Pocket Atlas of Acupuncture and Trigger Points E-Book

• Herausgeber: Thieme
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 321

Veröffentlichungsjahr: 2017

Beschreibung

This concise pocket-sized acupuncture guide is what professionals have been asking for! It is the first pocket atlas to cover all the major body and ear acupuncture points, including extensive coverage of the trigger points. Detailed descriptions of the localization, needling depth, indications, and functions of each point are provided. The different schools of ear acupuncture (e.g., Chinese vs. Nogier), often a source of confusion for practitioners, are presented side by side, usually in full-page illustrations, enhancing this book's usefulness as a daily reference guide.

The presentation of three acupuncture therapy systems follows a clear didactic concept: All points are shown in text and image, and the localization of the points is aided by means of anatomic drawings and photographs.

Coming from diverse specialties, the authors provide you with the most complete, useful, and accurate information available. Acupuncture points are described using the "visual-didactic processing system," which is rapidly gaining praise and recognition for its easy-to-use format. The clearly written text is augmented by high-quality color images.

Hecker's Pocket Atlas of Acupuncture and Trigger Points is ideal as a quick reference in your daily practice or as an exam preparation guide. This wealth of information makes it invaluable to experienced practitioners and to novices alike.

Leseprobe

Pocket Atlas of Acupuncture and Trigger Points

Hans-Ulrich Hecker, MD

Private Practice

Kiel, Germany

Angelika Steveling, MD

Private Practice

Essen, Germany

Elmar T. Peuker, MD

Private Practice

Münster, Germany

Kay Liebchen, MD

Private Practice

Borgwedel, Germany

With contributions by

Michael Hammes, Stefan Kopp, Gustav Peters, Beate Strittmatter

361 illustrations

Thieme

Stuttgart • New York • Delhi • Rio de Janeiro

Library of Congress Cataloging-in-Publication Data is available from the publisher.

This book is an authorized translation of the German edition published and copyrighted 2015 by Karl F. Haug Verlag, Stuttgart. Title of the German edition: Taschenatlas Akupunktur und Triggerpunkte

Translators: Ursula Vielkind, PhD, Dundas, Ontario, Canada; Johanna Cummings-Pertl, Hopland, CA, USA

Illustrator: Rüdiger Bremert, Munich, Germany; Helmut Holtermann, Dannenberg, Germany; Martin Wunderlich, Kiel, Germany

© 2018 Georg Thieme Verlag KG

Thieme Publishers Stuttgart

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    5 4 3 2 1

ISBN 978-3-13-241603-1

Also available as an e-book:

