Download Study Questions – Exam 2

Course:
Point Location 1
Document: Study Questions – Exam 2 on Wk 10
Date:
Nov 26, 2007
Study Questions – Exam 2
Do:
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
Know Chinese names of all channels (i.e. Lung – Lung Channel of the Hand Taiyin)
General path of each channel (i.e., lung begins at MJ, where it goes, etc.)
Know location of all acu points
Know categories of all points
Know needle depths/angles of points
Know cautions/contraindications of points (like LI 4 not for preggers, ST 17 not for cupping)
Don’t need to know for exams in this class:
 Don’t need to know paths of divergents, luos, just the main paths
 Don’t need to know chinese names of acupoints.
 Don’t need to know energetics/indications of any point for this class.
Know the following cun measurements:
From:
Axillary crease (anatomical neck of
humerus) to cubital crease
Lateral hairline to lateral hairline on
forehead
Distance between the mastoid
proceses on the back of the head
Front hairline to back hairline
Yintang point to front hairline
Yintang to Du 20
Front hairline to Du 20
Cubital crease to wrist crease
Sternal notch to acromion process
Sternal angle (where ribs angle in,
ends just above xyphoid proc) to
umbilicus
(Males) nipple to nipple
(Females) distance between mid
clavicular lines
Umbilicus to pubic symphysis
Gluteal fold to popliteal crease
Popliteal crease to medial malleolus
Cun:
9
9
9
12
3
8
5
12
8
8
8
8
5
14
15
Popliteal crease to lateral malleolus
Great trochanter (find this lying on
side—highest point of hip) to
anterior popliteal crease
Du 20 to back hairline
Back hairline to Du 14
Yintang to Du 14
Between medial borders of scapula
Top to bottom of patella
Index finger: proximal phalangeal
joint to tip
Thumb: width of proximal
phalangeal joint
Index+mid finger: width of
proximal phalangeal joints
16
19
7
3
18
6
2
2
1
1.5
Know these needling angles:
Angle
Oblique
Perpendicular
Perpendicular-oblique
Transverse-oblique
Transverse
See CAMS for the ones I am missing here.
Page 1 of 32
Catnotes – Study questions for Pt loc I - Exam 2
Degrees
45
90
70
20
0
Lung Taiyin Channel of the Hand
Highlights of the Lung Taiyin channel of the hand.
1. Originates in Middle Jiao
2. Two branches split at LU 7
a. Collateral channel:
Back of hand to LI channel on index finger
b. Part of Primary:
Branch to thenar eminence of the thumb
Point
LU 1
Categories
Front Mu of Lung
Meeting pt of LU and SP
Location
Level with 1st intercostal space 6 cun lateral
to midline and 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
Angle/Depth
Transverse oblique,
pointing laterally.
0.5 – 0.8 cun.
Caution/Contra
Possible pneumothorax
with deep
perpendicular needling.
Transverse oblique,
pointing laterally.
0.5 – 0.8 cun.
Possible pneumothorax
with deep
perpendicular needling.
Can palpate when pt raises arm straight out
and parallel to the ground.
LU 3
Window of Heaven/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.
Perpendicular.
0.5 – 1 cun
To locate:
1. Divide distance between tip of
Page 2 of 32
Catnotes – Study questions for Pt loc I - Exam 2
Point
Categories
LU 4
LU 5
LU 6
LU 7
He Sea point of LU
Water point of LU
Xi cleft point of LU
Luo connecting pt of LU
Command pt head/nape
Location
axillary fold and cubital crease
(9cun) into thirds.
2. Find border between top 1/3 and
bottom 2/3.
Point lies on this borderline in
groove between lateral border of
biceps brachii and shaft of humerus.
3.
In upper arm, groove between lateral border
of biceps brachii and shaft of humerus.
To locate:
1. Divide distance between tip of
axillary fold and cubital crease
(9cun) into thirds.
2. Find border between top 1/3 and
bottom 2/3. Go down 1 cun in
groove between lateral border of
biceps brachii and shaft of humerus..
Cubital crease of elbow in radial side
depression next to the tendon of the biceps
brachii.
Angle/Depth
Perpendicular
0.5 – 1 cun
Perpendicular
0.8 – 1.2 cun
Slightly flex the elbow for easiest find.
On flexor aspect of forearm in a line
between LU 5 and LU 9.
Perpendicular
0.5 – 1 cun
To locate:
1. Locate LU 5 and LU 9
2. Divide the distance between LU 5
and LU 9 in ½ and go 1 cun
proximal on this line.
Should be a palpable depression here.
Radial forearm superior to styloid process
of radius. (abt 1.5 cun prox to LI 5)
Pinch skin, insert either
with or against the channel.
Page 3 of 32
Catnotes – Study questions for Pt loc I - Exam 2
Caution/Contra
Point
Categories
Location
Between tendons of brachioradialis and
abductor pollicus longus
Convenient though not always accurate
locator: hook thumbs together and find
point where index finger tip falls.
