09-20-25 | ACU III | Acupuncture Extra Points: Upper & Lower Limbs

Class Logistics and Schedule

• Online Session Today:

  • Ends at $3:00$ PM.

  • Focus: Completing extra points.

• Travel Time: $2$ hours for everyone to travel to school.

• In-Person Session:

  • Resumes at $5:30$ PM and continues until $9:30$ PM.

  • Location: In-person at school.

  • Purpose: Practice locating points discussed.

• Breaks: Short breaks during the evening session; dinner planned individually.

Attendance Check

• Attendance was taken at the beginning and end of the online portion.

• Paper attendance will be used for the in-person session.

• Missing students at the start of the online session: Serena, Megan, Savannah, Cherry, Larry, Kevin.

  • Hope they join soon; possible mix-up with class timing.

General Class Information

• Course Notes: Not yet available for pickup; Karina confirmed they will be ready next week.

  • Electronic versions are available for today's practice.

• Micro-Registration: Most students successfully completed it.

  • Troubleshooting Tip: Codes may not display fully on phone screens; open the file on a computer to copy/paste the full code for registration.

  • Instructor can help with non-working codes; technical issues might require assistance from classmates or the instructor can try to find help.

• Practice Approach:

  • Today's main goal is to finish discussing extra points, specifically for the arms, hands, legs, and feet.

  • Limited time for practice questions to understand how information appears in exam scenarios.

  • Briefly review organization, schedule, or assignments if time permits.

• Practice with Partners: Encourage practicing on classmates during the in-person session to get familiar with locating points on another person's body.

  • Bring devices (phone, tablet, laptop) to access lecture notes/PDF files.

  • Yoga mats are optional for comfort during practice.

Extra Points of the Upper Limbs

This section covers extra points located on the upper limbs, including their names, locations, needling techniques, functions, and indications.

1. Xinxian (肩前) - Anterior Shoulder

• Translation: Shoulder Front or Anterior Shoulder.

• Location: Midway between $LI15$ (Jianyu) and the anterior axillary crease. Often in the region of the deltoid muscle and shoulder joint.

  • Locating $LI15$: In the anterior depression formed when the arm is abducted, at the origin of the deltoid muscle (specifically the clavicular part).

  • Locating Axillary Crease: Stick a pen under the armpit; the anterior point where the pen touches is the anterior axillary crease.

  • Note: Pictures may not accurately represent $LI15$'s position when the arm is down; it should remain close to the acromion.

• Needling:

  • Perpendicular: $0.8$ to $1.5$ cun.

  • Towards the elbow (along the arm): $2$ to $3$ cun (due to muscle tissue length).

  • Angle decision depends on target: towards shoulder joint for joint issues, towards elbow for arm issues.

• Functions: Activates Qi and blood flow, benefits the shoulder joint.

• Indications: Stiffness, pain (anterior aspect of shoulder), numbness, paralysis, immobility of the shoulder joint.

  • Broadly, treats all sorts of shoulder conditions (pain, aches, numbness, tingling, stiffness, limited range of motion).

• Special Notes: Often used with other local shoulder points (e.g., $LI15$, $SI10$, $SJ14$) and distant points (e.g., $ST38$).

2. Bi Zhong (臂中) - Arm Center

• Translation: Arm Center.

• Location: On the medial aspect of the forearm, halfway between the transverse crease of the wrist and the cubital crease (elbow crease). Located between the ulna and radius.

  • The distance from wrist to cubital crease is $12$ cun, so this point is $6$ cun from the wrist and $6$ cun from the elbow.

• Needling: Perpendicular: $1$ to $1.2$ cun.

• Functions & Indications: Mainly treats conditions of the forearm and upper arm.

  • Paralysis, spasm, contracture of the upper arm.

  • Pain of the forearm.

  • Treats channels and collaterals of the arm.

3. Erbai (二白) - Two Whites

• Translation: Two Whites.