eISBN 978-3-13-241602-4

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Contents

Part 1Body Acupuncture Points

1 Introduction

2 Lung Channel

3 Large Intestine Channel

4 Stomach Channel

5 Spleen Channel

6 Heart Channel

7 Small Intestine Channel

8 Bladder Channel

9 Kidney Channel

10 Pericardium Channel

11 Triple Energizer Channel

12 Gallbladder Channel

13 Liver Channel

14 Conception Vessel (Ren Mai)

15 Governing Vessel (Du Mai)

16 Extra Points

Part 2Ear Acupuncture Points

17 Anatomy of the Outer Ear (Auricula)

18 Zones of Auricular Innervation According to Nogier

19 Newer Research on Auricular Innervation

20 Topography of Reflex Zones

21 Points on the Auricular Lobule According to Chinese Nomenclature

22 Points on the Auricular Lobule According to Nogier

23 Points on the Tragus According to Chinese Nomenclature

24 Points on the Tragus According to Nogier and Bahr

25 Points on the Intertragic Notch According to Chinese Nomenclature

26 Points on the Intertragic Notch According to Nogier

27 Points on the Antitragus According to Chinese Nomenclature

28 Points on the Antitragus According to Nogier

29 Projection of the Bony Skeleton According to Nogier

30 Projection Zones of the Spinal Column According to Nogier

31 Plexus Points in the Concha According to Nogier

32 Points in the Triangular Fossa According to Chinese Nomenclature

33 Points on the Ascending Helix According to Chinese Nomenclature

34 Points on the Helix According to Nogier

35 Covered Points on the Helix According to Nogier

36 Projection Zones of Internal Organs According to Chinese Nomenclature

37 Projection Zones of Internal Organs According to Nogier

38 Energy and Treatment Lines on the Auricula

Part 3Trigger Points

39 Definition of Trigger Points

40 Temporal Muscle

41 Masseter Muscle

42 Lateral Pterygoid Muscle

43 Short Muscles of the Neck

44 Splenius Muscle of the Head

45 Anterior, Middle, and Posterior Scalene Muscles

46 Trapezius Muscle

47 Levator Muscle of the Scapula

48 Sternocleidomastoid Muscle

49 Subclavius Muscle

50 Greater Pectoral Muscle

51 Smaller Pectoral Muscle

52 Smaller and Greater Rhomboid Muscles

53 Supraspinatus Muscle

54 Infraspinatus Muscle

55 Subscapular Muscle

56 Supinator Muscle

57 Long Radial Extensor Muscle of the Wrist

58 Extensor Muscle of the Fingers

59 Pronator Teres Muscle

60 Superficial Flexor Muscle of the Fingers

61 External Oblique Muscle of the Abdomen

62 Iliac Muscle / Psoas Muscle

63 Quadratus Lumborum Muscle

64 Gluteus Maximus Muscle

65 Gluteus Medius Muscle

66 Gluteus Minimus Muscle

67 Piriformis Muscle

68 Quadriceps Femoris Muscle

69 Hamstring Muscles

70 Gracilis Muscle

71 Tensor Muscle of the Fascia Lata

72 Gastrocnemius Muscle

73 Anterior Tibial Muscle

Part 4Appendix

74 Localization of Acupuncture Points

75 References

76 Illustration Credits

Body Points

Ear Points

Trigger Points

General Index

Preface

Acupuncture has developed into a recognized therapy option for many different disorders. Many universities have teaching positions for acupuncture. Even a few professorships for acupuncture and/or Chinese medicine have been established.

Acupuncture that meets the “lege artis” standard requires precise localization of acupuncture points. The concept we introduce for localizing acupuncture points based on given anatomical structures has established itself as a standard.

This pocket atlas contains three parts:

Part 1, Body Acupuncture Points, contains the most important points for body acupuncture and describes their location, depth of needling, indications and actions in Chinese medicine. A brief introduction presents the most important aspects of the history of body acupuncture and an overview of its mode of action.

Part 2, Ear Acupuncture Points, describes ear acupuncture points according to the Western school of acupuncture of Nogier and Bahr as well as according to Chinese teachings and explains the differences between them. This part also includes the latest findings and research on auricular innervation by Peuker et al.

Part 3, Trigger Points, introduces the most important defined trigger points of relevance in clinical practice, describes their relationship to corresponding acupuncture points, and discusses theoretical foundations.

We would like to thank everyone involved in the creation of this book, especially Ruediger Bremert and Helmut Holtermann for their excellent anatomical drawings. We are grateful to the entire staff at Thieme Publishers for their support in realizing this English edition.

Dr. Hans-Ulrich Hecker

Dr. Angelika Steveling

Dr. Elmar T. Peuker

Dr. Kay Liebchen

The Authors

Hecker, Hans-Ulrich, MD

Medical specialist in general medicine, naturopathy, homeopathy, acupuncture. Lecturer in Naturopathy and Acupuncture, Christian Albrecht University, Kiel, Germany.

Research Director of Education in Naturopathy and Acupuncture, Academy of Continuing Medical Education of the Regional Medical Association of Schleswig-Holstein. Certified Medical Quality Manager. Assessor of the European Foundation of Quality Management (EFQM).

Steveling, Angelika, MD

Department of Traditional Medicine and Pain Management, Grönemeyer Institute of Microtherapy, Bochum, Germany, Chair of Radiology and Microtherapy, University of Witten-Herdecke, Germany. Chiropractor, NLP practitioner, dietetic treatment.

Lecturer for continuing acupuncture education of the Regional Medical Association of Schleswig-Holstein.

Lecturer of the German Medical Association of Acupuncture (DÄGfA).

Peuker, Elmar T., MD

Medical specialist in internal and general medicine, medical specialist in anatomy, acupuncture, chiropractic, naturopathy, special pain management, and osteopathy. Certified health economist. Research Director of Education in Acupuncture, Academy of Continuing Medical Education of the Regional Medical Association of Westfalen-Lippe. Author and coauthor of many books and articles.

Liebchen, Kay, MD

Medical specialist in orthopedics/rheumatology, chiropractic, physiotherapy, special pain management, sports medicine.

Instructor at the German Society for Chiropractic (MWE) and at the Academy for Osteopathy, Damp, Germany.

Lecturer for Acupuncture, Academy of Continuing Medical Education of the Regional Medical Association of Schleswig-Holstein, Germany, with a focus on combining acupuncture with manual therapy, osteopathy, trigger point therapy, and acu-taping. Author and co-author of many books and articles.

Chairman of the German Society for Acu-Taping.

Contributors

Hammes, Michael G., MD

Assistant physician, Neurological Clinic, Clinical Center Lippe-Lemgo, Germany. Acupuncture, special pain management. Postgraduate studies of TCM in China. Lecturer and board member of the German Medical Association of Acupuncture (DÄGfA).

Prof. Kopp, Stefan, DMD

Chief Physician and Director of the “Carolinum” Dental Institute, Orthodontic Outpatient Clinic, Clinical Center of the Johann Wolfgang Goethe-University, Frankfurt, Germany.

Peters, Gustav, MD

Medical specialist in general medicine, acupuncture, homeopathy, and chiropractic, Hankensbüttel, Germany.

Lecturer of the German Medical Association of Acupuncture (DÄGfA).

Focus on ear acupuncture/auriculomedicine.

Strittmatter, Beate, MD

Medical specialist in general medicine and sports medicine; naturopath and acupuncturist; Director of Education at the German Academy for Acupuncture and Auriculomedicine (DAA).