LU 8
Jing River pt of LU
Metal pt of LU
Note: not on line with LU 5 and LU 9
1 cun proximal to LU 9 in a line connecting
LU 5 and LU 9
Angle/Depth
Transverse
0.5 – 1 cun per Deadman
0.3 – 0.5 per CAMS
Oblique (proximally)
Perpendicular
0.3 – 0.5 cun.
Find the depression at the base of the styloid
process radius and the radial artery. Point is
between these 2.
LU 9
Shu Stream pt of LU
Yuan Source pt of LU
Hui Mtg pt of Vessels
Earth pt of LU channel.
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 pt of LU
Fire pt of LU
Level with Heart (HE) 7 point.
On thenar emminence, midway down the
shaft of the 1st metacarpal (thumb).
LU 11
Jing Well pt of LU
Wood pt of LU
Ghost pt (sun simiao)
Locate the point on the border of the red
and white skin (or where skin changes
textures)
Outer corner of thumbnail.
To locate:
Draw a line down the radial edge of the nail
and along the base line of the nail. Point is
locate on their intersection.
Caution/Contra
Beware of the radial
artery!!
Takes about 5 minutes
to stop bleeding should
you hit it.
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
0.1 cun from corner of nail.
Page 4 of 32
Catnotes – Study questions for Pt loc I - Exam 2
Page 5 of 32
Catnotes – Study questions for Pt loc I - Exam 2
Large Intestine Yangming Channel of the Hand
Highlights of the LI channel
1. Channel crosses midpoint of body, ends on opposite side from start.
2. LI 4 is command pt for face/mouth
a. Use right LI 4 to treat problems no left face/mouth
b. Use left LI 4 to treat problems on right face/mouth
3. Bilateral channel
4. Twenty points going from lateral index finger nail to naso-labial groove at side of the wing of the nose.
Point
LI 1
LI 2
Categories
Jing Well pt of LI
Metal pt of LI
Ying Spring pt of LI
Water pt of LI
Location
Radial edge of corner of index fingernail.
Draw a line down from radial border of the
nail and the base of the nail. Junction of
these lines is the point, approx 0.1 cun from
the corner of the nail.
Radial border of index finger in a
depression just distal to the flare of the
metacarpo-phalangeal joint.
Located where the skin changes color
and/or texture.
LI 3
Shu Stream pt of the LI
Wood pt of the Li
Easier to find if patient makes a loose fist
Radial border of the 2nd metacarpal bone
just proximal to the flare on the distal head
of the bone. Find the depression here.
Angle/Depth
Perpendicular or oblique
0.1 – 0.2 cun
Alternatively,
Prick to bleed.
Oblique (prox or dist)
0.2 – 0.3 cun
Perpendicular-oblique
towards palm
0.5 cun
Perpendicular
0.5 – 0.8 cun
Located where the skin changes
color/texture.
Easier to find if patient makes a loose fist.
Page 6 of 32
Catnotes – Study questions for Pt loc I - Exam 2
Caution/Contra
Point
LI 4
Categories
Yuan Source pt of LI
Command pt face/mouth
Note:
LI 4 + LV 3 = 4 gates
Location
Most accurate:
1. find the middle point of the 2nd
metacarpal bone
2. find the mid distance between the 2nd
metacarpal and the 1st metacarpal (prethumb).
3. go in toward the 2nd metacarpal bone a
bit.
Angle/Depth
Perpendicular
0.5 – 1 cun
Caution/Contra
Contraindicated for
pregnancy…unless
you’re trying to induce
labor.
Perpendicular
0.5 – 0.8 cun
Caution: avoid cephalic
vein. Cover it with
fingertip, needle next to
the nail.
Convenient but less accurate:
1. stretch your thumb and forefinger out in
an L shape to create a tight edge in the
webbing between the two.
2. place the mid line of the bend of your
opposite thumb on the tight edge from
step 1.
3. bend the thumb here to that the tip
touches between the 1st and 2nd
metacarpals.
LI 5
Jing River point of LI
Fire point of LI
In “anatomical snuffbox” just across from
the transverse crease of the wrist (where LU
9 is)
1. Stretch hand out like shaking hands.
2. Cock thumb back
3. Point is in the hollow created
between the thumb (extensor
pollicus longus) and the brevis
(tendon leading to the thumb on
radial edge of wrist).
Don’t needle too proximally!
Page 7 of 32
Catnotes – Study questions for Pt loc I - Exam 2
Point
LI 6
Categories
Luo Connecting pt of LI
(fx both LU and LI)
Locate LI 5 and LI 11
first!
Location
Locate LI 5 and LI 11 first. Point is on a
line between these two, 3 cun proximal to
LI 5, 9 cun distal to LI 11.
Angle/Depth
Perpendicular
0.5 – 0.8
1. Find LI 5 and LI 11.
2. Use a measure - tape, string, paper, edge
of sheet, etc - to mark the distance (12
cun)
3. Divide the distance in ½ to find
midpoint. (6 cun)
4. Mark the midpoint and divide the distal
½ into half again. (3 cun)
This is LI 6.
(3 cun above crease, 9 cun distal to LI 11)
LI 7
Xi Cleft point of LI
Locate LI 5 and LI 11 first. Point is on a
line between these two, 5 cun proximal to
LI 5, 7 cun distal to LI 11.
