Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Course: Doc: Point Locations III Comprehensive Point Location Date: Lung Channel of the Hand Taiyin Pt Category Loc LU 1 Front Mu of Lung Level with 1st intercostal space 6 cun Mtg pt of LU/SP lateral to midline, 1 cun inferior to LU 2 Methods to locate: 1. Find 1st intercostal space. Find midline, measure 6 cun lateral. 2. Have pt raise arm straight out and parallel to ground. Find hollow of delta/pec triangle. Measure down 1 cun. 1 cun superior and slightly medial to LU 1 in hollow of delta-pectoral triangle. LU 2 Can palpate when pt raises arm straight out and parallel to the ground. LU 3 Window of Sky 3 cun below tip of axillary fold, 6 cun superior to cubital crease on upper arm, groove between lateral border of biceps brachii and shaft of humerus. 4/18/08 Needling Transverse oblique, pointing laterally. ½ – 0.8 cun. Caution: possible pneumothorax w/deep perpendicular needle Transverse oblique, pointing laterally. 0.5 – 0.8 cun. Caution: possible pneumothorax w/deep perpendicular needle Perpendicular. 0.5 – 1 cun Divide distance between axillary tip and cubital crease into 1/3’s for most accurate location. 4 cun inferior to tip of axillary fold, 5 cun superior to LU 5 at cubital crease. In groove between lateral border of biceps brachii and shaft of humerus. LU 4 Perpendicular 0.5 – 1 cun Divide distance between axillary tip and cubital crease into 1/3’s for most accurate measure. LU 5 He Sea (water) On cubital crease of elbow in the depression to the radial side of the tendon of the biceps brachii. Slightly flex elbow to locate. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 1 Perpendicular 0.8 – 1.2 cun Pt LU 6 Category Xi Cleft Loc On the flexor aspect of the forearm 5 cun distal to LU 5, 7 cun prox to LU 9. Inline between LU 5 – LU 9. Needling Perpendicular 0.5 – 1 cun Divide distance between LU 5 and LU 9 in half and go 1 cun proximal from here for best measure. Should be a palpable depression here. LU 7 Luo Cnx Confluent of Ren Cmd head/nape Radial aspect of forearm ~ 1.5 cun prox to LI 5 between tendons of brachioradialis and abductor pollicus longus. Pinch to insert either with or against the channel. Transverse ½ - 1 cun Slide fingertip from LI 5 proximal over radius bump here and into the cleft between the tendons. Convenient, but not so accurate: hook your opposite hand thumb into your patient’s with your thumb in their palm. Your fingertip should fall onto the point. LU 8 Jing River (metal) 1 cun proximal to LU 9 in a line connecting LU 5 and LU 9 Find the depression at the base of the styloid process radius and the radial artery. Point is between these 2. LU 9 Shu Stream Yuan Source Hui of Vessels (earth) At wrist joint in depression between radial artery and tendon of abductor pollicus longus (thumb tendon) on border of pisiform bone. LU 10 Ying Spring (fire) Level with Heart (HE) 7 point. On thenar emminence, midway down the shaft of the 1st metacarpal (thumb). LU 11 Jing Well Ghost (wood) Locate the point on the border of the red and white skin (or where skin changes textures) 0.1 cun from radial corner of thumbnail Note: there are several like this. To find, draw an imaginary line along the bottom border of the nail and another along the vertical border of the nail. Intersection = 0.1 cun Cat’s Notes Point Location III – Comprehensive from Class I - III Page 2 Oblique (proximally) Perpendicular 0.3 – 0.5 cun. Caution: radial artery (take about 5 min to stop bleeding here. Perpendicular 0.3 – 0.5 cun per Deadman 0.2 – 0.3 per CAMS Perpendicular 0.5 – 1 cun Best to use acupressure or for bleeding techniques. Perpendicular or Oblique (proximal) 0.1 – 0.2 cun Or prick to bleed Large Intestine of the Hand Yangming Pt LI 1 LI 2 LI 3 Category Jing Well (metal) Ying Spring (water) Shu Stream (wood) Loc 0.1 cun from radial corner of index fingernail. Radial edge of 1st phalanx of index finger just distal to the knuckle of the MCP joint in a depression on the line where the skin changes color/texture. Needling Perpendicular or obl 0.1 – 0.2 cun Alternatively, Prick to bleed. Obl (prox or dist), 0.2 – 0.3 cun -or- Find/needle with hand in a loose fist. Perp-obl toward palm, ½ cun. Radial edge of MC 2, just proximal to the MCP joint in a depression on the line where the skin changes color/texture. Perpendicular ½ - 0.8 cun Find/needle with hand in a loose fist. LI 4 Yuan Source pt of Mid point of the 2nd MC bone, inbetween LI the 1st and 2nd MC, but slightly closer to Command pt the 2nd MC. face/mouth Perpendicular ½ - 1 cun Contra: preggers. Induces labor. LI 4 + LV 3 = 4 gates LI 5 Jing River (fire) In the anatomical snuffbox. Stretch the palm flat and stretch the thumb as far toward the back of the hand as possible. Feel the depression between the base of the thumb and the wrist. Perpendicular ½ - 0.8 cun Don’t needle too proximally! Feel for the hollow. Caution: avoid cephalic vein. LI 6 Luo Connecting One quarter of the distance from LI 5-11 (3 cun proximal to LI 5) and inline between them. Perpendicular ½ - 1 cun LI 7 Xi Cleft 5 cun proximal to LI 5, inline between LI 5-11. Perpendicular ½ - 1 cun For most accurate location, use a measure to find ½ distance between LI 5-11. Locate point 1 cun distal to here. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 3 Pt LI 8 Category Note: LI 8-10 are all 1 cun apart!!! Note: LI 8-10 are all 1 cun apart!!! Note: LI 8-10 are all 1 cun apart!!! He Sea Ghost (earth) Perpendicular ½ - 1 cun Use a measure to find the ¼ mark between the two points. 2 cun distal to LI 11, inline between LI 5 and LI 11. LI 10 Needling Perpendicular ½ - 1 cun Use a measure to find the ¼ mark between the two points, go 1 cun distal to this. 3 cun distal to LI 11, inline between LI 5 and LI 11. LI 9 LI 11 Loc 4 cun distal to LI 11, inline between LI 5 and LI 11. Perpendicular ½ - 1 cun Either find LI 11 and LI 8 and divide distance in ½ or find LI 9 and go proximal by 1 cun. At the lateral end of the cubital crease. Perpendicular 1 – 1½ cun With elbow fully flexed: Find the lateral tip of the crease. With the elbow only partially flexed: Locate LU 5 and prominence of lateral epicondyle of the humerus. Point is ½ distance between these 2 points. LI 12 Flex the elbow to 90 °. Palpate the lateral epicondyle of the humerus and the humeral shaft. Run finger down the humeral shaft until you feel the curve begin. Locate LI 12 here. Perpendicular ½ - 1 cun LI 13 3 cun proximal to LI 11 (6 cun distal to tip Perpendicular ½ - 1 cun of axillary crease), inline between LI 11 and LI 15. Measure proportionally or use hand cun. LI 14 Lateral side of the upper arm in a depression formed by the distal insertion of the deltoid muscle. Tense muscle to see more easily. Inline between LI 11 and 15. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 4 Obl 1 – 1½ cun Pt LI 15 Category Loc Depression anterior/inferior to the acromion – at the origin of the deltoid. Needling Trans-obl, 0.8 – 1 ½ cun Hold the arm out in “airplane” to see the depression more easily. Change your angle of vision to see it if necessary Upper aspect of the shoulder in a depression medial to the acromion process. Between the lateral extremity of the clavicle and the scapular spine. LI 16 1 cun inferior to LI 18 on the posterior border of SCM. LI 17 LI 18 Window of Sky Between sternal and clavicular heads of SCM, level with the laryngeal prominence. Turn pts head, hold your hand on their chin and have them resist slightly to make the muscle more visible. LI 19 On the face, ½ cun lateral to the midline of the philtrum, level with the border between the upper 1/3 and lower 2/3 of the philtrum. Perp, ½ - 1 cun. Caution: risk of pnths with deep perpendicular or medial insert. Perpendicular 0.3 – 0.5 cun Perp, 0.3 – ½ cun Caution: carotid a. and jugular v. are both deep to here. Carotid artery is under very high pressure here. Hard to stop bleeding, will bruise. Perpendicular or obl-trans up to 1 cun. Contra: moxa per ancient txts. NOTE: LI channel crosses the midline of the body, so for the left side points 1-18, LI 19 would be on the right side! LI 20 In naso-labial groove level with the midpoint of the lateral edge of the ala nasi (wing of the nostril). Trans, directed mediosuperiorly, 0.3 – ½ cun Contra: moxa. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 5 Stomach Channel of the Foot Yangming Pt ST 1 Category Loc Loc’d mid between inner and outer canthus between pupil of eyeball and infraorbital ridge. Method 1: Have patient look straight ahead, go down between infraorbital ridge and eyeball Method 2: Find the midline between the inner and outer canthus. Find infraorbital ridge/eyeball space. ST 2 Directly below midline of eye (below pupils when looking straight ahead) in the depression of the infraorbital foramen on the infraorbital ridge. Inline with ST 1 and ST 3 ST 3 Level with the lower wing of the ala nasi on the lateral side of the naso-labial groove. Below ST 1-2 and often (though not always) inline with them. Have patient smile to find the groove if needed. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 6 Needling Have pt look upward w/eyes closed. Use a dry cotton ball to push eyeball upwards and away from insertion point. 