Part I Body Acupuncture Points

1 Introduction

2 Lung Channel

3 Large Intestine Channel

4 Stomach Channel

5 Spleen Channel

6 Heart Channel

7 Small Intestine Channel

8 Bladder Channel

9 Kidney Channel

10 Pericardium Channel

11 Triple Energizer Channel

12 Gallbladder Channel

13 Liver Channel

14 Conception Vessel (Ren Mai)

15 Governing Vessel (Du Mai)

16 Extra Points

1 Introduction

Body acupuncture originated in China and was first recorded in the literature about 90 BC. Initially, these records described five needle-insertion points on the lower arms and lower legs, which bore names analogous to the course of a running river:

Well

Spring

Stream

Channel (river)

Uniting point

Even earlier, there existed wooden figurines with acupuncture channels, for example, those found in a grave from the Han Dynasty (200 BC to AD 9). According to traditional Chinese thinking, life energy, or Qi, circulates in these acupuncture channels, also called meridians.

Over time, more acupuncture points have been added to these channels and beyond. These are called extraordinary points. Current teaching includes 361 classic body acupuncture points.

The description and passing down of these acupuncture points probably follows empirical knowledge. For example, local points in especially painful areas were added and—if successful—retained and integrated into the system. This explains, for example, the more than coincidental correlation between acupuncture and trigger points. Other functions and combinations of points were added later based on observation or theoretical analysis.

Mechanisms of action on a segmental, or higher, functional level for treatment of pain disorders with acupuncture have been scientifically proven. Segmentally, acupuncture activates inhibitory interneurons via Aß fibers (A beta fibers, mechanoreception) and Aδ fibers (A delta fibers, rapidly conducting pain fibers). At a higher functional level, acupuncture causes the hypothalamic systems to produce endorphins that activate serotonergic and noradrenergic pathways.

There is also proof that acupuncture can inhibit the sympathetic nervous system and can activate the immune system. The connecting element here is most likely the hypothalamus–pituitary–adrenal system.

In the past, several attempts were made to define the anatomical correlations of acupuncture points. Initial work in this field came from the school of the Viennese anatomist G. Kellner, which postulated that acupuncture points are based on concentrations of certain receptors. However, it was not possible to provide specific proof of such concentrations.

In the 1980s, older research about acupuncture points was revisited, namely that they correspond to perforations in superficial body fascia by specific bundles of blood vessels and nerves. This theory is being tested primarily by a working group led by Professor Hartmut Heine. Other teams of researchers have also found that such fascia perforations are often located near acupuncture points. However, this does not provide specific proof, because such perforations are to be found in thousands of locations on the entire body.

Newer research (e.g., Dung, Peuker et al, Ma et al) indicates that the morphological correlation responsible for causing acupuncture effects may go beyond the structure reached by the tip of the needle. Given the varying effects of acupuncture, one can assume that the morphological substrates are also highly variable. This thesis is largely accepted in the English-speaking world, while the theory of fascia perforations is more common in the German-speaking areas.

The main target structures reached by acupuncture needles are—among others—septa, layers of connective tissue, and fasciae, as well as joint capsules, periostea, and epineural sheaths. These result in varying target theories for the effects of acupuncture.

Newer research shows a direct effect of needling on connective tissue fibers (Langevin). Considering the link between collagen fibers and cells that produce connective tissue via integrins, and the ability to influence the production and composition of the extracellular matrix, it becomes possible to build a stable bridge to the system of basic regulation (Pischinger and Heine) and therefore, connect acupuncture and classic natural healing methods.

2 Lung Channel

▶ Fig. 2.1

Fig. 2.1 Major points of the Lung Channel.

2.1 Major Points

LU-1: Front collecting point (Mu Point)

LU-5: Sedation point

LU-7: Connecting point (Luo Point). Opening point of the Conception Vessel Ren Mai

LU-9: Source point (Yuan Point). Tonification point, master point of the blood vessels

LU-11: Local point

2.2 Associated Points

LU-1: Front collecting point (Mu Point) of the lung

BL-13: Back transport point (Back Shu Point) of the lung

2.3 Coupling Relationships

▶ Fig. 2.2

Fig. 2.2 Coupling relationships of the Lung Channel.

Top-to-bottom coupling: Lung–spleen

Yin-Yang coupling: Lung–large intestine

2.4LU-1 Zhong Fu

“Central Treasury” (“Central Mansion”), Front Collecting Point (Mu Point)

Location: 6 Cun lateral to the median line, 1 Cun below the clavicle, slightly medial to the caudal border of the coracoid process, at the level of the first intercostal space (ICS 1) ( ▶ Fig. 2.3).

Fig. 2.3LU-1.

Note

To locate the coracoid process, palpate in a cranial direction along the anterior fold of the armpit until you feel a distinct bony marker. The easiest way to palpate the coracoid process is by gliding the finger laterally at the caudal margin of the clavicle. Just before reaching the bony structure you are looking for, the finger slides into a soft depression (absence of bony ribs). The coracoid process is located laterally, slightly beyond that depression.

