Acupuncture Point SI-4: Wangu (腕骨, Wrist Bone)

Classifications:

Location:

On the ulnar border of the hand, in the depression between the base of the fifth metacarpal bone and the triquetral bone.

Needling:

Perpendicular insertion 0.3 - 5 cun

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 two fen, (the needle) is retained for a duration of three exhalations, and it is moxaed with three cones" (Huangfu Mi 皇甫謐, 3rd Century, Zhenjiu Jiayi Jing 針灸甲乙經).

TCM Actions:

Activates the channel and alleviates pain
Clears Heat and reduces swelling
Clears Damp-heat and treats jaundice

TCM Indications:

Contraction of the five fingers with difficulty in flexing and extending, weakness and pain of the wrist, contraction of the arm and elbow with difficulty in flexing and extending, stiffness and swelling of the neck, headache, pain of the shoulder, coldness and pain of the shoulder and back, pain of the lateral costal region with inability to catch the breath, lumbar pain radiating to the leg, hemiplegia, clonic spasm.
Pain and swelling of the cheek radiating to the ear, swelling of the neck, submandibular region and jaw, Throat Painful Obstruction (喉痹, Hou Bi), tinnitus, Superficial Visual Obstruction, lacrimation, loss of sense of taste.
Jaundice, Spleen deficiency jaundice, febrile disease with absence of sweating, chills and fever, Malarial (瘧, Nue) Disorders, wasting and thirsting disorder, agitation and fullness.

Neuroanatomy:

Superficial Innervation: Ulnar nerve (palmar branch) from C8 and T1

Dermatome Segment: C8

Martial Applications & Effects of Injury:

Not easy to get at unless controlled in a lock, a strike here will cause energy loss and can have long term effects of loss of forming new ideas, increased Heat in the Heart and the eyes becoming sore, itchy and burning (Montaigue, Dim Mak Locations, Taijiworld.com).

Major Combinations:

Nosebleed: Pierce Wangu SI-4. If it does not end bleed Weizhong Bl-40
(Anon, 400BC-260AD: Huang Di Nei Jing Ling Shu, 黃帝內經靈樞, Yellow Emperor's Inner Classic: Spiritual Pivot, Ch. 26, On Miscellaneous Diseases).
Contraction of the five fingers with inability to flex and extend:
Wangu SI-4 with Zhongzhu SJ-3
(Sun Simiao, 孫思邈, 625: Bei Ji Qian Jin Yao Fang, 備急千金要方, Essential Prescriptions Worth A Thousand Gold).
Pain of the shoulder and arm:
Wangu SI-4 with Tianzong SI-11
(Wang Zhizhong, 王執中, 1220: Zhen Jiu Zi Sheng Jing, 針灸資生經, Classic of Supporting Life with Acupuncture and Moxibustion).
Pain of the submandibular region giving rise to tinnitus and difficult hearing:
Wangu SI-4 with Yanggu SI-5,Jianzhen SI-9, Xiaxi GB-43 and Zuqiaoyin GB-44
(Thousand Ducat formulas).
Toothache and tooth decay:
Wangu SI-4 with Xiaguan St-7, Daying St-5 and Yifeng SJ-17
(Wang Zhizhong, 王執中, 1220: Zhen Jiu Zi Sheng Jing, 針灸資生經, Classic of Supporting Life with Acupuncture and Moxibustion).
Pain of the lateral costal region with inability to catch the breath:
Wangu SI-4 with Yanggu SI-5
(Sun Simiao, 孫思邈, 625: Bei Ji Qian Jin Yao Fang, 備急千金要方, Essential Prescriptions Worth A Thousand Gold).
Spleen deficiency jaundice:
Wangu SI-4 with Zhongwan Ren-12
(Yu Long Fu, 玉龍賦, Ode of the Jade Dragon. First recorded in Gao Wu, 高武, 1529: Zhen Jiu Yu Jing, 針灸聚英, Glorious Anthology of Acupuncture and Moxibustion).

I Ching Hexagram:

䷍ Da You 大有 Great Possessions

Trigrams: Qian (Heaven) below, Li (Fire) above.

