The Neck and Windows of the Sky Points

Question 1

Ren 22 (W): TIANTU Heavenly Chimney

Answer 1

In the centre of the hollow at the top of the sternum.
About 1/2 cun superior to the supra-sternal notch. To needle this point angle the needle obliquely downwards posteriorly to the suprasternal notch 0.3 cun.

Question 2

Ren 23: LIANQUAN Corner Spring

Answer 2

On the mid-line of the neck, just under the chin. Tilt the person’s head slightly up and feel down the mid-line from the chin to the top of the neck where you will find the hyoid bone, which feels like a smooth ring. The point lies in a depression at the superior edge of the hyoid bone.

Question 3

Ren 24: CHENGJIANG Receiving Fluid

Answer 3

In the middle of the crease that lies on the chin beneath the lower lip. The depression is slightly easier to feel when the mouth is open.

Question 4

St 9 (W): RENYING People Welcome

Answer 4

Look at your patient in profile in order to find the laryngeal prominence on her neck. Then find its highest point, or tip. The point will lie lateral to, and a little inferior to the level of this tip. Ask the person to turn her head to one side so that you may feel the lateral wing of the thyroid cartilage. On the lateral aspect of this wing you can feel how the cartilage flares out for its upper third. Keeping your finger in the angle of this flare ask the patient to bring her head back to facing forwards. Your finger is now at the position of St 9.
The carotid artery lies at the anterior border of the sternocleidomastoid muscle and by pressing gently in this area you will be able to feel it’s pulsation. The point lies between the carotid artery and the lateral border of the thyroid cartilage.

Question 5

St 10: SHUITU Water Rushing Out

Answer 5

Looking at the patient’s neck from the front, this point lies on the anterior margin of the sternocleidomastoid muscle, at the mid- point of a line connecting St 9 – St 11.

Question 6

St 11: QISHE Qi Abode

Answer 6

Find the two heads of the sternocleidomastoid muscle. This point lies between the two heads in a hollow that is just lateral to the sternal head of the SCM muscle, on the superior edge of the sternal end of the clavicle.
(Caution on needling – shallow insertion)

Question 7

LI 17: TIANDING Heavenly Vessel

Answer 7

Draw an imaginary line from LI 18 – St 12. The point lies on this line, at roughly 1 cun below LI 18, on the posterior border of the sternocleidomastoid muscle. (St 12 is found in the supraclavicular fossa, posterior to the superior border of the clavicle at it’s midpoint, 4 cun lateral to the midline).

Question 7

LI 18 (W): FUTU Support the Prominence

Answer 7

This point lies on a roughly horizontal ring on the person’s neck that passes just below the Adam’s apple, through St 9, LI 18 and SI 16. The ring in fact tilts slightly up towards the back following the contour of the neck.
LI 18 is found half-way between the anterior and posterior borders of the sternocleidomastoid muscle. This is where the two heads (sternal and clavicular) begin to fuse. To find the point, identify the centre of the muscle at the level of St 9 and then gently press in to the muscle to find where the two heads separate a little.

Question 8

SI 16 (W): TIANCHUANG Heavenly Window

Answer 8

On the horizontal ring of points that runs out and slightly upwards from just below the Adam’s apple, through St 9 and LI 18. This point lies on that ring just posterior to the sternocleidomastoid muscle. If you stroke the back of the muscle very gently you can feel a slight depression at the point.

Question 9

SI 17 (W): TIANRONG Heavenly Appearance

Answer 9

Posterior to the angle of the jaw and at that level, in the depression on the anterior border of the sternocleidomastoid muscle.

Question 10

TB 16 (W): TIANYOU Heavenly Window

Answer 10

The point lies on the posterior border of the
sternocleidomastoid muscle approximately 1 cun inferior to GB 12 and just slightly superior to the level of SI 17.
(GB 12 is found by rolling your finger off the back of the mastoid process where you will fall into a depression, and is roughly on a horizontal level with DU 16).