Functional Note

Differentiation between the coracoid process and the lesser tubercle of the humerus: When the arm is rotated slightly outward with the elbow flexed, the coracoid process does not move, while the lesser tubercle of the humerus immediately follows the movement.

Practical Tip

LU-1 is located in the area of tendon insertions of the smaller pectoral muscle, biceps muscle of arm (short head), and coracobrachial muscle; these muscles are often shortened and sensitive to pressure in cases of poor posture in the thoracic region.

Depth of needling: 0.3 to 0.5 Cun.

This is one of the generally dangerous acupuncture points, because improper needling in the mediodorsal direction may create the risk of causing pneumothorax (e.g., in older patients with vesicular emphysema). To cause a pneumothorax, however, requires certain anatomical conditions and incorrect needling in the mediodorsal direction. This point should only be needled in the laterodorsal direction, that is, in the direction of the coracoid process, or tangential to the coracoid process.

Indication:Respiratory tract disorders, cough and bronchitis with phlegm, bronchial asthma, tonsillitis, shoulder–arm syndrome, thoracalgia (pain in the chest).

Action in TCM: Regulates the circulation of Lung Qi and in case of Lung Qi Stagnation.

2.5LU-5 Chi Ze

“Cubit Marsh" Sedation Point

Location: Radial to the biceps tendon, in the elbow crease ( ▶ Fig. 2.4).

Fig. 2.4LU-5.

Note

Locating the biceps tendons is easiest when the lower arm is flexed and supine.

Depth of needling: 0.5 to 1 Cun, perpendicularly.

Indication:Bronchial asthma, bronchitis, croup, tonsillitis, epicondylopathia, skin disorders; possibly microphlebotomy in case of repletion disorders, possibly moxibustion in case of weakness (caution: asthma, ragweed allergy); pain and swelling on the inside of the knee; shoulder pain.

H. Schmidt:Repeated moxa in case of croup.

J. Bischko:For facial skin disorders.

Action in TCM: Expels Phlegm Heat from the Lung Channel.

2.6LU-7 Lie Que

“Broken Sequence” (“Branching Crevice”), Connecting Point (Luo Point), Opening Point of the Conception Vessel

Location: Radiolateral on the lower arm, in a V-shaped groove proximal to the styloid process of the radius, 1.5 Cun proximal to the wrist crease ( ▶ Fig. 2.5).

Fig. 2.5LU-7

Note

This groove is created by the tendon of the brachioradial muscle, which inserts here at the radius, below the long abductor muscle of the thumb.

The tiger mouth grip may be used to find this point ( ▶ Fig. 2.6). LU-7 is located on the border between the inside and outside of the lower arm, right in front of the tip of the index finger.

Fig. 2.6Tiger mouth grip.

As a point on a Yin channel, LU-7 still lies just within the Yin region.

Note

To find this point: When using the tiger mouth grip, both practitioner and patient should keep the hand and lower arm of both arms straight and avoid bending or flexing the wrist.

Method of needling: Lift the skin to form a skin fold proximal to the styloid process of the radius, then insert the needle obliquely into the lifted fold in the proximal direction.

Depth of needling: 0.5 to 1 Cun.

Indication:Bronchial asthma, bronchitis, cough, wrist arthralgia, migraine, cephalgia, autonomic dysregulation, tics in the facial area, stuffy nose, facial paralysis.

Action in TCM:

Regulates and descends Lung Qi

Regulates Lung Disharmony caused by grief

Clears the surface of pathogenic climate factors

2.7LU-9 Tai Yuan

“Great Abyss” (“Great Gulf”), Source Point (Yuan Point), Tonification Point, Master Point of the Blood Vessels

Location: Radial side of the wrist flexion crease, lateral to the radial artery ( ▶ Fig. 2.7). Of the existing wrist creases, use the one running from the transition of the radius and ulna on one side and the wrist bones (carpal bones) on the other side. Select the wrist crease that is located distal to the clearly palpable end of the styloid process of the radius.

Fig. 2.7LU-9.

Note

The desired position of the needle is close to the radial artery. This results in a direct effect on the perivascular sympathetic neurovascular plexus. (Explanation of the effect of acupuncture according to König/Wancura: LU-9 is the master point for blood vessels.) The position of the needle is therefore correct when the needle pulses. From that point onward, however, there must be no more stimulation with the needle, that is, the sedation method must not be used. Accidental puncture of the radial artery has no effect whatsoever, as long as bypass circulation through the ulnar artery exists (to be established by prior palpation of the ulnar artery) and compression is subsequently applied.

Depth of needling: 2 to 3 mm, perpendicularly.

Indication:Respiratory tract disorders, bronchial asthma, chronic bronchitis, cough, circulatory disorders, peripheral arterial occlusive disease, Raynaud’s disease, disorders of the wrist.

