下脘 : Xiawan : Lower Cavity

Location Guides:

Classifications:

Master Tung's Bowel Nest Twenty-Three

Location:

On the midline of the abdomen, 2 cun above the umbilicus and 6 cun below the sternocostal angle.

Needling:

Perpendicular insertion 0.8 - 1.5 cun

Warnings:

In thin patients deep needling may penetrate the peritoneal cavity. According to the Illustrated Supplement to the Classic of Categories, moxibustion is contraindicated in pregnancy. No perpendicular needling in advanced pregnancy.

Classical Needling:

"It is needled to a depth of one cun and moxaed with five cones" (Huangfu Mi 皇甫謐, 3rd Century, Zhenjiu Jiayi Jing 針灸甲乙經).

TCM Actions:

Harmonises the Stomach and regulates Qi
Dispels food stagnation

TCM Indications:

• Abdominal fullness, abdominal hardness, epigastric pain, nausea and vomiting after eating, focal distension, undigested food in the stool, no pleasure in eating, cold qi of the six fu.
  
• Thready pulse lacking in force, emaciation, dark urine.

Neuroanatomy:

Superficial Innervation: Anterior cutaneous thoracic nerve from T9

Dermatome Segment: T9

Martial Applications & Effects of Injury:

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

Major Combinations:

• Undigested food in the stool, vomiting immediately after ingestion:
    First needle Xiawan Ren-10 and then reduce Zusanli St-36
    (Sun Simiao, 孫思邈, 625: Bei Ji Qian Jin Yao Fang, 備急千金要方, Essential Prescriptions Worth A Thousand Gold).
  
  
• Undigested food in the stool:
    Xiawan Ren-10 with Zusanli St-36, Liangmen St-21, Sanyinjiao Sp-6, Dachangshu Bl-25, Sanjiaoshu Bl-22 and Xuanshu Du-5
    (Wang Zhizhong, 王執中, 1220: Zhen Jiu Zi Sheng Jing, 針灸資生經, Classic of Supporting Life with Acupuncture and Moxibustion).
  
  
• Borborygmus:
    Xiawan Ren-10 with Xiangu St-43
    (Gao Wu, 高武, 1529: Bai Zheng Fu, 百症賦, Ode of a Hundred Symptoms).
  
  
• Hardness of the abdomen:
    Xiawan Ren-10 with Zhongwan Ren-12
    (Ling Guang Fu, 靈光賦, Ode of Spiritual Brightness. First recorded in Xu Feng, 徐鳳, 1439: Zhen Jiu Da Quan, 針灸大全, Complete Collection of Acupuncture and Moxibustion).

Notes:

From Yuen's school, this point along with Jizhong Du-6, relate to the Fourth Level of Manifestation of the Soul (Po).

The fourth Po is connected to early adulthood and the Heart - Spleen dynamic, adulthood, social relations, compromise and the need to lie to maintain the balance between feelings (Heart) and reason (Spleen). Obstruction at this level results in an inability to maintain integrated in society through compromise.

It is the first level without a connection to the Kidneys and instead connecting to the Heart.

Treatment typically involves the Po Activation points Changqiang Du-1 and Jiuwei Ren-15 which are the Luo of the Ren and Du channels, accessing emotion at the level of the Jing, followed by the points associated with the particular level of blockage.

Berardinis & Navarra (2017). The succession of Po in the ladder of life. https://www.acupuncturesida.com/The-succession-of-Po-in-the-ladder-of-life.aspx

In Tung lineage acupuncture the Bowel Nest 23 (Fu Chao Er Shi San) are a group of points located in a line at 1 cun intervals between Ren-2 and Ren-10. An additional eight points on either side form a 4x5 grid at the levels of Ren-9 to Ren-5, also at 1 cun intervals. Ren-8, on the navel, is not included.

They are pricked using Tung's method in local disorders of pain, stagnation and heat in the abdomen such as uteritis, nephritis, umbilical area pain, enteritis, appendicitis and intestinal cancers (McCann, 2014, Pricking the Vessels).

In nine palaces abdominal acupuncture, this point is located in the region associated with ☲ Li, Fire, the south and the Heart and Small Intestine organs (Schelbert, 2014, Ryan, 2009).

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

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