Acupuncture

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Acupuncture of the Upper Limb

 

Meridians

All 6 Hand Meridians pass through the upper limb:

-      Interiorly Exteriorly related Zang-Fu pairs: Lung & Large Intestine

o     Lung Meridian of Hand Tai Yin (肺经手太阴)

o     Large Intestine Meridian of Hand Yang Ming (大场经手阳明)

-      Interiorly Exteriorly related Zang-Fu pairs: Heart & Small Intestine

o     Heart Meridian of Hand Shao Yin (心经手少阴)

o     Small Intestine Meridian of Hand Tai Yang (小肠经手太阳)

-      Interiorly Exteriorly related Zang-Fu pairs: Pericardium & San Jiao

o     Pericardium Meridian of Hand Jue Yin (心包经手绝阴)

o     San Jiao Meridian of Hand Shao Yang (三焦经手少阳)

 

Also the following meridians pass through the region of the upper limb:

-      Stomach Meridian of Foot Yang Ming

o     ST13 [subclavius muscle]

-      Bladder Meridian of Foot S

o     BL10

-      Kidney Meridian of Foot Shao Yin

o     KI27 [subclavius muscle]

           

The Hand Yin Meridians (Lung, Heart, Pericardium)

-      originate in the torso

-      first acupoint lies on the chest or axilla

-      passes exteriorly from the chest or axilla to the fingers

-      pathway along the anterior aspect of the arm and forearm

The Hand Yang Meridians (Large Intestine, Small Intestine, San Jiao)

-      originate in the torso

-      first acupoint lies on the chest or axilla

-      passes exteriorly from the chest or axilla to the fingers

-      pathway along the anterior aspect of the arm and forearm

 

Acupoints

ST38

ST13

KI27

BL 11-17?

BL42-48?

 

Extra Points

 

Lung Meridian of Hand Tai Yin

 

LU1 Zhong Fu ()

LU2 Yun Men ()

LU3 Tian Fu ()

LU4 Xia Bai ()

LU5 Chi Ze ()

LU6 Kong Zui ()

LU7 Lie Que ()

LU8 Jing Qu ()

LU9 Tai Yuan ()

LU10 Yu Ji ()

LU11 Shao Shang ()

Generalisation of the Lung Meridian

 

Neurophysiological Generalisations

Cutaneous Innervation:

-      LU1 and LU2: supraclavicular nerves (C3, C4) or Intercostobrachial nerve (T1)

-      LU3 and LU4: lower lateral cutaneous nerve of arm (radial nerve)

-      LU5 to LU8: lower lateral cutaneous nerve of arm (radial nerve), lateral cutaneous nerve of forearm (musculocutaneous nerve)

-      LU9 and LU10: lateral cutaneous nerve of forearm (musculocutaneous nerve), superficial radial nerve (radial nerve)

-      LU11: median nerve

 

Dermatomes:

-      LU1 and LU2: C3,C4 or T1

-      LU3 and LU4: C5

-      LU5 to LU11: C6

 

Functional and Action Generalisations

 

Vascular Generalisations

-      LU1 to LU3: along path of cephalic vein

-       

 

LU1 Zhong Fu ( )

Location:

1st intercostal space 6 cun lateral to midline

-      Inferior to clavicle

-      Inferiomedial to coracoid process

-      Inferior to the deltopectoral triangle

Method of location:

-      Find sternal angle (manubrosternal junction) in midline and follow lateral to costal cartilage of 2nd rib

-      1st intercostal space lies superior to this between 1st and 2nd rib

-      Follow 1st intercostal space laterally until midclavicular line

-      Continue transversely at same level as the intercostal space disappears superiorly under the clavicle

-      Until 6 cun from the midline

Proportional Measurements:

-      8 cun from sternal extremity to acromial extremity of clavicle

-      4 cun from midline to nipple (males more reliable)

Local Anatomy:

-      Pectoralis major muscle (clavicular head)