Action in TCM:

Tonifies and replenishes Lung Qi and regulates its circulation

Promotes circulation of Qi and Blood

2.8LU-11 Shao Shang

“Lesser Shang” (“Young Shang”)

Location: Radial corner of the thumbnail (Chinese), ulnar corner of the thumbnail (J. Bischko). As shown in the figure, the thumbnail corner point is located at the intersection of vertical and horizontal lines running along the bottom and side of the nail ( ▶ Fig. 2.8).

Fig. 2.8LU-11.

Depth of needling: 1 to 2 mm, perpendicularly; let bleed if necessary.

Indication:Inflammatory throat disorders.

J. Bischko: Master point for throat disorders (see ▶ Additional Information), possibly with microphlebotomy in case of acute symptoms.

Additional Information

In addition to the eight proper master points (LR-13, CV-12 and 17, BL-11 and 17, GB-34 and 39, LU-9), J. Bischko described about 40 other “master points.”

Action in TCM: Expels exterior Wind Heat.

3 Large Intestine Channel

▶ Fig. 3.1

Fig. 3.1 Major points of the Large Intestine Channel.

3.1 Major Points

LI-1: Local point

LI-4: Source point (Yuan Point)

LI-10: Local point

LI-11: Tonification point

LI-14: Local point

LI-15: Local point

LI-20: Local point

3.2 Associated Points

ST-25: Front collecting point (Mu Point) of the large intestine

BL-25: Back transport point (Back Shu Point) of the large intestine

ST-37: Lower sea point (Lower He Point) of the large intestine

3.3 Coupling Relationships

▶ Fig. 3.2

Fig. 3.2 Coupling relationships of the Large Intestine Channel.

Top-to-bottom coupling: Large intestine–stomach

Yang-Yin coupling: Large intestine–lung

3.4LI-1 Shang Yang

“Metal Yang”

Location: Radial corner of the index finger nail ( ▶ Fig. 3.3); for exact localization of starting and end points of the channels of the hand, see ▶ LU-11.

Fig. 3.3LI-1.

Depth of needling: 1 to 2 mm, perpendicularly; let bleed if necessary.

Indication:Acute fever, acute toothache, acute inflammation of the throat; important analgesic point.

J. Bischko: Master point for toothache.

Additional Information

For more details on master points according to J. Bischko, see ▶ LU-11.

Action in TCM: Expels Heat and Wind Heat.

3.5LI-4 He Gu

“Union Valley” (“Connected Valleys,” “Enclosed Valley”), Source Point (Yuan Point)

Location: There are several possibilities for localizing this most commonly used acupuncture point:

With thumb abducted, this point is located halfway on the line connecting the middle of the first metacarpal bone with the middle of the second metacarpal bone ( ▶ Fig. 3.4). The needle is pushed forward about 0.5 to 1 Cun toward the center of the lower surface of the shaft of the second metacarpal bone.

With thumb adducted, insert the needle into the highest point of the first dorsal interosseous muscle, which is contracted during adduction and pushed upward by the adductor muscle of the thumb ( ▶ Fig. 3.5). After inserting the needle, allow the hand to relax immediately and push the needle forward approximately 0.5 to 1 Cun toward the middle of the lower surface of the second metacarpal bone. This kind of localization can only be used when the highest point of the muscle bulge is located in the middle of the second metacarpal bone.

With thumb abducted, palpate in the direction of the second metacarpal bone with the flexed phalanx of the thumb of other hand. This localization aid serves particularly well for sensing the De Qi. The angled thumb is pressed moderately firmly against the lower surface of the second metacarpal bone. LI-4 in ▶ Fig. 3.6 corresponds to the deep localization of this point.

Fig. 3.4LI-4 (1).

Fig. 3.5LI-4 (2).

Fig. 3.6LI-4 (3).

Depth of needling: 0.5 to 1 Cun, slightly oblique in a proximal direction toward the palm.

Indication:This is the most important analgesic point and affects the entire body; fever, beginning of feverish colds, hemiplegia, acne, eczema, disorders of the head region (pain, inflammation, allergic reactions), facial paralysis, abdominal symptoms, general stimulation of metabolism, stimulates labor, dysmenorrhea.

Note

Do not perform downward (descending) stimulation during pregnancy.

Action in TCM:

Expels exterior pathogenic climate factors

Calms the Mind, consciousness (Shen)

Regulates Lung Qi

Removes Stagnation

3.6LI-10 Shou San Li

“Arm Three Li” (“Hand Three Li”)

Location: 2 Cun distal to LI-11 on the line connecting LI-5 and LI-11, in the long radial extensor muscle of the wrist ( ▶ Fig. 3.7); with deeper needling into the supinator muscle).

Fig. 3.7LI-10 and LI-11.

Note

Search for this point on a slightly flexed lower arm, with the thumb pointing upward.

Depth of Needling: 1 to 2 Cun, perpendicularly.

Indication:General tonification point (moxa); lateral humeral epicondylitis (tennis elbow), paresis of the upper extremity.

H. Schmidt: Inflammatory facial rash, nasal furuncle (moxa).

J. Bischko: Test point for obstipation.

Action in TCM: Removes obstructions from the channel.

