Upper Jiao Points

Question 1

Ren 16: ZHONGTING Middle Hall

Answer 1

8 cun directly above the centre of the navel, at the inferior edge of the sternum (at the xiphisternal joint), on a level with the 5th intercostal space. To find this point, with one hand on each side follow up the two sides of the ribcage. As they converge you will find that the space becomes so small that you can only fit in one finger, and maybe only your little finger. This finger will then butt up against the inferior edge of the sternum. If the base of the sternum is a little unclear, stand back and get an overall picture of the ribcage to assess visually the place where the sides of the ribcage converge. Ask the person to raise her arms and try rolling your finger downward off the bottom of the ribcage and the sternum to find the xiphisternal joint. When you have found it, ask the person to bring her arms back down in order to relax her body. On a few people the two sides of the ribcage do not completely fuse at Ren 16, in which case use these extra guides:
The point should be
i) on a level with, or just a little below, the 5th
intercostal space.
ii) at a distance of a minimum of 1 rib space, or 1.6
cun, below Ren 17.

Question 2

Ren 17: SHANZHONG Middle of the Chest

Answer 2

On the mid-line of the sternum, on a level with the 4th intercostal space. On most men the nipples lie in the 4th intercostal space, and hence this point lies between the nipples. It may feel as if a small scoop has been taken out of the surface of the bone at this point and on many people it is unusually tender on pressure.
NB: On 9% of men and 4% of women there are congenital sternal foramina (the bones have not fused properly). Always be cautious with needle depth so as not to penetrate the sternum.

Question 3

Ren 18: YUTANG Jade Hall

Answer 3

On the mid-line of the sternum, on a level with the 3rd intercostal space. About 1.6 cun above Ren 17.

Question 4

Ren 19: ZIGONG Purple Palace

Answer 4

On the mid-line of the sternum, on a level with the 2nd intercostal space. About 1.6 cun above Ren 18.

Question 5

Ren 20: HUAGAI Flower Covering

Answer 5

On the mid-line of the sternum, on the sternal angle, on a level with the 1st intercostal space. The second rib attaches to the sternum at the sternal angle, and here the bone rises up to form a ridge. The point is just superior to the crest of this ridge. About 1.6 cun above Ren 19.

Question 6

Ren 21: XUANJI Jade Pivot

Answer 6

On the mid-line, in the centre of the sternal manubrium, on a level with the articulations of the first ribs with the sternum. 1 cun below Ren 22.

Question 7

Ren 22: TIANTU Heavenly Chimney

Answer 7

In the centre of the hollow at the top of the sternum. About
1/2 cun superior to the supra-sternal notch.

Question 8

Kid 27:
SHUFU Empty Treasury

Answer 8

Kid 27 is found in the small space under the inferior notch of the clavicle. It is 2 cun lateral to Ren 21. Starting at the supra-sternal notch, with your index finger on the superior edge of the clavicle and your thumb immediately underneath on its inferior edge, in little steps walk your thumb and finger out along the bone as far as the area of the line of the Kidney Channel. Here you will find two notches that lie in a vertical line to one another, on the top and bottom edges of the bone. Below the lower notch is the rather small space between the first rib and the clavicle.

Question 9

Kid 26: YUZHON Amidst Elegance

Answer 9

Find the 1st intercostal space, below the 1st rib. Follow the line of the Kidney meridian down from Kid 27 as above, and feel for the point. It is 2 cun lateral to Ren 20.

Question 10

Kid 25: SHENCANG Shen Storehouse

Answer 10

Find the 2nd intercostal space, below the 2nd rib. Follow the line of the Kidney meridian down from Kid 27 as above, and feel for the point. It is 2 cun lateral to Ren 19.

Question 11

Kid 24: LINGXU Spirit Burial Ground

Answer 11

Find the 3rd intercostal space. Follow the line of the Kidney meridian down from Kid 27 as above, and feel for the point. It is 2 cun lateral to Ren 18.
On a woman this may be on her breast. It is forbidden to needle a point on breast tissue, or on any gland. If the breast is in the way then gently move the gland tissue over to one side by smoothing it with your hand. Alternatively you may ask the woman to do this herself and to hold her breast while you mark or needle the point.