0.2 – ½ cun Contra/Cautions about needling near the eyeball: Moxa contraindic’d (smoke and burns) Use strict CNT practices Communicate w/pt Risk of hematoma – use short/thin needles Don’t manip/retain. Press 1 min when w/draw, have pt press addit 2-3 minutes. Perpendicular (very superficial), 0.2 – 0.4 cun Contra/Cautions Moxa is contraindicated No lift/thrust manipulation due to possible damage to the infraorbital nerve Deep insertion could injure eyeball (though possibility is slim) Perpendicular , ½ – 0.8 cun Pt ST 4 Category ST 5 Don’t get this too high! ST 6 ST 7 Loc 0.4 cun lateral to the corner of the mouth. Needling Perpendicular, 0.2 – 0.3 cun Generally in line with ST 1-3, but not always. Should be in the naso-labial groove. Transverse/oblique toward another feature (usually ST 6), ½ – 0.8 cun ½ cun above the lower border of the mandible bone just anterior to the masseter muscle attachment here. Oblique, 0.3 – ½ cun Caution: artery located here. Clench teeth to find, relax to needle. Ghost point (Sun Simiao) On the highest point (prominence) of the masseter muscle, 1 finger’s breadth anterior/superior to the angle of the jaw – about 45° angle from the corner of the Don’t get this one jaw. too high either. Clench teeth to find, relax to needle. Located below the zygomatic arch, usually just anterior to the auditory opening of the ear. Perpendicular, 0.3 – 0.5 cun Transverse toward another point. Perpendicular and slightly inferior, ½ – 1 cun 1. Find the depression just in front of the ear in the zygomatic arch (ridge of cheekbone as it approaches the ear. 2. Have pt open mouth, should feel a bone pop into this depression. ST 8 Corner of the forehead, 4.5 cun lateral to Du 24, 0.5 cun within anterior hairline. Small depression here. Method 1: 1. Find the corner of the hairline 2. Go back 0.5 cun within anterior hairline. Method 2: 1. Double the distance from GB 15 to Du 24 2. Go lateral by this distance from Du 24. Method 3: 1. 4.5 cun (5 fingers) from midline of hairline (remember it’s 3 cun from Yintang up to hairline) 2. 0.5 cun posterior into hairline. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 7 Oblique or transverse ½ – 1 cun, into the 4th layer of the scalp in loose cnx tissue Contraindication: Moxa. Pt ST 9 Category Window of sky Loc On the neck level with the laryngeal prominence (tip of Adam’s Apple) on the anterior border of the SCM (sternocleidomastoid muscle) Have patient turn head to see this more easily. If you still can’t see it, put your fingers against their chin and have them resist against you. ST 10 Find ST 11 first!! On neck, anterior border of the sternal head of the SCM, midway between ST 9 and ST 11…but not inline with them. The 3 of them make a shallow triangle. Have patient turn their head to the side while you apply resistance to the chin to make this area more prominent. At the root of neck in the depression located just above the collar bone in the triangle formed by the sternal and clavicular heads of the SCM muscle. ST 11 Have pt turn their head to the side to see this triangular depression. ST 12 Meeting pt of ST, LI, SI, SJ, GB!! Midpoint of the clavicle on the upper border in the supraclavicular fossa. Know this! Can stim many areas w/o adding more points. (Note: this is how you find the mamillary line which you will need for stomach points on the upper trunk) Needling Perpendicular, ½ – 1 cun Contraindication: Moxa contra’d. Burns infect, carotid artery moves it thru the body. Caution: Carotid artery located here. Palpate for it then use the pressing method to hold it aside when you needle. Perpendicular, 0.3 – ½ cun Contraindication: Moxa contra’d. Burns infect, carotid artery moves it thru the body. Caution: Carotid artery located here. Palpate for it then use the pressing method to hold it aside when you needle. Perpendicular, 0.3 – ½ cun Cautions: Small artery here Deep insertion = risk of pneumothorax Safest: Transverse posterior toward trapezius muscle, ½ – 1 cun Not so safe: Perpendicular, 0.3 – ½ cun Contraindicated = preggers! Cat’s Notes Point Location III – Comprehensive from Class I - III Page 8 Pt ST 13 Category Loc On mamillary line. Directly below ST 12 just below the inferior border of the clavicle. Needling Transverse, aiming toward manifestation, 0.3 – ½ cun Caution: Deep perpendicular insert = risk of pneumothorax and/or injury to subclavian vessel. ST 14 ST 15 Middle of the 1st intercostal space on the mamillary line Transverse, aiming toward manifestation, 0.3 – ½ cun Note that the intercostal spaces curve upward as they go lateral Caution: Deep perpendicular insert = risk of pneumothx. Middle of the 2nd intercostal space on mamillary line. Transverse, aiming toward manifestation, 0.3 – ½ cun Caution: Deep perpendicular insert = risk of pneumothx. Middle of the 3rd intercostal space on the mamillary line ST 16 Transverse, aiming toward manifestation, 0.3 – ½ cun Caution: Deep perpendicular insert = risk of pneumothx. ST 17 Unique… Landmark point only! ST 18 Technically in the middle of the 4th intercostal space, but always located in the center of the nipple regardless of where that falls. Don’t!! Contraindicated for everything – this is a landmark only. Middle of the 5th intercostal space, on Transverse, aiming toward mamillary line. Might need to push breast manifestation, 0.3 – ½ cun up on women to find this intercostal. Caution: Deep perpendicular Some books say is in 5th intercostal just insert = risk of pneumothx. below nipple…ain’t necessarily so. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 9 Pt NOTE Category Stomach 19-25 Loc Stomach 19-25 are all upper abdominal points. Lie on a different line than 13-18 – located 2 cun from the midline. To find 2 cun you can do any of these: 1. Measure with finger cun – least reliable. 2. Measure ½ way between mamillary line and the midline. Probably the best. 3. On a muscular patient with 6pack abs look for the ridge. ST 19 ST 20 Needling Location for these points works like this: 1. Find the center of the umbilicus and the sternal costal angle. Distance between these = 8 cun. 2. Divide the distance in half. 4 cun. This is ST 21. 3. Divide the upper half again – 2 cun. This is ST 19 4. Divide the lower half into halves – this is ST 23. 5. ST 25 is on either side of the umbilicus. Other points (even points) lie exactly inbetween. 2 cun lateral to midline. Locate as described above, locate ST 21 first, then ST 19 Perpendicular, ½ – 1 cun See location notes above and locate accordingly Perpendicular, ½ – 1 cun Caution: Deep insertion may injure heart (left), liver (right) if either organ enlarged. Caution: In thin subjects deep needle can puncture peritoneal cavity. Can penetrate liver on right side if enlarged. ST 21 See location notes above and locate accordingly Perpendicular, ½ – 1 cun Caution: In thin subjects deep needle can puncture peritoneal cavity. Can penetrate liver on right side if enlarged. ST 22 See location notes above and locate accordingly Perpendicular, ½ – 1 cun Caution: In thin subjects deep needling can puncture peritoneal cavity. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 10 Pt ST 23 Category Loc See location notes above and locate accordingly Needling Perpendicular, ½ – 1 cun Caution: In thin subjects deep needling can puncture peritoneal cavity. See location notes above and locate accordingly ST 24 Perpendicular, ½ – 1 cun Caution: In thin subjects deep needling can puncture peritoneal cavity. ST 25 Front Mu point of 2 cun lateral to center of umbilicus LI Perpendicular, 1 – 1½ cun Caution: In thin subjects deep needling can puncture peritoneal cavity. NOTE: ST 26 – 30 ST 26 – 30 are lower abdomen points. Cun measures here are larger than the thumb width, so use proportional measures. 3. Find the location by dividing the distance a. Divide the distance between the umbilicus 1. Palpate for top margin of the pubic mark and the top bone. Be sure you communicate well margin of the with your patient, telling them what pubic bone in half. you’re palpating for, what these This is a reference points will do for them, etc. point 2. Find the center of the umbilicus b. ST 27: Go ½ cun ST 26 through ST 30 are located 2 above the middle cun lateral to this line on both sides of mark in 3a. the body. c. ST 26: Go ½ way a. ST 29: Go ½ way between ST between ST 27 30 and ST 28. and ST 25. d. ST 28: Go ½ cun below the middle mark in 3a. e. ST 30: Top margin of the pubic bone, 2 cun lateral from the midline. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 11 Pt ST 26 Category Loc See location notes above Needling Perpendicular, 1 – 1½ cun Caution: In thin subjects deep needling can puncture peritoneal cavity. ST 27 See location notes above Perpendicular, 1 – 1½ cun Caution: In thin subjects deep needling can puncture peritoneal cavity. ST 28 ST 29 ST 30 See location notes above Perpendicular, 1 – 1½ cun KNOW: Indicated for abdominal edema Caution: In thin subjects deep needling can puncture peritoneal cavity. See location notes above Perpendicular, 1 – 1½ cun KNOW: Indicated for irregular menstruation Caution: In thin subjects deep needling can puncture peritoneal cavity. Level with superior border of pubic symphysis, 2 cun off of midline Perpendicular, ½ - 1 cun Contraindication: Moxa! Caution: Deep insert superior direction can = penetration peritoneal cav or full bladder. On men, can penetrate spermatic cord. ST 31 Located on upper thigh.To find: 1. Find ASIS and lower border of pubic symphysis 2. Draw a line down from ASIS and over from pubic symphysis. Intersection is ST 31. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 12 Perpendicular, 1-2 cun Pt ST 32 Category Needling Perpendicular, 1-2 cun 1. Draw a line from ST 31 or from ASIS lateral superior corner of patella. 2. Locate point 6 cun above superior border of patella on this line. Locate 32-24 with knee flexed Perpendicular, 1 – 1½ cun ST 33 Easy to locate, but often mistaken on exams ST 34 Loc Locate 32-34 with knee flexed Xi Cleft point of ST On same line as ST 31 and 32, 3 cun above superior border of patella or 1 cun above ST 34. Locate 32-24 with knee flexed Perpendicular, 1 – 1½ cun Three methods to locate this: 1. Three fingers to 2 cun measure 2. Best: Measure length of knee cap (2 cun) with fingers. Go up above superior border this distance then rotate fingers 45 degrees laterally. 