3.7LI-11 Qu Chi

“Pool at the Bend” (“Bent Pond”), Tonification Point

Location: Lateral to the radial end of the elbow flexion crease when the lower arm is flexed at a right angle, in a depression between the end of the elbow crease and the lateral epicondyle, in the region of the long radial extensor muscle ( ▶ Fig. 3.7). This point is located between LU-5 and the lateral epicondyle of the humerus.

Note

If there are two creases, pulling the skin slightly toward the olecranon will identify the crease to be used.

Depth of needling: 1 to 2 Cun, perpendicularly.

Indication:Lateral humeral epicondylitis, paresis of the upper extremity, general immune-modulating effect, homeostatic effect, skin disorders, reducing fever; allergic disorders, abdominal disorders, soft or liquid stools with bad odor (traveler’s diarrhea). Allow to bleed in cases of pharyngitis and laryngitis (hoarseness).

Action in TCM: Dispels Heat.

3.8LI-14 Bi Nao

“Upper Arm” (“Middle of Upper Arm”)

Location: At the insertion of the medial part of the deltoid muscle. The point is located on the line connecting LI-11 and LI-15, 2 Cun caudal to the anterior end of the armpit fold ( ▶ Fig. 3.8). The insertion of the deltoid muscle can be easily localized when the arm is abducted.

Fig. 3.8LI-14 and LI-15.

Depth of needling: 0.5 to 1.5 Cun, perpendicularly.

Indication:Periarthritis of shoulder, neuralgia and paresis of the upper extremity.

Action in TCM: Removes obstructions from the channel.

3.9LI-15 Jian Yu

“Shoulder Bone” (“Shoulder Blade”)

Location: When the arm is abducted, two depressions are created slightly ventral and dorsal to the acromion. LI-15 is located in the area of the ventral depression, immediately below the ventral pole of the acromion ( ▶ Fig. 3.8).

Additional Information

The two depressions ventral and dorsal to the acromion have the following anatomical explanation:

The deltoid muscle consists of three parts:

The clavicular part.

The acromial part.

The spinal part (belonging to the spine of the scapula).

At each location on the shoulder girdle where two parts originate, a depression forms below the acromion, at the end of muscle grooves, which are often clearly visible.

Note

The easiest way to find the ventral pole of the acromion is by laterally palpating along the ventral clavicular region. The dorsal pole of the acromion becomes palpable by following the scapular spine in a lateral direction.

Depth of needling: 0.5 Cun, perpendicularly, or 1 to 2 Cun oblique distal.

Note

There is a risk of piercing the shoulder joint if needling in a vertical direction.

Indication:Periarthritis of the shoulder (frozen shoulder), paresis of the upper extremity, neuralgia of the upper extremity.

J. Bischko: Master point for paresis of the upper extremity (for more details on master points according to J. Bischko, see ▶ LU-11).

H. Schmidt: In case of hemiplegia, daily moxa starting on day 7 after paralysis; prophylactic to prevent muscle atrophy.

Action in TCM: Removes obstructions from the channel.

3.10LI-20 Ying Xiang

“Welcome Fragrance” (“Welcoming Perfume”)

Location: Approximately 5 Fen lateral to the middle of the nasal wing, in the nasolabial groove ( ▶ Fig. 3.9).

Fig. 3.9LI-20.

Depth of needling: 3 to 8 mm, obliquely in a craniomedial direction.

Practical Tip

Cleanliness is particularly important in this region. Infected regions must not be needled under any circumstances. LI-20 is located close to the angular vein, which drains the blood from the facial area above the lips. The angular vein has an anastomosis to the ophthalmic vein and thereby is connected with the cavernous sinus. In the worst case, with infections, there is a risk of sinus thrombosis and central inflammatory processes.

Indication:Rhinitis, sinusitis, anosmia, toothache, facial paralysis, trigeminal neuralgia.

Action in TCM: Opens the nose, disperses Heat.

4 Stomach Channel

▶ Fig. 4.1

Fig. 4.1 Major points of the Stomach Channel.

4.1 Major Points

ST-2: Local point

ST-6: Local point

ST-7: Local point

ST-8: Local point

ST-25: Front collecting point (Mu Point) of the large intestine

ST-34: Cleft point (Xi Point)

ST-35: Local point

ST-36: Lower sea point (Lower He Point) of the stomach

ST-38: Local point with remote effect on the shoulder

ST-40: Connecting point (Luo Point)

ST-41: Tonification point

ST-44: Peripheral pain point

4.2 Associated Points

CV-12: Front collecting point (Mu Point) of the stomach

BL-21: Back transport point (Back Shu Point) of the stomach

ST-36: Lower sea point (Lower He Point) of the stomach

4.3 Coupling Relationships

▶ Fig. 4.2

Fig. 4.2 Coupling relationships of the Stomach Channel.

