水突 : Shuitu : Water Prominence

Classifications:

Trigger point (Travell & Simons, 1998, Trigger Point Manual)
Master Tung's Tonsilitis Nine

Meetings:

Meeting of Stomach with Gall Bladder Divergent, Liver Divergent, Stomach Divergent, Spleen Divergent, Heart Divergent and Pericardium Divergent

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Location:

On the neck, at the anterior border of the sternocleidemastoid muscle, midway between Renying ST-9 and Qishe ST-11.

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Needling:

Perpendicular-oblique insertion directed medially to avoid the carotid artery 0.5 - 1 cun

Warnings:

Palpate and hold the carotid artery lateral to the point while needling

Classical Needling:

"The Yangming usually has much Qi and much Blood" (Su Wen 素問 ch. 24) implying this channel can normally be needled or bled.
"The foot Yangming is to be pierced 6 fen deep and remain inserted for ten exhalations" (Ling Shu 靈樞 ch. 12).
"It is needled to a depth of one cun and is 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:

Benefits the throat and neck
Descends Lung Qi

TCM Indications:

• Swelling and pain of the throat, goitre, scrofula.
  
• Cough, whooping cough, shortness of breath, dyspnoea, swelling and pain of the shoulder.

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Neuroanatomy:

Superficial Innervation: Transverse cervical nerve (C2 - C3)

Dermatome Segment: C2, C3

Trigger Point Associations:

Muscle:
Sternomastoid

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

Location Notes:
The exact trigger point location should be on the belly of the sternomastoid

Pain Referral Pattern:
To back of head and from top of cheek to temple, to the forehead above the eyebrow and into the inner canthus of the eye. Some spillover onto cheek, top of head and front of throat

Indications:
Torticollis ; Myalgia of neck muscles ; Head and facial pains

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Martial Applications & Effects of Injury:

Despite being less famous than Renying St-9, this point is equally, if not more dangerous. A strike here causes an immediate rush of Yang Qi to the head causing knock out, the face goes red and the tongue turns blue. A hard strike will cause knock out. Combine with Neiguan Pc-6 to add further Qi rushing to the head and the recipient will fall down a split second after the strike from shock (Montaigue, Dim Mak Locations, Taijiworld.com).

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Major Combinations:

• Swelling of the throat:
    Shuitu St-10 with Qishe St-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:

This point would also be on the upper trajectory of the Chong mai in Jeffrey Yuen's descriptions (Yuen, 2005, The Extraordinary Vessels).

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In Tung's acupuncture the Tonsilitis Nine (Hou E Jiu) points are located between these two points. The centre point is located at the superior notch of the thyroid cartilage with two more 1.5 cun lateral. Two more points are located 1 cun above and 1 cun below each of these three. The lower lateral points would be approximately at St-10. They are indicated for tonsilitis, throat pain, thyroiditis, throat itching and phlegm obstructing the throat. All are pricked to bleed. Due to their close proximity to the thyroid cartilage and blood vessels the skin must be pinched up and pricked to prevent unintended damage (McCann, 2014, Pricking the Vessels).

This technique, properly performed, could be safer, avoiding the risk of patient's moving and pushing a retained needle deeper than intended.

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Jin's Three Needles for Protrusion are located at this point, Tiantu Ren-22 and Futu LI-18. They are indicated for goiter and thyroid nodules (eLotus, 2021).

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This point would be the approximate location of the stellate ganglion which is a cluster of nerves related to the vagus. Anaesthetising this cluster has been used in a number of circulation problems, pain conditions and nerve injuries, as well as complex syndromes such as long covid, PTSD, and other esoteric conditions with refractory symptoms.

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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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