• Location: A group of two points on the flexor side (palmar side) of the forearm, $4$ cun proximal to the wrist crease (or $8$ cun from the elbow crease).

  • Located on the two sides of the flexor carpi radialis tendon.

  • One point is between the flexor carpi radialis and palmaris longus tendons (on the PC channel line).

  • The other point is more medially (ulnarly) to the flexor carpi radialis tendon.

• Needling:

  • Perpendicular: $0.5$ to $1$ cun.

  • Oblique (proximally): $1$ to $1.5$ cun.

• Functions & Indications: Great for conditions related to the lower digestive tract.

  • Hemorrhoids.

  • Prolapse of the rectum.

  • Itchiness or bloody discharge of the anus, tenesmus.

• Special Notes: Pay attention to precise location, especially when looking at another person's arm.

4. Zhoujian (肘尖) - Elbow Tip

• Translation: Elbow Tip.

• Location: At the tip of the elbow; anatomically, the tip of the olecranon process of the ulna.

• Needling: Treated with moxibustion (not needling).

• Functions & Indications: Addresses lung-related pathologies with specific manifestations.

  • Scrofula (lymph node swelling, often tuberculous).

  • Carbuncles, furuncles (skin infections/abscesses).

  • Deep-rooted ulcers.

  • Intestinal abscess.

5. Zhongquan (中泉) - Middle Spring

• Translation: Middle Spring.

• Location: On the dorsal side of the wrist joint, radial to the tendon of the extensor digitorum communis.

  • Background: $SJ4$ (Yangchi) is located in the depression between the extensor digitorum communis tendon and the extensor digiti minimi tendon. Zhongquan is on the other side of the larger extensor digitorum communis tendon bundle (i.e., more radially).

  • The extensor digitorum communis tendons extend towards the middle three fingers.

• Needling: Perpendicular: $0.3$ to $0.5$ cun.

• Functions & Indications: Regulates Qi, alleviates pain.

  • Stuffy chest (Qi dysregulation).

  • Gastric pain (Qi rebellion, ascending stomach Qi).

  • Spitting of blood (bleeding condition).

6. Yaoqi (腰奇) - Lumbar Odd (Strenuous Lumbar Point)

• Translation: Lumbar Pain Point.

• Location: A group of two points on each hand (total four points).

  • On the dorsum of the hand, in the depressions immediately distal to the base of the metacarpals.

  • One point between the $2^{nd}$ and $3^{rd}$ metacarpals.

  • The other point between the $4^{th}$ and $5^{th}$ metacarpals.

• Needling: Perpendicular: $0.5$ to $1$ cun.

• Functions & Indications: Primarily for acute lumbar pain.

  • Acute lumbar sprain, acute lumbar injury.

• Special Notes: Acupressure is also effective for this point if needles are not available.

7. Luo Zhen (落枕) - Stiff Neck (Fall Off Pillow)

• Translation: Fall Off Pillow or Stiff Neck Point.

• Location: On the dorsum of the hand, in a depression just proximal to the metacarpophalangeal (MCP) joints between the $2^{nd}$ and $3^{rd}$ metacarpals.

  • Only one point on each hand.

• Needling:

  • Perpendicular or oblique (proximally): $0.5$ to $1$ cun.

• Functions & Indications: Primarily for stiff neck and associated symptoms.

  • Stiff neck, inability to turn the head, headache.

  • Pain of the shoulder and arm (related to stiff neck).

• Additional Indications: Epigastric pain, diarrhea, acute or chronic childhood convulsions (SARS - Spleen and Kidney deficiency leading to convulsions).

8. Sifeng (四縫) - Four Seams

• Translation: Four Seams/Cracks.

• Location: A group of four points on each hand (total eight points).

  • On the palmar surface of the hand, at the midpoint of the transverse crease of the proximal interphalangeal (PIP) joint of the four fingers (from $2^{nd}$ to $5^{th}$ fingers).

• Needling: Pricking to bleed.

  • Fluid squeezed out is typically yellow-whitish, not necessarily blood-colored.

• Functions & Indications: Primarily for childhood digestive and nutritional issues.

  • Childhood indigestion, childhood nutritional impairment/disorder, childhood accumulation disorder (Gan Ji or Gan Zheng - 疳證).

  • Diarrhea (as a symptom of indigestion).

  • Whooping cough (pertussis).

• Special Notes:

  • Usually all four points are used together if the child permits.

  • Can be used in adults for indigestion, though not typically listed.

  • Contraindication: Deficiency syndrome (due to bleeding), but in accumulation disorders (excess) due to indigestion, it is acceptable if used judiciously and stopped when the condition resolves.

  • Safety: Use a small needle for pricking. Similar to drawing blood from a finger-tip, generally safe if not done too aggressively.

  • Heat Component: Accumulation often leads to heat, but the fluid color is not directly linked to a heat component by the instructor.

  • Informed Consent: For children, informed consent from a caregiver is crucial as children cannot give it themselves.

9. Zhongkui (中魁) - Middle Eminence

• Translation: Middle Eminence.

• Location: On the middle finger, at the midpoint of the dorsal side of the proximal interphalangeal (PIP) joint.

  • Only one point on each hand.

• Needling: Treated with moxibustion (not needling).

• Functions & Indications: Addresses rebellious Stomach Qi.

  • Nausea, vomiting, hiccups.

• Special Notes: For children, it can be used for various ages, but as they approach $12$ years, acupuncture becomes more feasible due to developing body and channel systems.

10. Baxie (八邪) - Eight Pathogens (Evil)

• Translation: Eight Pathogens or Eight Evils.

• Location: A group of eight points (four on each hand).

  • On the dorsum of the hand, between the fingers in the spaces proximal to the web margins, near the metacarpophalangeal (MCP) joints.

  • Three points are between the $2^{nd}/3^{rd}$, $3^{rd}/4^{th}$, and $4^{th}/5^{th}$ metacarpal heads.

  • The fourth point is in the larger space between the thumb and index finger metacarpals.

  • Easiest to locate when fingers are slightly bent.

• Needling: Oblique (towards the hand/palm): $0.3$ to $0.5$ cun.

• Functions & Indications: Primarily for local hand/finger conditions.

  • Numbness, stiffness, pain, redness, swelling, spasm of the hand, wrist, fingers.

• Additional Indications: Redness/swelling of the throat, eye issues (related to heat), headache, toothache, febrile diseases (reduces heat).

11. Shixuan (十宣) - Ten Diffusions

• Translation: Ten Diffusions (referring to qi diffusing at the fingertips).

• Location: A group of ten points (five on each hand).

  • On the tips of all ten fingers, approximately $0.1$ cun from the fingernail.

• Needling: Pricking to bleed.

  • In emergencies without a needle, can stimulate strongly by cutting the nail.

• Functions & Indications: Primarily for acute emergencies to revive consciousness and open portals.

  • Fainting (syncope), stroke, summer heat stroke, febrile diseases.

  • Swelling and pain of the throat (heat component, common in children).

  • Childhood convulsions (acute).

  • Chronic spasm, epilepsy, mania (altered consciousness states).

  • Vomiting, diarrhea.

  • Numbness, pain of the fingers (local effect).

Collective Review of Upper Limb Extra Points (Digestive Focus)

Many upper limb extra points have indications related to the digestive system:

• Erbai: For lower digestive tract issues (hemorrhoids, rectal prolapse, bloody stool).

• Zhoujian: For intestinal abscess (pus-forming condition).

• Zhongquan (Middle Spring): Regulates Qi in the chest and epigastric region, treats gastric pain, spitting blood (digestive tract issues).

• Luo Zhen: Can treat epigastric pain and diarrhea, in addition to stiff neck.

• Sifeng: Primarily for childhood indigestion, accumulation disorders, diarrhea.

