Points Database

Location Guides:

: Dabao : Great Wrapping

Sp-21 : Foot Taiyin Spleen 21

Classifications:
Great Luo of the Spleen
Exit point
Trigger point (Travell & Simons, 1998, Trigger Point Manual)

Location:
On the mid-axillary line, in the seventh intercostal space (note: some sources locate this point in the sixth intercostal space)

Needling:
Transverse-oblique insertion along the intercostal space 0.5 - 1 cun

Warning:
Perpendicular insertion, especially in thin patients, carries a substanstial risk of inducing a pneumothorax.


TCM Actions:
Regulates qi and blood and firms the sinews and joints
Unbinds the chest and benefits the lateral costal region

TCM Indications:
  • Pain of the whole body, weariness of the four limbs, flaccidity of the limbs, flaccidity of the hundred joints.
  • Cough, dyspnoea, chest pain, pain in the chest and lateral costal region on respiration, distension and fullness of the lateral costal region.

    Neuroanatomy:
    Superficial Innervation: Lateral cutaneous thoracic nerve from T6 or T7
    Dermatome Segment: T6, T7

    Trigger Point Associations:
    Muscle: Latissimus dorsi, serratus anterior or intercostals
    Myotome Innervation: Latissimus dorsi: Thoracodorsal (long scapular) nerve (C6 - C8); Serratus anterior: Long thoracic nerve (C5 - C7); Intercostals: Intercostal nerve from T6 or T7
    Location Notes: For latissimus dorsi trigger point palpation or needling needs to be directed into the latissimus dorsi muscle posteriorly. Can also be located posteriorly on the back just lateral to the inferior angle of the scapula. Melzack (1977) locates the serratus anterior point at Shidou sp-17, but Travell & Simons (1998) diagram clearly shows it to be on the axillary line at the 6th intercostal space.
    Pain Referral Pattern:
    \nLatissimus dorsi: To inferior corner of scapula and down posterior and ulnar side of the arm
    \nSerratus anterior: Around point and to inferior medial border of scapula
    Indications: Mid-thoracic backache unresponsive to stretching and movement (latissimus dorsi) or chest pain, especially on deep or heavy breathing (serratus anterior)

    Notes:
    Ling Shu Ch. 10 describes the diseases relating to the Luo emanating from this point as:
    Repletion: Entire body aches
    Depletion: All the joints relax
    (Unschuld, 2016).

    This point creates the connection between Blood and the lower Jiao via the Bao mai which drains Blood stasis from this point, the great Luo of the Spleen, to the Dai mai, first via the Luo of the Ren Jiuwei Ren-15 to the Du, and then from the Luo of the Du Chanqiang Du-1 to the Dai mai to create symptoms of Blood stagnation with Shen disturbance often seen in gynaecological disorders (Yuen, 2005, The Eight Extraordinary Vessels).

    The Ling Shu and the Nan Jing disagree on the location of the Great Luo of the Spleen. The Nan Jing places it at Yuanye GB-22 while the Ling Shu places it 3 cun lower at this point. Ann Cecil-Sterman (2012, Advanced Acupuncture) prefers to use Yuanye GB-22 for Luo treatments.

    Medieval phlebotomy point (John de Foxton, 1408: Liber Cosmographiae, maa.cam.ac.uk; Hans von Gersdorff, 1517: Feldtbüch der Wundartzney, www.nlm.nih.gov)

    In ayurvedic medicine:
    Apalapa marma point
    Size: 1/2 angula (cun)
    Effect of Injury: Premature death (kalantarpranahar marma)
    (Harish Johari, 1996, Ayurvedic Massage, Sanatan Society; Anupama Bhattacharya, Marma Shastra)

    Lad and Durve (2008) in Marma Points of Ayurveda call this point Stanya Parshava and associate it with Vyana Vayu, Avalambaka Kapha, Udana Vayu and Ranjaka Pitta.

    They give the following functions:
    - Benefits the breasts
    - Regulates lactation
    - Relieves congestion in breast tissue
    - Enhances lymphatic circulation
    The right side is connected to the liver and right chamber of the heart, the left side with the spleen and left chamber of the heart.


    Reference Notes: (click to display)