Upper Jiao Points Flashcards
Ren 16: ZHONGTING Middle Hall
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.
Ren 17: SHANZHONG Middle of the Chest
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.
Ren 18: YUTANG Jade Hall
On the mid-line of the sternum, on a level with the 3rd intercostal space. About 1.6 cun above Ren 17.
Ren 19: ZIGONG Purple Palace
On the mid-line of the sternum, on a level with the 2nd intercostal space. About 1.6 cun above Ren 18.
Ren 20: HUAGAI Flower Covering
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.
Ren 21: XUANJI Jade Pivot
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.
Ren 22: TIANTU Heavenly Chimney
In the centre of the hollow at the top of the sternum. About
1/2 cun superior to the supra-sternal notch.
Kid 27:
SHUFU Empty Treasury
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.
Kid 26: YUZHON Amidst Elegance
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.
Kid 25: SHENCANG Shen Storehouse
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.
Kid 24: LINGXU Spirit Burial Ground
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.
Kid 22: BULANG Verandah Walk
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.
St 12: QUEPEN Empty Basin
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.
Lu 1: ZHONGFU Central Treasury
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.
Lu 2: YUNMEN Cloud Gate
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.
Sp 21:
DABAO Great Enveloping
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.
Sp 20: ZHOURONG Encircling Glory
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.
Pc 1: TIANCHI Heavenly Pond
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.
He 1:
JIQUAN Supreme Spring
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.
