巨骨 : Jugu : Great Bone

Location Guides:

Classifications:

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

Meetings:

Meeting of Large Intestine with Yang Qiao Mai

Location:

On the upper aspect of the shoulder, in the depression medial to the acromion process and between the lateral extremity of the clavicle and the scapular spine

Needling:

Perpendicular or oblique insertion 0.5 to 1 cun

Warnings:

Deep medial insertion carries a risk of causing a pneumothorax, particularly in thin patients

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 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 one cun and 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:

Activates the channel, alleviates pain and benefits the shoulder joint
Regulates Qi and Blood and dissipates Phlegm nodules

TCM Indications:

• Pain of the shoulder and back, blood stasis in the shoulder, difficulty in moving or raising the arm, pain of the upper arm.
  
• Fright, epilepsy, vomiting of copious quantities of blood, blood stasis in the chest, scrofula, goitre.

Neuroanatomy:

Superficial Innervation: Supraclavicular from C3 - C4

Dermatome Segment: C3

Trigger Point Associations:

Muscle:
Middle trapezius or supraspinatus

Pain Referral Pattern:

Middle trapezius: Around joint
Supraspinatus: To lateral aspects of shoulder and elbow, with spillover across top of shoulder and all down lateral and radial aspects of the arm

Indications:
Shoulder pain, especially on abducting the arm

Martial Applications & Effects of Injury:

Striking hard here will cause great Qi drainage and physical damage to the clavicle. It is hard to strike precisely so usually struck with a broad surface like a palm strike with the hope of catching this point. In ancient times Jugu was simply a name for the collarbone so it may have implied exactly this, that any strike on the collarbone was to this point (Montaigue, Dim Mak Locations, Taijiworld.com).

Major Combinations:

• Inability to raise the arm:
    Jugu LI-16 with Qiangu SI-2
    (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:
    Jugu LI-16 with Tianyou SJ-16, Quepen St-12, Shendao Du-11, Dazhu Bl-11, Tiantu Ren-22 and Shuidao St-28
    (Sun Simiao, 孫思邈, 625: Bei Ji Qian Jin Yao Fang, 備急千金要方, Essential Prescriptions Worth A Thousand Gold).

Notes:

Its location at the subacromial space where impingement often happens would provide an anatomical explanation for this points actions in moving Blood and dispelling Phlegm nodules while being indicated for chronic, recalcitrant shoulder pain. In such cases the chronic impingement (Blood stasis) may be due to a narrowing of the space from arthritis bone spurs (Phlegm nodules).

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