肩外俞 : Jianwaishu : Outer Shoulder Shu

Location Guides:

Classifications:

Trigger point (Travell & Simons, 1998, Trigger Point Manual; Melzack, Stillwell & Fox, 1977)
Homeostatic point 13 (Ma, Ma & Cho, 2005, Biomedical Acupuncture for Pain Management)

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Location:

3 cun lateral to the lower border of the spinous process of T1 (Taodao Du-13). The medial border of the scapula is at 3 cun when relaxed.

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Needling:

Oblique medial insertion 0.5 - 1 cun

Warnings:

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

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 sixfen and it 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:

Activates the channel and alleviates pain
Expels Wind and Cold and benefits the shoulder and scapula

TCM Indications:

• Pain of the shoulder and scapula with cold sensation extending to the elbow, chills and fever accompanied by neck rigidity and inability to turn the head, generalised Painful Obstruction (痹, Bi).

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Neuroanatomy:

Superficial Innervation: Dorsal scapular from ventral ramus of C5

Dermatome Segment: C6

Trigger Point Associations:

Muscle:
Middle trapezius and middle levator scapulae (deep)

Myotome Innervation:
Trapezius: Motor - accessory nerve (CN XI), Sensation - dorsal rami of C2 - C3; Levator scapulae: Cervical nerve (C3 - C4) and dorsal scapular nerve (C5)

Location Notes:
A second levator scapulae trigger point may be located directly above this point, between Jianjing GB-21 and bailao

Pain Referral Pattern:

Middle trapezius: to midline around spine at levels of neck and scapula
Levator scapulae: directly superior to this point to the posterior neck and medial portion of the trapezius with some spillover to the medial border of the scapula and the posterior lateral joint of the scapula (around Naoshu SI-10)

Indications:
Myalgia in shoulder region ; Shoulder and neck pain

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Martial Applications & Effects of Injury:

Striking this point will put a shock into the upper body causing the lungs and heart to falter. Extreme nausea will result with vomiting and later even death if untreated, especially if used with Juque Ren-14 (Montaigue, Dim Mak Locations, Taijiworld.com).

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Major Combinations:

• Pain of the shoulder and back:
    Jianwaishu SI-14 with Kunlun Bl-60 and Dazhui Du-14 (Deadman, Al-Khafaji and Baker, 2001, A Manual of Acupuncture).

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Notes:

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 Mizar (開陽 Kaiyang, Open & Positive).

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 Pherkard (勾陳二 Gou Chen Er, "Old Hook Two").

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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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