Perpendicular 0.5 – 1 cun
Combine proportional and thumb 1 cun to
find this.
1. After locating LI 5 and 11, use a
tape or string to find the ½ way
point between the two.
2. Measure 1 cun distal to this location.
This is LI 7.
Page 8 of 32
Catnotes – Study questions for Pt loc I - Exam 2
Caution/Contra
Point
LI 8
Categories
Note: LI 8-10 are all 1
cun apart!!!
Measure from middle of
dot, not edges!
Location
Locate LI 5 and LI 11 first. Point is on a
line between these two, 4 cun distal to LI 11
(8 cun proximal to LI 5)
Angle/Depth
Perpendicular
0.5 – 1 cun
1. Use a tape measure or string to find the
½ mark between LI 5 and 11.
2. Half this again to find the ¼ mark.
3. Measure distal from LI 11 and then add
1 more cun distal
Should be 2 cun away from LI 9
Locate LI 5 and LI 11 first. Point is on a
line between these two, 3 cun distal to LI 11
(9 cun proximal to LI 5)
LI 9
Note: LI 8-10 are all 1
cun apart!!!
Perpendicular
0.5 – 1 cun
1. Use a tape measure or string to find the
½ mark between LI 5 and 11.
2. Half this again to find the point.
Should be 1 cun away from LI 8
LI 10
Note: LI 8-10 are all 1
cun apart!!!
Locate LI 5 and LI 11 first. Point is on a
line between these two, 2 cun distal from LI
11 (10 cun proximal to LI 5)
Method 1: find LI 8 and divide distance in
half.
Method 2: Find LI 9, measure proximally
by 1 cun.
Perpendicular
0.5 – 1 cun
(good for acute lumbar
pain – insert then do mild
activity in the area of the
pain, pushing up to pain
threshold, but not injuring)
Should be 1 cun away from LI 8
Page 9 of 32
Catnotes – Study questions for Pt loc I - Exam 2
Caution/Contra
Point
LI 11
Categories
He Sea pt of LI
Earth point of LI
Ghost point (sun sim)
Location
At elbow mid way between LUNG 5 and
lateral epicondyle of humerus
Angle/Depth
Perpendicular
1 – 1.5 cun
Location:
1. Fully flex elbow. Point is located at
the radial end of the cubital
transverse crease.
2. If can’t flex elbow: find LU 5 and
lateral epicondyle of humerus. Point
is radial to the tendon of the biceps
brachii.
Locate by landmarks, not by cun measures.
Locate with elbow flexed to 90 degrees.
LI 12
Perp 0.5 – 1 cun
Palpate lateral epicondyle of humerus.
Find the humeral shaft, run finger down
until you feel the curve begin.
LI 13
Find LI 11 and 15 first
Not in line with LI 11and LI 14. Backward a
bit.
Find LI 11 and LI 15. This point lies inline
Perpendicular
between them, 3 cun prox to LI 11, 6 cun
0.5 – 1 cun
distal to the axillary fold.
(Also is inline with LU 3 and 4)
1. Use a measure to find distance
between LI 11 and axillary fold.
2. Divide this into 1/3’s.
3. Point is located on border between
distal 1/3 and prox 2/3 in the
depression between the lateral
border of the biceps brachii and the
shaft of the humerus.
Page 10 of 32
Catnotes – Study questions for Pt loc I - Exam 2
Caution/Contra
Point
Categories
LI 14
Find LI 11 and 15 first
Location
Finger cun and proportional measurements
are about the same here, but proportions are
more accurate. But you can use 1 hand
breadth above LI 11 on line between LI 11
and 15.
Angle/Depth
Lateral side upper arm, in visible depression
formed by the distal insertion of the deltoid
and brachialis. Tense the arm to feel/see
more easily.
Oblique 1 – 1.5 cun
Inline with LI 11-15
Note: some ppl have bigger delts from
working out and such, so may not be so
reliable.
I found this by finding the delt tip, up by ~ 1
cun…
LI 15
Locate by landmark only!!
Trans/Oblique
0.8 – 1.5 cun
In depression anterior and inferior to the
acromion at the origin of the delt.
Hold the arm out (airplane) to see the
depression here. Women and overweight
ppl will have softer definiton here.
SJ 14 is the depression on the back side of
the acromion.
Move your angle of vision to see it better.
Page 11 of 32
Catnotes – Study questions for Pt loc I - Exam 2
Caution/Contra
Point
LI 16
Categories
Location
Locate by landmark only!
Angle/Depth
Perpendicular
0.5 – 1 cun
Upper aspect of shoulder, depression medial
to the acromion process. Between lateral
extremity of clavicle and scapular spine.
(supraspinatus is here?)
Locate LI 18 first.
LI 17
Caution/Contra
Risk of pneumothorax
with deep needling –
medial insertion.
Perpendicular
0.3 – 0.5 cun
Point is 1 cun inferior to LI 18, but on
posterior border of SCL muscle
LI 18
Window of Heaven
LI 17-18 hardest to find
on practicum.
