/49 Back Shu of Spleen BL 20: Level with T11, 1½ cun lateral to midline BL 20: Trans/obl spine, ½ - 1½ cun BL 49: Level with T11, 3 cun lateral to midline BL 49: Trans/obl lateral, 0.3 – ½ cun Caution: pnthx Bl 21/50 Back Shu of Stomach BL 21: Level with T12, 1½ cun lateral to midline BL 21: Trans/obl spine, ½ - 1½ cun BL 50: Level with T12, 3 cun lateral to midline BL 50: Trans/obl lateral, 0.3 – ½ cun Caution : pnthx Bl 22/51 Back Shu of San Jiao BL 22: Level with L1, 1½ cun lateral to midline BL 22: Obl or perp/obl spine, 1 - 1½ cun BL 51: Level with L1, 3 cun lateral to midline BL 51: Obl lateral, ½ - 1 cun Caution: kidney puncture Bl 23/52 Back Shu of Kidney BL 23: Level with L2, 1½ cun lateral to midline BL 23: Obl or perp/obl spine, 1 - 1½ cun BL 52: Level with L2, 3 cun lateral to midline BL 52: Obl lateral, ½ - 1 cun Caution: kidney puncture Bl 24 Bl 25 Bl 26 Back Shu of Lg Intestine Level with L3 and 1½ cun lateral to midline Perp, 1 - 1½ cun Level with L4, 1½ cun lateral to midline Perp, 1 - 1½ cun Level with L5, 1½ cun lateral to midline Perp, 1 - 1½ cun Page 9 of 21 Pt Bl 27 Loc Level with S1, 1½ cun lateral to midline Needling Perp, ½ - 1 cun BL 28: Level with S2, 1½ cun lateral to midline BL 28: Perp, ½ - 1 cun BL 53: Level with S2, 3 cun lateral to midline BL 53: Perp, 1 - 1½ cun Bl 29 Level with S3, 1½ cun lateral to midline Perp, ½ - 1 cun Bl 30/54 BL 30: Level with S4, 1½ cun lateral to midline BL 30: Perp, ½ - 1 cun BL 54: Level with S4, 3 cun lateral to midline BL 54: Perp 2 – 3 cun Bl 28/53 Category Back Shu of Sm Intestine Back Shu of Bladder Points over Sacral Foramen and (BL 35) ½ cun lateral to of coccyx Bl 31 Meeting of BL and GB S1, Over 1st sacral foramen Slightly oblique, medial and inferior, then perp, 1 - 1½ cun Caution: nerves! Contra: moxa Bl 32 Meeting of BL and GB S2, over 2nd sacral foramen Slightly oblique, medial and inferior, then perp, 1 - 1½ cun Caution: nerves! Bl 33 Bl 34 Bl 35 Meeting of BL and GB Meeting of BL and GB S3, over 3rd sacral foramen Perp, ½ - 1½ cun S4, over 4th sacral foramen Perp, ½ - 1½ cun ½ cun lateral to the tip of the coccyx Perp, 1 - 1½ cun Upper leg points Bl 36 Mid point of gluteal crease in depression between the hamstrings Inline with 36, 37, 40 Page 10 of 21 Perp, 1 - 1½ cun - or – 1-2 cun Pt Bl 37 Category Loc Back of thigh in a depression between the hamstrings, inline between BL 36 and BL 40. (6 cun inferior to BL 36, 8 cun superior to BL 40) Needling Perp, 1 - 1½ cun To locate: 1. Find the midpoint between BL 36 and BL 40. 2. Measure proximally by 1 cun Bl 38 Bl 39 Located in reference to BL 39. 1 cun proximal to BL 39 along the medial edge of the tendon of the biceps femoris. Lower He-Sea Back of knee on popliteal crease toward of San Jiao the lateral end on the medial side of the tendon of the biceps femoris. Perp, 1 - 1½ cun Perp, 1 - 1½ cun To locate: 1. Flex the knee 2. Feel for the large tendon toward the lateral side of the popliteal crease. 3. Point is located in this depression on the popliteal crease. Bl 40 He Sea/Lower He-Sea of Bladder Command point, Back and Lower Back Mid-popliteal crease between the tendon of the biceps femoris on the lateral side and the semitendinosus on the medial side. Flex the knee to locate and feel for a depression here. Perp, 1 - 1½ cun - or – Prick to bleed Caution: Tibial nerve, popliteal artery and popliteal vein Lower leg/foot points Bl 55 Back of calf, 2 cun inferior from BL 40 in a depression between the 2 heads of the gastrocnemius on the upper border between them. Page 11 of 21 Perp, 1 - 1½ cun Pt Bl 56 Category Loc Back of calf, 5 cun inferior to BL 40 on the belly of the gastrocnemius muscle. Needling Perp, 1 - 1½ cun To locate: 1. Find the midpoint between BL 55 and 57 and inline between BL 40 and BL 57. Bl 57 Half way between popliteal crease (BL 40) and the level of the prominence of the lateral malleolus (16 cun total) and between the 2 gastrocnemius muscle ends in a depression here. Perp, 1 - 1½ cun To find: 1. Have patient press ball of foot against resistance to emphasize muscles. 