曲垣 : Quyuan : Crooked Wall

Location Guides:

Classifications:

Trigger point (Travell & Simons, 1998, Trigger Point Manual)

Location:

In the tender depression superior to the medial end of the scapular spine, midway between Naoshu S.I.-10 and the spinous process of T2.

Needling:

Perpendicular insertion 0.3 - 0.5 cun, or oblique lateral insertion 0.5 - 1 cun

Warnings:

Too medial insertion or deep medial-oblique needling may puncture the lungs.

Classical Needling:

"The Taiyang usually has much Blood and little Qi" (Su Wen 素問 ch. 24) implying this channel should normally be 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 nine fen and moxaed with ten cones" (Huangfu Mi 皇甫謐, 3rd Century, Zhenjiu Jiayi Jing 針灸甲乙經).

TCM Actions:

Benefits the shoulders and scapula

TCM Indications:

• Generalised Painful Obstruction (痹, Bi), Painful Obstruction (痹, Bi) of the shoulder and scapula, hot Painful Obstruction (痹, Bi) of the shoulder with contraction, pain and an oppressive sensation of the shoulder.

Neuroanatomy:

Superficial Innervation: Suprascapular nerve from C5 - C6

Dermatome Segment: T1

Trigger Point Associations:

Muscle:
Serratus posterior

Location Notes:
This point is located beneath the scapula and accessible only when the scapula is abducted. When needling Travell & Simons (1998) suggest putting fingers on the underlying rib to fix its location and needling at a tangent to the skin, keeping the needle directed towards the rib at all times. Melzack (1977) correlates this point to the infraspinatus trigger point but his diagrams clearly point beneath the scapular spine making Tianzhong SI-11 a better alternative.

Pain Referral Pattern:
To the entire scapula and through to the anterior chest wall. Also down the posterior aspect of the arm, the dorsal aspect of the forearm and to the little finger

Indications:
Deep ache at rest exacerbated by lifting objects with outstretched hands, but unaffected by unloaded movements

Martial Applications & Effects of Injury:

As well as scapular damage and potential lung damage, this point causes a feeling like something is draining from the whole upper body and a loss of the will to fight (Montaigue, Dim Mak Locations, Taijiworld.com).

In seizing martial arts (Qin Na) this point is a cavity pressing point (Dian Xue, 點穴). Pressing or striking this point can agitate the lung and cause coughing. A serious attack can seal the breath (Bi Qi, 閉氣) (Yang, 2004, Analysis of Shaolin Chin Na, 2nd Edition).

Major Combinations:

• Pain of the shoulder and scapula:
    Quyuan SI-13 with Tianzong SI-11 and Jianzhen SI-9 (Deadman, Al-Khafaji and Baker, 2001, A Manual of Acupuncture).

Notes:

This point is part of a group of seven on the Small Intestine channel which trace the Big Dipper constellation over the shoulder (Kim, 2020). This point would be equivalent to Alioth (玉衡 Yuheng, Jade Balance).

Alternatively, since there is already a point named 天樞 Tianshu St-25 on the front of the body, which may represent a set of points correlating to the Big Dipper, this set of points on the back may correlate to the Little Dipper instead which was known in the Han dynasty as 勾陳七星 Gouchen Qixing, the seven stars of the god Gou Chen ("Old Hook"). This point would be ε-Ursae Minoris (勾陳三 Gou Chen San, "Old Hook Three").

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