申脈 : Shenmai : Extending Vessel

Classifications:

Confluent point of the Yang Qiao Mai, coupled with Houxi SI-3
Sun Si-miao Ghost point (2nd trinity)

Meetings:

Meeting of Bladder with Yang Qiao Mai

Location:

On the lateral side of the foot, approximately 0.5 cun inferior to the inferior border of the lateral malleolus, in a depression posterior to the peroneal tendons, directly inferior to the prominence of the lateral malleolus.

Needling:

Oblique insertion directed inferiorly 0.3 - 0.5 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 foot Taiyang is to be pierced 5 fen deep and remain inserted for seven exhalations" (Ling Shu 靈樞 ch. 12).
"It is needled to a depth of three 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:

Pacifies interior Wind and expels Exterior Wind
Calms the Shen and treats epilepsy
Benefits the head and eyes
Opens and regulatess the Yang Qiao Mai
Activates the channel and alleviates pain

TCM Indications:

• Chills and fever, aversion to wind with spontaneous sweating and headache.
  
• Wind dizziness, head wind, headache, lateral and midline headache, thunder head wind, opisthotonos, upward staring eyes, lockjaw, epilepsy, daytime epilepsy, Windstroke (中風, Zhong Feng) with inability to speak and hemiplegia, deviation of the mouth, eye and face, counterflow qi.
  
• Red eyes, eye pain that originates at the inner canthus, nosebleed, deafness and tinnitus.
  
• Mania-Withdrawal (癲狂, Dian Kuang), palpitations, Heart fright, insomnia.
  
• Stiffness of the nape of the neck, stiffness and difficulty in extending the neck, cold Painful Obstruction (痹, Bi) of the lumbar region and hip, pain of the lumbar region and leg, difficulty in extending and flexing the knee, redness and swelling of the lateral malleolus, straw shoe wind (redness, swelling and pain of the leg and foot).
  
• Blood and qi pain in women, fullness of the chest, swelling at the neck and axilla.

Neuroanatomy:

Superficial Innervation: Sural nerve (L5 - S2)

Dermatome Segment: S1

Deeper Structures: Sural nerve (L5 - S2)

Martial Applications & Effects of Injury:

One of the 36 vital points of Feng Yiyuan 馮一元 listed in the Wu Bei Zhi 武備志 (Treatise on Armament Technology) by Mao Yuanyi 茅元儀 (1621). Also listed in Article 21: Delayed Death Touches with Twelve-Hour (Shichen 時辰) Diagrams. This point, along with Shenting Du-24, Taichong Liv-3, Shenque Ren-8 and Tianding LI-17, are associated with Chou 丑 Ox (1 - 3 am) and if struck during this time is said to cause death within 14 days from trauma to the external calcaneal artery. Along with Wailing St-26, it is associated with Xu 戌 Dog (7 - 9 pm) and if struck during this time is said to cause death within 3 days (McCarthy, 2016, Bubishi: The Classic Manual of Combat).

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

Major Combinations:

• Head Wind and headache:
    Shenmai Bl-62 with Jinmen Bl-63
    (Biao You Fu, 標幽賦, Ode to Elucidate Mysteries. First recoreded in Shi Guitang, 施桂堂. 1241: Zhen Jiu Zhi Nan, 針灸指南, Guide to Acupuncture and Moxibustion).
  
  
• Head Wind, Visual Dizziness and stiffness of the nape of the neck:
    Shenman Bl-62 with Jinmen Bl-63 and Shousanli LI-10
    (Miscellaneous Disease).
  
  
• Dian Kuang (Madness):
    Shenmai Bl-62 with Jiexi St-41
    (Sun Simiao, 孫思邈, 625: Bei Ji Qian Jin Yao Fang, 備急千金要方, Essential Prescriptions Worth A Thousand Gold).
  
  
• Night-time epilepsy:
    Moxa Shenmai Bl-62 and Zhaohai Kid-6
    (Gao Wu, 高武, 1529: Zhen Jiu Yu Jing, 針灸聚英, Glorious Anthology of Acupuncture and Moxibustion).
  
  
• Coldness and pain of the bone marrow:
    Shenmai Bl-62 with Dazhu Bl-11, Xuanzhong GB-39, Fuliu Kid-7, Lidui St-45 and Shenshu Bl-23
    (Liao Runhong, 廖润鸿, 1874: Zhen Jiu Ji Cheng, 針灸集成, Compilation of Acupuncture and Moxibustion).
  