-      Pectorlais minor muscle

-      Clavicopectoral fascia

-      Medial pectoral nerve

-      Lateral pectoral nerve

-      Brachial plexus

-      Thoracoacromial artery

-      Axillary artery

-      Lateral thoracic artery

-      Cephalic vein

-      Axillary vein

-      Pectoral lymph nodes

Differential Points: LU2

Cutaneous Innervation: supraclavicular nerves (C3, C4) or Intercostobrachial nerve (T1)

Dermatome: C3, C4 or T1

Myotome: C5 to T1

Viscerotome:

Sclerotome:

De Qi:

Actions:

Indications:

Special Indication/Function:

Combinations:

Potential Physiological Effects:

-      Myofascial release of:

o     Pectoralis major

o     Pectoralis minor

o     Clavicopectoral fascia

 

LU2 Yun Men ()

Location:

Infracalvicular fossa 6 cun lateral to midline

-      Immediately inferior to clavicle

-      Medial to coracoid process

-      Within deltopectoral triangle

Method of location:

-      Find infraclavicular fossa inferior to clavicle

-      Measure 6 cun from midline (see below)

Proportional Measurements:

-      8 cun from sternal extremity to acromial extremity of clavicle

-      4 cun from midline to nipple (males more reliable)

Local Anatomy:

-      Pectoralis major muscle

-      Pectorlais minor muscle

-      Clavicopectoral fascia

-      Medial pectoral nerve

-      Lateral pectoral nerve

-      Brachial plexus

-      Thoracoacromial artery

-      Axillary artery

-      Lateral thoracic artery

-      Cephalic vein

-      Axillary vein

-      Pectoral lymph nodes

Differential Points: LU1

Cutaneous Innervation: supraclavicular nerves (C3, C4) or Intercostobrachial nerve (T1)

Dermatome: C3, C4 or T1

Myotome: C5 to T1

Viscerotome:

Sclerotome:

De Qi:

Actions:

Indications:

Special Indication/Function:

Combinations:

Potential Physiological Effects:

-      Myofascial release of:

o     Pectoralis major

o     Pectoralis minor

o     Clavicopectoral fascia

-      Influence of cephalic vein as it empties into axillary vein

 

LU3 Tian Fu ()

Location:

Lateral side of biceps brachi muscle 3 cun inferior to anterior axillary fold

-      1 cun superior to LU4

-      Anterior to LI14

-      Anterior to lateral intermuscular septum

-      Between biceps brachi muscle and brachialis muscle

Method of location:

-      Find 3 cun inferior to anterior margin of axillary fold

-      Palpate anteriorly and posteriorly over lateral border of biceps brachi muscle

Proportional Measurements:

-      9 cun from anterior margin of axillary fold to cubital crease

Local Anatomy:

-      Biceps brachi muscle

-      Brachialis muscle

-      Lateral intermuscular septum

-      Cephalic vein

Differential Points: LU4, LI14

Cutaneous Innervation: lower lateral cutaneous nerve of arm (radial nerve)

Dermatome: C5

Myotome:

Viscerotome:

Sclerotome:

De Qi:

Actions:

Indications:

Special Indication/Function:

Combinations:

Potential Physiological Effects:

Myofascial trigger point: brachialis muscle

 

U4 Xia Bai ()

Lateral side of biceps brachi muscle 4 cun inferior to anterior axillary fold

-      1 cun inferior to LU3

-      Anteroinferior to LI14

-      Anterior to lateral intermuscular septum

-      Between biceps brachi muscle and brachialis muscle

Method of location:

-      Find 4 cun inferior to anterior margin of axillary fold

-      Palpate anteriorly and posteriorly over lateral border of biceps brachi muscle

Proportional Measurements:

-      9 cun from anterior margin of axillary fold to cubital crease

Local Anatomy:

-      Biceps brachi muscle

-      Brachialis muscle

-      Lateral intermuscular septum

-      In the vicinity of the emergence of the musculocutaneous nerve from underneath the lateral aspect of biceps brachi muscle as it forms the lateral cutaneos nerve of forearm