LI 19
Between the sternal head (cnx to sternal
notch) and the clavicular head (wider and
flat, more lateral)
Perpendicular
0.3 – 0.5 cun
1. Find the laryngeal prominence
(adam’s apple). Make sure you are
finding the tip!
2. Have patient turn head to emphasize
SCL muscle. Locate point level with
adam’s apple between sternal head
and clavicular head of SCL muscle.
This channel crosses the midline of the
body! Located on opposite side from where
the channel started! Located just lateral to
philtrum of the nose.
Carotid artery and
jugular vein are both
very close here! Palpate
for the artery.
Carotid A. is under
high pressure here –
hard to stop bleeding,
bruises when you do.
Perpendicular or oblique
Transverse
up to 1 cun.
1. Divide the philtrum into thirds
vertically.
2. Find the junction between the upper
1/3 and lower 2/3 (Du 26)
3. Go lateral 0.5 cun
Page 12 of 32
Catnotes – Study questions for Pt loc I - Exam 2
Contraindicated for
moxabustion (classical
texts)
Point
Categories
LI 20
Terminus of the LI
channel
Location
Again, this is on the opposite side of the
midline from where you started!
Angle/Depth
Caution/Contra
Located in naso-labial groove level with the
midpoint of the lateral edge of the wing of
the nose (ala nasi)
Transverse insertion
directed medio-superiorly.
0.3 – 0.5 cun
Contraindicated for
moxa.
Opposite side of the body across the midline
from where the channel started!
Stomach Yangming Channel of the Foot
Highlights of the Stomach Yangming Channel of the Foot
1.
2.
3.
4.
5.
Originates at LI 20 in naso-labial groove lateral to the wing of the nose.
ST 8 doesn’t connect to ST 9, but to ST 5
Split in ST channel around ST 5.
ST channel goes to upper gums. For numbness/pain/swelling in upper gums, use points on legs for ST.
Three branches of ST channel
a. Lower anterior aspect of midline on top of foot, terminates at ST 45 - lateral aspect of 2nd toe nail lower corner.
b. Split at ST 36, down lateral aspect of lower leg, terminates at lateral aspect of 3rd toe.
c. Split at ST 42, oblique across foot to meet SP 1at medial aspect of great toe.
What do you need to do/know about needling around the eyes? (esp ST 1)
1. Need good communication with your patient – they need to know what you’re going to do, what the risks are, what to expect. Bruising
is a real possibility.
2. CNT techniques should be strictly applied. High risk of infection.
3. Select short, thin needles.
4. Use a clean dry cotton ball to push the closed eye up and away from the insertion site.
5. Insert slightly downward, then push in no more than 0.2 – 0.5 cun perpendicular.
6. No manipulation, no retention.
7. Press 1 minute after withdrawl, have pt hold another 2-3 minutes.
Page 13 of 32
Catnotes – Study questions for Pt loc I - Exam 2
8. In the event of hematoma, ice 24-48 hours, then switch to heat to speed healing of bruises.
9. No moxa!!!
Point
ST 1
Categories
Location
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
Angle/Depth
Have pt look upward
w/eyes closed. Use a dry
cotton ball to push eyeball
upwards and away from
insertion point.
0.2 – 0.5 cun
Method 2:
Find the midline between the inner and
outer canthus. Find infraorbital
ridge/eyeball space.
ST 2
Located by landmark only.
Located directly below midline of eye
(below pupils when looking straight ahead)
in the depression of the infraorbital foramen
depression on the infraorbital ridge.
Perpendicular (very
superficial)
0.2 – 0.4 cun
Location: Inline with ST 1 and ST 3
ST 3
ST 4
Below ST 1 and 2 (usually in a line with
them, not always), level with the lower
border of the wing of the nose (ala nasi) on
the lateral side of the naso-labial groove.
Might need to have pt smile to find groove
0.4 cun lateral to corner of mouth.
Perpendicular
0.5 – 0.8 cun
Perpendicular
0.2 – 0.3 cun
Page 14 of 32
Catnotes – Study questions for Pt loc I - Exam 2
Caution/Contra
 Moxa contraindic’d
(smoke and burns)
 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.
 Moxa
contraindicated.
 No lift/thrust
manip. Damage to
infraorbital nerve in
foramen
 Deep insertion
could injure eyeball,
but hard to do.
Point
Categories
Location
Generally in line with ST 1-3, but not
always.
Should be in the naso-labial groove.
ST 5
Don’t get this one too high!!
ST 6
1. Clench teeth.
2. Feel for the masseter muscle at the
angle of the jaw.
3. Find the anterior border of this
muscle.
4. Go 0.5 cun above lower border of
the mandible bone at this location.
Don’t get this one too high either!!
Ghost point (sunsim)
Located on the prominence (highest point)
of the masseter (chewing) muscle, 1
fingerbreadth anterior/superior to angle of
the jaw – about 45 degree angle from corner
of jaw.
Angle/Depth
Caution/Contra
Transverse/oblique toward
another feature (usually
ST 6)
0.5 – 0.8 cun
Oblique
0.3 – 0.5 cun
There’s an artery here
to avoid.
Perpendicular
0.3 – 0.5 cun
Transverse toward another
point.
Have pt clench teeth to find it, relax to
needle it.
ST 7
ST 8
Located in the zygomatic arch, usually just
anterior to the ear hole.
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.
Corner of the forehead, 4.5 cun lateral to Du
24, 0.5 cun within anterior hairline. Small
Perpendicular and slightly
inferior
0.5 – 1 cun
Oblique or transverse
0.5 – 1 cun
Page 15 of 32
Catnotes – Study questions for Pt loc I - Exam 2
Contraindicated to
moxabustion
Point
Categories
Location
depression here.
Angle/Depth
Into the 4th layer of the
scalp in loose cnx tissue
Caution/Contra
Perpendicular
0.5 – 1 cun
1. Contraindication:
Moxa contra’d.
Burns infect,
carotid artery
moves it thru the
body.
2. Caution: Carotid
artery located here
Perpendicular
0.3 – 0.5 cun
1. Contraindication:
Moxa contra’d.
Not perpendicular!
Three methods for locating.
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
(0.5 cun into hairline and above
midline eye) to Du 24 (0,.5 cun into
hairline and above midline of body)
2. Go lateral from midline of body at
Du 24 this distance.
ST 9
Window of heaven
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.
More closely related to ST 5 than to ST 8!!!
1. Find the tip of the adam’s apple
(laryngeal prominence)
2. Have pt turn head to side
3. Go lateral, level with adam’s apple
tip, to the anterior border of the
sternal head of the SCL. Point is just
anterior to this border.
ST 10
Carotid artery is here – palpate for it then
use pressing to hold it aside for puncture
On neck, anterior border of SCL sternal
head, midway between ST 9 and ST
Page 16 of 32
Catnotes – Study questions for Pt loc I - Exam 2
Point
Categories
Location
11…but not inline with them.
Angle/Depth
Caution/Contra
Burns infect,
carotid artery
moves it thru the
body.
2. Caution: Carotid
artery located here
Perpendicular
0.3 – 0.5 cun
1. Small artery here
2. Deep insertion =
risk of
pneumothorax
Find ST 11 first!!
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.
Located at root of neck in the depression
located just above the collar bone in the
triangle formed by the sternal and clavicular
heads of the SCL muscle.
ST 11
ST 12
Meeting pt of ST, LI, SI,
SJ, GB!!
Know this! Can stim
many areas w/o adding
more points.
Have pt turn their head to the side to see this
triangular depression.
1. Find midpoint of clavicle
Safer:
2. Go up into supraclavicular fossa.
Transverse  posterior
toward trapezius muscle
Point is located at the upper border of the
0.5 – 1 cun
clavicular bone in the fossa.
Not so safe:
Perpendicular
0.3 – 0.5 cun
ST 13-18: on mamillary line – 4 cun lateral to the midline of the body. Two methods to locate mamillary line:
1. Use finger cun – 4 cun from midline
2. Find midpoint of clavicle then go downward. More accurate than the finger cun method.
Point
Categories
Location
Angle/Depth
On mamillary line. Directly below ST 12
Transverse, aiming toward
ST 13
just below the inferior border of the
manifestation
clavicle.
0.3 – 0.5 cun
ST 14
Middle of the 1st intercostal space on the
mamillary line
Transverse, aiming toward
manifestation
Page 17 of 32
Catnotes – Study questions for Pt loc I - Exam 2
Contraindicated in
preggers.
Contraindic/Cautions
Deep or perpendicular
insert carries risk of
pneumothorax and/or
injuring subclavian
vessel
Deep or perpendicular
insert carries risk of
Point
Categories
Location
Angle/Depth
0.3 – 0.5 cun
Contraindic/Cautions
pneumothorax
Note that the intercostal spaces curve
upward as they go lateral
ST 15
Middle of the 2nd intercostal space on
mamillary line.
Transverse, aiming toward
manifestation
0.3 – 0.5 cun
Deep or perpendicular
insert carries risk of
pneumothorax
ST 16
Middle of the 3rd intercostal space on the
mamillary line
Transverse, aiming toward
manifestation
0.3 – 0.5 cun
Deep or perpendicular
insert carries risk of
pneumothorax
ST 17
Technically in the middle of the 4th
intercostal space, but always located in the
center of the nipple regardless of where that
falls.
Middle of the 5th intercostal space, on
mamillary line. Might need to push breast
up to find this intercostal.
Don’t!!!
Contraindicated for
everything – this is a
landmark only.
Transverse, aiming toward
manifestation
0.3 – 0.5 cun
Deep or perpendicular
insert carries risk of
pneumothorax
Unique…
Landmark point
ST 18
Some books say is in 5th intercostal just
below nipple…ain’t necessarily so.
Page 18 of 32
Catnotes – Study questions for Pt loc I - Exam 2
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 6-pack abs look for the ridge.
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.
Point
ST 19
ST 20
ST 21
ST 22
Categories
Location
2 cun lateral to midline. Locate as described
above, locate ST 21 first, then ST 19
Angle/Depth
Perpendicular
0.5 – 1 cun
Contraindic/Cautions
Deep insertion may
injure heart (left), liver
(right) if either organ
enlarged.
See location notes above and locate
accordingly
Perpendicular
0.5 – 1 cun
In thin subjects deep
needle can puncture
peritoneal cavity.
See location notes above and locate
accordingly
See location notes above and locate
accordingly
Perpendicular
0.5 – 1 cun
Perpendicular
0.5 – 1 cun
Page 19 of 32
Catnotes – Study questions for Pt loc I - Exam 2
On right side if liver is
enlarged can penetrate.
In thin subjects deep
needle can puncture
peritoneal cavity.
On right side if liver is
enlarged can penetrate.
In thin subjects deep
needling can puncture
peritoneal cavity.
Point
ST 23
Categories
ST 24
ST 25
Front Mu point of LI
Location
See location notes above and locate
accordingly
Angle/Depth
Perpendicular
0.5 – 1 cun
See location notes above and locate
accordingly
Perpendicular
0.5 – 1 cun
2 cun lateral to umbilicus
Perpendicular
1 – 1.5 cun
Contraindic/Cautions
In thin subjects deep
needling can puncture
peritoneal cavity.
In thin subjects deep
needling can puncture
peritoneal cavity.
In thin subjects deep
needling can puncture
peritoneal cavity.
ST 26 – 30 are lower abdomen points. Cun measures here are larger than the thumb width, so use proportional measures.
1. Palpate for top margin of the pubic bone.
Be sure you communicate well with your patient, telling them what you’re palpating for, what these points will do for them, etc. They
may be more comfortable finding this for you. More on that in a minute.
2. Find the center of the umbilicus
ST 26 through ST 30 are located 2 cun lateral to this line on both sides of the body.
3. Find the location by dividing the distance
a. Divide the distance between the umbilicus mark and the top margin of the pubic bone in half. This is a reference point
b. ST 27: Go ½ cun above the middle mark in 3a.
c. ST 26: Go ½ way between ST 27 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.
f. ST 29: Go ½ way between ST 30 and ST 28.
Point
ST 26
ST 27
Categories
Location
See location notes above
Angle/Depth
Perpendicular
1 – 1.5 cun
Contraindic/Cautions
In thin subjects deep
needling can puncture
peritoneal cavity.
See location notes above
Perpendicular
1 – 1.5 cun
In thin subjects deep
needling can puncture
peritoneal cavity.
Page 20 of 32
Catnotes – Study questions for Pt loc I - Exam 2
Point
ST 28
Categories
Location
See location notes above
Angle/Depth
Perpendicular
1 – 1.5 cun
Contraindic/Cautions
In thin subjects deep
needling can puncture
peritoneal cavity.
Perpendicular
1 – 1.5 cun
In thin subjects deep
needling can puncture
peritoneal cavity.
Contraindication: No
Moxa!
Cautions:
Deep insert superior
direction can =
penetration peritoneal
cav or full bladder. On
men, can penetrate
spermatic cord.
KNOW: for Abdominal Edema
ST 29
See location notes above
KNOW: for irregular menstruation
ST 30
Level with superior border of pubic
symphysis, 2 cun off of midline
Perpendicular
0.5 – 1 cun
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.
Locate 32-24 with knee flexed
Perpendicular
1-2 cun
ST 32
Perpendicular
1-2 cun
1. Draw a line from ST 31 – lateral
superior corner of patella.
2. Locate point 6 cun above superior
border of patella on this line.
Alternately, you can draw a line from the
ASIS to the superior lateral corner of the
patella and locate the point on this line.
Page 21 of 32
Catnotes – Study questions for Pt loc I - Exam 2
Point
ST 33
ST 34
Categories
Location
Locate 32-24 with knee flexed
Easy to locate, but often
mistaken on exams
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
Xi Cleft point of ST
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
Locate with knee flexed
ST 35
Level with lower border of patella and
lateral to the ligament, yet lower than where
the patella is.
Angle/Depth
Perpendicular
1 – 1.5 cun
Perpendicular
1 – 1.5 cun
Oblique towards
middle/back of popliteal
crease – UB 40
1 – 1.5 cun
This ligament looks like an ox’s nose where
you’d put the ring through. Use the top
depression here, not the lower one.
ST 36
He Sea of ST & Earth pt
Lower He-Sea of ST
Command pt (ab dis’s)
Note: Extrapoint called Xiyan is in the same
place, but both lateral and medial, so ST 35
overlaps.
Ways to find this:
Contraindic/Cautions
Perpendicular
1 – 1.5 cun
1. Proportional method is better than 3 cun
hand method, but hand method is close.
Three cun below ST 35
2. Body landmarks:
Where tibia flares and 1 finger wid off
bone crest.
Page 22 of 32
Catnotes – Study questions for Pt loc I - Exam 2
Insertion into joint
capsule carries risk of
infection of capsule.
Point
Categories
ST 37
Highlights to know
1. Makes sure ST 35 is
correct.
2. One fingerwidth
lateral to crest of tibia.
3. Know locating
methods
Lower He Sea pt of LI
ST 38
Location
Angle/Depth
Level with lower border of tuberosity of
tibia, 1 fingerwid lateral to bone crest.
3. Find ST 38/40 (in middle – 8 cun –
between prominence of lateral malleolus
and tibiofemoral joint/popliteal crease).
Divide distance from here to popliteal
crease to get 4 cun. Go proximal by 1
cun.
Lower leg, 3 cun inferior to ST 36, 2 cun
Perpendicular
above ST 38.
1 – 1.5 cun
1. Find ST 38. This is the midmark
between prominence of lateral
malleolus and the tibio-femoral joint
crease (level with poplit.crease). It is
8 cun to both extremes.
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.
4.
1. Use a measure (tape, string, etc) to
find the distance between the tibiofemoral joint line (even with the
popliteal crease) and the lateral
malleolus.
2. Divide this in half, measuring up
from the lateral malleolus.
3. Mark a spot at this level, one
finger’s breadth lateral to the
anterior crest of the tibia. This is ST
38.
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)
Page 23 of 32
Catnotes – Study questions for Pt loc I - Exam 2
Contraindic/Cautions
Point
ST 39
ST 40
ST 41
ST 42
Categories
Lower He Sea pt of SI
Location
Located 1 cun below ST 38. See measure
techniques for ST 38 above.
Luo connecting pt of ST
Be sure to go one finger’s breadth lateral to
anterior crest of the tibia.
Level with ST 38. See location notes above.
Jing River point of ST
Fire point of ST
2 finger’s breadth lateral to the anterior
crest of the tibia.
On the ankle, level with the prominence of
the lateral malleolus.
Yuan Source for ST
Hard to find
Angle/Depth
Perpendicular
1 – 1.5 cun
Contraindic/Cautions
Perpendicular
1 – 1.5 cun
Perpendicular
0.5 – 1 cun
1. Slight dorsal-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
Located on dorsum of foot in a depression
Perpendicular
nd
rd
formed where the 2 and 3 metatarsals
0.3 – 0.5 cun
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.
Good luck with that.
Page 24 of 32
Catnotes – Study questions for Pt loc I - Exam 2
Caution: anterior tibial
vessels/nerve lie deep
to this point.
Caution: dorsalis pedis
artery here. Feel for it,
use pressing tech if
possible.
Point
ST 43
Categories
Shu Stream pt of ST
Wood pt of ST
Location
Located between 2nd and 3rd metatarsal
bones.
Angle/Depth
Perpendicular
0.3 – 0.5 cun
1. Curl toes so you can see the
knuckles.
2. Locate the depression between the
2nd and 3rd metatarsals. Point is in a
depression just proximal to the
knuckles, just below the flare at the
distal end of the metatarsals.
ST 44
ST 45
Ying Spring pt of ST
Water pt of ST
Located between 2nd and 3rd metatarsal
bones.
Perpendicular
0.5 – 1 cun
Jing Well pt of ST
Metal pt of ST
1. Curl toes so you can see the knuckles.
2. Locate the depression between the 2nd
and 3rd metatarsals. Point is in a
depression just distal to the knuckles.
Located on 2nd toenail, lateral side, bottom
corner.
Perpendicular
0.1 – 0.2 cun
1. Intuit a line drawn along the lateral
border of the nail and the base of the
nail.
2. Point lies on this junction at the
lateral aspect of the 2nd toenail.
Alternatively, prick to
bleed.
Page 25 of 32
Catnotes – Study questions for Pt loc I - Exam 2
Contraindic/Cautions
Spleen Channel of the Foot Taiyin
What channel does the Spleen Channel change positions with, which is anterior and posterior, and where do they change positions?
The SP channel changes positions with the LV channel 8 cun above the medial malleolus. Up to this point the Liver channel is anterior. After
this measurement the Spleen channel is anterior and the Liver channel is posterior.
Does the Spleen channel go above the neck? If so, where does it go?
Yes, it does. It travels under the lower surface of the tongue to the root of the tongue (Heart channel is on the upper surface)
Briefly describe the path of the Spleen channel.
Begins at the medial corner of the nail of the big toe (SP 1)
Runs along the medial aspect of the foot on the border where the skin changes color/texture
Lower leg: Follows the posterior border of the tibia on the medial aspect.
Upper leg: ascends along antero-medial aspect of the thigh.
Trunk: intersects Conception vessel, enters Spleen, cnx with Stomach. Runs 6 cun lateral to midline
Point
SP 1
Category
Jing Well
Ghost point (SSM)
Location
Needling
Medial/dorsal aspect of big toe 0.1 cun from Perp or oblique 0.1 cun
the corner of the nail.
Moxa
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.
Perp 0.3-0.5 cun
1. Curl the toes to see the knuckle, uncurl
Page 26 of 32
Catnotes – Study questions for Pt loc I - Exam 2
Caution/Contra
Point
Category
Location
to locate.
2. Slide fingertip distally 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.
Needling
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).
Perp 0.5 – 1 cun
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.
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 0.5 – 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
Page 27 of 32
Catnotes – Study questions for Pt loc I - Exam 2
Caution/Contra
Point
SP 5
Category
Jing River
Location
Anterior and inferior to the medial
malleolus.
Needling
Perp 0.3 – 0.5 cun
Caution/Contra
Perp 1-1.5cun
Contra: preggers
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.
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 1-1.5
Locate this point in relation to SP 6.
Measure 1 hand-breadth above SP 6.
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.
Perp 1-1.5cun
Page 28 of 32
Catnotes – Study questions for Pt loc I - Exam 2
Point
Category
Location
Needling
Caution/Contra
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.
SP 9
He Sea Point of SP
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.
Perp 1 – 1.5 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.”
SP 11
Perp 1 – 1.5 cun
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 and SP 12.
Perp 0.5 – 1 cun
To locate, find SP 10, go 6 cun proximal.
Alternately, find the ½ way distance
between SP 12 and the tibiofemoral joint
Page 29 of 32
Catnotes – Study questions for Pt loc I - Exam 2
Caution: deep needling
can puncture the
femoral artery
Point
Category
Location
(pop crease).
SP 12
Meeting point of SP &
LV with Yin Linking
Three point five (3.5) cun lateral to Ren 2
Perp 0.5 – 1 cun
(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.
Not commonly used
Not strong function
Needling
Caution/Contra
Caution: deep needle
medially may puncture
the femoral artery
while deep needling
laterally can puncture
the femoral nerve!
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
SP 13
Meeting pt of SP & LIV
with Yin Linking
Lower ab, .7 cun superior, .5 lateral to SP
12, 4 cun lateral to the midline of the body.
Perp 1-1.5 cun
Caution:
Possible peritoneal
puncture with deep
needling in thin
patients.
Perp 1-1.5 cun
Caution:
Can punc peritoneal
cav in thin patients if
deep needle.
Perp 0.5 – 1 cun
Cautions:
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
(NOT part of SP/LIV
meeting with Yin
Linking…will be on test!)
Lower ab, 1.3 cun inferior to SP 15 (level
with umbilicus), 4 cun from midline.
Shen says measure to 1.25 cun and that
should be fine. On same vertical as the
mamillary line.
SP 15
Meeting pt of SP & LIV
Four (4) cun lateral to the center of the
Page 30 of 32
Catnotes – Study questions for Pt loc I - Exam 2
Point
Category
with Yin Linking
Location
umbilicus. (In the depression at the lateral
border of the rectus abdominis muscle …)
Needling
SP 16
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.
Perp 0.5 – 1 cun
Caution/Contra
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
SP 17 – 20 are 6 cun lateral to anterior midline, inline with LU 1 and 2. Needle all of them transverse with intercostal spaces 0.5 – 0.8 cun
deep. Guide needle towards manifestations that need help.
Point
SP 17
Category
Location
Lateral side of chest, 5th intercostal space, 6
cun to midline.
Needling
Trans-obl, 0.5 – 0.8 cun
either lateral or medial
Caution/Contra
Caution: perp insert =
risk of pneumothorax.
Trans-obl, 0.5 – 0.8 cun
either lateral or medial
Caution: perp insert =
risk of pneumothorax.
1. Find the 6 cun mark from midline.
a. Same line as LU 1 and 2
b. 8 fingers from anterior mid
c. Mamillary line + 2 cun
2. Count to the 5th intercostal space (‘bout
level with the bra-line)
SP 18
Lateral side of chest, 4th intercostal space, 6
cun to midline.
1. Find the 6 cun mark from midline. 3
ways:
a. Same line as LU 1 and 2
b. 8 fingers from anterior mid
c. Mamillary line + 2 cun.
2. Count to 4th intercostal (almost always =
nip level on dudes)
Page 31 of 32
Catnotes – Study questions for Pt loc I - Exam 2
Point
Category
SP 19
Location
Needling
Caution/Contra
Lateral side of chest, 3rd intercostal space, 6
cun to midline.
Trans-obl, 0.5 – 0.8 cun
either lateral or medial
Caution: perp insert =
risk of pneumothorax.
Trans-obl, 0.5 – 0.8 cun
either lateral or medial
Caution: perp insert =
risk of pneumothorax.
Trans-obl along intercostal
space 0.5 – 1 cun
Caution: perp insert =
risk of pneumothorax.
1. Find the 6 cun mark from midline. 3
ways:
a. Same line as LU 1 and 2
b. 8 fingers from anterior mid
c. Mamillary line + 2 cun.
2. Count to 3rd intercostal space.
Lateral side of chest, 2nd intercostal space, 6
cun to midline.
SP 20
1. Find the 6 cun mark from midline. 3
ways:
a. Same line as LU 1 and 2
b. 8 fingers from anterior mid
c. Mamillary line + 2 cun.
2. Count to 2nd intercostal space.
SP 21
Great Luo Connecting of
the Spleen
Located on the mid-axillary line (from front
edge of armpit crease to back edge), level
with the 6th or 7th intercostal space
Page 32 of 32
Catnotes – Study questions for Pt loc I - Exam 2