TJ

Course Notes: Attendance, Huatuo Jiaji Paravertebral Points, Bladder Channel Back Points, and Abdominal/Extra Points — Practical and Theoretical Summary

Attendance and class logistics

  • Course structure: two portions in a day (afternoon theory and evening practical). Material planning includes blending theory and practice for continuity. Attendance is taken before/after the afternoon session and before/after the evening session. Afternoon attendance counts toward tier marks; evening attendance toward practical marks.
  • First class adjustments: late arrivals are forgiven for this first session; starting next class, late arrivals are marked as they are.
  • Attendance protocol: call names, mark present if already accounted for, otherwise re-call up to three times; if still missing, mark as absent for this session.
  • Class logistics for next session: online for the first two hours (starting at 1:00 PM), then in-person from 5:30 PM to 9:30 PM at the school. Practical focuses on point location; bring markers and wipes; do not need the entire needle box for the in-person portion.
  • Tools for in-person practice: gel pens or washable markers; stickers optional; elastic markers and ruler suggested for proportional measurements and point location practice. A dedicated practice setup to help with self-checking of measurements will be demonstrated in class.
  • Content focus for next class: finish all extra points previously introduced, then practice location of extra points; if time allows, introduction to coalescent points and review of channel points. Tests will cover extra points and the naming conventions for extra points; regular channel points (Ren and Du) will be reviewed later in the semester.
  • Assessment and quizzes:
    • First quiz: on extra points only.
    • No mock quiz; in-class practice will prepare you for questions.
    • Emphasis on understanding indications and functions of extra points rather than memorizing exhaustive word-for-word indications.
  • Registration and class lists:
    • There is an ongoing issue with registration codes; a deadline was set (around 21:00) to complete registration before codes are redistributed to others. If issues persist, contact the instructor via email.
    • If you’re not on the class list, there may be an administrative discrepancy; you’ll be included in the attendance by cross-checking lists.
  • Final reminders: speak clearly when pronouncing terminology (especially non-English terms); the instructor will slow down for difficult segments, but the emphasis is on clarity and understanding rather than perfect pronunciation.
  • End-of-class wrap-up: recap major points; confirm questions; outline what to bring and what to expect for the next session.

Key concepts and terms

  • Extra points (Hua to Jiaji): paravertebral points located along the thoracic and lumbar spine, used to access the nerves and connections near the spine.
  • Huatuo Jiaji points (华佗夹脊): group of paravertebral points; located on the sides of the spine, adjacent to the spinous processes, across 17 thoracic (T1–T12) and lumbar (L1–L5) levels.
  • Back-shu and back-shi relationships: extra points on the back relate to organizing and regulating internal organs and back structures; they provide a different access point than regular channel points.
  • Bladder channel (Bladder meridian) medial branch points: back points aligned along the bladder channel on the back; many lie 1.5 lateral to the posterior midline with specific levels corresponding to organ regulation and musculoskeletal conditions.
  • Influential and back-shu points mentioned:
    • Bladder 17 (BL-17): Influential Blood point.
    • Bladder 18 (BL-18): Back-Shu Liver point (liver back-shu).
    • Bladder 19 (BL-19) and other level points: used to discuss relationships with the liver/gallbladder region; some references indicate their place along the back.
  • Tuberculosis (TB) point discussion: a back point described as a point for tuberculosis conditions that can also be used for local shoulder and upper back pain; location given as 3.5 cun lateral to a referenced level along the back, with specific lateral relationships to spinous processes.
  • Paravertebral location details:
    • 0.5 to 1 cun lateral to the spinous processes for the Huatuo Jiaji points (across all thoracic and lumbar levels).
    • Levels span T1–T12 and L1–L5, with bilateral points (left and right) at each level.
  • Needling directions for Huatuo Jiaji points:
    • Cervical and thoracic regions: oblique toward the spine, approximately 0.5\text{ to }1.0\text{ cun}.
    • Lumbar region: perpendicular to the skin, approximately 0.5\text{ to }1.5\text{ cun}; oblique toward the spine can be used as well.
  • Pneumothorax risk: deep perpendicular needling near the spine carries a risk of pneumothorax; safer to angle toward the spine rather than away from it when near thoracic levels.
  • Spinal anatomy reminder: the back is shaped with the spine in the midline and the rib cage broadening laterally; safe needling angles are often toward the spine to stay within safer tissue planes.

Huatuo Jiaji (Paravertebral) points: location, needling, and significance

  • Location:
    • Across thoracic (T1–T12) and lumbar (L1–L5) levels, 0.5 to 1 cun lateral to the spinous processes on each side; total of 17 thoracic and 5 lumbar levels, bilateral points.
    • Each level corresponds to a bilateral pair of points near the posterior midline.
  • Needle direction and depth:
    • Cervical and chest regions: oblique toward the spine; depth around 0.5\text{ to }1.0\text{ cun}.
    • Lumbar region: perpendicular or oblique toward the spine; depth around 0.5\text{ to }1.5\text{ cun}; general rule is to avoid deep perpendicular needling that could approach the thoracic cavity.
  • Functions/indications (overview):
    • Regulate and harmonize sub-organs associated with the spinal levels; support the back and spine; influence channel connections to internal organs at corresponding levels.
    • The levels may have different indications depending on the organ connections and nerves involved; similar to how channel points map to organ systems.
  • Examples by region (as discussed):
    • T1–T4: mainly related to lung and upper limb conditions.
    • T4–T7: more for heart-related conditions.
    • T7–T10: more for liver and gallbladder conditions.
    • T10–T12: more for spleen and stomach conditions.
    • L1–L3 (and L5): more for kidneys and lower jiao conditions (bladder, intestines, uterus, lumbar pain).
  • Special notes:
    • These points can be used individually or in groups; group use depends on condition and accessibility; different points have distinct roles and may be selected based on patient positioning and clinical findings.
  • Practical considerations:
    • The choice between using single Jiaji points or a combination may depend on how structures and nerves at a given level are affected.
    • The Jiaji points serve as a bridge between local back pain and systemic organ-related indications by engaging nerve pathways along the spinal levels.

Extra back points along the Bladder channel and related considerations

  • Bladder channel medial branch points: located on the back along the bladder channel, about 1.5\text{ cun} lateral to the midline at various thoracic and lumbar levels; these points run along the back in parallel to the spinal column.
  • Specific landmark notes mentioned:
    • BL-17 (Influential Blood) is used as a key point on the back; BL-18 (Back-Shu Liver) is noted as the back-shu point for the liver.
    • Level mapping mentioned includes references to T8 and T9 corresponding to BL-17 and BL-18, though the exact level-to-point mappings can vary by text.
  • Level-specific notes:
    • Some levels do not have a bladder channel point directly on the level; at certain levels, extra points are described between adjacent levels (for example, a point located between BL-14 and BL-15 at a given level).
    • Points along the back are typically placed 1.5 cun lateral to the posterior midline; a subset of these is described as being on the “medial branch” line of the bladder channel.
  • Indications and scope:
    • Help regulate channel collateral conditions, musculoskeletal back issues, and herpes zoster along the spinal nerve pathways.
    • Back-shu and paravertebral points can address systemic organ networks and localized back problems.

Specific back and abdominal extra points and their functions

  • Pigen (脾根, “Spleen Root”):
    • Location: lumbar region, left and right sides, at level L1, about 3.5\text{ to }3.5\text{ cun}? lateral to midline (as described: L1, 3.5 cun lateral to midline).
    • Needling: perpendicular, about 0.5\text{ to }1.5\text{ cun} (subcutaneous in some cases). Subcutaneous approach emphasized.
    • Functions/indications: treats abdominal masses such as hepatosplenomegaly; strengthens the kidneys and the lumbar region; relieves lumbar pain.
  • Yao Yan (腰眼, “Lumbar Eyes”):
    • Location: level L4, 3.5 cun lateral to midline.
    • Needling: subcutaneous, 0.3\text{ to }0.5\text{ cun}.
    • Functions/indications: strengthens the kidneys and lumbar region; helpful for lumbar pain and certain gynecological issues (e.g., irregular menstruation).
  • TRE (下十七椎, “Below the Seventeenth Vertebra”):
    • Location: midline back, below the seventeenth vertebra (below L5).
    • Needling: perpendicular, around 0.5\text{ to }2.0\text{ cun}; parallels the posterior midline and is along a back line similar to the bladder channel.
    • Indications: lumbar pain, leg pain with a lumbar connection, and urinary issues related to pregnancy; supports the lower back and leg regions.
  • Yaoqi (腰竅, “Lumbar Miracle”):
    • Location: directly above the coccyx; about two bumps above the coccyx tip, closest to the coccygeal area; often described as two turns above the coccyx tip (coccygeal region).
    • Needling: subcutaneous upward along midline, 1\text{ to }2.5\text{ cun} (approximate values given; exact depth varies with body habitus).
    • Indications: constipation, calming the mind, stopping convulsions (epilepsy), and aiding lumbar region issues; similar to the same channels as Dù Shū (Du channel)-related indications.
  • Abdominal triangle points (Moxibustion Triangle, 三穴):
    • Concept: an equilateral triangle in the abdomen around the umbilicus used for moxibustion; apex at the umbilicus; the other two points are on either side below the umbilicus, at a distance equal to the patient’s smile length.
    • Practical notes: one of the three triangle points is at the umbilicus; the other two are inferior-left and inferior-right; the length of the triangle side is approximately the length of the patient’s smile.
    • Indications: abdominal issues (abdominal pain, diarrhea, abdominal distension, Shen (spirit) disorders, running piglet qi, chronic diarrhea with possible deficiency component).
    • Moxibustion methods: direct or indirect; indirect options include using ginger slices, crushed garlic, or aconite cake to mediate; moxa sticks are also acceptable.
    • Cautions: avoid moxibustion in heat or damp-heat conditions; in heat conditions, reduce heat rather than applying moxa locally.
    • Running piglet qi (运行脾气): sensation of qi running from the lower abdomen upward through the abdomen to the chest or even the throat, described as a dysregulation of qi with upward movement; often described with palms or smiles as cues for the patient to illustrate the sensation.
  • Prolapse and uterine-related abdominal points:
    • T2 (提托, “to lift”): located four cun lateral to the midline, level with the upper border of the pubic symphysis. Needle perpendicularly, 0.8\text{ to }1.2\text{ cun}; with thinner patients, shallower depths may be used. Main indication: prolapse of the uterus; also useful for dysmenorrhea and abdominal distension.
    • Zigong (子宮, “Uterus Palace”) and Ti Tuo (提托, “Support”) points: Zigong is at three cun lateral to the midline, level with the upper border of the pubic symphysis, needle perpendicularly, 0.8\text{ to }1.2\text{ cun}; Ti Tuo is at four cun lateral to the midline, level with the fourth rib, with similar needling depth. Both are used for prolapse and menstrual conditions; Zigong is often referenced as “the uterus point” and is commonly paired with Ti Tuo for prolapse management.
  • Triangle relationship for abdominal points:
    • Zigong and Ti Tuo are arranged in a way that mirrors the abdominal anatomy; Zigong is more superior/medial (near rib three), while Ti Tuo is more inferior/lateral (near rib four).
  • Moxibustion triangle vs channel points: some points in the moxibustion triangle overlap with nearby channel points; preference for using triangle points depends on pattern and patient tolerance; these points are not always tested on standard college lists but are included for practical understanding.

Upper limb and exam focus (brief note)

  • The session transitions to upper limb points after covering the trunk and back areas; expect future classes to cover limb-related extra points and their indications.
  • For exams: focus on naming conventions and indications of extra points rather than memorizing every fine detail; you should be able to identify the clinical scenarios where a given extra point would be chosen and the type of approach (direct vs indirect moxibustion, subcutaneous vs perpendicular needling) used.

Practical tips for upcoming in-person class

  • For the in-person session: bring a gel pen or washable marker (to mark points on the body) and wipes to remove marks after practice.
  • If you have a personal marker tool (like a flexible elastic ruler used to measure distances across the body), bring it for self-checking of proportional measurements and point locations.
  • You will practice locating extra points; there will be demonstrations and TAs to assist; some coalescent points will be introduced later in the course; you may not practice all coalescent points in this session.
  • Expect two rooms and multiple instructors/TAs to facilitate hands-on practice; there will be examples of test items and practice questions in class sessions.

Pronunciation and language notes

  • The instructor emphasized speaking slowly and clearly when pronouncing Chinese terms; some terms are learned through practice and repetition; you may encounter terms pronounced in a non-native style.
  • If pronunciation is unclear, focus on understanding the location and function first; the exam will test recognition and usage rather than perfect pronunciation.

Ethical and practical implications discussed

  • Emphasis on safe practice: risk of pneumothorax with deep or angled needling near the thoracic region; always aim for safe depths and angles, especially around the spine.
  • Patient safety and comfort: adapt needling depth and direction to patient body habitus; use oblique approaches when safer than perpendicular approaches near the spine.
  • Clinical reasoning: selection of extra points depends on pattern differentiation, anatomical considerations (nerve pathways and spinal segment connections), and patient tolerance; different practitioners may prefer different points (e.g., JD points vs. Jiaji points) for the same symptom based on structural changes.
  • Evidence and exam relevance: understanding the indications and functional rationale for extra points helps prepare for exams that test knowledge of both location and clinical reasoning rather than rote memorization of every indication.

Quick reference of commonly described measurements and land marks (summary)

  • Huatuo Jiaji points: at each thoracic (T1–T12) and lumbar (L1–L5) level, 0.5 to 1 cun lateral to the spinous processes; bilateral.
  • Needling guidance:
    • Cervical/chest: oblique toward spine; 0.5\text{ to }1.0\text{ cun}.
    • Lumbar: perpendicular or oblique toward spine; 0.5\text{ to }1.5\text{ cun}.
  • Bladder channel medial branch points (back): approximately 1.5\text{ cun} lateral to posterior midline; two sides; levels map to organ-regional function (lung/heart/liver/spleen–stomach, etc.).
  • BL-17 (Influential Blood) and BL-18 (Back-Shu Liver): key posterior landmarks on the bladder channel.
  • Pigen (脾根, Spleen Root): L1, ~3.5\text{ to }3.5\text{ cun} lateral; perpendicular to skin about 0.5\text{ to }1.5\text{ cun}; abdominal masses and lumbar support.
  • Yao Yan (腰眼, Lumbar Eyes): L4, ~3.5\text{ to }3.5\text{ cun} lateral; subcutaneous needling 0.3\text{ to }0.5\text{ cun}; lumbar and menstrual indications.
  • TRE: Below the seventeenth vertebra (below L5); midline; back-point for lumbar and leg issues; needling depth around 0.5\text{ to }2.0\text{ cun}.
  • Yaoqi (腰竅, Lumbar Miracle): two cun above coccyx; subcutaneous upward needling 1\text{ to }2.5\text{ cun}; calming the mind, treating constipation, convulsions; near Du/DU-related pathways.
  • Abdominal points for prolapse and related conditions:
    • T2 (To Lift): four cun lateral to midline; level with upper border of pubic symphysis; perpendicular 0.8\text{ to }1.2\text{ cun}; prolapse of uterus; also for dysmenorrhea and abdominal distension.
    • Zigong (Uterus Palace): three cun lateral; level with upper border of pubic symphysis; perpendicular 0.8\text{ to }1.2\text{ cun}; used for prolapse, infertility, irregular menstruation, dysmenorrhea.
    • Ti Tou (Lift/Support): four cun lateral; level with rim four; similar depth; used for prolapse.
  • Moxibustion triangle (triangle of moxibustion around the umbilicus): apex at the umbilicus; two lower points on either side at a distance equal to the patient’s smile; used for abdominal conditions and diarreha; indirect or direct moxibustion; caution with heat/damp-heat conditions.

Note: The content above summarizes the main ideas and terms discussed in the transcript. Some point names and levels come from the lecturer’s phrasing in the video and may appear with alternate spellings in standard textbooks. Always cross-check with your course materials for exam-ready terminology.