Question 11

TB 17: YIFENG Wind Screen

Answer 11

Flatten the bottom of the person’s earlobe against her neck. Slip the tip of your index finger just under the tip of her earlobe. The tip of your finger should now be on TB 17. The point lies in the middle of the depression between the mandible and the mastoid process. If you apply pressure the person will feel a very uncomfortable sensation.
In order to needle the point you must bend the earlobe forwards in order to get it out of the way.
Needle insertion should be angled forwards towards the jaw.

Question 12

Du 15: YAMEN Gate to Dumbness

Answer 12

On the mid- line of the neck, between C 1 and C 2 (the atlas and the axis). It lies at about 1/2 cun below Du 16 and roughly 1/2 cun above the natural hair-line.

Question 13

Du 16 (W FENGFU Wind Treasury

Answer 13

This point lies
just below the occiput. Run your index finger up the mid-line of the spine of the neck, until you reach the base of the occiput. With your other hand on your patient’s forehead, gently rock the patient’s head backwards and forwards. This rocking will highlight the joint between the head and the neck. The point lies here just under the occiput.
This is roughly 1 cun superior to the natural hair-line.

Question 14

GB 20: FENGCHI Wind Pond

Answer 14

Starting with your index finger on Du 16 (see location above) slide your finger out laterally over the trapezius muscle until you arrive at a large hollow (2.25 cun from the mid-line). The point is found here about 1 cun above the natural hair-line, and just below the base of the occiput. (It is worth rocking your patient’s head above your finger in order to be sure that you are below the occiput).
The hollow of the point lies half-way from the mid-line of the neck to the lower edge of the mastoid bone, in a recess between the trapezius and the sternocleidomastoid muscles.

Question 15

Bl 10 (W) TIANZHU Heavenly Pillar

Answer 15

Starting with your finger on Du 15 (see location above) roll it out on to the trapezius. The point is here in a depression on the trapezius muscle, about 1.3 cun lateral to Du 15 and just inferior to the occiput.
On a person with a well-defined hair-line, it lies roughly 1/2 cun superior to the natural hair-line of the neck.

Question 16

Pc 1 (W): TIANCHI Heavenly Pond

Answer 16

1 cun lateral to the centre of the nipple.
On a man, it is in the 4th intercostal space, 5 cun lateral to Ren 17. It may be close to the superior edge of the 5th rib.
This point is not usually used on women as it is forbidden to needle glandular tissue.

Question 17

Pc 2: TIANQUAN Heavenly Spring

Answer 17

7 cun above the flexure of the elbow (Pc 3), between the two heads of the biceps muscle. Ask the patient to turn her hand palm-side up (supine).
The easiest way to identify the point is to ask the patient to move her arm in two ways to expose the cun and muscle landmarks. Ask the patient to push her arm out laterally against the resistance of your hand; this will reveal the ‘V’ of the insertion of the deltoid, on the lateral side of her arm, and this lies at 7 cun. Then ask the patient to raise her forearm against the resistance of your hand to show off her biceps muscle and reveal the gap between the heads of the biceps. Where these two coordinates overlap is Pc 2.
Notice that on someone with well-developed biceps muscles this looks like the mid-line of the anterior surface of the arm, but on someone with smaller muscles (often women!) it may appear to be more medial than you would have expected visually.

Question 18

Lu 3 (W) TIANFU Heavenly Treasury

Answer 18

6 cun above the flexure of the elbow (Lu 5), on the posterio-lateral border of the biceps muscle.
With her hand supine, ask the patient to raise her forearm against the resistance of your hand to expose the biceps muscle. As with Pc 2 the position of the posterior border of the biceps varies enormously depending on a person’s build. Put your fingers on the lateral surface of the patient’s arm where you can feel the humerus bone. Inch your fingers up (anteriorly) until they fall into the seam between bone and muscle. This is the line of the Lung Channel.
Find 6 cun by dividing the 9 cun length into 3 equal parts, or come down 1 cun from the level of the ‘V’ of the insertion of the deltoid (which is at 7 cun).