天髎 : Tianliao : Heavenly Crevice

Location Guides:

Classifications:

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

Meetings:

Meeting of San Jiao with Gall Bladder, Large Intestine Divergent and Yang Wei Mai

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Location:

In the suprascapular fossa, in the depression midway between Jianjing GB-21 and Quyuan SI-13 (at the medial end of the suprascapular fossa).

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Needling:

Oblique insertion directed according to the clinical manifestations 0.5 - 1 cun

Warnings:

Perpendicular insertion, especially in thin patients, carries a substantial risk of inducing and pneumothorax.

Classical Needling:

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

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TCM Actions:

Dispels Wind-Damp, activates the channel and alleviates pain
Unbinds the chest and regulates Qi

TCM Indications:

• Pain of the shoulder and arm, stiffness and pain of the neck, tension of the nape of the neck, pain in the supraclavicular fossa.
  
• Agitation and oppression of the chest, heat and fullness of the chest, oppression of the Heart with absence of sweating, heat in the body with absence of sweating, chills and fever, febrile disease.

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Neuroanatomy:

Superficial Innervation: Supraclavicular nerve from C3 - C4

Dermatome Segment: C4

Deeper Structures: Neuromuscular junction of spinal accessory nerve (XI) in trapezius muscle

Trigger Point Associations:

Muscle:
Upper trapezius

Myotome Innervation:
Motor functions supplied by ipsilateral accessory nerve (CN XI); Sensation provided by dorsal rami of C2 - C3

Location Notes:
Melzack (1977) correlates this point to the suprascapular trigger point but it is far better suited to Bingfeng SI-12

Pain Referral Pattern:
Radiating from the point, along the muscle to the base of the occiput.
May also be a skin trigger point around here that send a shivery sensation and goosebumps down the lateral side of the arm

Indications:
Musculoskeletal diseases of the shoulder

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Martial Applications & Effects of Injury:

See Montaigue, Dim Mak Locations, Taijiworld.com for explanation of effects.

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Major Combinations:

• Pain and heaviness of the shoulder with inability to raise the arm:
    Tianliao SJ-15 with Quchi LI-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).

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Notes:

In effect this point is the same and Jainjing GB-21 and which one is used is usually decided by palpation and the most tender selected.

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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

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