3. Locate point in bulge of vastus lateralis ST 35 Locate with knee flexed Level with lower border of patella and lateral to the ligament, yet lower than where the patella is. Oblique towards middle/back of popliteal crease (UB 40), 1 – 1½ cun Caution: Insertion into joint capsule This ligament looks like an ox’s nose carries risk of infection to where you’d put the ring through. Use the capsule. top depression here, not the lower one. Note: Extrapoint called Xiyan is in the same place, but both lateral and medial, so ST 35 overlaps. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 13 Pt ST 36 Category He Sea of ST Lower HeSea of ST Command pt (abdomen) (earth point) Loc 3 cun inferior to ST 35 and lateral to the crest of the tibia by 1 finger’s breadth. Use index or middle finger. Needling Perpendicular 1 – 1½ cun 3 ways to locate this: 1. Most reliable: Three cun below ST 35. Use proportional method or hand cun to find. 2. Run finger up the lateral side of the crest of the tibia until you hit the flare level with the lower border of the tuberosity of the tibia. Measure 1 finger width lateral to the crest of the tibia. Highlights to know 1. Makes sure ST 35 is correct. 2. One fingerwidth lateral to crest of tibia. 3. Know locating methods 3. Measure from ST 38 to the popliteal crease and divide distance in half to get 4 cun. Measure 1 cun proximal. 1 finger width lateral to the crest of the tibia. ST 37 Lower He Sea pt of LI Lower leg, 3 cun inferior to ST 36, 2 cun above ST 38. Perpendicular, 1 – 1½ cun 1. Find ST 38. (see below) 2. Divide the distance between ST 38 and the popliteal crease level into ½ and into ½ again to get 2 cun above ST 38. 3. Use middle or index finger to measure 1 finger breadth lateral to anterior crest of tibia. This is ST 37. ST 38 Half of the distance between the popliteal crease and the prominence of the lateral malleolus. 1 finger’s width lateral to the crest of the tibia. Use a measuring tape or string to get this distance. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 14 Perpendicular, 1 – 2 cun You can also thread from here to UB 57 (at the back of the calf near the base of the calf muscles) Pt ST 39 Category Lower He Sea pt of SI Loc Located 1 cun below ST 38. See measure techniques for ST 38 above. Needling Perpendicular, 1 – 1½ cun Be sure to go one finger’s breadth lateral to anterior crest of the tibia. ST 40 Luo connecting pt of ST Level with ST 38. See location notes above. Perpendicular, 1 – 1½ cun 2 finger’s breadth lateral to the anterior crest of the tibia. ST 41 Jing River point of ST Fire point of ST On the ankle, level with the prominence of the lateral malleolus. 1. Slightly dorsa-flex the foot to see the depression here. There are 3 major tendons here: tibialis anterior (most medial), extensor hallicus longus (going to the big toe), and extensor digitorum longus (most lateral - goes to remaining 4 toes). 2. Find the depression between extensor hallicus longus and digitorum longus at the bend of the ankle. This is ST 41 ST 42 Yuan Source for ST Hard to find ST 43 Shu Stream (Wood pt) Located on dorsum of foot in a depression formed where the 2nd and 3rd metatarsals meet the cuneiform bones. 1. Find the depression between the 2nd and 3rd metatarsals. 2. Slide your finger proximally and find the end of the depression. 3. Keep going proximal and feel for a depression on the other side of the flare of the metatarsals. Perpendicular , ½ – 1 cun Caution: anterior tibial vessels/nerve lie deep to this point Perpendicular, 0.3 – ½ cun Caution: dorsalis pedis artery here. Feel for it, use pressing technique to needle. Located between 2nd and 3rd metatarsal Perpendicular, 0.3 – ½ cun bones in a depression just proximal to the knuckles of the toes below the flare of the boens of the metatarsals. Curl the toes to see the knuckles easily. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 15 Pt ST 44 Category Ying Spring (water point) Loc Located between 2nd and 3rd metatarsal bones in the depression just distal to the knuckles of the toes. Needling Perpendicular, ½ – 1 cun Curl the toes to see the knuckles easily. ST 45 Jing Well (metal point) Located on the lateral bottom corner of the 2nd toenail. Perpendicular, 0.1 – 0.2 cun Alternatively, prick to bleed. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 16 Spleen Channel of the Foot Taiyin Pt SP 1 Category Jing Well Ghost point Loc Medial/dorsal aspect of big toe 0.1 cun from the corner of the nail. Needling Perp or oblique 0.1 cun Moxa is appropriate as well. Draw a line down the medial aspect of the nail and another across the lower border of the nail. The intersection is the point. SP 2 Ying Spring Medial side of the big toe in a depression distal/inferior to the first metatarsophalangeal joint, almost on the bottom of the bone. 1. Curl the toes to see the knuckle, uncurl to locate. 2. Slide fingertip distally over the side of the ball of the foot to find the depression. 3. On the border where skin changes color/texture. Perp 0.3 - ½ cun SP 3 Shu Stream Yuan Source Medial inferior side of the foot in the depression proximal to the head of the first metatarsal bone (almost under the foot). 1. Find the ball of the foot by curling the toes. 2. Slide your fingertip proximally over the side of the ball of the foot to find the depression. 3. Locate the point on the border where skin changes color/texture. Perp ½ – 1 cun SP 4 Luo Connecting Confluent Pt of the Penetrating Vessel Medial side of foot in depression distal/inferior to the base of the first metatarsal. Perp ½ – 1 cun 1. Palpate along the shaft under the foot to feel. Beware of the deeper depression and see if it goes all the way up to the top of the foot—if so, you’re too proximal and you’re on the MT joint. 2. Locate the point on the border where the skin changes texture/color Cat’s Notes Point Location III – Comprehensive from Class I - III Page 17 Pt SP 5 Category Jing River Loc Anterior and inferior to the medial malleolus. Needling Perp 0.3 – ½ cun 1. Observe first – look for the bulge and the depression here. 2. Draw a line along the anterior border of the prominence of the medial malleolus and the inferior border of the medial malleolus. 3. Locate the point on the intersection of these lines in the depression that you will find here. SP 6 Meeting point of the SP, LIV, and KI channels On medial aspect of lower leg just posterior to the medial crest of the tibia, 3 cun superior to the prominence of the medial malleolus. Perp 1-1½ cun Contraindicated for preggers! While proportional measure is more accurate, it’s 15cun from medial mal to the popliteal crease…if you can do 20% of this, bully for you, if not, use hand cun measure. On medial aspect of the lower leg, 6 cun proximal to the tip of the medial malleolus. Locate the point just posterior to the medial crest of the tibia. SP 7 Perp 1-1½ cun Locate this point in relation to SP 6 1 hand-breadth superior to it. SP 8 Xi Cleft of SP channel Medial leg 3 cun inferior to SP 9 in a depression just posterior to the medial crest of the tibia. Might be slightly more anterior than SP 9 due to the curvature of the bone. To locate: 1. Locate SP 9 first, then distal by 1 handbreadth. 2. Alternately, divide 15cun between pop crease and the medial mal into 1/3’s and locate this point at the border between the top 1/3 and bottom 2/3’s. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 18 Perp 1-1½ cun Pt SP 9 Category He Sea Point of SP Loc Medial side of lower leg in a depression at the angle formed by the medial condyle of the tibia and the posterior border of the tibia. Needling Perp 1 – 1½ cun Run finger in the groove posterior to tibia’s medial border until you find the point where the bone curves back. Point is located in the depression here. (FYI, located at same level as GB 34) Two cun proximal to the superior border of the patella on the medial side on the bulge of the vastus medialis. SP 10 #1 point for Blood…tonify and move blood, skin problems. “To treat wind, treat the blood.” Locate this point like ST 34 – flex the knee, then use the kneecap as a measure, go above the superior border of the patella this much, rotate medially by 45 degrees. Medial side of thigh, 6 cun proximal to SP 10 inline with SP 10 - SP 12. SP 11 To locate, find SP 10, go 6 cun proximal. Alternately, find the ½ way distance between SP 12 and the popliteal crease. SP 12 Meeting point of SP & LV with Yin Linking Not commonly used Not strong function Perp 1 – 1½ cun 3.5 cun lateral to Ren 2 (top margin of the pubic symphysis level with ST 30, but on the anterior midpoint) or 1.5 cun lateral to ST 30 on the lateral side of the femoral artery. 1. Locate upper border of pubic symphysis at the level of the anterior midline of the body. Go lateral 3.5 cun from here. 2. Locate the pulse of the femoral artery on this line. 3. Locate SP 12 immediately lateral in the depression Cat’s Notes Point Location III – Comprehensive from Class I - III Page 19 Perp ½ – 1 cun Caution: deep needling can puncture the femoral artery Perp ½ – 1 cun Caution: deep needle medially may puncture the femoral artery while deep needling laterally can puncture the femoral nerve! Pt SP 13 Category Meeting pt of SP & LIV with Yin Linking Loc Lower ab, .7 cun superior, ½ cun lateral to SP 12, 4 cun lateral to the midline of the body. To locate, find SP 12. Measure 1 cun diagonally (lateral and superior). This should be about right. Verify that you are 4 cun lateral to the midline (on the same vertical level as the mamillary line) SP 14 SP 15 SP 16 NOTE: Needling Perp 1-1½ cun Caution: Possible peritoneal puncture with deep needling in thin patients. (NOT part of SP/LIV meeting with Yin Linking…will be on test!) Lower ab, 1.3 cun inferior to SP 15, 4 cun from midline (on mamillary line). Meeting pt of SP & LIV with Yin Linking 4 cun lateral to the center of the umbilicus. (In the depression at the lateral border of the rectus abdominis muscle … on the mamillary line) Perp ½ – 1 cun Meeting pt of SP with Yin Linking On ab 3 cun superior to SP 15 and 4 cun lateral to the midline on lateral border of rectus abdominis muscle, aka on the mamillary line Perp ½ – 1 cun Shen says measure to 1.25 cun and that should be fine. SP 17 – 20 are 6 cun lateral to anterior midline, inline with LU 1 and 2. Needle all of them transverse with intercostal spaces ½ – 0.8 cun deep. Guide needle towards manifestations that need help. To find the 6 cun mark from the midline either 1. Find LU 1 - 2 and use this line 2. 