Comprehensive Study Guide: Acupuncture Channels, Extraordinary Points, and Renal Physiology

Liver Channel of Foot Jue Yin (足厥陰肝經)

• General Channel Attributes:

  • Alternate Name: Foot Jue Yin
  • Horary Diurnal Timing: $1-3\text{ a.m.}$
  • Organs Entered Directly: Liver, Gallbladder, Lung
  • Primary Clinical Indications and Standout Pathologies:
    • Vertex headaches
    • Hernia disorders
    • Chest and hypochondriac pain
    • Urinary disturbances including enuresis and dysuria
    • Emotional stress and irritability
    • Hiccups
    • Jaundice

• Pathway Trajectory and Internal Branches:

  • Originates at the lateral aspect of the big toe at Liv 1.
  • Crosses Spleen 6 (Sp 6) on the medial aspect of the lower leg.
  • Courses superiorly along the medial border of the tibia.
  • Crosses to the posterior side of the Spleen channel at an anatomical milestone of $8\,\text{cun}$ superior to the medial malleolus.
  • Ascends to wrap directly around the external genitalia.
  • Enters internal pathways penetrating the Liver, Gallbladder (GB), and Lung.
  • Ascends along the throat, encircles the inner surface of the lips, and connects with the tissues surrounding the eyes (eye system).
  • Reaches the vertex of the head to connect with the Governing Vessel at Du 20 (Baihui).

• Crucial Channel Intersections (Crossing Points):

  • Sp 6 (Sanyinjiao): Point of convergence for all three leg yin channels (Liver, Spleen, Kidney).
  • Ren 2 (Qugu): Crossing point with the Conception Vessel.
  • Ren 3 (Zhongji): Meeting point with the Conception Vessel and the convergence of all three leg yin channels.
  • Ren 4 (Guanyuan): Meeting point with the Conception Vessel and the convergence of all three leg yin channels.

• Standout Acupoints: Locations and Clinical Actions:

  • Liv 1 (Dadun): Located on the lateral aspect of the terminal phalanx of the great toe; primary point for the treatment of hernia.
  • Liv 2 (Xingjian): Ying-Spring point (Fire point); actions clear excess heat, indicated for Liver Fire flaring and Liver Yang Rising.
  • Liv 3 (Taichong): Shu-Stream and Yuan-Source point; primary function is to spread Liver Qi, serving as the benchmark point for Liver Qi stagnation.
  • Liv 4 (Zhongfeng): Jing-River point; situated just medial to the tendon of the tibialis anterior muscle.
  • Liv 5 (Ligou): Located $5\,\text{cun}$ superior to the prominence of the medial malleolus; Luo-Connecting point; addresses genital disorders including leucorrhea and genital pruritus; specialized indication for globus hystericus (plum pit Qi).
  • Liv 6 (Zhongdu): Located $7\,\text{cun}$ superior to the prominence of the medial malleolus; Xi-Cleft point; utilized for acute conditions, localized pain, and blood disorders manifesting on yin channels (such as irregular or painful menses).
  • Liv 7 (Xiguan): Located $1\,\text{cun}$ posterior to Spleen 9 (Sp 9), inferior to the medial condyle of the tibia.
  • Liv 8 (Ququan): He-Sea point (Water point on a Wood channel), functioning as the mother/tonification point; utilized clinically to tonify Liver Blood or Liver Yin.
  • Liv 13 (Zhangmen): Located directly below the free extremity of the 11th rib; Front-Mu point of the Spleen; Hui-Meeting (Influential) point of the Zang (Yin) organs; principal point selected when Liver Qi overacts on the Spleen.
  • Liv 14 (Qimen): Located $4\,\text{cun}$ lateral to the anterior midline in the 6th intercostal space (ICS); Front-Mu point of the Liver.

• Associated Extra Channels (Divergent, Luo, and Tendinomuscular):

  • The Divergent, Luo-Connecting, and Tendinomuscular (TMM) channels of the Liver all originate or course from the lower leg region directly to the external genitalia.

