天鼎 : Tianding : Heaven's Tripod

Location Guides:

Classifications:

Trigger point (Travell & Simons, 1998, Trigger Point Manual; Melzack, Stillwell & Fox, 1977)

Meetings:

Meeting of Large Intestine with Large Intestine Divergent and Lung Divergent

Location:

On the lateral side of the neck, 1 cun inferior to Futu L.I.-18, on the posterior border of the sternocleidomastoid muscle

Needling:

Perpendicular insertion 0.3 - 0.5 cun or oblique insertion 0.5 - 0.8 cun

Warnings:

Deeper needling may puncture the carotid artery or jugular vein

Classical Needling:

"The Yangming usually has much Qi and much Blood" (Su Wen 素問 ch. 24) implying this channel can normally be needled or bled.
"The hand Yin and Yang receive their Qi via nearby paths so their Qi arrive swiftly. The depth of piercing must not exceed 2 fen and must not remain inserted for longer than one exhalation" (Ling Shu 靈樞 ch. 12).
"It is needled to a depth of four fen and is moxaed with three cones" (Huangfu Mi 皇甫謐, 3rd Century, Zhenjiu Jiayi Jing 針灸甲乙經).

TCM Actions:

Benefits the voice and throat

TCM Indications:

• Sudden loss of voice, Throat Painful Obstruction (喉痹, Hou Bi), rattling sound in the throat, goitre, scrofula, difficulty in breathing, difficult ingestion.

Neuroanatomy:

Superficial Innervation: C4 - C8 via cervical plexus

Dermatome Segment: C3

Trigger Point Associations:

Muscle:
Scalenus medius

Pain Referral Pattern:
To zones of the chest, along the medial aspect of the scapula, and all down the lateral aspect of the upper arm and radial side of the forearm to the dorsal aspect of the hand

Indications:
Pain in neck, shoulder and upper arm

Martial Applications & Effects of Injury:

Listed in the Wu Bei Zhi 武備志 (Treatise on Armament Technology) by Mao Yuanyi 茅元儀 (1621), Article 21: Delayed Death Touches with Twelve-Hour (Shichen 時辰) Diagrams. This point, along with Shenting Du-24, Taichong Liv-3, Shenque Ren-8 and Shenmai Bl-62, are associated with Chou 丑 Ox (1 - 3 am) and if struck during this time is said to cause death within 14 days from trauma to the carotid artery and sublingual nerve but must be exposed by tilting the head back by pulling the hair. Along with Kunlun Bl-60 and Rugen St-18 it is associated with Yin 寅 Tiger (3-5 am) and if struck during this time is said to cause death within 20 days (McCarthy, 2016, Bubishi: The Classic Manual of Combat).

One of the most dangerous points which can cause death if struck. Qi and Blood will be blocked and the brain will be shocked. Not even CPR can revive after a strike here (Montaigue, Dim Mak Locations, Taijiworld.com).

Major Combinations:

• Halting speech and loss of voice:
    Tianding LI-17 with Jianshi Pc-5
    (Gao Wu, 高武, 1529: Bai Zheng Fu, 百症賦, Ode of a Hundred Symptoms).

Notes:

Avicenna describes cupping at this point in his treatise On Cupping:

"Cupping on the two veins along the neck is second to venesection of the cephalic vein. Their cupping is beneficial in cases of head trembling and to the organs of the head, such as the face, teeth, ears, eyes, throat and nose... Cupping the veins of the neck may cause head trembling." (Aspects of Treatment According to General Diseases, 22nd section in Abu-Asab, Amri & Micozzi, 2013, Avicenna's Medicine)

Any point along the path of the jugular could be indicated by this point but the proximity of LI-18 to the carotid would make it even riskier than cupping the jugular alone. Given that Avicenna generally refers to wet cupping (Hijama) this would be a risky procedure anyway.

In the Unani Islamic medical practice of Hijama this point is known as Akhda’ain.

It is "narrated by ibn majah, on the authority of Ali razi allaho anh that angel Jibreel advised prophet Muhammad Sallallahoo Alaihi Wa Sallam for hijama at Akhda’ain (posterior jugulars) and KAHIL (upper back ~between the shoulder)."

Kahn, 2019, http://hijamacups.com/sunnah-points/. Accessed 12 May 2019.

In ayurvedic medicine:
Siramatrika marma point
Size: 4 angula (cun)
Structure: Blood vessels.
Effect of Injury: Fatal (sadhyapranahat marma).
(Harish Johari, 1996, Ayurvedic Massage, Sanatan Society; Anupama Bhattacharya, n.d. Marma Shastra)

Lad and Durve (2008) in Marma Points of Ayurveda locate Siramantha anterior to the this point on the anterior of the SCM and associate it with the doshas: Prana Vayu, Udana Vayu, Vyana Vayu, Ranajaka Pitta and Sadhaka Pitta.

They give the following functions:
- Regulates thyroid and parathyroid functions
- Enhances cervical lymphatic circulation
- Regulates blood pressure and cardiac functions
- Relieves neck tension
- Benefits pharynx and larynx

Reference Notes:

Basic information on location, needle depth, TCM actions, indications and combinations is taken from Deadman et al (2001): A Manual of Acupuncture with additional anatomical information researched by reference to Gray's Anatomy (38th Ed., 1995) unless otherwise referenced. Images were found on acupunctureschoolonline.com and can be traced back to Claudia Focks (2008) Atlas of Acupuncture originally. I cannot claim any credit or rights over them. Other sources should be quoted in the text.

For some of the more unusual terms I have created a glossary here