  
• Pain of the legs and lumbar region:
    Shenmai Bl-62 with Fengshi GB-31, Huantiao GB-30, Weizhong Bl-40, Kunlun Bl-60, Yinshi St-33 and Changsshan Bl-57
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Disease below the ankle:
    Shenmai Bl-62 with Zhaohai Kid-6
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Swelling of the axilla:
    Shenmai Bl-62 with Diwuhui GB-42, Yangfu GB-38, Weiyang Bl-39, Tianchi Pc-1 and Zulinqi GB-41
    (Sun Simiao, 孫思邈, 625: Bei Ji Qian Jin Yao Fang, 備急千金要方, Essential Prescriptions Worth A Thousand Gold).
  
  
• Agitation, sudden outbursts of rage, contortions of the face or absent staring, vivid dreams and sleepwalking in the second stage of Ghost Possession:
    Moxa Shenmai Bl-62, bleed Daling Pc-7 and needle Fengfu Du-16
    (Yuen, 2005, 3 Spirits & 7 Souls, see notes below).

Notes:

Ling Shu Ch. 73, Each According to His Ability, suggests pricking (Wu & Wu, 2010) or applying Moxa (Unschuld, 2016) to the Qiao Mai when the location of a suffering is unknown. It warns that this point should be used for a man and Shaohai Kid-6 on a woman, and prohibits the reverse.

Ghost Points:
The second trinity of ghost points, consisting of this point Daling Pc-7 and Fengfu Du-16, is concerned with the ghost trying to get you to search for the remnants of its past, either by dreamwork or literally going to places and seeking people it longs for. This is the most Yang phase of possession with many signs of Wind and Heat leading to agitation, uncontrollable movement and outbursts.

The alternative name Guilu, Ghost Path, represents the stage of possession when a person begins to walk the path of the ghost, actively seeking out the places or people of the ghosts past. With its relationship to the Yang qiao mai the symptoms often include symptoms similar to epilepsy, especially when confronted including disengagement and a blank forward stare, or at the other extreme uncontrollable aggression, contortions and deviations in the face.

This point would be treated with moxa (Yuen, 2005, 3 Spirits & 7 Souls).

In the Twelve Branches the Ghost Points follow a cycle from top to bottom with this point representing Xu, 戌 and the Pericardium channel (Ayal, 2021, The 13 Ghost Points 十三鬼穴).

申 "Shen", besides being an obvious homonym for 神 "Spirit" by simply adding the radical 礻 for "ancestor, veneration", is also the name of the 9th Earthly Branch and so can be seen as the vessel for the properties associated with this branch, such as: the monkey, the 7th month, southwest (240°), Yang Fire, the Hexagram ䷋ (否 Pi; "Obstruction"), the beginning of autumn (Metal) and the time from 3-5 pm which governs the Bladder channel and is the beginning of the Yangming phase in the Shang Han Lun circadian cycle.

Personal experience has revealed that Shimian Ex-LE-15, located in the centre of the heel, is a powerful inducer of sleep when massaged. Being on the heel and between Shenmai Bl-62 and Shaohai Kid-6, it may be the original meeting point of the Qiao Mai. The skin, being thick here, may not have been conducive to needling through the heel, especially if trying to induce sleep, and so its locations were moved to either side. This could suggest that lower locations that can penetrate under the heel to this point may be better than the traditional locations that are just under the malleoli and enter the joint space here.

In Mayan medicine:
Used to treat pain in the lower limbs (Garcia, Sierra, Balam, 1999: Wind in the Blood)

Lad and Durve (2008) in Marma Points of Ayurveda call this point lateral Gulpha and associate it with the doshas: Prana Vayu, Apana Vayu, Vyana Vayu, Shleshaka Kapha.

They give the following functions:
- Benefits the ankles
- Improves circulation in the feet
- Relieves pain locally
- Regulates kidney function and water filtration
- Pacifies kapha dosha

A medial Gulpha point is located at Shuiquan Kid-5.

In an interesting parallel, the Arabic word for Kaaba the holiest site in Islam, derives from the root Kaf-Ayn-Ba which refers to "a focal point where things/paths come together and create a balance" and is used in the Qu'ran in reference to kaabayn (5:6; the ankles/heels; Islam, 2023). This suggests a spiritual connection to the ankles/heels in Islam that parallels Zhuangzi's comment that "the True Man breathes from his heels" (Zhuangzi, book 6) and the origin of the Qiao Mai as an anatomical metaphor for what we use to walk on the Way (Dao / Tariqa).

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