Gallbladder Channel of Foot Shao Yang (足少陽膽經)

• General Channel Attributes:

  • Alternate Name: Foot Shao Yang
  • Horary Diurnal Timing: $11\text{ p.m.} - 1\text{ a.m.}$
  • Organs Entered Directly: Gallbladder, Liver
  • Primary Clinical Indications and Standout Pathologies:
    • Temporal headaches and migraines
    • Hypochondriac pain
    • Aural pathologies (tinnitus, ear pain, hearing impairment)
    • Dizziness and vertigo
    • Bitter taste in the mouth

• Pathway Trajectory and Intersections:

  • Follows an extensive course over the lateral head, thorax, flank, and lower extremity.
  • Dispatches two separate branches encircling and entering the ear.
  • Gives off a branch descending to the external genitalia and the sacral region.
  • Du 14 (Dazhui): General crossing point where all yang channels intersect.
  • ST 12 (Quepen): Crucial landmark crossed by all primary yang channels with the exception of the Urinary Bladder channel.

• Standout Acupoints: Locations and Clinical Actions:

  • GB 2 (Tinghui): Located anterior to the intertragic notch, just anterior to the tragus of the ear. (Vertical tragus alignment from superior to inferior: SJ 21, SI 19, GB 2).
  • GB 8 (Shuaigu): Located $1\,\text{cun}$ superior to the auricular apex, or superior to SJ 20.
  • GB 12 (Wangu): Located in the depression just inferior and posterior to the tip of the mastoid process.
  • GB 13 (Benshen): Positioned $0.5\,\text{cun}$ within the anterior hairline, $3\,\text{cun}$ lateral to the anterior midline.
  • GB 14 (Yangbai): Situated $1\,\text{cun}$ superior to the middle of the eyebrow, directly above the pupil when looking straight ahead.
  • GB 15 (Toulinqi): Positioned $0.5\,\text{cun}$ within the anterior hairline, directly superior to the pupil ($2.25\,\text{cun}$ lateral to the anterior midline).
  • GB 20 (Fengchi): Located inferior to the occipital bone, in the depression between the upper portion of the sternocleidomastoid muscle and the lateral border of the upper trapezius muscle; actions eliminate exterior and interior wind, treat headaches, and benefit the eyes.
  • GB 21 (Jianjing): Positioned at the midpoint of the line connecting Du 14 and the acromion process; promotes lactation; strictly contraindicated in pregnancy; carries an explicit caution against deep needling due to the imminent risk of inducing a traumatic pneumothorax.
  • GB 22 (Yuanye): Located $3\,\text{cun}$ inferior to the axillary fossa on the midaxillary line.
  • GB 23 (Zhejin): Located $3\,\text{cun}$ inferior to the axilla, precisely $1\,\text{cun}$ anterior to GB 22. (Comparative reference: Spleen 21 is located $6\,\text{cun}$ inferior to the axilla).
  • GB 24 (Riyue): Located in the 7th intercostal space, directly below the nipple; only point positioned in the 7th ICS; Front-Mu point of the Gallbladder.
  • GB 25 (Jingmen): Located on the lateral aspect of the abdomen, just below the free extremity of the 12th rib; Front-Mu point of the Kidney.
  • GB 26 (Daimai): Situated at the intersection of a vertical line drawn down from the free extremity of the 11th rib and a horizontal line crossing through the umbilicus.
  • GB 29 (Juliao): Located midway between the anterior superior iliac spine (ASIS) and the highest prominence of the greater trochanter, marking the functional center of the tensor fasciae latae (TFL) muscle.
  • GB 30 (Huantiao): Situated at the junction of the lateral $1/3$ and medial $2/3$ of the distance between the prominence of the greater trochanter and the sacral hiatus (Du 2); lies directly superior to the sciatic nerve and the piriformis muscle.
  • GB 31 (Fengshi): Positioned on the lateral midline of the thigh, $7\,\text{cun}$ superior to the popliteal crease; primary empirical point for skin rashes and itching.
  • GB 33 (Xiyangguan): Located on the lateral side of the knee joint, precisely at the level of the transverse popliteal crease.
  • GB 34 (Yanglingquan): He-Sea point (Earth point) of the Gallbladder; Hui-Meeting (Influential) point of Sinews and Tendons; actions resolve musculoskeletal disorders, smooth Liver Qi, and eliminate damp-heat (indicated for jaundice).
  • GB 35 (Yangjiao): Located $7\,\text{cun}$ superior to the prominence of the lateral malleolus, along the posterior border of the fibula.
  • GB 36 (Waiqiu): Located $7\,\text{cun}$ superior to the prominence of the lateral malleolus, along the anterior border of the fibula; Xi-Cleft point.
  • GB 37 (Guangming): Located $5\,\text{cun}$ superior to the lateral malleolus, along the anterior border of the fibula; Luo-Connecting point; actions directly benefit eye pathologies.
  • GB 38 (Yangfu): Located $4\,\text{cun}$ superior to the lateral malleolus, along the anterior border of the fibula; Jing-River point.
  • GB 39 (Xuanzhong): Located $3\,\text{cun}$ superior to the lateral malleolus; can be located along either the anterior or posterior border of the fibula; Hui-Meeting (Influential) point of Marrow.
  • GB 40 (Qiuxu): Yuan-Source point; situated anterior and inferior to the lateral malleolus; indicated psycho-emotionally for timidity and lack of confidence.
  • GB 41 (Zulinqi): Located in the depression distal to the junction of the 4th and 5th metatarsal bones, lateral to the tendon of extensor digiti minimi; Shu-Stream point; master point of the Dai Mai; widely selected for temporal migraines.
  • GB 42 (Diwuhui): Located between the 4th and 5th metatarsal bones, medial to the tendon of extensor digiti minimi.