Top-to-bottom coupling: Large intestine–stomach

Yang-Yin coupling: Stomach–spleen

4.4ST-2 Si Bai

“Four Whites”

Location: Above the infraorbital foramen, below the pupil when looking straight ahead ( ▶ Fig. 4.3).

Fig. 4.3ST-2.

Note

The infraorbital foramen is usually located slightly medial to the vertical line drawn through the middle of the pupil when looking straight ahead, approximately in the middle of the total length of the nose.

Depth of needling: 0.3 to 0.5 Cun, perpendicularly.

Practical Tip

The risks resulting from needling in infected regions within the drainage area of the angular vein are as described for LI-20.

Indication:Eye disorders, migraine, rhinitis, sinusitis, facial paralysis, trigeminal neuralgia.

Action in TCM: Clears the eyes and supports vision.

4.5ST-6 Jia Che

“Cheek Carriage” (“Mandibular Angle”)

Location: 1 Cun cranial and ventral to the angle of the lower jaw. When biting down, a gap in the masseter muscle can be palpated in this location ( ▶ Fig. 4.4).

Fig. 4.4ST-6.

Note

The localization of ST-6 corresponds to that of a common trigger point in the insertion of the masseter muscle.

Depth of needling: 0.3 Cun, perpendicularly.

Indication:Myofacial pain dysfunction (temporomandibular disorder, Costen’s syndrome), facial pain, facial paralysis, trigeminal neuralgia, toothache, gnathologic problems, teeth grinding.

J. Bischko: Peroral skin efflorescence.

Action in TCM: Removes obstructions from the channel.

4.6ST-7 Xia Guan

“Below the Joint” (“Lower Pass”)

Location: In the center of the depression below the zygomatic arch, in the mandibular notch between the coronoid process and the condylar process of the mandible. The condylar process of the mandible can be easily palpated in front of the tragus (it glides toward the front when the mouth is open). ST-7 is located in a depression immediately in front of it ( ▶ Fig. 4.5). This point is searched for and needled while the mouth is closed.

Fig. 4.5ST-7.

Note

Deep needling of this point reaches the lateral pterygoid muscle. Localization of ST-7 often corresponds to a trigger point in the lateral pterygoid muscle.

Depth of needling: 0.3 to 0.5 Cun, perpendicularly.

Indication:Myofacial pain dysfunction (Costen’s syndrome), atypical facial pain, temporomandibular joint problems, facial paralysis, tinnitus, otalgia.

Action in TCM: Removes obstructions from the channel.

4.7ST-8 Tou Wei

“Head Corner”

Location: 0.5 Cun into the hair from the frontal hairline, in the angle of this hairline with the temporal hairline running perpendicular to it ( ▶ Fig. 4.6).

Fig. 4.6ST-8.

Point ST-8 is located 4.5 Cun lateral to Point GV-24.

Note

Points ST-6, 7, and 8 lie approximately on a vertical line ( ▶ Fig. 4.4). If the original frontal hairline is no longer visible because of hair loss, it can be located by the patient frowning and identifying the border of the frontal folds.

Depth of needling: 2 to 4 mm, subcutaneously in a dorsal direction.

Indication:Cephalgia, migraine, eye disorders, atypical facial pain, vertigo.

Action in TCM: Clears Heat, eliminates Dampness and Phlegm in the head.

4.8ST-25 Tian Shu

“Celestial Pivot” (“Upper Pivot”), Front Collecting Point (Mu Point)

Location: 2 Cun lateral to the navel ( ▶ Fig. 4.7).

Fig. 4.7ST-25.

Depth of needling: 0.5 to 1.5 Cun, perpendicularly.

Indication:Obstipation, meteorism, diarrhea, ulcers of the stomach and duodenum, Crohn’s disease, ulcerative colitis, functional gastrointestinal problems.

Action in TCM: Eliminates Heat and Dampness in the intestine.

4.9ST-34 Liang Qiu

“Beam Hill” (“Hill Ridge”), Cleft Point (Xi Point)

Location: With the knee slightly flexed, 2 Cun above the lateral upper margin of the patella, in a depression within the lateral vastus muscle ( ▶ Fig. 4.8). This point is located on a line connecting the superior anterior iliac spine and the lateral upper pole of the patella.

Fig. 4.8ST-34 to ST-36.

Note

All points of the knee region are searched for and needled with the knee slightly flexed (use padding to better support the patient).

Depth of needling: 1 to 2 Cun, perpendicularly.

Indication:Acute symptoms of the gastrointestinal tract, knee problems, nausea and vomiting; distant point used in mastitis.

Action in TCM:

Descends rebellious Stomach Qi

Clears channels, relieves pain

4.10ST-35 Du Bi

“Calf’s Nose”

Location: With the knee slightly flexed, below the patella and lateral to the patellar tendon ( ▶ Fig. 4.8, ▶ Fig. 4.9); lateral “Eye of the Knee” (“Eye of the Knee" applies to the points caudal, medial, and lateral to the patella).

Fig. 4.9ST-35 to ST-41.

The lateral “Eye of the Knee” corresponds to Point ST-35, the medial “Eye of the Knee” corresponds to Extra Point Xi Yan (EX-LE-5).