Differential Points: LU3, LI14

Cutaneous Innervation: lower lateral cutaneous nerve of arm (radial nerve)

Dermatome: C5

Myotome:

Viscerotome:

Sclerotome:

De Qi:

Actions:

Indications:

Special Indication/Function:

Combinations:

Potential Physiological Effects:

Myofascial trigger point: brachialis muscle

 

LU5 Chi Ze ()

Location:

Lateral to biceps brachi tendon within the cubital crease

-      Within cubital fossa

Method of location:

-      Flex forearm to highlight biceps brachi tendon within cubital fossa

-      Find depression lateral to tendon

Proportional Measurements:

-      None required

Local Anatomy:

-      Brachialis muscle

-      Brachioradialis muscle

-      Humeral head of supinator muscle

-      Lower lateral antebrachial cuteanous nerve (radial nerve)

-      Radial nerve as it bifurcates into superficial and deep branches

-      Recurrent branch of radial artery

-      Cephalic vein

Differential Points: LI11, PC5

Cutaneous Innervation: lower lateral cutaneous nerve of arm (radial nerve), lateral cutaneous nerve of forearm (musculocutaneous nerve)

Dermatome: C6

Myotome:

Viscerotome:

Sclerotome:

De Qi:

-      Cutaneous nerves

o        Lower lateral antebrachial cuteanous nerve (radial nerve) refers to lateral aspect of lower arm and elbow

o        Superficial branch of radial nerve refers to posterior aspect of hand including dorsum of wrist, hand, 1st digit (thumb), 2nd digit (index finger) and the medial ½ of the 3rd digit (middle finger)

-      Myofascial referred pain

o        Brachialis muscle

o        Supinator muscle

Actions:

Indications:

Special Indication/Function:

Combinations:

Potential Physiological Effects:

 

LU6 Kong Zui ()

Location:

5 cun inferior to transverse cubital crease on line linking LU5 and LU9

-      7 cun superior to palmar wrist crease

Method of location:

-      Find 5 cun inferior to transverse cubital crease

-      Align with LU5 at transverse cubital crease and LU9 at palmar wrist crease

Proportional Measurements:

-      12 cun from transverse cubital crease to palmar wrist crease

Local Anatomy:

-      Brachioradialis muscle

-      Flexor digitorum profundus muscle

-      Superficial radial nerve

-      Radial artery

Differential Points: LI6, LI7, LI8

Cutaneous Innervation: lateral cutaneous nerve of forearm (musculocutaneous nerve)

Dermatome: C6

Myotome:

Viscerotome:

Sclerotome:

De Qi:

Actions:

Indications:

Special Indication/Function:

Combinations:

Potential Physiological Effects:

 

LU7 Lie Que ()

Location:

1.5 cun proximal (superior) to lateral extremity of palmar wrist crease

-      Proximal to styloid process of radius

-      Anterior to tendon of extensor carpi radialis longus

-      Posterior to tendon of extensor pollicis brevis and brachioradialis

-      Deep to tendons of extensor pollicis brevis and abductor pollicis longus

-      Lateral aspect of radius

-      Not inline with LU5 to LU9

-      1.5 cun proximal to LI5

Method of location:

-      Find styloid process of radius in anterolateral aspect of anatomical “snuff box”

-      Find 1.5 cun superior to palmar wrist crease

-      In groove anterior to tendon of extensor carpi radialis longus (passes to base 2nd metacarpal)

Proportional Measurements:

-      12 cun from transverse cubital crease to palmar wrist crease

Local Anatomy:

-      Superficial radial nerve

-      Tendons of extensor carpi radialis longus and brevis, extensor pollicis brevis, abductor pollicis longus

-      Tributries of cephalic vein

-      Radius

Differential Points: LU8, LI5

Cutaneous Innervation: lateral cutaneous nerve of forearm (musculocutaneous nerve)