• Associated Extra Channel Behavior:

  • Gallbladder Divergent Channel: Penetrates and communicates with the Liver, Gallbladder, and the Heart.

Pericardium Channel of Hand Jue Yin (手厥陰心包經)

• General Channel Attributes:

  • Alternate Name: Hand Jue Yin
  • Horary Diurnal Timing: $7-9\text{ p.m.}$
  • Organs Entered Directly: Pericardium, San Jiao
  • Primary Clinical Indications and Standout Pathologies:
    • Mental restlessness and cognitive agitation
    • Anxiety disorders
    • Palpitations
    • Axillary swelling
    • Feverish sensation in the palms
    • Flushed facial complexion
    • Chest, precordial, or cardiac pain

• Pathway Trajectory and Crossing Points:

  • Originates internally in the chest, emerges at PC 1, runs down the medial aspect of the arm between the tendons of the anterior forearm, and terminates at the tip of the middle finger (PC 9).
  • Dispatches an internal communication branch from the thorax through the diaphragm down to the San Jiao (Upper, Middle, and Lower burners).
  • Crossing Points: None. Yin channels of the arm possess no crossing points with other primary channels.

• Standout Acupoints: Locations and Clinical Actions:

  • PC 1 (Tianchi): Located $1\,\text{cun}$ lateral to the nipple in the 4th intercostal space; classified as a Window of Heaven point.
  • PC 2 (Tianquan): Located $2\,\text{cun}$ inferior to the anterior axillary fold, between the two heads of the biceps brachii muscle.
  • PC 3 (Quze): He-Sea point (Water point); situated on the transverse cubital crease, just medial to the tendon of biceps brachii; clears pathogenic heat across the Qi, Nutritive (Ying), and Blood (Xue) levels (a specific therapeutic hallmark of key Pericardium points).
  • Topographical Interrelationship of Forearm Points (PC 4 to PC 7):
    • All lie between the tendons of the palmaris longus and flexor carpi radialis muscles.
    • The median nerve courses deeply beneath these acupoints, while the Pericardium channel trajectory runs superficial to the median nerve.
  • PC 4 (Ximen): Located $5\,\text{cun}$ superior to the distal transverse wrist crease; Xi-Cleft point; primary point for acute chest and cardiac pain.
  • PC 5 (Jianshi): Located $3\,\text{cun}$ superior to the distal transverse wrist crease; Jing-River point; chief selection for resolving Phlegm misting the Heart Orifices.
  • PC 6 (Neiguan): Located $2\,\text{cun}$ superior to the distal transverse wrist crease; Luo-Connecting point; Confluent/Master point of the Yin Wei Mai; actions calm the Shen, unbind constriction in the chest, regulate heart rhythm, and relieve nausea and vomiting.
  • PC 7 (Daling): Located directly at the midpoint of the distal transverse crease of the wrist, immediately over the carpal tunnel; Shu-Stream and Yuan-Source point.
  • PC 8 (Laogong): Located on the palmar surface between the 2nd and 3rd metacarpal bones; Ying-Spring point (Fire point); clears heat and fire from the Heart, Pericardium, and thoracic cavity.
  • PC 9 (Zhongchong): Located at the terminal tip of the middle finger; Jing-Well point; actions clear heat and resuscitate consciousness in acute collapse.

