天容 : Tianrong : Heavenly Appearance

Location Guides:

Classifications:

Window of Heaven point
Binding point of the hand Taiyang Sinews

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

Meetings:

Meeting of Small Intestine with Gall Bladder Divergent, Liver Divergent, Pericardium Divergent and Large Intestine Divergent

Location:

In the depression between the angle of the mandible and the anterior border of the sternocleidemastoid muscle.

Needling:

Directed towards the root of the tongue, anterior to the carotid vessels, 0.5 - 1 cun

Warnings:

When needling manual occlusion to highlight the external jugular is reccomended to avoid penetration

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 one cun deep and is moxaed with three cones" (Huangfu Mi 皇甫謐, 3rd Century, Zhenjiu Jiayi Jing 針灸甲乙經).

TCM Actions:

Benefits the neck and throat and disperses swelling
Descends rebellious Qi
Benefits the ears

TCM Indications:

• Throat Painful Obstruction (喉痹, Hou Bi), obstruction of the throat, goitre, scrofula of the neck, swelling and pain of the neck with inability to speak, clenched teeth, swelling of the cheek, chills and fever.
  
• Chest fullness with difficulty in breathing, wheezing, asthma, cough, chest pain, vomiting foam.
  
• Tinnitus and deafness.
  
• Pain of the shoulder with inability to raise the arm.

Neuroanatomy:

Superficial Innervation: Transverse cervical nerve (C2 - C3)

Dermatome Segment: C3

Trigger Point Associations:

Muscle:
Medial pterygoid and posterior diagastric

Pain Referral Pattern:
Medial pterygoid (pressure upwards to jaw): To condyloid process and posterior of mandible
Posterior diagastric (into muscles of neck): To mastoid process and occipital region

Indications:
Pain in jaw, sore throat and difficulty swallowing, lump in the throat

Martial Applications & Effects of Injury:

Listed in the Wu Bei Zhi 武備志 (Treatise on Armament Technology) by Mao Yuanyi 茅元儀 (1621), Article 21: Delayed Death Touches with Twelve-Hour (Shichen 時辰) Diagrams. This point, along with Xingjian Liv-2, Shangguan GB-3 and Quanliao SI-18, are associated with Zi 子 Rat (11 pm - 1 am) and if struck during this time is said to cause death within 1 day from trauma to the carotid artery (McCarthy, 2016, Bubishi: The Classic Manual of Combat).

Very close to the vagus nerve and external carotid artery, this is also a deadly point that will cause an easy knock out by sealing the blood to the brain when struck. Usually used in choke holds where it feels like the head will explode before passing out seconds later (Montaigue, Dim Mak Locations, Taijiworld.com).

In seizing martial arts (Qin Na) this point is a blood vessel pressing point (Dian Xue, 點脈) which can be struck with the thumb to seal the artery (Duan Mai, 斷脈) (Yang, 1995, Tai Chi Chin Na, p. 267).

Major Combinations:

• Cough with chest pain, agitation, breathing with the shoulders, panting noisily and sitting forward, with aversion to dust or smoke:
    Tianrong SI-17 and Lianquan Ren-23
    (Anon, 400BC-260AD: Huang Di Nei Jing Ling Shu, 黃帝內經靈樞, Yellow Emperor's Inner Classic: Spiritual Pivot)
  
  
• Cough with Rebellious Qi, dyspnoea, vomiting of foam and clenched teeth:
    Tianrong SI-17 with Futu LI-18, Lianquan Ren-23, Puhu Bl-42, Qishe St-11 and Yixi Bl-45
    (Sun Simiao, 孫思邈, 625: Bei Ji Qian Jin Yao Fang, 備急千金要方, Essential Prescriptions Worth A Thousand Gold).
  
  
• Oppressive sensation of the chest with inability to catch the breath:
    Tianrong SI-17 with Yangxi LI-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).
  
  
• Deafness and tinnitus:
    Tianrong SI-17 with Tinggong SI-19, Tinggui GB-2 and Zhongzhu SJ-3
    (Sun Simiao, 孫思邈, 625: Bei Ji Qian Jin Yao Fang, 備急千金要方, Essential Prescriptions Worth A Thousand Gold).
  
  
• Pain of the shoulder with inability to raise the arm:
    Tianrong SI-17 with Bingfeng SI-12
    (Haungfu Mi, 皇甫謐, 282: Zhen Jiu Jia Yi Jing, 針灸甲乙經, Systematic Classic of Acupuncture and Moxibustion).

Notes:

The Su Wen ch. 46, suggests that the Qi moves in the Yangming under usual circumstances, implying the carotid pulse felt at Renying St-9. It contrasts this to abnormal pulses that may appear in the Shaoyang and Taiyang (Wang Bing considers this to mean Tianyou SJ-16 and this point at the front and rear of the SCM muscle above Renying St-9 although other possibilities can exist). These abnormal pulses appear as a sign of "pulsation disease" (Shidong Bing 是动病) that indicates Yang Reversal (Yang Jue 陽厥) where Yang is trapped in the interior resulting in anger and mania and recommends depriving the patient of food to reduce their Qi.

Ling Shu Ch. 2, The Roots of the Acupuncture Points, lists this point along with 9 others, with no indications for their use. This chapter later became the origin of the "Window of Heaven" points, although this name was not given until modern times.

Ling Shu Ch. 75, On Piercing to Regulate True and Evil Qi, recommends this point and Lianquan Ren-23 as part of the "Shaking Off Dust" treatment for when Yang Qi rebels upwards to fill the chest making the patient agitated, breathing with his shoulders, averse to dust or smoke, panting noisily and sitting forward. The throat seems closed. The piercing must not exceed 1 Cun in depth.

In ayurvedic medicine:
Nila marma point
Size: 4 angula (cun)
Structure: Blood vessels
Effect of Injury: Disability (vaikalyakar marma)
(Harish Johari, 1996, Ayurvedic Massage, Sanatan Society; Anupama Bhattacharya, n.d. Marma Shastra)

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