Dermatome: C6

Myotome:

Viscerotome:

Sclerotome:

De Qi:

Actions:

Indications:

Special Indication/Function:

Combinations:

Potential Physiological Effects:

 

LU8 Jing Qu ()

Location:

1 cun proximal (superior) to lateral extremity of palmar wrist crease on line linking LU5 and LU9

-      Proximal to styloid process of radius

Method of location:

-      Find styloid process of radius in anterolateral aspect of anatomical “snuff box”

-      Find 1.5 cun superior to palmar wrist crease

-      In groove anterior to tendon of extensor carpi radialis longus (passes to base 2nd metacarpal)

Proportional Measurements:

-      12 cun from transverse cubital crease to palmar wrist crease

Local Anatomy:

-      Superficial radial nerve

-      Tendons of extensor carpi radialis longus and brevis, extensor pollicis brevis, abductor pollicis longus

-      Radius

Differential Points: LU8, LI5

Cutaneous Innervation: lateral cutaneous nerve of forearm (musculocutaneous nerve)

Dermatome: C6

Myotome:

Viscerotome:

Sclerotome:

De Qi:

Actions:

Indications:

Special Indication/Function:

Combinations:

Potential Physiological Effects:

 

LU9 Tai Yuan ()

Location:

At the lateral extremity of palmar wrist crease

-      Between distal extremity of radius and scaphoid

-      Lateral to radial artery and flexor carpi radialis muscle

-      Medial to tendon of abductor pollicis longus

Method of location:

-      Find styloid process of radius in anterolateral aspect of anatomical “snuff box”

-      Find 1.5 cun superior to palmar wrist crease

-      In groove anterior to tendon of extensor carpi radialis longus (passes to base 2nd metacarpal)

Proportional Measurements:

-      12 cun from transverse cubital crease to palmar wrist crease

Local Anatomy:

-      Superficial radial nerve

-      Tendons of extensor carpi radialis longus and brevis, extensor pollicis brevis, abductor pollicis longus

-      Palmar radiocarpal ligament

Differential Points: LU8, LI5

Cutaneous Innervation: superficial radial nerve (radial nerve), lateral cutaneous nerve of forearm (musculocutaneous nerve)

Dermatome: C6

Myotome:

Viscerotome:

Sclerotome:

De Qi:

Actions:

Indications:

Special Indication/Function:

Combinations:

Potential Physiological Effects:

 

LU10 Yu Ji ()

Location:

Midpoint of 1st metacarpal at the junction of red and white skin

-      Anterolateral aspect of 1st metacarpal

-      Lateral to abductor pollicis brevis muscle

-      Overlies opponens pollicis muscle

Method of location:

-      Find head and base of 1st metacarpal

-      Locate midpoint at anterolateral aspect

-      Where skin of dorsal surface transitions to palmar surface

Proportional Measurements:

-      None required

Local Anatomy:

-      Opponens pollicis muscle

-      Abductor pollicis brevis muscle

-      1st metacarpal

Differential Points:

Cutaneous Innervation: superficial radial nerve (radial nerve), median nerve

Dermatome: C6

Myotome:

Viscerotome:

Sclerotome:

De Qi:

Actions:

Indications:

Special Indication/Function:

Combinations:

Potential Physiological Effects:

 

LU11 Shao Shang ()

Location:

0.1 cun lateral and 0.1 cun proximal to superiolateral corner of 1st finger nail

Method of location:

-      Junction of vertical line from most lateral aspect of nail with transverse line from most proximal aspect of nail

Proportional Measurements:

-      None required

Local Anatomy:

-      Digital nerve of median nerve

-      Digital artery of radial artery???

Differential Points:

Cutaneous Innervation: median nerve

Dermatome: C6

Myotome:

Viscerotome:

Sclerotome:

De Qi:

Actions:

Indications:

Special Indication/Function:

Combinations:

Potential Physiological Effects: