Course: Point Location 1 Document: Study Questions Exam 2 on Wk 10

Date:

Nov 26, 2007

Study Questions Exam 2

Do: 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)

Dont need to know for exams in this class: Dont need to know paths of divergents, luos, just the main paths Dont need to know chinese names of acupoints. Dont 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 sidehighest 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 Know these needling angles: Angle Oblique Perpendicular Perpendicular-oblique Transverse-oblique Transverse Degrees 45 90 70 20 0 16 19 7 3 18 6 2 2 1 1.5

See CAMS for the ones I am missing here.

Page 1 of 33 Catnotes Study questions for Pt loc I - Exam 2

Page 2 of 33 Catnotes Study questions for Pt loc I - Exam 2

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. 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. To locate: 1. Divide distance between tip of axillary fold and cubital crease Perpendicular. 0.5 1 cun Angle/Depth Transverse oblique, pointing laterally. 0.5 0.8 cun. Caution/Contra Possible pneumothorax with deep perpendicular needling.

LU 2

Transverse oblique, pointing laterally. 0.5 0.8 cun.

Possible pneumothorax with deep perpendicular needling.

Point

Categories

LU 4

Location (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. Slightly flex the elbow for easiest find. On flexor aspect of forearm in a line between LU 5 and LU 9. To locate: 1. Locate LU 5 and LU 9 2. Divide the distance between LU 5 and LU 9 in 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) Between tendons of brachioradialis and

Angle/Depth

Caution/Contra

Perpendicular 0.5 1 cun

LU 5

He Sea point of LU Water point of LU

Perpendicular 0.8 1.2 cun

LU 6

Xi cleft point of LU

Perpendicular 0.5 1 cun

LU 7

Luo connecting pt of LU Command pt head/nape

Pinch skin, insert either with or against the channel.

Point

Categories

Location abductor pollicus longus Convenient though not always accurate locator: hook thumbs together and find point where index finger tip falls.

Angle/Depth Transverse 0.5 1 cun per Deadman 0.3 0.5 per CAMS

Caution/Contra

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 Find the depression at the base of the styloid process radius and the radial artery. Point is between these 2.

Oblique (proximally) Perpendicular 0.3 0.5 cun.

Beware of the radial artery!! Takes about 5 minutes to stop bleeding should you hit it.

LU 9

Shu Stream pt of LU Yuan Source pt of LU Hui Mtg pt of Vessels Earth pt of LU channel. Ying Spring pt of LU Fire pt of LU

At wrist joint in depression between radial artery and tendon of abductor pollicus longus (thumb tendon) on border of pisiform bone. Level with Heart (HE) 7 point. On thenar emminence, midway down the shaft of the 1st metacarpal (thumb). 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. 0.1 cun from corner of nail.

Perpendicular 0.3 0.5 cun per Deadman 0.2 0.3 per CAMS

LU 10

Perpendicular 0.5 1 cun

LU 11

Jing Well pt of LU Wood pt of LU Ghost pt (sun simiao)

Best to use acupressure or for bleeding techniques. Perpendicular or Oblique (proximal) 0.1 0.2 cun Or prick to bleed

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 Categories Jing Well pt of LI Metal 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. Located where the skin changes color/texture. Easier to find if patient makes a loose fist. 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 Caution/Contra

LI 2

Ying Spring pt of LI Water pt of LI

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. 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.

Angle/Depth Perpendicular 0.5 1 cun

Caution/Contra Contraindicated for pregnancyunless youre trying to induce labor.

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). Dont needle too proximally!

Perpendicular 0.5 0.8 cun

Caution: avoid cephalic vein. Cover it with fingertip, needle next to the nail.

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. 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 to find midpoint. (6 cun) 4. Mark the midpoint and divide the distal into half again. (3 cun) This is LI 6. (3 cun above crease, 9 cun distal to LI 11)

Angle/Depth Perpendicular 0.5 0.8

Caution/Contra

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. Combine proportional and thumb 1 cun to find this. 1. After locating LI 5 and 11, use a tape or string to find the way point between the two. 2. Measure 1 cun distal to this location. This is LI 7.

Perpendicular 0.5 1 cun

Point LI 8

Categories

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) 1. Use a tape measure or string to find the mark between LI 5 and 11. 2. Half this again to find the mark. 3. Measure distal from LI 11 and then add 1 more cun distal Should be 2 cun away from LI 9

Angle/Depth Perpendicular 0.5 1 cun

Caution/Contra

Note: LI 8-10 are all 1 cun apart!!! Measure from middle of dot, not edges!