Question 12

Kid 22: BULANG Verandah Walk

Answer 12

Exit Pt Find the 5th intercostal space. Follow the line of the Kidney meridian down from Kid 27 as above, and feel for the point. It is 2 cun lateral to Ren 16.
This point will generally be accessible on everyone, man or woman, although again you may need to hold a woman’s breast out of the way.
Double check that you are in the correct intercostal space by finding Ren 16 in the sub-sternal notch. Kid 22 often lies at a level just a little superior to Ren 16.

Question 13

St 12: QUEPEN Empty Basin

Answer 13

With your thumb and index finger above and below the clavicle, edge them step by step out towards the area of the Stomach Channel, the mid- point of the clavicle. (On a man this will be in line with, or just a little medial to the nipple). Here the clavicle changes its shape – it narrows. You will find two notches that are vertical to one another, on the wide part of the clavicle, just as it begins to narrow. This is the line of the Stomach Channel. St 12 is in the notch on the top of the clavicle, in the depression of the supra-clavicular fossa.
LOCATION
On the middle of the superior border of the clavicle, verti- cally above the nipple, or in the midpoint of the supracla- vicular fossa, 4 cun lateral to the ren (conception channel).
LOCATION GUIDE
Have the patient sit and slightly raise their neck while looking forward. Locate the point in the anterior region of their neck in the greater supraclavicular fossa. The point is located 4 cun lateral to the anterior midline, in the depres- sion superior to the clavicle. The distance from the anterior midline to the acromion is 8 cun.

Question 14

St 13: QIHU Qi Door

Answer 14

Follow the procedure for St 12. St 13 is in the notch on the inferior border of the clavicle.
LOCATION
In between the middle of the inferior border of the clavicle and the superior border of the first rib, 4 cun lateral to the ren (conception channel), on the mammillary line.
LOCATION GUIDE
Have the patient lie in the supine position. Locate the point in the anterior thoracic region, inferior to the clavicle, 4 cun lateral to the anterior midline.

Question 15

St 14: KUFANG Storehouse

Answer 15

Continue the line of the Stomach Channel down from St 12 and 13, until you are just above the 2nd rib, in the 1st intercostal space. This will be level with, or just a little superior, and roughly 4 cun lateral to, Ren 20.
LOCATION
On the mammillary line, in the first intercostal space, 4 cun lateral to the ren (conception channel).
LOCATION GUIDE
Have the patient lie in the supine position. Locate the sternal angle, which is the palpable raised section of the sternum where the manubrium meets the body of the sternum. The second rib is located laterally to the sternal angle. Locate the point in the first intercostal space, 4 cun lateral to the anterior midline.

Question 16

St 15: WUYI Room Screen

Answer 16

Continue the line of the Stomach Channel down from St 12 and 13, until you are in the 2nd intercostal space. This will be level with, or just a little superior, and roughly 4 cun lateral to Ren 19. On a woman, if the breast is covering this point see if you can move it out of the way with your hand. Alternatively sit her up and see if the point is then available. If neither of these approaches work, and the point remains within the breast tissue it is forbidden to needle.
On the mammillary line, in the second intercostal space, 4 cun lateral to the ren (conception channel).
LOCATION GUIDE
Have the patient lie in the supine position. Locate the sternal angle, which is the palpable raised section of the sternum where the manubrium meets the body of the sternum. The second rib is located laterally to the sternal angle. Locate the point in the anterior thoracic region, in the second intercos- tal space, 4 cun lateral to the anterior midline.

Question 17

St 16: YINGCHUAN Breast Window

Answer 17

Continue the line of the Stomach Channel down from St 12 and 13, until you are in the 3rd intercostal space. This will be level with, or just a little superior, and roughly 4 cun lateral to Ren 18. On a woman, follow the same procedure as for St 15.
LOCATION
On the mammillary line, in the third intercostal space, 4 cun lateral to the ren (conception channel).
LOCATION GUIDE
Have the patient lie in the supine position. Locate the ster- nal angle, which is the palpable raised section of the sternum where the manubrium meets the body of the sternum. The second rib is located laterally to the sternal angle. Count down in the anterior thoracic region to the third intercostal space, and locate the point 4 cun lateral to the anterior midline.

Question 18

St 17: RUZHONG Breast Centre

Answer 18

In the middle of
the nipple. Forbidden to needle!
On a man the nipple is generally in the 4th intercostal space, on a level with, and 4 cun lateral to Ren 17.
LOCATION
In the fourth intercostal space, at the center of the nipple. This point acts only as a landmark for locating points on the chest and abdomen.
LOCATION GUIDE
Have the patient lie in the supine position. Locate the point in the anterior thoracic region at the center of the nipple. Note: In males, the center of the nipple is located in the fourth intercostal space.

Question 19

St 18: RUGEN Breast Root

Answer 19

On a man, continue the Stomach line down from the nipple to the 5th intercostal space. This will be level with, or just a little superior, and roughly 4 cun lateral to Ren 16. On a woman you need to visualise the line of the Stomach Channel from St 12 – 15, and carry that on down to find St 18 in the 5th intercostal space. You or she will need to hold her breast up and out of the way. You may not be able to needle this point on a woman with large breasts.
LOCATION
Located in the fifth intercostal space, 4 cun lateral to the ren (conception channel).
LOCATION GUIDE
Have the patient lie in the supine position. Locate the point in the anterior thoracic region at the intersection of the mamillary line and the fifth intercostal space. Note: In females, it is located at the midpoint of the inferior crease of the breast. In males, it is located at the inferior curvature of pectoralis major.

Question 20

Lu 1: ZHONGFU Central Treasury

Answer 20

Entry Pt. Find the large hollow that lies below the lateral end of the clavicle and just lateral to the top of the ribcage. Lu 1 is found at roughly 1.6 cun inferior to this dip and allowing for the barrel shape of the ribcage the point may lie very slightly lateral to this horizontal line. The point is just below a ridge of muscle (the pectoralis major). If the patient rests her hand on her hip, the sub-clavicular triangular dip becomes more pronounced; if she then pushes her hand firmly down on to her hip bone, the muscle ridge is highlighted (the pectoralis major). In order to mark and needle the point, the patient must return to a relaxed position with her arm by her side. Another method to highlight the muscles is with your patient’s arm lying prone by their side ask them to lift their arm whilst you resist the movement by pressing down on their hand.
Alternatively, the point is 6 cun lateral to the mid-line on a level with the 1st intercostal space. At the mid-line find the raised bump, the sternal ridge, where the manubrium joins the body of the sternum. From here, walk two fingers out laterally along the prominent 2nd rib until you fall off its end into a cavity. This is Lu 1. It is often tender.

Question 21

Lu 2: YUNMEN Cloud Gate

Answer 21

Find the large hollow that lies inferior to the acromial end of the clavicle, and lateral to the top of the ribcage, or the point where you feel the ribcage starts to curve posteriorly. The point lies here in the infra-clavicular fossa, at roughly 6 cun lateral to the mid-line at Ren 22.

LOCATION
In the depression of the infraclavicular fossa, below the acro- mial extremity of the clavicle (medial and superior to the cora- coid process), and in between the border of the pectoralis major and the deltoid muscles (deltopectoral triangle). It is found 6 cun lateral to the anterior midline and REN-22 (tian tu).
LOCATION GUIDE
Have the patient sit with their hand on their hip with their elbow turned outward. Locate the point in the middle of the triangular depression, inferior to the lateral end of the clavicle, and medial to the coracoid process of the scapula.

Question 22

Sp 21:
DABAO Great Enveloping

Answer 22

Exit Pt. Unlike the other Spleen points, this one is found on the person’s side, on an imaginary vertical line that drops down from the centre of the axilla, the mid-axillary line. The mid-axillary line runs from the centre of the axilla to the base of the 11th rib.
Ask the patient to abduct their arm up to a horizontal position. It is helpful to ask a woman to use her opposite hand to hold her breast towards her mid-line while you are finding this point. The point is found on the 7th intercostal space on the mid-axillary line, though occasionally, on some patients, the point will fall in the 6th intercostal space. Feel for a large hollow that is usually quite tender and this will be the location of SP 21.
To find which rib space you are in, count up from the 11th rib. (To find the 11th rib, find the bottom of the person’s ribcage at her waist. Using your index finger, feel the base of the ribcage at the back of the person’s sides. Follow its bottom edge round towards the front of her side, passing over the free ends of the 12th and then the 11th ribs. To check that you have found the correct rib stand back and look at the position of your finger. It should be somewhere on the anterio-lateral aspect of the patient’s side.) Take a little time gently to apply pressure as you palpate for the point.

Question 23

Sp 20: ZHOURONG Encircling Glory

Answer 23

Find the line of the Lung Channel: three quarters of the distance from the mid-line to the tip of the clavicle. Continue this line and move out slightly laterally as it skirts the 2nd intercostal space. The point lies here, lateral to the ribcage, 61/2 cun lateral to, and roughly level with Ren 19.

Question 24

Sp 19: XIONGXIANG Chest Area

Answer 24

Continue the line of the Lung Channel and Sp 20 down to the level of the 3rd intercostal space. The point lies here, 6 cun lateral to, and roughly on a level with, Ren 18.

Question 25

Sp 18: TIANXI Heavenly Stream

Answer 25

Continue the line of Sp 20 – 19 down to the level of the 4th intercostal space. The point lies here, 6 cun lateral to, and roughly on a level with, Ren 17.

Question 26

Sp 17: SHIDOU Food Drain

Answer 26

Continue the line of Sp 20 – 18 down to the level of the 5th intercostal space. The point lies here, 6 cun lateral to, and roughly on a level with, Ren 16.

Question 27

GB 22: YUANYE Armpit Abyss

Answer 27

Ask the patient to abduct their arm to a horizontal position. GB 22 lies at 3 cun inferior to the centre of the axilla on the mid-axillary line, on a horizontal level with the nipple on a man, in the 5th intercostal space.

Question 28

GB 23: ZHEJIN Intercostal Muscles

Answer 28

Ask the patient to abduct their arm to a horizontal position. The point lies 1 cun anterior to GB 22. From GB 22 follow the 5th intercostal space forwards 1 cun towards the nipple. Both GB 22 and 23 are often very tender to the touch.

Question 30

Pc 1: TIANCHI Heavenly Pond

Answer 30

Entry Pt. Ask the patient to abduct their arm to a horizontal position. The point lies at 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. If it is essential to use this point it is possible on some small-breasted women.

Question 30

He 1:
JIQUAN Supreme Spring

Answer 30

Entry Pt. Put your finger on the anterior end of the axillary crease, where the upper arm joins the shoulder. Slide your finger down and under the muscle so that it is on the axilla. Ask the patient to abduct her arm and your finger will be on He 1.
Alternatively, raise the patient’s arm so that with her arm bent at a right angle, she has her hand pointing above her head. Rotate her forearm from pointing up, to pointing down to her feet. While you do this, look for an area at the apex of her axilla that becomes a deep hollow as her forearm points to her toes. This area is where the upper arm first joins the shoulder, just posterior to the pectoralis major muscle, and medial to the axillary artery.
(The point lies just medial to (or on the chest side of) the axillary artery. In order to feel the pulsation in the artery press out laterally against the arm.)
Reminder:
* With most of these chest points it is possible to needle into the pleural cavity and so potentially to collapse a lung.
* Patients with certain lung conditions (such as emphysema), and very thin people, are more at risk than others.
* Do not ask a patient to take a deep breath while you are needling these points.