• Associated Extra Channel Pathology:

  • Pericardium Tendinomuscular Meridian (TMM): Manifests an idiosyncratic clinical symptom characterized by acute pain in the chest accompanied by an "inverted cup" sensation beneath the lower rib cage.

San Jiao Channel of Hand Shao Yang (手少陽三焦經)

• General Channel Attributes:

  • Alternate Name: Hand Shao Yang
  • Horary Diurnal Timing: $9-11\text{ p.m.}$
  • Organs Entered Directly: San Jiao, Pericardium
  • Primary Clinical Indications and Standout Pathologies:
    • Systemic and localized edema
    • Dysuria and difficult urination
    • Auditory impairments including deafness and high-pitched tinnitus

• Pathway Trajectory and Crossing Points:

  • Originates at the ulnar corner of the ring fingernail, ascends the posterior midline of the upper extremity, traverses the shoulder and lateral neck, encircles the ear, and terminates at the lateral end of the eyebrow.
  • Gives off an internal branch entering the ear.
  • Crossing Points: Du 14 (intersected by all yang meridians); ST 12 (intersected by all yang meridians except the Urinary Bladder meridian).

• Standout Acupoints: Locations and Clinical Actions:

  • SJ 1 (Guanchong): Located on the ulnar aspect of the ring finger terminal phalanx, $0.1\,\text{cun}$ posterior to the corner of the nail; Jing-Well point; used to clear heat and revive consciousness.
  • SJ 3 (Zhongzhu): Located on the dorsum of the hand, proximal to the 4th metacarpophalangeal (MCP) joint in the depression between the 4th and 5th metacarpal bones; Shu-Stream point; strongly benefits the ears.
  • SJ 4 (Yangchi): Located on the transverse dorsal crease of the wrist, along the ulnar side of the extensor digitorum communis muscle tendon; Yuan-Source point.
  • SJ 5 (Waiguan): Located $2\,\text{cun}$ superior to the dorsal wrist crease between the radius and ulna; Luo-Connecting point; Confluent/Master point of the Yang Wei Mai; frequently deployed to expel external Wind-Heat.
  • SJ 6 (Zhigou): Located $3\,\text{cun}$ superior to the wrist crease on the radial side between the radius and ulna; Jing-River point; forms a classical clinical point pairing with GB 34 for clearing hypochondriac pain secondary to Liver Qi stagnation.
  • SJ 7 (Huizong): Located $3\,\text{cun}$ superior to the wrist crease, positioned on the ulnar border of the forearm; Xi-Cleft point.
  • SJ 8 (Sanyangluo): Located $4\,\text{cun}$ superior to the wrist crease between the radius and ulna; serves as the Group Luo meeting point interconnecting the three hand yang channels (San Jiao, Large Intestine, Small Intestine).
  • SJ 9 (Sidu): Located $7\,\text{cun}$ superior to the wrist crease, between the radius and ulna.
  • SJ 10 (Tianjing): Located in the depression $1\,\text{cun}$ superior to the olecranon process of the ulna when the elbow is flexed; He-Sea point.
  • SJ 14 (Jianliao): Located on the shoulder, posterior and inferior to the acromion, situated posterior to LI 15 (Jianyu); indicated for chronic shoulder pain, stiffness, and restricted range of motion.
  • SJ 15 (Tianliao): Located midway between GB 21 and SI 13, on the superior angle of the scapula.
  • SJ 17 (Yifeng): Located posterior to the lobule of the ear, in the depression between the mandible and mastoid process; major point for treating otitis, sore throat, and exterior Wind-Heat.
  • SJ 20 (Jiaosun): Located on the side of the head, directly above the auricular apex when the ear is folded forward.
  • SJ 21 (Ermen): Located in the depression anterior to the supratragic notch, slightly superior to the tragus of the ear. (Top-to-bottom spatial relationship: SJ 21 superiorly, SI 19 centrally, GB 2 inferiorly).

