肩井 : Jianjing : Shoulder Well

Location Guides:

Classifications:

Binding point of the foot Taiyang Sinews

Trigger point (Travell & Simons, 1998, Trigger Point Manual; Melzack, Stillwell & Fox, 1977)
Homeostatic point 3 (Ma, Ma & Cho, 2005, Biomedical Acupuncture for Pain Management)

Meetings:

Meeting of Gall Bladder with San Jiao, Stomach and Yang Wei Mai

Location:

Midway between Dazhui Du-14 and the top of the acromion, at the crest of the trapezius muscle.

Needling:

Posterior oblique insertion 0.5 - 1 cun. Pinch up the muscle with one hand and insert with the other to get deeper into the muscle without running the risk of inducing a pneuomothorax.

Warnings:

Perpendicular insertion, especially in thin patients carries a substantial risk of inducing a pneumothorox. Contraindicated in pregnancy.

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 foot Shaoyang is to be pierced 4 fen deep and remain inserted for five exhalations" (Ling Shu 靈樞 ch. 12).
"It is needled to a depth of five fen and is moxaed with five cones" (Huangfu Mi 皇甫謐, 3rd Century, Zhenjiu Jiayi Jing 針灸甲乙經).

TCM Actions:

Regulates Qi, activates the channel and alleviates pain
Transforms and lowers Phlegm and dissipates nodules
Benefits the breasts and expedites delivery

TCM Indications:

• Stiffness and pain of the neck, pain of the shoulder and back, inability to raise the hand and arm, hemiplegia.
  
• Loss of speech following Windstroke (中風, Zhong Feng), Windstroke (中風, Zhong Feng), wind-taxation, the Five Taxations (五勞, Wu Lao) and the Seven Injuries (七傷, Qi Shang), Steaming Bone Disorders, Kidney deficiency lumbar pain.
  
• Cough and dyspnoea, rebellion of qi, Mania-Withdrawal (癲狂, Dian Kuang), redness of the face.
  
• Scrofula, goitre, Leg Qi (腳氣, Jiao Qi) ascending to attack the Heart, pain of the Spleen.
  
• Difficult or prolonged labour, inversion counterflow of the arms and legs following miscarriage, retention of the placenta, uterine bleeding.
  
• Breast pain, breast abscess, breast milk does not flow, furuncles and carbuncles.

Neuroanatomy:

Superficial Innervation: Supraclavicular nerve from C3 and C4

Dermatome Segment: C3, C4

Deeper Structures: Neuromuscular junction of spinal accessory nerve (CN IX) into trapezius muscle

Trigger Point Associations:

Muscle:
Upper trapezius 1

Pain Referral Pattern:
Superiorly along the trapezius into the occiput and to a lesser degree across the side of the head to the temple and the angle of the mandible

Indications:
Shoulder, arm and neck pain ; Headache ; Stiff neck ; Cardiac syndromes

Martial Applications & Effects of Injury:

In seizing martial arts (Qin Na) this point is a dividing muscle/tendon point (Fen Jin, 分筋) which can be grabbed causing the shoulder to become numb. A serious attack can shock the brain with pain causing unconsciousness (Yang, 1995, Tai Chi Chin Na; Yang, 2004, Analysis of Shaolin Chin Na, 2nd Edition).

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

Major Combinations:

• Inability to turn the neck:
    Jianjing GB-21 with Pohu Bl-42
    (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 shoulder and back:
    Jianjing GB-21 with Fengmen Bl-12, Zhongzhu SJ-3, Zhigou SJ-6, Houxi SI-3, Wangu SI-4 and Weizhong Bl-40
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Pain of the forearm:
    Jianjing GB-21 with Quchi LI-11
    (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).
  
  
• Pain and Cold of the arm:
    Jianjing GB-21 with Quchi LI-11 and Xialian LI-8
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Scrofula:
    Jianjing GB-21 with Shaohai He-3, Ianchi Pc-1, Zhangmen Liv-13, Zulinqi GB-41, Zhigou SJ-6, Yangfu GB-38 and Shousanli LI-10
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Retention of lochia:
    Jianjing GB-21 with Zhongli Ren-3
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Retention of lochia:
    Jianjing GB-21 with Zhongli Ren-3 and Sanyinjiao Sp-6
    (Li Xuechuan, 李學川: Zhen Jiu Feng Yuan, 針灸逢源, Meeting the Source of Acupuncture and Moxibustion).
  
  
• Pain and soreness of Leg Qi:
    First needle Jianjing GB-21, then needle Zusanli St-36 and Yanglingquan GB-34
    (Anon, nd, Tian Xing Mi Jue, 天星秘訣, Secrets of the Celestial Star).
  
  
• Prolapse of the rectum:
    Jianjing GB-21 with Baihui Du-20, Changqiang Du-1, Dachangshu Bl-25, Hegu LI-4 and Qichong St-30
    (Liao Runhong, 廖润鸿, 1874: Zhen Jiu Ji Cheng, 針灸集成, Compilation of Acupuncture and Moxibustion).

Notes:

As trigger point of the trapezius this is a very common point in the treatment of tight neck and shoulders.

One of the 18 tender spots used in the diagnosis of fibromyalgia (Wang, Acupuncture and Traditional Chinese Medical Approaches for Fibromyalgia, Acupuncture Today, vol.6 no.3, 2005).

Named "shoulder well" due to its location on the shoulder and its ability to open all the Jing Well points of the fingers, especially when cupped (Yuen, 2004, Divgent Channels, p.77). Huantiao GB-30 (or Fengshi GB-31 if the client feels uncomfortable with cupping on their buttocks) does this for the lower Jing Well points.

The contraindication for pregnancy seems to be from its use in protocols for difficult labour to stimulate contractions and not an absolute contraindication if used appropriately in conjunction with other points (Betts & Budd, 2011). A review of trials where "forbidden points" were used in pregnancy found no objective evidence of harm (Carr, 2015).

In ayurvedic medicine:
Ansa marma point
Size: 1/2 angula (cun)
Structure: Ligament
Effect of Injury: Disability (vaikalyakar marma)
(Harish Johari, 1996, Ayurvedic Massage, Sanatan Society; Anupama Bhattacharya, n.d. Marma Shastra)

Lad and Durve (2008) in Marma Points of Ayurveda call this point Urdhva Skandha and associate it with the doshas: Prana Vayu, Udana Vayu, Vyana Vayu, Avalambaka Kapha and Shleshaka Kapha.

They give the following functions:
- Relieves local pain
- Relieves stiffness in the shoulder
- Facilitates the flow of prana into lungs and upper chest
- Relieves occipital headaches
- Relieves stress, calms the mind
- Releases stagnant, unexpressed emotions

In Tibetan medicine:
Moxa point (AMNH, Tibetan Medical Paintings)

In Thai massage:
Acupressure point (Salguero & Roylance, 2011, Encyclopedia of Thai Massage)

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