8 fingers from anterior midline 3. Find mamillary line and go 2 cun lateral. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 20 Perp 1-1½ cun Caution: Can punc peritoneal cav in thin patients if deep needle. Cautions: 1. Possible peritoneal cav punc in thins. 2. Enlarged liver or spleen at this level Cautions: 1. Possible peritoneal cav punc in thins. 2. Enlarged liver or spleen at this level Pt SP 17 Category Loc Lateral side of chest, 5th intercostal space, 6 cun to midline. (5th intercostal is often about the bra-line on women…4th intercostal is usually the nipple line on dudes) Needling Trans-obl, ½ – 0.8 cun either lateral or medial Caution: perp insert = risk of pneumothorax. Lateral side of chest, 4th intercostal space, Trans-obl, ½ – 0.8 cun either 6 cun to midline. lateral or medial SP 18 Caution: perp insert = risk of pneumothorax. Lateral side of chest, 3rd intercostal space, 6 cun to midline. SP 19 Trans-obl, ½ – 0.8 cun either lateral or medial Caution: perp insert = risk of pneumothorax. Lateral side of chest, 2nd intercostal space, 6 cun to midline. SP 20 Trans-obl, ½ – 0.8 cun either lateral or medial Caution: perp insert = risk of pneumothorax. SP 21 Great Luo Connecting of the Spleen Located on the mid-axillary line (from Trans-obl along intercostal front edge of armpit crease to back edge), space ½ – 1 cun level with the 6th or 7th intercostal space Caution: perp insert = risk of pneumothorax. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 21 Heart Channel of the Hand Shaoyin Pt HT 1 HT 2 Category Loc Depression at center of axilla. Needling Perpendicular ½ – 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. Pneumothorax 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 ½ – 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. 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. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 22 Great point for blurry vision due to the cnx between heart and eyes. Pt HT 3 Category He Sea point Loc Medial end of the transverse cubital crease when the elbow is fully flexed. Needling Perpendicular ½ – 1 cun To locate: Elbow slightly flexed: Midway between end of cubital crease and the bump of the humeral epicondyle. Elbow fully flexed: Medial edge of the transverse cubital crease. HT 4 Jing River point Radial side of the flexor carpi ulnaris, 1.5 cun proximal to HT 7. Perpendicular 0.3 – ½ 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 – ½ 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 – ½ 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 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. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 23 Perpendicular 0.3 – ½ cun Caution: Ulnar nerve and artery lie adjacent to this point. Pt HT 8 Category Ying Spring point Loc Between the 4th and 5th metacarpal bones where the tip of the pinkie rests when you make a fist. Needling Perpendicular 0.3 – ½ cun Usually located between the two transverse palmar creases. HT 9 Jing-Well point Dorsal aspect of pinkie on the radial corner of the fingernail. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 24 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 – ½ 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 – ½ 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: Have patient lie hand flat on a table or on their leg. Place the point of your finger on the styloid high point of the ulna just below the dorsal crease of their wrist. Have patient rotate wrist so the flat of their palm lies on their chest. Your finger should fall into a depression that is SI 6. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 25 Perpendicular ½ – 0.8 cun KNOW: Indicated for— 1) eye degeneration due to aging. 2) Headaches 3) Acute lower back pain 4) Shoulder joint pain such as bursitis or tendonitis. Pt SI 7 Category Luo-connecting point Loc Inline with SI-5 and SI-8, 5 cun proximal to SI-5. Needling Perpendicular ½ – 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 – ½ 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 1-1½ cun 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 1-1½ cun 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 ½ -1½ 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 ½ - 1cun Cat’s Notes Point Location III – Comprehensive from Class I - III Page 26 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: pneumothorax 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 ½ - 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 ½ - 1 cun 2 cun lateral to Du 14 (lower border of C7 spin process Oblique scapula ½ - 1 cun Caution: Risk of pneumothorax if point is angled to medially. Caution: pneumothorax Caution: pneumothorax 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) Perpendicular 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 Perpendicular 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. Perpendicular 0.3 - ½ cun SI 19 Contra: moxa Meeting of SI, SJ, Just anterior to the tragus of the ear (or the Perpendicular ½ - 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. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 27 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 Cat’s Notes Point Location III – Comprehensive from Class I - III Page 28 Pt Bl 8 Category Loc 5½ 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: pneumothorax 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: pneumothorax Cat’s Notes Point Location III – Comprehensive from Class I - III Page 29 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: pneumothorax 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 : pneumothorax 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: pneumothorax 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 : pneumothorax 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: pneumothorax 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: pneumothorax Cat’s Notes Point Location III – Comprehensive from Class I - III Page 30 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: pneumothorax 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: pneumothorax 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 : pneumothorax 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 Cat’s Notes Point Location III – Comprehensive from Class I - III Page 31 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: Perpendicular 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 Meeting of BL and GB S3, over 3rd sacral foramen Perp, ½ - 1½ cun Bl 34 Meeting of BL and GB S4, over 4th sacral foramen Perp, ½ - 1½ cun ½ cun lateral to the tip of the coccyx Perp, 1 - 1½ cun Bl 35 Upper leg points Bl 36 Mid point of gluteal crease in depression between the hamstrings Inline with 36, 37, 40 Cat’s Notes Point Location III – Comprehensive from Class I - III Page 32 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 of BL Lower He-Sea of BL 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. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 33 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. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 34 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. Perpendicular 0.1 – 0.2 -orPrick to bleed Caution: Can turn the fetus from breach. Expedites delivery. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 35 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-perpendicular 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. 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. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 36 Obl-perpendicular away from the bone, ½ - 1 cun. Pt K7 Category Jing River Loc 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. 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 K8 Xi Cleft of Yin Qiao 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 Perpendicular 1 – 1½ cun Caution: bladder punc Cat’s Notes Point Location III – Comprehensive from Class I - III Page 37 Pt K 14 Category Mtg of Kidney and Chong Loc 3 cun superior to K11, 2 cun inferior to umbilicus and ½ cun lateral to midline Needling Perpendicular 1 – 1½ cun Caution: peritoneal punc K 15 K 16 Mtg of Kidney and Chong Mtg of Kidney and Chong 1 cun inferior to umbilicus, ½ cun lateral to midline Level with the center of the umbilicus, ½ cun lateral to midline Perpendicular 1 – 1½ cun Caution: peritoneal punc Perpendicular 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 Perpendicular 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 Perpendicular 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 Perpendicular ½ - 1 cun 5 cun superior to umbilical center, ½ cun lateral to midline Perpendicular 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. Perpendicular ½ - 1 cun Caution: Right side = LV punc Left side = peritoneal punc Cat’s Notes Point Location III – Comprehensive from Class I - III Page 38 Pt Category Loc Needling 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 K 24 3rd IC space, 2 cun lateral to midline Trans along IC space, ½ - 0.8 cun Caution: LU punc Trans along IC space, ½ - 0.8 cun Caution: LU punc K 25 2nd IC space, 2 cun lateral to midline Trans along IC space, ½ - 0.8 cun Caution: LU punc K 26 1st IC space, 2 cun lateral to midline Trans along IC space, ½ - 0.8 cun Caution: LU punc K 27 Top of 1st IC space, depression on lower border of clavicle, 2 cun lateral to midline Trans along IC space, ½ - 0.8 cun Caution: LU punc Cat’s Notes Point Location III – Comprehensive from Class I - III Page 39 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: pneumothorax. 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 radialis, in line between P3-P7. Perpendicular ½ - 1 cun 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. Perpendicular ½ - 1 cun P6 2 cun prox to P7 between the tendons of the palmaris longus and the flexor carpi radialis, in line between P3-P7. Perpendicular ½ - 1 cun Luo Connecting Confluent of Yin Wei Shu Stream Yuan Source 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. Perpendicular 0.3 – ½ cun P7 Cat’s Notes Point Location III – Comprehensive from Class I - III Page 40 Caution: median nerve Pt P8 Category Ying Spring Ghost Loc On the palm between the 2nd and 3rd MC in a depression on the radial side of the 3rd MC. Needling Perp, 0.3 – ½ cun 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 Cat’s Notes Point Location III – Comprehensive from Class I - III Page 41 Perpendicular 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. Perpendicular 0.3 – ½ cun SJ 3 Shu Stream Have the pt make a loose fist and the point is probably located at the proximal end of the crease between the 2 fingers. Dorsum of the hand in a depression just Perp, ½ - 1 cun proximal to the metacarpo-phalangeal knuckle. 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). Perpendicular 0.3 – ½ cun Note: follow the space between MC 4 and 5 to the wrist joint. SJ 5 SJ 6 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. Perpendicular 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. Perpendicular 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 Cat’s Notes Point Location III – Comprehensive from Class I - III Page 42 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. Pt SJ 7 Category Xi Cleft of SJ SJ 8 SJ 9 Loc Needling Level with SJ 6 (3 cun prox to SJ4) on the Perpendicular 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. Perpendicular ½ - 1 cun Depression between radius and ulna 5 cun distal to the level of the olecranon, 7 cun proximal to SJ4 Perpendicular 1 – 2 cun. Or you can angle it up or down the channel 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 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. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 43 Perp, 0.8 – 1½ cun Pt SJ 14 Category Loc At the origin of the deltoid muscle in a depression posterior and inferior to the lateral extremety of the acromion. Needling Perpendicular 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. Perp, ½ - 1 cun Caution: deep insert perpendicular = pneumothorax. Alt: mid point of GB 21 and SI 13. SJ 16 Window of Sky Posterior border of SCM level with the angle of the jaw. 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) SJ 20 Mtg SJ, SI, GB Cat’s Notes Point Location III – Comprehensive from Class I - III Page 44 Pt SJ 21 Category Loc In a depression anterior to the supratragic notch, slightly superior to the condyloid process of the mandible. Needling Inferior/obl and slightly posterior, 0.3 – ½ cun 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. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 45 Gallbladder Channel of the Foot Shaoyang Pt GB 1 Category Loc Depression on lateral border of the orbital margin, ~ ½ cun lateral to the outer canthus. Needling Trans, 0.3 – ½ cun. Contra: Moxibustion (SJ 23 is very close to here) Gb + si + sj Depression just in front of intertragic notch. Point is posterior to condyloid process of mandible. GB 2 Perpendicular 0.3 – ½ cun Grouping just posterior to anterior border of the ear: SJ 21 on top, SI 19 middle, GB2 bottom. Locate with mouth open. GB 3 On the upper border of the zygomatic arch. Anterior to the ear and directly superior to ST 7. Perpendicular 0.3 – ½ cun Find this point in relation to ST 8 and GB 7. All scalp acupuncture techniques apply here. ¼ of the distance between ST 8 and GB 7 (just below ST 8) on a curved line. Transverse insert ½ - 0.8 cun, 15° angle Gb + sj + st GB 4 Gb + sj + st Easiest way to find: 1. Locate ST 8 and GB 7 2. Find the middle distance between these 2 on a gently curved line. This is GB 5. 3. Locate GB 4 ½ way between GB 5 and ST 8 GB 5 Find this point in relation to ST 8 and GB 7. All scalp acupuncture techniques apply here. ½ of the distance between ST 8 and GB 7 on a curved line. Transverse insert ½ - 0.8 cun, 15° angle Cat’s Notes Point Location III – Comprehensive from Class I - III Page 46 Pt GB 6 Category Loc Find this point in relation to ST 8 and GB 7. Needling All scalp acupuncture techniques apply here. ¼ of the distance between ST 8 and GB 7 (just above GB 7) on a curved line. Transverse insert ½ - 0.8 cun, 15° angle Easiest way to find: 4. Locate ST 8 and GB 7 5. Find the middle distance between these 2 on a gently curved line. This is GB 5. 6. Locate GB 6 ½ way between GB 7 and GB 5 GB 7 In temporal region in the hairline. Level with apex if the ear (SJ 20) and one finger breadth anterior to this point. All scalp acupuncture techniques apply here. Trans ½ - 1 cun, 15° angle Can also be located at the intersection of a line level with the apex of the ear and the line demarking the anterior edge of the ear. GB 8 In a slight depression 1 cun above the apex of the ear (SJ 20). All scalp acupuncture techniques apply here. Trans ½ - 0.8 cun, 15° angle GB 9 Slight depression ½ cun posterior to GB 8. All scalp acupuncture techniques apply here. Trans ½ - 0.8 cun, 15° angle GB 10 Located in relation to GB 9 and GB 12. 1/3 of the distance between GB 9 and 12 on a line following the curve of the ear, closer to GB 9. (Similar to SJ 17-20 which does the same, but is closer to the ear.) Cat’s Notes Point Location III – Comprehensive from Class I - III Page 47 All scalp acupuncture techniques apply here. Trans ½ - 0.8 cun, 15° angle Pt GB 11 Category Loc Located in relation to GB 9 and GB 12. 1/3 of the distance between GB 9 and 12 on a line following the curve of the ear, closer to GB 12. (Similar to SJ 17-20 which does the same, but is closer to the ear.) Needling All scalp acupuncture techniques apply here. Trans ½ - 0.8 cun, 15° angle GB 12 Depression just posterior to the lower border of the mastoid process. (SJ 17 is just anterior to this process) Obl-inferior ½ - 1 cun GB 13 On the forehead, ½ cun into the anterior hairline. 2/3 of the distance between Du 24 and ST 8. (3 cun lateral to Du 24) All scalp acupuncture techniques apply here. Midway between the inner and outer canthus of the eye and 1 cun superior to the eyebrow/supraorbital ridge. GB 14-20 are inline. Pinch and insert trans-inferior. ½ - 1 cun. GB 14 Trans ½ - 1 cun, 15° angle (can also use mid eyebrow or just above the pupil when pt is looking straight fwd) GB 15 ½ cun into the anterior hairline, midway All scalp acupuncture between Du 24 and ST 8 (directly superior techniques apply here. to GB 14). Trans ½ - 1 cun, 15° angle Inline between GB 14 – 20. GB 16 1½ cun into the anterior hairline, 1 cun posterior to GB 15. All scalp acupuncture techniques apply here. Inline between GB 14 – 20. Trans ½ - 1 cun, 15° angle 2½ cun into the anterior hairline, 1 cun posterior to GB 16. All scalp acupuncture techniques apply here. Inline between GB 14 – 20. Trans ½ - 1 cun, 15° angle 4 cun into the anterior hairline All scalp acupuncture techniques apply here. GB 17 GB 18 Inline between GB 14 – 20 Trans ½ - 1 cun, 15° angle Cat’s Notes Point Location III – Comprehensive from Class I - III Page 48 Pt GB 19 Category Loc In a depression in the occipital region, level with Du 17 and BL 9. About 1 cun lateral to BL 9. Inline between GB 14 – 20. In a depression between the origins of the SCM and the trapezius muscles on the lower margin of the skull. GB 20 (Midway between Du 16 and GB 12) Needling All scalp acupuncture techniques apply here. Trans-inferior ½ - 1 cun, 15° angle Either one of these: 1. Insert so is pointing toward the tip of the nose, ½ - 1.2 cun, slightly perpoblique. 2. Trans toward the middle. GB 21 On the crest of the trapezius muscle on the Either one of these three: shoulder. 1. Perp, ½ cun 2. Transverse along trapezius From the front: ½ - 1 cun. Find the midpoint of the clavicle and take 3. Obl-posterior, ½ - 1 cun this level up to the apex of the shoulder. Contra: preggers From the back: Find the midpoint between the lower Caution: Deep perpendicular border of the spinous process of C7 and = pneumothorax the apex of the acromion. Take this level up to the apex of the shoulder. GB 22 On mid-axillary line in the 4th IC space (some texts say 5th IC space) Trans with IC space, ½ - 1 cun. Caution: deep perpendicular = pneumothorax. 1 cun anterior to GB 22 and along the 4th IC space. GB 23 Trans with IC space, ½ - 1 cun. Caution: deep perpendicular = pneumothorax. GB 24 Mtg GB and SP Front Mu GB On the level of the mamillary line in the 7th IC space. Trans, ½ - 1 cun along IC space. If 7th IC space does not extend as far as the mamillary line, place point on medial end of the IC space. Caution: deep perpendicular = pneumothorax. For men, count down. For women, count up from free end of 11th rib. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 49 Pt GB 25 Category Front Mu of Kidney Loc Edge of the tip of the 12th rib. Locate the 11th rib first, palpate back from here. Can be hard, as may float under another rib. Needling Perpendicular or oblique, ½ - 0.8 cun. Caution: deep perpendicular needling may penetrate the peritoneal cavity. Note: May be located more on the back than the front of patient’s body. GB 26 Meeting point of the GB and Dai vessel At the intersection of a vertical line drawn through the free end of the 11th rib and a horizontal line drawn through the center of the umbilicus. Perpendicular, ½ - 0.8 cun GB 27 Meeting point of the GB and Dai vessel In a depression just anterior to the ASIS (anterior superior iliac spine). Off of the bony point by about ½ cun. Perpendicular 1 – 1½ cun GB 28 Meeting point of the GB and Dai vessel ½ cun anterior and inferior to GB 27 Perpendicular 1 – 1 ½ cun GB 29 Meeting point of the GB and Yang Qiao vessel On the lateral aspect of the hip joing at the Perpendicular 1 – 2 cun. midpoint of a line drawn between the ASIS and the prominence of the greater Can also moxa, especially if trochanter of the hip. the hip hurts when the patient is in a cold environment. Move the leg to feel the hip movement. Also, is the high point of the hip when the patient is lying on their side. GB 30 On the posterior/lateral side of the hip. Draw a line from the greater trochanter of the hip and the sacral hiatus. This point lies on the border between the lateral 1/3 and the medial 2/3. To find the sacral hiatus, start at the tailbone and palpate upwards. This is where the sacrum gets more vertical. There are also 2 “thorns” on either side of the hiatus. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 50 Perpendicular 2 – 3.5 cun. Pt GB 31 Category Loc On the midline of the lateral aspect of the thigh 7 cun superior to the popliteal crease. Needling Perpendicular 1 ½ - 2 cun Have the patient stand up straight and drop the arms to the sides. Be sure the chest is straight. GB 31 is located on the level of where the tip of the middle finger hits the thigh. GB 32 On the midline of the lateral side of the thigh about 2 cun inferior to GB 31 and in between the vastus lateralis and biceps femoris muscles. Perpendicular 1 – 2 cun GB 33 On the lateral side of the knee in a depression above the lateral epicondyle of the femur, between the femur and the tendon of the biceps femoris. Perpendicular 1 – 2 cun Bend the leg to see the tendon. Follow the tendon above the lateral epicondyle. GB 34 GB 35 He Sea of GB Lower He Sea of GB Hui of Sinews 1 cun anterior and inferior to the head of the fibula. Xi Cleft of the Yang Wei/Linking vessel On the lateral aspect of the lower leg 7 cun superior to the prominence of the lateral malleolus and 9 cun inferior to the popliteal crease. On the posterior aspect of the fibula. Perpendicular 1 – 1 ½ cun Locate the high point of the head of the fibula and the high point of the head of the tibula. GB 34 is located in a spot that would make an equilateral triangle of these 3 points. Find the midpoint between the popliteal crease and the high point of the lateral malleolus. Go inferior by 1 cun. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 51 Perpendicular 1 – 1 ½ cun Pt GB 36 Category Xi Cleft of GB Loc On the lateral aspect of the lower leg 7 cun superior to the prominence of the lateral malleolus and 9 cun inferior to the popliteal crease. On the anterior aspect of the fibula. Needling Perpendicular 1 – 1 ½ cun Find the midpoint between the popliteal crease and the high point of the lateral malleolus. Go inferior by 1 cun. GB 37 Luo Connecting of GB 5 cun superior to the prominence of the lateral malleolus on the anterior border of the fibula. Perpendicular 1 – 1 ½ cun GB 38 Jing River 4 cun superior to the prominence of the lateral malleolus on the anterior border of the fibula. Might be slightly anterior to this border. Perpendicular 0.8 – 1.2 cun GB 39 Hui Meeting point of Marrow 3 cun superior to the prominence of the lateral malleolus and on the posterior border of the fibula. Perpendicular 1 – 1 ½ cun GB 40 Yuan Source At the intersection of a line drawn vertical ½ - 0.8 cun to the anterior border of the lateral malleolus and a line drawn horizontally to the bottom margin of the lateral malleolus. GB 41 Shu Stream Confluent point of Dai vessel In a depression 1) lateral to the tendon of the extensor digitorum longus and 2) distal to the junction of the 4th and 5th metatarsal bones. Perpendicular 0.3 – ½ cun 1) medial to the tendon of the extensor digitorum longus 2) proximal to the heads of the 4th and 5th metatarsal bones. Perpendicular ½ - 0.8 cun. GB 42 Curl the toes to see this knuckle more easily. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 52 Pt GB 43 Category Ying Spring Loc Between the fourth and little toe at the point where the skin changes color/texture and distal to the knuckles of the toes. Needling Perpendicular 0.3 – ½ cun. Can also locate this at the tip of the crease between the 2 lateral toes. Curl the toes to see this. Spread the toes to see the line where the skin changes color/texture. GB 44 Jing Well On the lateral corner of the nail of the 4th toe. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 53 Perpendicular 0.1 or 0.2 cun. Or prick to bleed. Liver Channel of the Foot Jueyin Pt LV 1 Category Jing Well Loc Lateral corner of the big toenail, 0.1 cun off the corner. Needling Perp 0.1 – 0.3 cun, moxa, or prick to bleed. LV 2 Ying Spring Between the 1st and 2nd toes at the tip of the crease between the 2. Oblique or perp ½ - 1 cun Also, where the red/white skin meet in the webbing, about ½ cun from the web margin LV 3 Shu Stream Yuan Source In the hollow just distal to the junction of the bases of the 1st and 2nd MT bones Perp ½ - 1 cun Do not locate this too distally! LV 4 LV 5 Jing River Luo Connecting Level with and anterior to the prominence of the medial malleolus and just medial to the tendon of the tibialis anterior. Dorsiflex the ankle and the big toe to see this clearly. Needle into the depression here. Perp ½ - 1 cun 5 cun proximal to the prominence of the medial malleolus. ON the bone, midway between the anterior and medial crests of the tibia. Perp ½ - 1 cun Note: SP 5 is loc’d just below this, level with the intersection of the anterior and inferior margins of the med mal. (Reminder: pop crease prom med mal = 15cun) LV 6 LV 7 Xi Cleft 7 cun proximal to the prominence of the medial malleolus. ON the bone, midway between the anterior and medial crests of the tibia. Trans, ½ - 0.8 cun Posterior and inferior to the medial epicondyle of the tibia. Also, about 1 cun posterior and superior to SP 9 and on the lower margin of the epicondyle. Perp, 1 – 1 ½ cun Cat’s Notes Point Location III – Comprehensive from Class I - III Page 54 Pt LV 8 Category He Sea Loc Located at the medial end of the popliteal crease in a depression between the tendons of the semitendinosus and semimembranosus and medial epicondyle of the femur. Needling Perp, 1 – 1 ½ cun Flex the knee to find this point when possible, but needle relaxed. LV 9 4 cun proximal to the medial epicondyle of the femur on the medio-anterior aspect of the thigh between the vastus medialis and the sartorius muscles. Perp or obl 1 – 1 ½ cun LV 10 3 cun inferior to ST 30 Perp, ½ - 2 cun LV 11 2 cun inferior to ST 30 Perp, ½ - 2 cun LV 12 1 cun inferior to ST 30 and about ½ cun lateral to it. Medial, slightly oblique insert, ½ - 0.8 cun. This is also on the lower border of the pubic symphysis, but that’s rather hard to feel and somewhat personal! Caution: femoral vein. Front Mu of SP Hui of Zang Mt of LV/GB Slightly anterior and inferior to the free end of the 11th rib. Be sure you are off the bone! Trans, ½ - 0.8 cun From Mu of LV Mt LV/SP + Yin Wei Mamillary line, in 6th IC Trans or obl, ½ - 1 cun LV 13 LV 14 Cat’s Notes Point Location III – Comprehensive from Class I - III Page 55 Caution: deep perp can = enlg’d liver or spleen Du/Governing Channel Pt Du 1 Du 2 Category Luo Connecting Loc Between rectum and tip of coccyx Needling Perp ½ - 1 cun Obl along coccyx upward Posterior midline of body in the scarococcygeal haitus Obl-superior ½ - 1 cun Palpate strating at coccyx, upward, straight vertical part is the haitus area. Feel for a big depression here, inferior to the 4th sacral spinous process. This is the hiatus. Du 3 Level with lower border of the spinous process of L4, right on the posterior midline. Perp ½ - 1 cun Du 4 Level with lower border of the spinous process of L2, right on the posterior midline. Du 5 Level with lower border of the spinous process of L1, right on the posterior midline. Perp ½ - 1 cun Moxa, warm needle (Moxa contra for ppl under 20) Perp ½ - 1 cun Du 6 Level with lower border of the spinous process of T11, directly on the posterior midline. Perp, but slightly upwards between the vertebrae, ½ - 1 cun. Du 7 Level with lower border of the spinous process of T10, directly on the posterior midline. Perp, but slightly upwards between the vertebrae, ½ - 1 cun. Du 8 Level with lower border of the spinous process of T9, directly on the posterior midline. Perp, but slightly upwards between the vertebrae, ½ - 1 cun. Du 9 Level with lower border of the spinous process of T7, directly on the posterior midline. Perp, but slightly upwards between the vertebrae, ½ - 1 cun. Du 10 Level with lower border of the spinous process of T6, directly on the posterior midline. Perp, but slightly upwards between the vertebrae, ½ - 1 cun. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 56 Pt Du 11 Loc Level with lower border of the spinous process of T5, directly on the posterior midline. Needling Perp, but slightly upwards between the vertebrae, ½ - 1 cun. Du 12 Level with lower border of the spinous process of T3, directly on the posterior midline. Perp, but slightly upwards between the vertebrae, ½ - 1 cun. Du 13 Level with lower border of the spinous process of T1, directly on the posterior midline. Perp, but slightly upwards between the vertebrae, ½ - 1 cun. Du 14 Category Mtg of Du with 6 yang channels of hand/foot Point of the Sea of Qi Level with the lower border of the spinous Perp, but slightly downwards, process of C7, directly on the ½ - 1 cun. posteriormidline. Use w/reducing method! Du 15 Mtg of Du with Yang Linking Level with GB 20, in a depression ½ cun inferior to Du 16. Perp, but slightly downwards, ½ - 1 cun. Du 16 Midline of neck, depression just below external occipital protuberance. Perp, but slightly downwards, ½ - 1 cun. Towards chin. In a depression directly superior to the external occipital protuberance on the back of the head Scalp needling techs apply. Du 17 Window of Sky Du + Yang Wei Ghost 1.5 cun superior to Du 16 Du 18 Midline of the back of the head, 1.5 cun directly superior to Du 17 Scalp needling techs apply ½ way between Du 16 and Du 20 Du 19 Midline of the back of the head, 1.5 cun superior to Du 18 1.5 cun posterior to Du 20 3 cun superior to Du 17 Cat’s Notes Point Location III – Comprehensive from Class I - III Page 57 Scalp needling techs apply Pt Du 20 Category Du + Bl, GB, SJ, Liver Loc Vertex in a depression 5 cun posterior to the anterior hairline, 7 cun superior to the posterior hairline Needling Scalp needling techs apply. 1. Draw a line starting at the low point of the ear lobe, through the ear apexes and up to the to pof the head. 2. Where this line intersects with the midsagittal line is Du 20. Du 21 1.5 cun anterior to Du 20 3.5 cun posterior to the front hairline Scalp needling techs apply Du 22 2 cun posterior to the anterior hairline on the midline of the head. 3 cun anterior to Du 20 Scalp needling techs apply. Caution: don’t use if infant’s fontanelle is not closed. Du 23 Ghost 1 cun posterior to the front hairline. Scalp needling techs apply Du 24 Sometimes class’d as a ghost pt Scalp needling techs apply Du 25 Du 26 Ghost Du 27 Du 28 Du + Ren + ST ½ cun posterior to the front hairline 3 cun superior to the glabella 5 cun anterior to Du 20 Midline, tip of the nose Perp, 0.2 – 0.3 cun Trans superior ½ - 1 cun Prick to bleed. Junction between the upper 1/3 and lower 2/3 of the philtrum Obl-superior, 0.3 – ½ cun Midline, junction of the margin of the upper lip and philtrum Obl-superior, 0.2 – 0.3 cun Between the upper lip and gum in the superior frenulum Prick to bleed Cat’s Notes Point Location III – Comprehensive from Class I - III Page 58 Ren/Conception Channel Pt Ren 1 Category Ghost Ren 2 Loc All points on the Ren channel are located on the anterior midline of the body. Needling At the perineum, ½ way between the rectum and genitalia (scrotum or posterior labial commissure) Perp, less than 1 cun Perp, ½ - 1 cun Ren 3 Front Mu BL Use proportional measuring on all ab points! Caution: possible bladder puncture with deep needling. Have pt empty bladder 1st if possible 1 cun superior to upper border of the pubic symphysis 4 cun inferior to the umbilicus Perp, ½ - 1 cun 2 cun superior to upper border of the pubic symphysis 3 cun inferior to the umbilicus Perp, 1 – 1 ½ cun Moxa w/ginger for Kd yang xu Ren 4 Front Mu SI “Dantian!” Superior border of the pubic symphysis 5 cun inferior to the umbilicus. Caution: possible bladder puncture with deep needling. Have pt empty bladder 1st if possible Caution: possible bladder puncture with deep needling. Have pt empty bladder 1st if possible Ren 5 Front Mu SJ Ren 6 Ren 7 Ren + Chong 3 cun superior to upper border of the pubic symphysis 2 cun inferior to umbilicus Perp, 1 – 1 ½ cun 3.5 cun superior to upper border of pubic symphysis 1.5 cun inferior to umbilicus Perp, 0.8 – 1 ½ cun 4 cun superior to upper border of pubic symphysis 1 cun inferior to umbilicus Perp, 1 – 2 cun Cat’s Notes Point Location III – Comprehensive from Class I - III Page 59 Contra: preggers Caution: periotoneal punc Caution: peritoneal punc Caution: peritoneal punc Pt Ren 8 Category Ren 9 Loc Center of umbilicus Needling Contra to needling, but good for massage or moxa with salt, ginger, or garlic. Shen says you can flash cup as well with good results. Perp, 0.8 – 1 ½ cun 1 cun superior to umbilicus 7 cun inferior to sternal costal angle Contra: no moxa in preggers Caution: peritoneal punc Ren 10 2 cun superior to umbilicus 6 cun inferior to sternal costal angle Perp. 1 – 1 ½ cun Contra: no moxa in preggers Caution: peritoneal punc Ren 11 3 cun superior to umbilicus 5 cun inferior to sternal costal angle Perp ½ - 1 ½ cun Caution: peritoneal punc Ren 12 -Front Mu ST -Hui of Fu Ren 13 4 cun superior to umbilicus Midway between umbilicus and sternal costal angle Perp, 0.8 – 1 ½ cun 5 cun superior to umbilicus 3 cun inferior to sternal costal angle Perp, 0.8 – 1 ½ cun Caution: peritoneal punc Caution: peritoneal punc Ren 14 Front Mu HT 6 cun superior to umbilicus 2 cun inferior to sternal costal angle Perp, 0.3 – 0.8 cun If xyphoid proc extends this far, however, transverse or obl Caution: palpate for enlarged organs. Never insert superiorly toward heart! Ren 15 Luo Connecting 7 cun superior to umbilicus 1 cun inferior to sternocostal angle Perp, shallow If on xyphoid process or sternum, oblique ½ - 1 cun. Caution: palpate for enlarged organs. Never insert superiorly toward heart! Ren 16 On sternum, level with 5th IC space Cat’s Notes Point Location III – Comprehensive from Class I - III Page 60 Trans, 0.3 – ½ cun Pt Ren 17 Loc On sternum, level with 4th IC space Needling Trans ½ - 1 cun, with or against the channel Ren 18 On sternum, level with 3rd IC space Trans ½ - 1 cun, with or against the channel Ren 19 On sternum, level with 2nd IC space Trans ½ - 1 cun with or against the channel Ren 20 On sternum, level with 1st IC space Trans ½ - 1 cun with or against the channel Ren 21 On the manubrium, midway between Ren 20 and Ren 22 Trans inferiorly, ½ - 1 cun Perp for 0.3 – ½ cun, then inferiorly behind muscle and anterior to esophagus. Dangerous but tradit! Shallowly into muscle layer, but deep enough to stand on it’s own. Safer! Ren 22 Category -Front mu PC -Hui of Qi Window of Sky Center of the suprasternal fossa ½ cun superior to suprasternal notch Anterior midline of neck in the depression above the hyoid bone Ren 23 Oblique superior toward root of tongue, ½ - 1 cun Slide finger down from chin until it hits the border of the bone. Ren 24 Ghost Above the chin in the depression in the center of the mentolabial groove Cat’s Notes Point Location III – Comprehensive from Class I - III Page 61 Perp oblique, 0.3 – ½ cun Extra Points Name Qian Zhong “to pull straight” Location ½ - 1 cun (palpate for tenderest point) anterior to lowest point of ear lobe. Indication/Contras Deviation of the mouth Ulcers in mouth or on tongue Needle Tech Perp or obl, ½ - 1 cun Sishencong “4 intelligence points” 4 points, 1 cun anterior, posterior, and lateral to Du 20. Physical: Headache Vertigo Functional: Poor memory and concentration Insomnia Epilepsy/seizure attacks Trans, ½ - 1 cun Yintang “Hall of Seals” At glabella, midpoint between medial ends of eyebrows Emotional imbalances of all kinds including stress, anxiety, bipolar, etc. Headache, pain in forehead Vertigo Insomnia Nasal congestion, discharge, bleeding. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 62 1 From Du 20, outward to Sishencong (most stimulation for Du 20) 2 From Sishencong inward to Du 20 (less stimulation for Du 20) 3 Tonifying: Clockwise from one Sishencong to the next 4 Reducing: Counterclockwise from one Sishencong to the next Pinch and insert transversely either inferior down (most common), up, or lateral. 0.3 – ½ cun Name Yuyao “fish waist” Location Mid point of inner and outer canthus on the eyebrow (or mid eyebrow) Indication/Contras Eye and orbital area: Redness, swelling, pain, cloudiness Eyelids Ptosis and twitching Needle Tech Pinch, needle trans medial, lateral, or twd manifestation. ½ - 1 cun Qiuhou “Behind the ball” ¼ mark from the outer canthus to the inner canthus along the inferior edge of the orbit. All kinds of eye diseases, including those of vision and physical malfunction. All eye area needling techniques apply (i.e., push eyeball out of the way with a clean cotton ball, no manipulation, press to avoid hematoma, communicate w/pt, etc.) Cautions: all eye area needling techniques apply In obvious depression abt 1 cun posterior to midpt between lat extreme of eyebrow and outer canthus Erjian Apex of the ear Bitong Bailao “Hundreds of taxations” Taiyang Headache, migraine in temporal region Eye problems Perp 0.3 – ½ cun Prick to bleed Clear toxic heat, fever, conjunctivitis Prick to bleed Highest point of the nasolabial groove, close to LI 20 Symptomatic nasal allergies, rhinitis, congestion and discharge, nasal bleeding, polyps Trans twd bridge of nose or twd LI 20. 0.3 – ½ cun Alt: from LI 20 to Bitong 2 cun superior to C7 and 1 cun lateral to the midline Lung tuberculosis Also called consumption – sob, cough, night sweats, spontaneous sweating, bone steaming heat, tidal fevers, scrofula. Stiff neck Perp ½ - 0.8 cun Cat’s Notes Point Location III – Comprehensive from Class I - III Page 63 Name Location Anmian “Peaceful sleep” Behind ear, midway between GB 20 and SJ 17 on base of skull. May overlap with GB 12, but GB 12 usually posterior/slight superior to Anmian Insomnia Vertigo Headaches Bipolar disorder Perp ½ - 1 cun Jiachengjiang 1 cun lateral to Ren 24 (center of chin groove) over mental foramen Swelling and pain of gums Deviation of mouth Trans ½ - 1 cun Jinjin Yuyu On the veins on the underside of the tongue on either side of the frenulum. Jinjin is on the pt’s left side, Yuye is on the pt’s right side. Thirst, esp wasting disease type thirst like diabetes mellitus Vomiting Tongue swelling Mouth ulcers Prick on veins to bleed Jaihexue “tuberculosis point(xue)” 3 ½ cun lateral to Du 14/C7 All kinds of tuberculosis (compare to Bailao – more specific to Lung TB) Perp ½ - 1 cun Pigen “masses root (gen)” 2 ½ cun lateral to spinous process of L1. Perp ½ - 1 ½ cun Masses in the abdomen tumors, masses, fibroids, etc. Local back pain Asthma, wheezing, cough, sob Perp ½ - 1 cun Note: lower anmian is on heel ½ way between K6 and BL62 Jinjin (L) = golden liquid Yuye (R) = jade fluid Dingchuan “calm dyspnea” Indication/Contras ½ cun lateral to C7/Du 14. Treats acute, active symptoms – use during attack. For quiescent asthma, treat the root cause with acupuncture and herbs Cat’s Notes Point Location III – Comprehensive from Class I - III Page 64 Needle Tech Note: you must immobilize the tongue – either use clean gauze to grab it or use a wooden spatula to hold it back. Name Weiguanxiashu Location 1 ½ cun lateral to the T8 “stomach controller lower shu” or “insulin/diabetes point” or “pancreas shu” Indication/Contras Diabetes: wasting and thirsting disorder Dry throat Caution: pneumothorax In the 2 dimples on the lower back about 3 ½ - 4 cun lateral to L4 or L5 (Du 3) Shiqizhuixia “Below (xia) the 17th (shiqi) vertebra (zhu)” Depression below the spinous proc of L5. Slide finger up along midline sacrum until it meets the depression inferior to the lumbar spine. HuatuoJiaji Yaoyan “eyes of lower back” Yaoqi Needle Tech Obl, ½ - 1 cun. Needle toward spine. Lumbar pain: any etiology, acute or chronic Irregular or painful menstruation Perp, 1 – 1 ½ cun Lower back pain Uterus problems such as heavy bleeding Obl upwards, ½ - 1 cun between the 2 bones of the sacrum and L5 ½ cun lateral to the depressions below the spinous processes (du channel) of 12 thoracic and 5 lumbar verts. Combines the functions of Bl 1 and 2 lines as well as the Du points. Safer than back shu’s or du’s. Oblique-medial, ½ - 1 cun Place thumb on midline, needle next to thumb for correct spacing. Jiaji’s treat disorders in diff locations: T1 – T3 = upper limbs T1 – T8 = chest T6 – L5 = abdomen L1 – L5 = lower limbs 2 cun above tip of coccyx near Du 2 Seizure attacks Insomnia Headaches Cat’s Notes Point Location III – Comprehensive from Class I - III Page 65 Subcutaneous needling upwards toward the head, 1 – 2 cun Name Huan Zhong Location ½ dist between GB 30 and Du 2. Might also be worded ½ way between great trochanter and sacral hiatus Sanjiaojiu “triangle moxibustion” Lower ab in an equilateral triangle with top point at the belly button. The legs of the triangle should be the same distance as the width of the mouth Indication/Contras Sciatic pain, often more effective than GB 30. Needle Tech Perp, 1 ½ - 3 cun (depending on size of patient and depth of tissues here) Strong electrical stim w/ long needles works best Hernia Abdominal pain, especially menstrual and ab pain related to coldness Moxa only! Burn 5 – 7 cones on each side. Can be direct or indirect using ginger, garlic, aconite, etc. During menstruation or after child delivery for women and after sex/ejaculation for men, should not swim in cold water, take cold showers, or eat cold foods. The pores and channels are open during these times and the cold can invade the body easily. Takes time to show, but affects deep tissues/organs. Zigong “palace of the child” 3 cun lateral to Ren 3 Prolapse of the uterus Infertility Irregular menstruation Perp, ½ - 1 cun Occasionally used for men to treat hernia Tituo “lift and support” 4 cun lateral to Ren 4. Medial to superior iliac spine Prolapse of uterus, stomach, rectum, other organs Hernia Cat’s Notes Point Location III – Comprehensive from Class I - III Page 66 Perp ½ - 1.2 cun Name Shixuan Sifeng Location Indication/Contras 0.1 – 0.2 cun dist to nail, some overlap Coma with other points like P 9 Loss of consc Seizure Heat with high fever Palmar surface at mid pt transverse Treat malnutrition in children crease of proximal interphalangeal Whooping cough joint of index of fingers (not thumb) Needle Tech Needle superficially Retain 15-20 minutes, manipulating every 5 mintues Prick to bleed or prick on skin, squeeze out small amount of yellowish mucus. Pretty painful. Usually needle where there are dark veins or bubbles visible under the skin. Malnutrition causes this kind of bubble filled with yellowish mucus. Sifeng Study 1: after needling kids with malnutrition, calcium serum and phosphates were up, alkaline phosphatase decreased. Increases absorption of calcium from food. Sifeng Study 2: needling Sifeng in kids w/roundworm increases digestive enzyme activity. Breakdown and absorb food better. No study for adults, no material as to whether it increases digestive enzymes for adults with digestion problems. Zhong Kui “middle emminence” (CAM p249) Mid point of proximal interphalangeal joint on the dorsal side. Digestive problems, esp low appetite. Add Ren 11 for treatment. Also to treat overweight due to damp retention/SP Qi xu. Hiccups Vomiting Cat’s Notes Point Location III – Comprehensive from Class I - III Page 67 Needle superficially 0.1 – 0.3 cun or use direct moxa (5-7 cones) Name Baxie P579Deadman Location Dorsum of hand at jnx of red/white skin. End of crease when the fingers are closed. Between heads of the metacarpal bones. Indication/Contras Pain in the eyes Pain in hands/fingers Poisonous snakebite with swelling. Needle Tech Obl ½ - 1 cun or let out blood. Perp or obl ½ - 0.8 cun Some overlap with other points, like SJ 2 Luozhen On the dorsum of the hand, in the depression just proximal to the second and third metacarpophalangeal joints. Neck pain or stiffness Works better for acute than for chronic. Add LU 7 and local points with cupping, needling, elec stim. Stomach aches (less common than neck problems) Cat’s Notes Point Location III – Comprehensive from Class I - III Page 68 Name Yaotongxue P 580 Location Dorsum of hand on both sides of extensor digitorum communis tendon on the hand. Indication/Contras Acute lower back pain (not so great for chronic pain) Needle Tech Puncture obliquely from both sides toward the center of the palm. Can also puncture perpendicularly, ½ - 1 cun. Perp ½ - 1 cun Also just distal to the junction of the bones, right in front of jnx of 2nd and 3rd MC bones and 4th / 5th MC bones. Slide fingers from proximal side over the junction until falls into depression Erbai P 581 4 cun above the trans crease of the wrist on both sides of flexor carpi radialis (closest to the radial side). Pericardium channel Hemorrhoids (Herbal or surgery is better for more severe cases. Topical creams for instance, or suppositories for internal hemorrhoids.) Prolapse of rectum (less common use than for hemorrhoids) Combine with Bladder 56-57 Cat’s Notes Point Location III – Comprehensive from Class I - III Page 69 Surgical techniques, including for hemorrhoids, exist in TCM that are not allowed here in the damn US. Example: medicated threads to drain pus, stitching techniques and more. Remember Huatuo and his surgical prowess. Name Zhoujian P581 Jianqian P582 Location Indication/Contras At the tip of the elbow (tip of the ulnar Scrofula olecranon process) (uncommon in urban areas, but still seen in rural areas – some places still really hard to get to) 2 different locations, 2 methods. Both Local problems only – pain and acceptable. limited range of motion of the shoulder, pain in the arm. 1 cun above the upper end of the anterior axillary fold. Mirrors SI 9. Needle Tech Perp 1 – 1 ½ cun needled directly into the shoulder Midpoint of the line connecting the anterior end of the axillary fold and LI 15 Baichongwo “hundred bug burrow” Pg 583 1 cun above SP 10. For SP 10 or ST 34, make sure you bend the knee and locate the point at the bulge of the muscle. Heding “crane head” Pg 583 Midpoint of upper border of the patella. All kinds of skin conditions – rashes, eczema, boils, ulcers, etc. Parasites, esp in digestive system. Doesn’t kill them, but reduce sx’s. (Shen says herbal is better by far for parasites, even Western medicine – far faster) Perp 1 – 1 ½ cun Weakness, stiffness, pain of the knee Perp ½ - 1 cun. Cranes are considered good birds – longevity, purity, loyalty Cat’s Notes Point Location III – Comprehensive from Class I - III Page 70 Name Xiyan “knee eye” Location Depression medial and lateral to patellar ligament on the lower border of the patella. The lateral one overlaps with ST 35. Indication/Contras Knee joint pain Stiffness, heaviness in knee joint. There are depressions below this, so get this one right. Lanweixue “Appendix point” Located on both left and right legs, at the level 2 cun distal to ST 36. Needle Tech Perp or obl ½ - 1 cun Traditional technique: Needle towards BL 40 Some books recommend threading between the 2…Shen says not such a great idea. Acute and chronic appendicitis (Discovered by a German doc in the early part of the 20th century) Perp, 1 – 1 ½ cun 2 Studies on Lanwiexue: One study opened the abdomens of patients scheduled for this surgery, needled the point and observed the reaction of the appendix. Strong stim was applied on both legs ½ - 3 minutes (lift/thrust type manipulation, continuous). Increased movement observed in all cases, in some cases moved dramaticaly in a whirling motion! Another study: after 1 – 2 minutes after needling, increased evacuation of the appendix observed in a barium swallow test. Suggests that the infection is expelled, decreasing the infection, enabling the body to fight it off. Herbal medicine works well for appendix problems. Cat’s Notes Point Location III – Comprehensive from Class I - III Page 71 Name Dannangxue Location 1 – 2 cun below GB 34. Palpate for tenderness to pinpoint it Pg 585 Indication/Contras Gallbladder problems, inflammation of GB and biliary tract, gb stones, etc. Needle Tech Perp 1 – 2 cun. Gb 41 and 24 too. Can cause the increase of peristalsis of biliary tract and gallbladder, helping to squeeze out the contents (infection, stones) Caution: if stones are bigger than the tract, will cause a lot of pain, jaundice, etc. Make sure stones can pass. Patient needs MRI or ultrasonic exam. Must be familiar with the size of the tracts to make sure they will pass. Bafeng Dorsum of foot on depression between the webs of the toes on the margin where the skin changes color/texture Beriberi – fungus of the foot caused by vitamin deficiencies. Poisonous snake and insect bites Obl or perp ½ - 1 cun. Alt: prick to bleed. Homework: do 25 points to quiz the colleagues. Next week: whole 3 hours to practice. Come with questions!!! Cat’s Notes Point Location III – Comprehensive from Class I - III Page 72