• Zhongkui: For rebellious stomach Qi (nausea, vomiting, hiccups).

Extra Points of the Lower Limbs

This section covers extra points located on the lower limbs, including their names, locations, needling techniques, functions, and indications.

1. Huanzhong (環中) - Center of the Circle

• Translation: Center of the Circle.

• Location: On the thigh, halfway between $GB30$ (Huantiao) and $GB31$ (Fengshi).

  • Alternatively, it is $2/3$ the distance from the tip of the greater trochanter towards $GB31$.

• Needling: Perpendicular: $1$ to $1.5$ to $2$ cun.

• Functions & Indications: Similar to $GB30$, used for lumbar-thigh pain and sciatica-type conditions.

2. Bai Chong Wo (百蟲窩) - Hundred Insect Nest

• Translation: Hundred Insect Nest.

• Location: On the thigh, $3$ cun proximal to the superior border of the patella, in a tender depression on the bulge of the vastus medialis muscle.

  • Similar location to $SP10$ (Xuehai), which is $2$ cun proximal to patella on the vastus medialis.

• Needling:

  • Perpendicular: $1$ to $1.2$ cun.

  • Oblique: $1$ to $1.5$ cun.

• Functions & Indications: Clears heat from the blood, eliminates wind, drains dampness.

  • Gastrointestinal parasitic diseases.

  • Skin disorders with itchiness, wind rash (feeling of bugs crawling).

  • Soreness of the lower region (trunk or body, e.g., bed sores).

3. Heding (鶴頂) - Crane's Summit

• Translation: Crane's Summit (referring to the top of the knee).

• Location: At the midpoint of the superior border of the patella, in a depression.

• Needling: Perpendicular: $0.5$ to $1$ cun.

• Functions: Activates Qi and blood, benefits the knee joint.

• Indications: Primarily for knee conditions.

  • Swelling, pain, weakness of the knee joint and legs.

  • Paralysis, atrophy disorder of the knee.

  • Wing-Hoist-A-Phone (a type of knee pain).

4. Xiyan (膝眼) - Knee Eye (Medial/Lateral Knee Eyes)

• Translation: Knee Eye.

• Location: A pair of points located below the patella (kneecap) on both sides of the patellar ligament, in the depressions.

  • Often located with the knee slightly bent.

  • Medial Knee Eye (Neixiyan) and Lateral Knee Eye (Waixiyan).

• Needling:

  • Basic: Perpendicular into the depression: $0.5$ to $1$ cun.

  • Deeper: Towards $BL40$ (Weizhong): $1$ to $2$ cun (perpendicular).

  • Oblique: Medially and superiorly, towards the space behind the patella: $1$ to $2$ cun.

  • Through needling: Between Neixiyan and Waixiyan is also possible.

• Functions & Indications: Primarily for knee disorders.

  • Pain, stiffness, numbness, tingling, limited range of motion of the knee.

  • Flexion/atrophy disorder, difficulty extending or flexing the knee.

• Special Notes:

  • Start with basic perpendicular needling.

  • Deeper needling towards behind the patella can be effective but may be difficult or painful for some due to individual anatomy or joint conditions (e.g., bone proximity, limited synovial fluid).

  • Do not force the needle if resistance or pain is encountered.

  • These points sometimes overlap with $ST35$ (Dubi - often refers to the lateral knee eye).

5. Lanwei Xue (闌尾穴) - Appendix Point

• Translation: Appendix Point.

• Location: On the right leg only, $2$ cun distal to $ST36$ (Zusanli).

  • Located on the Stomach Channel line (one finger breadth lateral to the anterior crest of the tibia).

• Needling: Perpendicular: $1$ to $1.5$ to $2$ cun.

• Functions & Indications: Primarily to treat appendix issues.

  • Acute or chronic appendicitis (especially chronic cases, as acute often requires emergency surgery).

• Additional Indications: Paralysis of the lower limb, foot drop, pain/soreness of the lower leg.

