Acupuncture Point SI-11: Tianzhong (天宗, Heavenly Gathering)

Location Guides:

Classifications:

Binding point of the foot Taiyang Sinews

Trigger point (Travell & Simons, 1998, Trigger Point Manual; Melzack, Stillwell & Fox, 1977, Trigger Points and Acupuncture Points for Pain: Correlations and Implications, Pain 3, p3-23)
Homeostatic point 8 (Ma, Ma & Cho, 2005, Biomedical Acupuncture for Pain Management)

Meetings:

Meeting of Small Intestine with Small Intestine Divergent

Location:

On the scapula, in a tender depression one third of the distance from the midpoint of the inferior border of the scapular spine to the inferior angle of the scapula.

Needling:

Perpendicular or oblique insertion 0.5 - 1.5 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 five fen, (the needle) is retained for a duration of six 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
Moves Qi and unbinds the chest and lateral costal region
Benefits the breasts

TCM Indications:

Heaviness and pain of the shoulder, pain of the scapula, pain and inability to raise the elbow and arm, pain of the elbow, swelling of the cheek and submandibular region.
Fullness of the chest and lateral costal region, cough, pain and swelling of the breast, breast abscess, insufficient lactation.

Neuroanatomy:

Superficial Innervation: Suprascapular nerve, from posterior division of the superior trunk of the brachial plexus (C5 - C6)

Dermatome Segment: T2

Trigger Point Associations:

Muscle:
Infraspinatus and lower trapezius

Myotome Innervation:
Infraspinatus: suprascapular nerve (C5 - C6); trapezius: motor - accessory nerve (CN XI), sensory - cervical spinal nerves from C3 and C4

Location Notes:
There are three other trigger points near here that may become sensitized on the infraspinatus muscle. One lies superior, one superior and slightly lateral and one slightly medial

Pain Referral Pattern:

Infraspinatus: To shoulder with some spillover down radial side of arm and maybe to neck below occiput, or to medial side of scapula if located slightly medially
Lower trapezius: To medial border of scapula

Indications:
Shoulder and arm pain, especially with inability to reach arm behind ; Cardiac syndromes

Martial Applications & Effects of Injury:

Striking this point causes an electrical shock to run down the arm followed by paralysis of the whole arm while draining much Qi. Even a medium strike can cause considerably damage to the back and arm (Montaigue, Dim Mak Locations, Taijiworld.com).

In seizing martial arts (Qin Na) this point is a cavity striking point (Da Xue 打穴) which can be struck with a Phoenix Eye Fist causing numbness of the entire shoulder (Yang, 1995, Tai Chi Chin Na; Yang, 2004, Analysis of Shaolin Chin Na, 2nd Edition).

Major Combinations:

Pain of the shoulder and arm:
Tianzong SI-11 with Wangu SI-4
(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 arm:
Tianzong with Jianliao SJ-14 and Yanggu SI-5
(Wang Zhizhong, 王執中, 1220: Zhen Jiu Zi Sheng Jing, 針灸資生經, Classic of Supporting Life with Acupuncture and Moxibustion).

Notes:

天宗 consists of:

天 Tian: "heaven, sky"
宗 Zong: "a gathering, a group, family, school or sect" but also "ancestors". Its ideogram is a roof over the character for "manifestation, display or reveal".

This point is on the same level as Jueyinshu Bl-14 and Gaohuangshu Bl-43, referenced by the character 宗 Zong which is the same character used for 宗氣 Zong Qi translated as "Gathering Qi", "Ancentral Qi" or "Qi of the Chest". As such this point has an important role in opening the chest.

This point encourages the release of trauma trapped in the chest, facilitating harmony between the actions of man in harmony with those of his own destiny, his innate wisdom and the will of 'Heaven'. Taiyang also represents this departure from the phenomenal world and reconnection with Heaven.

Matsumoto also connects Zong to ancestors and uses this point to treat inherited disorders.

Su Wen, ch.18, describes the Xuli as crossing the diaphragm to end up at the lungs, coming out beneath the left breast at Rugen ST-18 / Qimen Liv-14 and having the function of venting the Zong Qi giving this point some influence over the Xuli.

Navarra (2016). The Scapula - SI10 SI11 SI12. https://www.acupuncturesida.com/The-Scapula---SI10-SI11-SI12-eng.aspx

In Tung Lineage Acupuncture two points, known as the Essence Branch (Jing Zhi) located slightly lateral to point, 6 cun from the midline level with T2 and T3. They are indicated for pain and ongoing soreness in the lower legs (McCann, 2014, Pricking the Vessels).

They are a subset of Tung's Five Mountain Ranges (Wu Ling) which would also be slightly lateral to this point. They are 6 cun from the midline level with T2 to T8.

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 Phecda (天玑 Tianji, Celestial Pearl).

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 &eta-Ursae Minoris (勾陳增九 Gou Chen Zeng Jiu, "Old Hook Adds Nine").

In ayurvedic medicine:
Ansa phalak marma point
Size: 1/2 angula (cun)
Structure: Bone
Effect of Injury: Disability (vaikalyakar marma)
(Harish Johari, 1996, Ayurvedic Massage, Sanatan Society; Anupama Bhattacharya, n.d. Marma Shastra)

Lad and Durve (2008) in Marma Points of Ayurveda call this point Amsa Phalaka and associate it with the doshas: Prana Vayu, Udana Vayu, Sadhaka Pitta, Avalambaka Kaph and Vyan Vayu.

They give the following functions:
- Facilitates optimal functioning of lungs and airways
- Enhances flow of prana
- Relieves lung congestion and bronchospam
- Relieves pain locally
- Benefits the heart
- Releases unresolved emotions

In Tibetan medicine:
Moxa point (AMNH, Tibetan Medical Paintings)

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

天 宗  : Tianzhong : Heavenly Gathering

SI-11 : Hand Taiyang Small Intestine 11