Strength within, clarity without — the creative power is made visible by the flame of clarity. This is great possession: abundance that is seen, shared, and illuminated.

Nuclear trigrams: Lines 2-3-4 form Qian (Heaven). Lines 3-4-5 form Dui (Lake). Beneath the abundance, there is creative strength (Qian) and openness and joy (Dui). The hidden message: possession is not hoarding. It is joyfully shared.

Judgement:
大有：元亨。
Great Possession. Supreme success.

Great possession is the abundance that comes from aligning with the creative source. It is not about accumulating things. It is about being a conduit for abundance. The fire (Li) makes the heaven (Qian) visible. What is possessed is not owned — it is held in trust and shared.

Lines:

Line	Yin/Yang	Image	Literal Translation	Commentary
1	Yang	無交害，匿咎，艱則無咎	No harmful interactions. Not trouble. Difficulty brings no trouble.	Yang at the bottom. The beginning of possession. There is no entanglement yet. The danger is not yet present. But difficulty is coming — if you meet it correctly, there is no trouble.
2	Yang	大車以載，有攸往，無咎	A great wagon carries. There is somewhere to go. No trouble.	Yang at 2, central and correct. The great wagon is the capacity to carry abundance. It is loaded and ready. There is somewhere to go — the abundance is not static; it is meant to be transported, shared. No trouble because the capacity is sufficient.
3	Yang	公用亨于天子，小人弗克	The prince offers tribute to the emperor. The small man cannot do this.	The threshold. The prince (the yang at 3) offers his abundance to the emperor (the yin at 5). The small man cannot do this because he hoards. The great possession is tested at the threshold: will you share it or keep it?
4	Yang	匿其彭，無咎	Not his abundance. No trouble.	Yang at 4. The first yang line above the threshold. The abundance is not his own. He does not claim it. This is the correct attitude: the abundance is held in trust, not owned. No trouble because the claim is released.
5	Yin	厥孚交如，威如，吉	His sincerity intermingles. Dignity. Gain.	The ruler line. Yin at 5, central and correct. The ruler is sincere and dignified. He does not claim the abundance as his own — he intermingles his sincerity with others. This is the highest form of possession: holding everything, claiming nothing. Gain because the generosity is complete.
6	Yang	自天祐之，吉無不利	Heaven helps him. Gain. Nothing is unfavourable.	Yang at the top. The abundance is complete. Heaven itself supports him. Nothing is unfavourable because he has not claimed the abundance as his own — he has become a conduit for it. Gain because the alignment with Heaven is complete.

Image:
火在天上，大有。君子以遏惡揚善，順天休命。
Heaven and fire: Tong Ren. Thus the gentleman distinguishes the classes of things and analyzes their natures..

Fire is above, heaven is below. The fire illuminates everything, and nothing is hidden. The gentleman suppresses evil (遏惡, e e) and promotes good (揚善, yang shan). Great possession is not neutral — it is a force for good. The abundance must be used to illuminate what is right and to restrain what is wrong.

Acupuncture Point Connections:

Shared with Tongli He-5.
Inverted into ䷌ (Xinshu Bl-15 or Xiaochangshu Bl-27).
Balanced by ䷇ (Taixi Kid-3 or Feiyang Bl-58.

Hexagram attributions are my own with an explanation given in the glossary.

Notes:

Abductor digiti minimi trigger point lies close to this point, just distal to the head of the fifth metacarpal and on the belly of the muscle (Travell & Simons, 1998, Trigger Point Manual)

In Tung acupuncture the Wan Shu Er, Wrist Flow Two, point is located slightly distal to this point. Its indications seem similar to this point echoing the Du and Taiyang channels (Back, neck, shoulder, arm, hip and side of foot pain, dizziness, vertigo, tinnitus and urinary disorders). It is often combined with Wan Shun Yi, slightly proximal to Houxi SI-3 (Chu, 2015).

In Mayan medicine:
Used to treat pain in the upper extremities (Garcia, Sierra, Balam, 1999: Wind in the Blood)

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

腕 骨  : Wangu : Wrist Bone

SI-4 : Hand Taiyang Small Intestine 4