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) Note: LI 8-10 are all 1 cun apart!!! 1. Use a tape measure or string to find the mark between LI 5 and 11. 2. Half this again to find the point. Should be 1 cun away from LI 8

Perpendicular 0.5 1 cun

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. Should be 1 cun away from LI 8

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)

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 Location: 1. Fully flex elbow. Point is located at the radial end of the cubital transverse crease. 2. If cant flex elbow: find LU 5 and lateral epicondyle of humerus. Point is radial to the tendon of the biceps brachii.

Angle/Depth Perpendicular 1 1.5 cun

Caution/Contra

LI 12

Locate by landmarks, not by cun measures. Locate with elbow flexed to 90 degrees. Palpate lateral epicondyle of humerus. Find the humeral shaft, run finger down until you feel the curve begin.

Perp 0.5 1 cun

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 1/3s. 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.

Point

Categories

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. 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. 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

Angle/Depth

Caution/Contra

LI 14 Find LI 11 and 15 first

Oblique 1 1.5 cun

LI 15

Locate by landmark only!! 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.

Trans/Oblique 0.8 1.5 cun

Point LI 16

Categories

Location Locate by landmark only! Upper aspect of shoulder, depression medial to the acromion process. Between lateral extremity of clavicle and scapular spine. (supraspinatus is here?)

Angle/Depth Perpendicular 0.5 1 cun

Caution/Contra Risk of pneumothorax with deep needling medial insertion.

LI 17

Locate LI 18 first. Point is 1 cun inferior to LI 18, but on posterior border of SCL muscle

Perpendicular 0.3 0.5 cun

LI 18

Window of Heaven LI 17-18 hardest to find on practicum.

Between the sternal head (cnx to sternal notch) and the clavicular head (wider and flat, more lateral) 1. Find the laryngeal prominence (adams apple). Make sure you are finding the tip! 2. Have patient turn head to emphasize SCL muscle. Locate point level with adams 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. 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

Perpendicular 0.3 0.5 cun

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.

LI 19

Perpendicular or oblique Transverse up to 1 cun.

Contraindicated for moxabustion (classical texts)

Point

Categories

Location Again, this is on the opposite side of the midline from where you started! Located in naso-labial groove level with the midpoint of the lateral edge of the wing of the nose (ala nasi)

Angle/Depth

Caution/Contra

LI 20 Terminus of the LI channel

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 doesnt 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 youre 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. 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 Locd 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 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. Location: Inline with ST 1 and ST 3 Perpendicular (very superficial) 0.2 0.4 cun 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 Caution/Contra Moxa contraindicd (smoke and burns) CNT practices Communicate w/pt Risk of hematoma use short/thin needles Dont 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.

ST 3

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

ST 4

Perpendicular

Point

Categories

Location Generally in line with ST 1-3, but not always. Should be in the naso-labial groove.

Angle/Depth 0.2 0.3 cun Transverse/oblique toward another feature (usually ST 6) 0.5 0.8 cun Oblique 0.3 0.5 cun

Caution/Contra

ST 5

Dont get this one too high!! 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. Dont get this one too high either!! 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. Have pt clench teeth to find it, relax to needle it.

Theres an artery here to avoid.

ST 6

Ghost point (sunsim)

Perpendicular 0.3 0.5 cun Transverse toward another point.

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

Perpendicular and slightly inferior 0.5 1 cun

Oblique or transverse

Contraindicated to

Point

Categories

Location 24, 0.5 cun within anterior hairline. Small depression here. 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. Method 3: 1. 4.5 cun (5 fingers) from midline of hairline (remember its 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 adams apple (laryngeal prominence) 2. Have pt turn head to side 3. Go lateral, level with adams apple tip, to the anterior border of the sternal head of the SCL. Point is just anterior to this border. Carotid artery is here palpate for it then use pressing to hold it aside for puncture On neck, anterior border of SCL sternal

Angle/Depth 0.5 1 cun Into the 4th layer of the scalp in loose cnx tissue

Caution/Contra moxabustion Not perpendicular!

ST 9

Window of heaven

Perpendicular 0.5 1 cun

1. Contraindication: Moxa contrad. Burns infect, carotid artery moves it thru the body. 2. Caution: Carotid artery located here

ST 10

Perpendicular

1. Contraindication:

Point

Categories Find ST 11 first!!