Note

Do not needle too deeply because of the risk of positioning the needle intra-articularly (within the joint). The lateral “Eye of the Knee” corresponds approximately to the location of arthroscopic access to the knee joint.

Depth of needling: 3 to 6 mm, in a slightly oblique medial direction.

Indication:Gonalgia.

Action in TCM:

Removes obstructions from the channel

Expels Wind and Cold

4.11ST-36 Zu San Li

“Leg Three Li” (“Foot Three Li”), Lower Sea Point (Lower He Point) of the Stomach

Location: With the knee slightly flexed, 3 Cun below ST-35, approximately at the level of the lower border of the tibial tuberosity as well as about 1 Cun lateral to the tibial edge in the anterior tibial muscle ( ▶ Fig. 4.8, ▶ Fig. 4.9)

Note

With dynamic palpating, a distinct depression is palpable at ST-36. In the German literature, the distance is usually given as 1 Cun lateral to the tibial edge, while Chinese literature always gives the slightly lesser width of 1 middle finger.

Depth of needling: 0.5 to 1.5 Cun, perpendicularly.

Indication: One of the most versatile and most frequently used acupuncture points (second to LI-4); a general tonification point, often used in moxa; homeostatic effect on metabolic disorders; distant point for abdominal disorders; strongly harmonizing effect on the psyche.

Action in TCM:

Regulates Spleen and Stomach functional circles

Tonifies/replenishes: whole body Qi and Defensive Qi (Wei Qi)

4.12ST-38 Tiao Kou

“Ribbon Opening” (“Narrow Mouth”)

Location: In the middle of the line connecting Points ST-35 and ST-41 ( ▶ Fig. 4.10), one width of the middle finger lateral to the tibial edge, or 2 Cun caudal to ST-37.

Fig. 4.10ST-38 and ST-40.

Note

According to König/Wancura, the middle between the two points is best determined using the hand-span method. For this purpose, place the two little fingers on Points ST-35 and ST-41 and locate the center using both thumbs.

Depth of needling: 1 to 2 Cun, perpendicularly.

Indication:Distant point used in acute shoulder–arm syndrome.

Action in TCM: Expels Wind Dampness, relieves pain.

4.13ST-40 Feng Long

“Bountiful Bulge” (“Rich and Prosperous”), Connecting Point (Luo Point)

Location: 1 width of the middle finger lateral to Point ST-38 ( ▶ Fig. 4.10).

Depth of needling: 1 to 2 Cun, obliquely in a medial direction.

Indication:Gastrointestinal disorders, hypersalivation (Dampness); “mucous disorders”—all disorders with excessive mucus production (mucous cough, mucous vomiting, mucous diarrhea).

Action in TCM: Drains Dampness, transforms Phlegm.

4.14ST-41 Jie Xi

“Ravine Divide” (“Opened Hollow”), Tonification Point

Location: In the anterior middle of the line connecting the lateral malleolus with the medial malleolus, between the tendons of the long extensor muscle of the great toe and the long extensor muscle of toes over the upper ankle joint ( ▶ Fig. 4.11).

Fig. 4.11ST-41 and ST-44.

Note

The tendon of the long extensor muscle of the great toe can be recognized by lifting the toe; Point ST-41 is located laterally. Deep needling reaches the upper ankle joint.

Depth of needling: 0.5 to 1 Cun, perpendicularly.

Indication:Stomach problems, disorders of the ankle joint.

Action in TCM: Disperses Heat, calms the Mind (Shen).

4.15ST-44 Nei Ting

“Inner Court”

Location: At the end of the interdigital fold, between second and third toe ( ▶ Fig. 4.11).

Depth of needling: 0.3 to 1 Cun, perpendicularly.

Indication:An important pain point; frontal headache, nosebleed, feverish colds.

H. Schmidt: For upset stomach.

Action in TCM: Clears Heat, drains Heat.

5 Spleen Channel

▶ Fig. 5.1

Fig. 5.1 Major points of the Spleen Channel.

5.1 Major Points

SP-3: Source point (Yuan Point)

SP-4: Connecting point (Luo Point). Opening point of the extraordinary channel Chong Mai (Penetrating Vessel)

SP-6: Crossing point of the three Yin Channels of the foot

SP-9: Local point with remote effect

SP-10: Local point with remote effect

5.2 Associated Points

LR-13: Front collecting point (Mu Point) of the spleen

BL-20: Back transport point (Back Shu Point) of the spleen

5.3 Coupling Relationships

▶ Fig. 5.2

Fig. 5.2 Coupling relationships of the Spleen Channel.

Top-to-bottom coupling: Lung–spleen

Yin-Yang coupling: Spleen–stomach

5.4SP-3 Tai Bai

“Supreme White” (“Grand White,” “Supreme Whiteness”), Source Point (Yuan Point)

Location: Inner side of the foot, proximal to the head of the first metatarsal bone, at the body–head transition of the first metatarsal bone ( ▶ Fig. 5.3