• Special Notes:

  • Right leg only: Corresponds to the anatomical location of the appendix in most individuals.

  • Can also support indigestion due to its location on the Stomach Channel.

6. Dannang Xue (膽囊穴) - Gallbladder Point

• Translation: Gallbladder Point.

• Location: On the right leg only, $1$ to $2$ cun distal to $GB34$ (Yanglingquan).

  • Located on the Gallbladder Channel line (more lateral than the Stomach Channel).

  • Palpate the $1-2$ cun region below $GB34$ to find the most tender point.

• Needling: Perpendicular: $1$ to $1.5$ to $2$ cun.

• Functions & Indications: Primarily to treat gallbladder conditions.

  • Acute or chronic cholecystitis (gallbladder inflammation).

  • Acute or chronic cholelithiasis (gallstones).

  • Diseases of the bile duct, biliary ascariasis (roundworm in bile duct).

  • Distension pain of the lateral costal region (hypochondriac pain).

• Additional Indications: Paralysis, numbness of the lower limb.

• Special Notes: Right leg only: Corresponds to the anatomical location of the gallbladder.

7. Bafeng (八風) - Eight Winds

• Translation: Eight Winds.

• Location: A group of eight points (four on each foot).

  • On the dorsum of the foot, between the toes, $0.5$ cun proximal to the web margin.

  • Located in the space between the metatarsals, proximal to the metatarsophalangeal (MTP) joints.

• Needling: Oblique (towards the ankle/foot's side, not towards the toes): $0.5$ to $1$ cun.

• Functions & Indications: Primarily treats local foot conditions.

  • Redness, pain, numbness, tingling, swelling of the foot and toes.

  • Beriberi (Qi accumulation in the legs), toe pain.

• Additional Indications: Malaria, headache, irregular menstruation.

8. Duanpi (斷痞) - Breaking Accumulation

• Translation: Breaking Accumulation.

• Location: On the dorsum of the foot, between the $2^{nd}$ and $3^{rd}$ metatarsals, in a depression anterior to the metatarsophalangeal (MTP) joint.

  • Located on the opposite side of $ST44$ (Neiting) which is proximal to the web between 2nd and 3rd toes.

• Needling: Perpendicular: $0.3$ to $0.5$ cun.

• Functions & Indications: Excellent for digestion, especially acute stomach conditions.

  • Indigestion with acute conditions of the stomach, abdominal pain.

• Additional Indications: Infantile convulsions, epilepsy (altered consciousness), local conditions of the foot and toes.

9. Duiduan (兌端) - Distal Tip (Toe Point)

• Translation: Distal Tip (though the classic point Duiduan is on the upper lip, this description refers to a toe point).

• Location: On the plantar side of the foot, in the center of the distal interphalangeal (DIP) crease of the $2^{nd}$ toe.

• Needling: Perpendicular: $0.1$ to $0.2$ cun (very shallow) or moxibustion.

• Functions & Indications:

  • Abdominal pain, vomiting.

  • Retention of the placenta after birth, irregular menstruation.

  • Hernia.

• Special Notes: Contraindicated for pregnancy (due to its action of stimulating expulsion of the placenta).

Practice Questions and Assignments

• No time for practice questions during the online session, will do in-person.

• Individual Assignments:

  • Example 1: Summary of $78$ most commonly used points (e.g., in Excel with pictures or Word files).

  • Example 2: Specific point summary (e.g., tables categorizing specific points, their functions, and characteristics).

• Group Assignments: Not discussed in detail today, but generally involve organizing and synthesizing information for study and clinical use.

• Referencing Materials: Instructor will re-send the corrected PDF file with proper formatting for two pages.

• College List: The college list contains all required points and their official names (including letter-number names where available).

  • Some points discussed (e.g., Yaoqi, Shang Lin Chen) are not on the college list and will not be tested, but are provided for information.

  • Focus on remembering the Pinyin names for tests as these are primarily used.