Location head, 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.

Angle/Depth 0.3 0.5 cun

Caution/Contra Moxa contrad. Burns infect, carotid artery moves it thru the body. 2. Caution: Carotid artery located here 1. Small artery here 2. Deep insertion = risk of pneumothorax

ST 11

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.

Perpendicular 0.3 0.5 cun

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

Contraindicated in preggers.

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 ST 13 On mamillary line. Directly below ST 12 Transverse, aiming toward just below the inferior border of the manifestation clavicle. 0.3 0.5 cun ST 14 Middle of the 1st intercostal space on the Transverse, aiming toward

Contraindic/Cautions Deep or perpendicular insert carries risk of pneumothorax and/or injuring subclavian vessel Deep or perpendicular

Point

Categories

Location mamillary line Note that the intercostal spaces curve upward as they go lateral

Angle/Depth manifestation 0.3 0.5 cun

Contraindic/Cautions insert carries risk of pneumothorax

ST 15

Middle of the 2nd intercostal space on mamillary line. Middle of the 3rd intercostal space on the mamillary line 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. Some books say is in 5th intercostal just below nippleaint necessarily so.

Transverse, aiming toward manifestation 0.3 0.5 cun Transverse, aiming toward manifestation 0.3 0.5 cun Dont!!!

Deep or perpendicular insert carries risk of pneumothorax Deep or perpendicular insert carries risk of pneumothorax Contraindicated for everything this is a landmark only. Deep or perpendicular insert carries risk of pneumothorax

ST 16

ST 17 Unique Landmark point ST 18

Transverse, aiming toward manifestation 0.3 0.5 cun

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 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 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. In thin subjects deep needle can puncture peritoneal cavity. 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.

ST 20

See location notes above and locate accordingly

Perpendicular 0.5 1 cun

ST 21

See location notes above and locate accordingly

Perpendicular 0.5 1 cun

ST 22

See location notes above and locate accordingly

Perpendicular 0.5 1 cun

Point ST 23 ST 24 ST 25

Categories

Location See location notes above and locate accordingly See location notes above and locate accordingly

Angle/Depth Perpendicular 0.5 1 cun Perpendicular 0.5 1 cun Perpendicular 1 1.5 cun

Front Mu point of LI

2 cun lateral to umbilicus

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 youre 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 cun above the middle mark in 3a. c. ST 26: Go way between ST 27 and ST 25. d. ST 28: Go 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 way between ST 30 and ST 28. Point ST 26 Categories Location See location notes above Angle/Depth Perpendicular 1 1.5 cun 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.

ST 27

See location notes above

Point ST 28

Categories

Location See location notes above KNOW: for Abdominal Edema

Angle/Depth Perpendicular 1 1.5 cun Perpendicular 1 1.5 cun Perpendicular 0.5 1 cun

Contraindic/Cautions In thin subjects deep needling can puncture peritoneal cavity. 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.

ST 29

See location notes above KNOW: for irregular menstruation

ST 30

Level with superior border of pubic symphysis, 2 cun off of midline

ST 31

ST 32

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 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.

Perpendicular 1-2 cun

Perpendicular 1-2 cun

Point ST 33

Categories Easy to locate, but often mistaken on exams

Location Locate 32-24 with knee flexed 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 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 Level with lower border of patella and lateral to the ligament, yet lower than where the patella is. This ligament looks like an oxs nose where youd put the ring through. Use the 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. Ways to find this: 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.

Angle/Depth Perpendicular 1 1.5 cun

Contraindic/Cautions

ST 34

Xi Cleft point of ST

Perpendicular 1 1.5 cun

ST 35

Oblique towards middle/back of popliteal crease UB 40 1 1.5 cun

Insertion into joint capsule carries risk of infection of capsule.

ST 36

He Sea of ST & Earth pt Lower He-Sea of ST Command pt (ab diss)

Perpendicular 1 1.5 cun

Point

Categories 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 37

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 and into 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 fingers breadth lateral to the anterior crest of the tibia. This is ST 38.

Contraindic/Cautions

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)

Point ST 39

Categories Lower He Sea pt of SI

Location Located 1 cun below ST 38. See measure techniques for ST 38 above. Be sure to go one fingers breadth lateral to anterior crest of the tibia. Level with ST 38. See location notes above. 2 fingers breadth lateral to the anterior crest of the tibia. On the ankle, level with the prominence of the lateral malleolus.

Angle/Depth Perpendicular 1 1.5 cun

Contraindic/Cautions

ST 40

Luo connecting pt of ST

Perpendicular 1 1.5 cun Perpendicular 0.5 1 cun Caution: anterior tibial vessels/nerve lie deep to this point.

ST 41

Jing River point of ST Fire point of ST

ST 42

Yuan Source for ST Hard to find

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.

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. 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.

Angle/Depth Perpendicular 0.3 0.5 cun

Contraindic/Cautions

ST 44

Ying Spring pt of ST Water pt of ST

Located between 2nd and 3rd metatarsal bones. 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. 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.

Perpendicular 0.5 1 cun

ST 45

Jing Well pt of ST Metal pt of ST

Perpendicular 0.1 0.2 cun Alternatively, prick to bleed.

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.

Caution/Contra

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.

Perp 0.3-0.5 cun

Point

Category

Location 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. 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.

Needling

Caution/Contra

SP 3

Shu Stream Yuan Source

Perp 0.5 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. 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 footif so, youre too proximal and youre on the MT joint. 2. Locate the point on the border where the skin changes texture/color

Perp 0.5 1 cun

SP 5

Jing River

Anterior and inferior to the medial

Perp 0.3 0.5 cun

Point

Category

Location malleolus. 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.

Needling

Caution/Contra

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, its 15cun from medial mal to the popliteal creaseif you can do 20% of this, bully for you, if not, use hand cun measure.

Perp 1-1.5cun

Contra: preggers

SP 7

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. Locate this point in relation to SP 6. Measure 1 hand-breadth above SP 6.

Perp 1-1.5

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

Point

Category

Location To locate: 1. Locate SP 9 first, then distal by 1 handbreadth. 2. Alternately, divide 15cun between pop crease and the medial mal into 1/3s and locate this point at the border between the top 1/3 and bottom 2/3s. 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. Run finger in the groove posterior to tibias 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)

Needling

Caution/Contra

SP 9

He Sea Point of SP

Perp 1 1.5 cun

SP 10 #1 point for Blood tonify and move blood, skin problems. To treat wind, treat the blood. SP 11

Two cun proximal to the superior border of the patella on the medial side on the bulge of the vastus medialis. 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. To locate, find SP 10, go 6 cun proximal. Alternately, find the way distance between SP 12 and the tibiofemoral joint (pop crease).

Perp 1 1.5 cun

Perp 0.5 1 cun

Caution: deep needling can puncture the femoral artery

Point

Category

Location

Needling

Caution/Contra

SP 12

Meeting point of SP & LV with Yin Linking Not commonly used Not strong function

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. 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

Caution: deep needle medially may puncture the femoral artery while deep needling laterally can puncture the femoral nerve!

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. 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)

Perp 1-1.5 cun

Caution: Possible peritoneal puncture with deep needling in thin patients.

SP 14

(NOT part of SP/LIV meeting with Yin Linkingwill 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.

Perp 1-1.5 cun

Caution: Can punc peritoneal cav in thin patients if deep needle.

SP 15

Meeting pt of SP & LIV with Yin Linking

Four (4) cun lateral to the center of the umbilicus. (In the depression at the lateral

Perp 0.5 1 cun

Cautions: 1. Possible peritoneal

Point

Category

Location border of the rectus abdominis muscle ) On ab 3 cun superior to SP 15 and 4 cun lateral to the midline on lateral border of rectus abdominis muscle.

Needling

SP 16

Meeting pt of SP with Yin Linking

Perp 0.5 1 cun

Caution/Contra 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. 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) Trans-obl, 0.5 0.8 cun either lateral or medial Caution: perp insert = risk of pneumothorax. Needling Trans-obl, 0.5 0.8 cun either lateral or medial Caution/Contra Caution: perp insert = risk of pneumothorax.

Point

Category

Location

Needling

Caution/Contra

SP 19

Lateral side of chest, 3rd 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 3rd intercostal space.

Trans-obl, 0.5 0.8 cun either lateral or medial

Caution: perp insert = risk of pneumothorax.

SP 20

Lateral side of chest, 2nd 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 2nd intercostal space.

Trans-obl, 0.5 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 front edge of armpit crease to back edge), level with the 6th or 7th intercostal space

Trans-obl along intercostal space 0.5 1 cun

Caution: perp insert = risk of pneumothorax.