• Associated Extra Channel Trajectories:

  • San Jiao Divergent Channel: Dispatches an internal collateral branch terminating at the vertex of the cranium.
  • San Jiao Tendinomuscular Meridian (TMM): Ascends across the neck and throat to insert specifically into the root of the tongue.

Renal Anatomy and Nephron Physiology

• Macroscopic Renal Anatomy and Orientation:

  • Anatomical Position: Retroperitoneal space along the posterior abdominal wall.
  • Visceral Relationships: Level with and situated immediately posterior to the stomach and the pancreas.
  • Vertebral Column Level: Spans bilaterally from the $T12$ vertebra to the $L3$ vertebra.
  • Renal Vasculature: Renal arteries supply systemic oxygenated blood directly from the abdominal aorta into the kidneys; renal veins clear deoxygenated blood away from the kidneys into the inferior vena cava.

• The Nephron Structure and Microvasculature:

  • Functional Population: There are approximately $2.2 \times 10^6$ ($2.2\text{ million}$) nephrons functioning as the basic anatomical filtration units of the renal system.
  • Core Nephron Functions: Filtration of nitrogenous metabolic waste from circulating plasma, regulatory excretion of excess water, regulation of systemic electrolytes, and the active formation of urine.
  • Afferent Arterioles: High-pressure branches of the interlobular arteries delivering incoming blood directly into the individual glomerulus of each nephron.
  • Glomerulus: An encapsulated tuft/ball of specialized fenestrated capillaries engineered to filter plasma fluids under hydrostatic pressure.
  • Basement Membrane and Bowman's Capsule: Blood within glomerular capillaries passes across the basement membrane filtration barrier into Bowman's space within Bowman's capsule.
  • Efferent Arterioles: Narrowed arteriolar vessels collecting unfiltered cellular elements and plasma out of the glomerulus.
  • Peritubular Capillaries: Branching capillary networks emerging from the efferent arteriole that closely surround the tubular portions of the nephron to reabsorb essential water and solutes back into the systemic circulation.
  • Macula Densa: Specialized sensory epithelial cells clustered tightly adjacent to the afferent arteriole and distal tubule, responsible for monitoring tubular luminal flow and sodium chloride concentrations.

• Filtration Selectivity and Barriers:

  • Glomerular Filtrate Constituents: Molecules permitted through the basement membrane into Bowman's space include water ($H_2O$), inorganic ions, nitrogenous waste products (urea, creatinine), glucose, and amino acids.
  • Excluded Large Elements: Red blood cells (RBCs), white blood cells (WBCs), platelets, and bulky plasma proteins (notably albumin) are physiologically barred from passing through the glomerular filtration barrier due to high molecular size and electrostatic charge. Under normal physiologic parameters, these components stay in the vascular tree and must never be detected in end-stage urine.

