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).

Zhou Yi 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:
元亨。
Supreme opening.
The point has access to the Yuan level — the source of original qi. The channel can be opened. The abundance is not static; it flows.

Overall: 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	Clinical Reading
1	Yang	無交害，匪咎，艱則無咎	No harmful interactions. Not trouble. Difficulty brings no trouble.	Caught early, Xie Qi cannot cause harm, even if it appears so. The point can easily hold latency, even in difficult times.
2	Yang	大車以載，有攸往，無咎	A great wagon carries. There is somewhere to go. No trouble.	The point is loaded like a wagon causing acute pain. Treatment should be sought to lighten the burden and there will be no trouble.
3	Yang	公用亨于天子，小人弗克	The duke offers tribute to the emperor. The small man cannot do this.	The point is the duke, offering its service to the Heart, the Son of Heaven, or the emperor. This must be a bold treatment, worthy of a duke. A timid treatment, worthy of a small man, cannot achieve the result needed.
4	Yang	匪其彭，無咎	Not his abundance. No trouble.	The abundance is not with the Zheng Qi, but the Xie Qi. If this is understood, there is no trouble.
5	Yin	厥孚交如，威如，吉	His captives intermingle. Dignity. Auspicious.	The Xie Qi must be distributed among other channels to prevent its progression beyond this channel and direct to the Small Intestine and ultimately, the Heart.
6	Yang	自天祐之，吉無不利	Heaven blesses him. Auspicious. Nothing is unfavourable.	The channel is exhausted and the practitioner has done all that can be done. Now the outcome must be entrusted to Heaven. Hence, it is auspicious and nothing is unfavourable because it is now a matter of faith and acceptance of destiny.

Image:
火在天上，大有。君子以適惡揚善，順天休命。
Fire above heaven: Da You. Thus the gentleman suppresses evil and promotes good, complying with the favourable will of Heaven.

Fire is above, heaven is below. The fire illuminates everything, and nothing is hidden. The gentleman suppresses evil and promotes good. 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).
Opposed by ䷇ (Taixi Kid-3 or Feiyang Bl-58.

Hexagram attributions are my own with an explanation given in the glossary.
Translations are my own, assisted by DSeek and compared to Richard Rutt's interpretion (2002).

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