2. Run finger up from Achilles tendon insert until it falls into a depression between the gastrocnemius tails. Bl 58 Bl 59 Bl 60 Bl 61 Luo Connecting point of Bladder Located in relation to BL 57. Inferior and about 45° lateral to BL 57. Xi Cleft of Yang Qiao Located in relation to BL 60. 3 cun directly superior to BL 60 between the Achilles and peroneal tendons. Perp, 1 - 1½ cun Level with the prominence of the lateral malleolus between the malleolus and the Achilles tendon. Perp, ½ - 0.8 cun Lateral side of foot on calcaneus in a tender depression where the skin changes color/texture. Perp, 0.3 – ½ cun Jing River of the Bladder Meeting of BL w/Yang Qiao Perp, 1 - 1½ cun Can often find this point by drawing a line between BL 40 and the prominence of the lateral malleolus and comparing that to the location of BL 57. This point is usually directly below BL 60. Page 12 of 21 Note: this is on the final practicum!!! Contra: Preggers. Promotes labor. Pt Bl 62 Category Confluent of Yang Qiao Ghost Point Loc In a depression directly below the prominence of the lateral malleolus ~ ½ cun inferior and posterior to the 2 tendons here. Needling Obl-inferior, 0.3 – ½ cun Do not locate this in the depression below the calcaneus! Bl 63 Xi Cleft of Bladder Lateral side of foot in a depression: 1. Posterior to the tuberosity of MT 5 2. Anterior to the anterior border of the lateral malleolus 3. On lower border of cuboid bone 4. On line where skin changes color/texture. Perp, 0.3 – ½ cun Bl 64 Yuan Source Lateral side of foot in a depression on MT 5 on curvy part and on the border where the skin changes color/texture. Perp, 0.3 – ½ cun This is the most palpable landmark on the side of the foot Bl 65 Shu Stream On the lateral side of the foot proximal to the knuckle of MT 5. On the line where the skin changes color/texture. Perp, 0.3 – ½ cun Curl toes to see more easily. Bl 66 Ying Spring On lateral side of the foot distal to the knuckle of MT 5. On the border where the skin changes color/texture. Perp/obl sole 0.2 – 0.3 Curl toes to see more easily. Bl 67 Jing Well On the lateral corner of the nail of the little toe. Perp 0.1 – 0.2 -orPrick to bleed Caution: Can turn the fetus from breach. Expedites delivery. Page 13 of 21 Kidney Channel of the Foot Shaoyin Pt K1 Category Jing Well Loc Sole of foot, 1/3 of the way between the base of the 2nd toe and the heel. Between MT 2 and 3. Needling Perp, ½ - 1 cun For people that don’t have flat feet, plantar flex the foot to see a depression here. K2 Ying Spring Medial side of foot in a depression distal and inferior to the navicular tuberosity, just proximal to SP 4, on the line where the skin changes color/texture. Perp, ½ - 1 cun Locate from the bottom of the foot and verify that the depression goes up to the top of the foot. K3 Shu Stream Yuan Source K4 Luo Connecting Point Depression between the medial malleolus and the Achilles tendon level with the prominence of the medial malleolus. Perp, ½ - 1 cun Locate in relation to K3 and K5. Midway between K3 and K5 along the anterior border of the Achilles tendon. Obl-perp anterior, ½ - 1 cun As a rule of thumb, is usually ½ cun below K3/above K5 K5 Xi Cleft of Kidney Depression between the calcaneal tuberosity and the Achilles tendon, just above the insertion point of the Achilles tendon. Obl-perp away from the bone, ½ - 1 cun. K6 Confluent of Yin Qiao Just below the center of the prominence of Obl-superior, 0.3 – ½ cun the medial malleolus in the groove shallow insert. between the 2 tendons. Vertically level with a line drawn thru the prominence. If you only feel one tendon, needle posterior to it. K7 Jing River On the medial aspect of the lower leg in a depression 2 cun proximal to K3, on the anterior border of the Achilles tendon. Same horz lvl as K8, but more posterior. Page 14 of 21 Perp, ½ - 1 cun Pt K8 Category Xi Cleft of Yin Qiao Loc Same horizontal level as K7, 2 cun proximal to K3, on posterior edge of tibia on the medial side of the leg. Needling Perp, ½ - 1 cun K9 Xi Cleft of Yin Wei In-line with K3 and K10, 1/3 of the way Perp, 1 – ½ cun between them. (5 cun prox from K3). About 1 cun posterior to the medial border of the tibia. K 10 He Sea of Kidney Medial end of the popliteal crease in a depression between the semitendinosus and the semimembranosus. Perp, 1 – 1½ cun Needle with knee slightly flexed. Locate and needle with knee slightly flexed. Lower ab points begin here – ½ cun lat to mid Locate: 1. Find upper margin of pubic sym and center of umbilicus. 2. Place ref dot between the two 3. Place a dot ½ cun above ref and ½ cun below ref. 4. Place a dot between the ½ cun’s in #3. K 11 K 12 Mtg of Kidney and Chong Mtg of Kidney and Chong Upper border of pubic symphysis, ½ cun lateral to the midline. 5 cun inferior to the center of the umbilicus. Perp, 1 – 1½ cun 1 cun superior to K11, 4 cun inferior to umbilicus and ½ cun lateral to midline Perp, ½ - 1 cun Caution: 1. Can turn fetus, promote labor 2. BL punc – make sure BL is empty Caution: bladder punc K 13 Mtg of Kidney and Chong 2 cun superior to K11, 3 cun inferior to umbilicus and ½ cun lateral to midline Perp 1 – 1½ cun Caution: bladder punc K 14 Mtg of Kidney and Chong 3 cun superior to K11, 2 cun inferior to umbilicus and ½ cun lateral to midline Perp 1 – 1½ cun Caution: peritoneal punc K 15 Mtg of Kidney and Chong 1 cun inferior to umbilicus, ½ cun lateral to midline Perp 1 – 1½ cun Caution: peritoneal punc Page 15 of 21 Pt K 16 Category Mtg of Kidney and Chong Loc Level with the center of the umbilicus, ½ cun lateral to midline Needling Perp 1 – 1½ cun Caution: peritoneal punc Upper ab points begin here – ½ cun lat to mid To locate: 1. Find the center of the umbilicus and the sternal costal angle. 2. Find mid point between the 2 = K19 3. Find quarter points between K19, umbilicus and sternal costal angle = K21 and K17 4. Mark inbetweens K 17 Mtg of Kidney and Chong 2 cun superior to the center of the umbilicus, ½ cun lateral to midline Perp 1 – 1½ cun Caution: peritoneal punc K 18 Mtg of Kidney and Chong 3 cun superior to the center of the umbilicus, ½ cun lateral to midline Perp 1 – 1½ cun Caution: peritoneal punc K 19 K 20 Mtg of Kidney and Chong Mtg of Kidney and Chong Located ½ way between umbilicus and sternal costal angle, 4 cun superior to umbilicus. ½ cun lateral to midline Perp ½ - 1 cun 5 cun superior to umbilical center, ½ cun lateral to midline Perp ½ - 1 cun Caution: peritoneal punc Caution: peritoneal punc K 21 Mtg of Kidney and Chong 6 cun superior to center of umbilicus, ½ cun lateral to midline. Perp ½ - 1 cun Caution: Right side = LV punc Left side = peritoneal punc Chest points begin here – 2 cun lat to mid In intercostal spaces (IC) K 22 5th IC space, 2 cun lateral to midline Trans along IC space, ½ - 0.8 cun ST 18 is in this space at the 4 cun level. Caution: LU of LV punc K 23 4th IC space, 2 cun lateral to midline Trans along IC space, ½ - 0.8 cun Caution: LU punc Page 16 of 21 Pt K 24 Category Loc 3rd IC space, 2 cun lateral to midline Needling Trans along IC space, ½ - 0.8 cun Caution: LU punc 2nd IC space, 2 cun lateral to midline K 25 Trans along IC space, ½ - 0.8 cun Caution: LU punc 1st IC space, 2 cun lateral to midline K 26 Trans along IC space, ½ - 0.8 cun Caution: LU punc Top of 1st IC space, depression on lower border of clavicle, 2 cun lateral to midline K 27 Trans along IC space, ½ - 0.8 cun Caution: LU punc Pericardium Channel of the Hand Jueyin Pt P1 Category Window of Sky Loc In 4 IC space, 5 cun lateral to midline. th To locate: 1. Locate mamillary line and deltopectoral triangle 2. Find the middle of these two on the 4th IC space. P2 P3 He Sea of PC Needling Trans (either lateral or medial) along I.C., 0.3 – ½ cun Caution: pnthx. On the anterior surface of the biceps brachii muscle, 2 cun inferior from the tip of the axillary fold between the 2 heads of the muscle. Perp, ½ - 1 cun On the transverse cubital crease in a depression on the ulnar side of the tendon of the biceps brachii (opposite from LU 5) 1. Perp, ½ - 1 cun -or2. Prick to bleed Caution: brachial artery/vein are just medial to here. P4 Xi Cleft of PC 5 cun prox to P7 between the tendons of the palmaris longus and the flexor carpi Page 17 of 21 Perp ½ - 1 cun Pt Category Loc radialis, in line between P3-P7. Needling If you cannot find 2 tendons, you probably found the flexor carpi radialis. Needle on the ulnar side of this. P5 Jing River 3 cun prox to P7 between the tendons of the palmaris longus and the flexor carpi radialis, in line between P3-P7. Perp ½ - 1 cun P6 1. Luo Connecting 2. Confluent of Yin Wei 2 cun prox to P7 between the tendons of the palmaris longus and the flexor carpi radialis, in line between P3-P7. Perp ½ - 1 cun P7 1. Shu Stream 2. Yuan Source 3. Ghost At wrist joint, transverse wrist crease, between the tendons of the palmaris longus and flexor carpi radialis. Level with HT 7 and LU 9. Use the crease which crosses the pisiform bone. Perp 0.3 – ½ cun 1. Ying Spring 2. Ghost On the palm between the 2nd and 3rd MC in a depression on the radial side of the 3rd MC. Perp, 0.3 – ½ cun P8 Caution: median nerve To locate, make a loose fist. Point is located about where the tip of the middle finger falls on the palm P9 Jing Well Tip of the middle finger Perp 0.1 – 0.2 -orPrick to bleed San Jiao Channel of the Hand Shaoyang Pt SJ 1 Category Jing Well Loc Dorsal aspect of the ring finger 0.1 cun from the ulnar corner of the nail. Needling Perp, 0.1 – 0.2 cun -orPrick to bleed SJ 2 Ying Spring Between the ring and little fingers ½ cun proximal to the margin of the web on the line where the skin changes color. Perp 0.3 – ½ cun Have the pt make a loose fist and the point is probably located at the proximal end of the crease between the 2 fingers. Page 18 of 21 Pt SJ 3 Category Shu Stream Loc Dorsum of the hand in a depression just proximal to the metacarpo-phalangeal knuckle. Needling Perp, ½ - 1 cun Have the pt make a loose fist to find it more easily. SJ 4 Yuan Source On the dorsal crease of the wrist joint between the tendons of the extensor digitorum communis (a bundle of tendons rather like the palmaris longus on the other side) and the extensor digiti minimi (which goes to the little finger). Perp 0.3 – ½ cun Note: follow the space between MC 4 and 5 to the wrist joint. SJ 5 SJ 6 SJ 7 SJ 8 1. Luo Connecting 2. Confluent of Yang Linking 2 cun proximal to SJ 4 in the depression between the radius and the ulna. Between radius and extensor digitorum communis tendon, closer to the border of the radius. Perp ½ - 1 cun (or angle up or down channel) Jing River 3 cun proximal to SJ 4 in the depression between the radius and the ulna on the radial side of the extensor digitorum communis muscle. Closer to radius. Perp ½ - 1 cun Measure proportionally! ¼ of the way between the cubital crease and the transverse wrist crease. Or you can angle it up or down the channel Xi Cleft of SJ Caution: ulnar nerve can cause a shock sensation. Also, movement of arm or hand can result in bent needle. Caution: movement of arm or hand can result in bent needle. Level with SJ 6 (3 cun prox to SJ4) on the Perp ½ - 1 cun ulnar side in a depression between ulna and extensor digitorum communis muscle. Or you can angle it up or down the channel Locate it about 1 fingerbreadth to the ulnar side of SJ 6 close to the border of the ulna. 4 cun proximal to dorsal transverse wrist crease in depression between radius and ulna. Locate on radial side of extensor digitorum communis muscle. Measure proportionally – use ¼ of the way and add 1 cun or divide into 3rds. Page 19 of 21 Perp ½ - 1 cun Or you can angle it up or down the channel Pt SJ 9 Category Loc Depression between radius and ulna 5 cun distal to the level of the olecranon, 7 cun proximal to SJ4 Needling Perp 1 – 2 cun. You can also angle prox or dist. Use a measure to find the distance between SJ 4 and epicondyle of humerus, divide in ½, go proximal by 1 cun. SJ 10 He Sea of SJ On the yang aspect of the upper arm ~ 1 cun proximal to the olecranon process. Flex the elbow and slide your finger upwards to find the depression above the process. Perp, ½ - 1 cun. Caution: located at the beginning of the ulnar nerve. Don’t manipulate if there is pain! SJ 11 1 cun proximal to SJ 10. Locate with elbow flexed. Perp, ½ - 1 cun SJ 12 Lateral upper arm (yang side) inline with SJ 10 and SJ 14. Perp, 1 – 2 cun Measure SJ 14 – SJ 10, divide in ½ and go distal by 1 cun. SJ 13 Mtg of SJ and Yang Wei SJ 14 Locate in reference to SJ 14. Use a measure to find the line between SJ 10 and SJ 14. At the point where this line crosses the posterior border of the deltoid muscle is SJ 13. Perp, 0.8 – 1½ cun At the origin of the deltoid muscle in a depression posterior and inferior to the lateral extremety of the acromion. Perp 0.8 – 1.2 cun or manifestation. Hold the arm out from the side with the palm down. Look for the depression from the top down. SJ 15 Mtg of SJ, GB, Yang Wei In the suprascapular fossa on the posterior side. To locate, find the superior angle of the scapula (the curve on the medial side that goes to the tip above SI 13). Follow this curve to just above the tip of the scapula and that’s the point. Alt: mid point of GB 21 and SI 13. Page 20 of 21 Perp, ½ - 1 cun Caution: deep insert perp = pnthx. Pt SJ 16 Category Window of Sky Loc Posterior border of SCM level with the angle of the jaw. Needling Perp, ½ - 1 cun SJ 17 Mtg of SJ, GB Level with and anterior to the lower Perp, ½ - 1 cun border of the mastoid process, just behind earlobe in the depression between the two. SJ 18 Locate in relation to SJ 20 and 17. Posterior to ear, in small depression on mastoid bone, 2/3 distance from SJ 20 along a curved line from SJ 17 to SJ 20 following the rim of the ear. Trans, 0.3 – ½ cun into subaponeurotic space (scalp acupuncture) SJ 19 Locate in relation to SJ 20 and 17. Posterior to ear, in small depression 1/3 from SJ 20 along a curved line from SJ 17 to SJ 20 following the rim of the ear. Trans, 0.3 – ½ cun into subaponeurotic space (scalp acupuncture) On the side of the scalp, directly level with the apex of the ear when the ear is folded forward. Trans, 0.3 – ½ cun into subaponeurotic space (scalp acupuncture) In a depression anterior to the supratragic notch, slightly superior to the condyloid process of the mandible. Inferior/obl and slightly posterior, 0.3 – ½ cun SJ 20 Mtg SJ, SI, GB SJ 21 If there are 2 apexes/traguses, find the highest one. Note: SJ 21, SI 19, GB 2 are all stacked from top to bottom here. SJ 22 Mtg SJ, GB, SI On posterior margin of hairline at the temple. Find the hairless space between the temporal hairline and the ear. Draw a line from the outercanthus to the ear. The intersection is usually SJ 22. Trans or obl 0.3 – ½ cun Caution: temporal artery is here. Approx ½ cun anterior to the upper border of the root of the ear. SJ 23 In a depressionon the supraorbital margin at the lateral end of the eyebrow. Trans medially along eyebrow or posteriorly, ½ - 1 cun. Contra: moxa. Page 21 of 21