• Segmental Tubular Reabsorption and Excretion:

  • Proximal Convoluted Tubule (PCT):
    • Reabsorbs approximately $65\%$ of all filtered water, inorganic ions, bicarbonate ($\text{HCO}_3^-$), and hydrogen ions ($H^+$).
    • Accomplishes $100\%$ complete reabsorption of filtered glucose and amino acids via active transport. Under healthy baseline physiology, zero glucose and zero amino acids bypass this segment into excreted urine.
  • Descending Limb of the Loop of Henle:
    • Exclusively permeable to water; water reabsorption takes place passively via concentrated medullary osmotic gradients.
    • Impermeable to solutes.
  • Ascending Limb of the Loop of Henle and Early Distal Convoluted Tubule (DCT):
    • Exclusively permeable to solutes; active and passive reabsorption of solutes (predominantly sodium, $\text{Na}^+$) takes place here.
    • Completely impermeable to water movement.
  • Late Distal Convoluted Tubule (DCT) and Collecting Duct:
    • Facilitates final physiologic "fine-tuning" of the tubular fluid based upon precise real-time systemic homeostatic needs.
    • Regulated by end-stage endocrine hormones.

• Hormonal Control of Fluid and Electrolyte Retention:

  • Antidiuretic Hormone (ADH / Vasopressin): Stimulates the insertion of water channels in the late DCT and collecting duct epithelium, causing increased systemic reabsorption of pure water.
  • Aldosterone: Mineralocorticoid hormone acting directly on the late DCT and collecting duct cells to dramatically increase the active reabsorption of sodium ($\text{Na}^+$) in exchange for potassium or hydrogen excretion.

• Post-Nephron Excretory Conduit:

  • Collecting Duct $\rightarrow$ Renal Pelvis $\rightarrow$ Ureter $\rightarrow$ Urinary Bladder (UB) $\rightarrow$ Urethra (evacuation to external environment).

The 40 Extraordinary Acupuncture Points (CAM Classification)

• Head and Facial Region Extraordinary Points:

  • 1. Tai Yang (太陽 - Supreme Yang): Indicated for temporal headache, various ophthalmic diseases, and unilateral deviation of the eyes and mouth.
  • 2. Yin Tang (印堂 - Hall of Impression): Indicated for headache, sensation of head heaviness, epistaxis (nosebleeds), rhinorrhea, infantile convulsions, frontal headache, and intractable insomnia.
  • 3. Shang Lian Quan (上廉泉 - Upper Ridge Spring): Indicated for alalia (inability to speak), profuse salivation accompanied by tongue stiffness, acute sore throat, dysphagia (difficulty in swallowing), and sudden loss of voice.
  • 4. Er Jian (耳尖 - Ear Apex): Indicated for conjunctival redness, ocular swelling and pain, acute febrile illnesses, and corneal nebula.
  • 5. Yu Yao (魚腰 - Fish's Waist): Indicated for acute supraorbital neuralgia and pain, involuntary twitching of the eyelids, blepharoptosis (ptosis), cloudiness of the cornea, and conjunctival redness, swelling, and pain.
  • 6. Si Shen Cong (四神聰 - Four Alert Spirit): Four points surrounding the vertex; indicated for persistent headache, vertigo, insomnia, memory loss (poor memory), and epilepsy.
  • 7. Qiu Hou (球後 - Behind the Ball): Positioned on the inferior orbital margin; exclusively indicated for ophthalmic disorders and eye diseases.
  • 8. Jia Cheng Jiang (夾承漿 - Adjacent to RN24): Positioned lateral to Ren 24; indicated for trigeminal facial pain, deviation of the eyes and mouth, and muscular spasms of the face.
  • 9. Jin Jin & Yu Ye (金津 & 玉液 - Golden Fluid & Jade Humor): Paired sublingual veins; indicated for acute swelling of the tongue, nausea, vomiting, and sudden aphasia associated with stiffness of the tongue.
  • 10. Bi Tong (鼻通 - Nose Passage): Located at the upper notch of the nasolabial groove; indicated for chronic rhinitis, complete nasal obstruction, and localized nasal boils/furuncles.
  • 11. Qian Zheng (牽正 - Pull Aright): Positioned anterior to the earlobe; indicated for facial paralysis manifesting as deviation of the eyes and mouth, and persistent ulcerations of the tongue and inner buccal mucosa.
  • 12. Yi Ming (翳明 - Shielding Brightness): Located posterior to SJ 17; indicated for complex eye diseases, tinnitus, and persistent insomnia.
  • 13. An Mian (安眠 - Peaceful Sleep): Situated between SJ 17 and GB 20; actions soothe the mind; indicated for insomnia, vertigo, migraine/headache, heart palpitations, and neuropsychiatric mental disorders.

• Trunk and Back Region Extraordinary Points:

  • 14. Ding Chuan (定喘 - Calm Dyspnea): Positioned $0.5\,\text{cun}$ lateral to Du 14; indicated for bronchial asthma, coughing spasms, neck rigidity, acute pain of the shoulder and back, and rubella outbreaks.
  • 15. Hua Tuo Jia Ji (華佗夾脊 - Huatuo's Paravertebral Points): Bilateral points located $0.5\,\text{cun}$ lateral to the lower border of the spinous processes from T1 through L5. Segmental regional indications include:
    • T1 - T3: Functional and structural diseases of the upper extremities.
    • T1 - T8: Pathologies located within the thoracic and chest cavity.
    • T6 - L5: Pathologies of the visceral abdominal region.
    • L1 - L5: Structural and neuromuscular diseases of the lower extremities.
  • 16. Bai Lao (百勞 - Hundred Taxations): Positioned on the posterior neck; indicated for scrofula (cervical lymphadenopathy), cough, dyspnea/asthma, whooping cough (pertussis), and acute or chronic neck rigidity.
  • 17. Wei Guan Xia Shu (胃管下俞 - Pancreas Hollow): Located $1.5\,\text{cun}$ lateral to the spinous process of T8; also recognized historically as the Pancreas Back-Shu point; indicated for diabetes mellitus, acute vomiting, localized abdominal pain, and referral pain in the chest and hypochondriac regions.
  • 18. Shi Qi Zhui (十七椎 - Below the 17th Vertebra): Located inferior to the spinous process of the 5th lumbar vertebra ($L5$); indicated for acute lumbar pain, radiating thigh pain, flaccid paralysis of the lower extremities, irregular menstruation, and dysmenorrhea.
  • 19. Yao Qi (腰奇 - Lumbar Extra): Located superior to the coccyx along the sacrum; indicated for intractable epilepsy, severe headaches, insomnia, and chronic obstipation/constipation.
  • 20. Pi Gen (痞根 - Root of Glomus): Located $3.5\,\text{cun}$ lateral to the lower border of the spinous process of L1; indicated for hepatosplenomegaly, internal abdominal masses, and chronic lumbar strain.
  • 21. Yao Yan (腰眼 - Lumbar Eye): Located in the hollow depressions approximately $3.5-4\,\text{cun}$ lateral to the lower border of the spinous process of L4; indicated for structural lumbar pain, urinary frequency, and irregular menses.
  • 22. Zi Gong Xue (子宮穴 - Uterus): Located $3\,\text{cun}$ lateral to Ren 3 ($4\,\text{cun}$ inferior to the umbilicus); indicated for prolapse of the uterus, irregular menstruation, and pelvic reproductive dysfunction.

• Upper Extremity (Arm) Extraordinary Points:

  • 23. Jian Qian (肩前 - Shoulder Inner Mound): Located midway between the anterior axillary fold and LI 15; indicated for localized anterior shoulder and arm pain, frozen shoulder, and paralysis of the upper extremity.
  • 24. Shi Xuan (十宣 - Ten Diffusions): Located on the distal tips of all ten fingers, approximately $0.1\,\text{cun}$ distal to the nails; utilized for acute apoplexy (stroke), comatose collapse, epilepsy, high fever, acute tonsillitis, infantile convulsions, and acroparesthesia/numbness of the fingertips.
  • 25. Si Feng (四縫 - Four Seams): Located on the palmar surface in the transverse skin creases of the proximal interphalangeal (PIP) joints of the index, middle, ring, and little fingers; indicated for childhood malnutrition and indigestion syndrome (Gan syndrome), and whooping cough.
  • 26. Zhong Kui (中魁 - Central Boss): Located on the midpoint of the proximal interphalangeal (PIP) joint of the middle finger on the dorsal aspect; indicated for severe nausea, vomiting, and acute intractable hiccups.
  • 27. Ba Xie (八邪 - Eight Pathogens): Located on the dorsum of the hand, in the web margins between all five digits (four points on each hand, eight in total); indicated for excessive pathogenic heat, persistent finger numbness, muscle spasms, and localized swelling of the dorsum of the hand.
  • 28. Luo Zhen (落枕 - Stiff Neck): Located on the dorsum of the hand between the 2nd and 3rd metacarpal bones, just proximal to the MCP joints; primary empirical point for acute sore neck (torticollis) and radiating pain across the shoulder and arm.
  • 29. Yao Tong Xue (腰痛穴 - Lumbar Pain): Located on the dorsum of the hand, consisting of two points located between the 2nd/3rd and 4th/5th metacarpal bases; primary point for traumatic acute lumbar sprain.
  • 30. Zhong Quan (中泉 - Central Spring): Located on the dorsal transverse wrist crease, between the tendons of extensor digitorum communis and extensor carpi radialis longus; indicated for stuffy sensation in the chest, gastric epigastric pain, and spitting of blood (hemoptysis).
  • 31. Er Bai (二白 - Two Whites): Two points situated on the anterior forearm, $4\,\text{cun}$ superior to the transverse wrist crease, flanking the tendon of flexor carpi radialis; primary empirical selection for internal and external hemorrhoids, and rectal prolapse.
  • 32. Bi Zhong (臂中 - Central Arm): Located midway between the transverse wrist crease and transverse cubital crease, between the radius and ulna; indicated for flaccid paralysis, spasms, contractures of the upper extremities, and deep forearm neuralgia.
  • 33. Zhou Jian (肘尖 - Tip of the Elbow): Located directly over the olecranon prominence of the ulna; treated typically with moxibustion for scrofula (tuberculous cervical lymphadenitis).

• Lower Extremity (Leg) Extraordinary Points:

  • 34. Huan Zhong (環中 - Central Round): Located midway between the prominence of the greater trochanter and the sacral hiatus (Du 2); indicated for chronic lumbar and sciatica-like radiating thigh pain.
  • 35. Bai Chong Wo (百蟲窩 - Shelter of Hundred Insects): Located $3\,\text{cun}$ superior to the medial superior border of the patella ($1\,\text{cun}$ superior to Sp 10); indicated for rubella, acute pruritic eczema, and gastrointestinal parasitic infestations.
  • 36. Xi Yan (膝眼 - Knee Eye): Located in the bilateral hollows (medial and lateral) flanking the patellar ligament when the knee is flexed (lateral Xi Yan coincides with ST 35); indicated for arthralgia and knee pain, and motor weakness of the lower limbs.
  • 37. Lan Wei Xue (闌尾穴 - Appendix Point): Located approximately $2\,\text{cun}$ inferior to ST 36 (Zusanli) along the anterior crest of the tibia; diagnostic and therapeutic trigger for acute and chronic appendicitis, generalized indigestion, and paralysis of the lower extremities.
  • 38. He Ding (鶴頂 - Crane's Summit): Located in the depression at the midpoint of the superior border of the patella; indicated for knee joint arthralgia, functional weakness of the foot and leg, and paralytic conditions.
  • 39. Dan Nang Xue (膽囊穴 - Gallbladder Point): Located approximately $1-2\,\text{cun}$ directly inferior to GB 34; specific diagnostic and therapeutic point for acute and chronic cholecystitis, cholelithiasis (gallstones), biliary ascariasis, and lower extremity muscular atrophy with sensory numbness.
  • 40. Ba Feng (八風 - Eight Pathogens): Located on the dorsum of the foot in the margins between the toes (four points per foot, eight total); indicated for beriberi (thiamine deficiency edema/neuropathy), sharp toe pain, and inflammatory redness and swelling of the dorsum of the foot.