小海 : Xiaohai : Small Sea

Location Guides:

Classifications:

He-Sea and Earth point
Child point of the Small Intestine channel
Binding point of the hand Taiyang Sinews

Location:

In the depression between the tip of the olecranon process of the ulna and the tip of the medial epicondyle of the humerus.

Needling:

Oblique distal or proximal insertion 0.5 - 1 cun, or perpendicular insertion 0.3 - 0.5 cun

Warnings:

The ulnar nerve lies deep to this point

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).
"Locate it with the" (patient’s) elbow bent. It is needled to a depth of two fen, (the needle) is retained for a duration of seven exhalations, and it is moxaed with seven cones" (Huangfu Mi 皇甫謐, 3rd Century, Zhenjiu Jiayi Jing 針灸甲乙經).

TCM Actions:

Clears Heat and dissipates swelling
Calms the Shen
Activates the channel and alleviates pain

TCM Indications:

• Scrofula, swelling and pain of the throat, swelling of the cheek, swelling of the gums, swelling and pain of the elbow and axilla, toothache, tooth decay, wind dizziness, headache, deafness, yellow eyes, Malarial (瘧, Nue) Disorders.
  
• Epilepsy, tongue thrusting, clonic spasm, mad walking, agitation of the Heart.
  
• Pain of the neck, pain of the neck radiating to the elbow, pain of the scapula, pain of the postero-lateral aspect of the shoulder, pain of the upper arm and elbow, inability to raise the four limbs, lumbar pain radiating to the hypogastrium, lower abdominal pain.

I Ching Hexagram:

䷷ Lu 旅 Wanderer

Shared with Shenmen He-7 and balanced by ䷻ (Fuliu Kid-7 or Zhiyin Bl-67).

Hexagram attributions are my own with an explanation given in the glossary.

Neuroanatomy:

Superficial Innervation: Medial cutaneous nerve of the arm (C8 - T1) and ulnar nerve (C8 - T1)

Dermatome Segment: T1

Martial Applications & Effects of Injury:

This point is where pressure is applied in most bent elbow locks, while also gripping the wrist.

Listed in the Wu Bei Zhi 武備志 (Treatise on Armament Technology) by Mao Yuanyi 茅元儀 (1621), Article 24: Bronze Man Statue, which divides the body into zones associated with the Twelve-Hour branches (Shichen 時辰) going from top downwards, the lower bicep and elbow (He-3, SJ-10, SI 8, LI 10, LI 11, LI 12 & Lu 5) and the xiphoid process (Juque Ren-14) are the vital points of Wu 午 Horse (11 am - 1 pm) and considered most vulnerable to a palm thrust during this time (McCarthy, 2016, Bubishi: The Classic Manual of Combat).

Striking here will cause considerable pain and Qi drainage. If combined with Qize Lu-5 it can cause knockout or even death. It is also an excellent controlling point by using finger pressure which will cause enough pain to immobilise an opponent and make them drop to the ground. It may leave the person with continuing headaches until treated. Works well with Neiguan Pc-6, Tianchuang SI-16 and Guanyuan Ren-4 (Montaigue, Dim Mak Locations, Taijiworld.com).

Major Combinations:

• Contraction of the elbow:
    Xiaohai SI-8 with Chize Lu-5, Jianyu LI-15, Jianshi Pc-6, Daling Pc-7, Houxi SI-3 and Yuji Lu-10
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Pain of the gums:
    Xiaohai SI-8 with Jiaosun SJ-20
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Epileptic convulsions, mad walking, inability to sleep, agitation of the Heart:
    Xiaohai SI-8 with Houxi SI-3, Zanzhu Bl-2 and Qiangjian Du-18
    (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:

In five element acupuncture this point is reduced to drain excess in the Small Intestine.

Ling Shu Ch. 6 suggests piercing the He points of the Yang channels if a disease is in the Yang of the Yang realm (e.g. the skin). This would mean using this point, presumably needled at a very superficial level, to treat skin level disorders relating to this channel.

Combining this with the needling techniques described in Chapter 7 we could suggest using either superficial needling here to influence pathogens in the skin, or leopard spot needling (three needles aimed at letting blood from each side) for pathogens in the Blood.

Ling Shu Ch. 9, On Ends and Beginnings, advises that in the case of Heat associated with receding Yin Qi the Yang conduit should be pierced once and the Yin conduits twice. Based on other recommendation to use the He-Sea of the Yang conduits (Ch. 19) and the Yuan-Source with the Ying-Spring points (Chs. 6, 19 and 24) to clear Heat from the Zangfu, that would suggest this point, Shenmen He-7 and Shaofu He-8 as a protocol to clear Heat in the Heart/Small Intestine (although other chapters suggest the Heart channel is not treatable in Ling Shu acupuncture). Next it advises that in Cold associated with receding Yang Qi the Yang should be pierced twice and the Yin once but no such obvious protocol is evident for this situation. Another interpretation that would match with common practice today, based on the idea of odd numbers being Yang/moving/clearing while even numbers are Yin/tonifying/reinforcing, is that the points on the channel to be cleared are pierced on one side only while those on the channel to be tonified are pierced bilaterally.

Ling Shu Ch. 19, on the Four Seasonal Qi, advises using the He-Sea points in autumn when diseases are in the Fu organs.

Ling Shu Ch. 71, On Evil Visitors, says that when a depletion evil is in the Lung and Heart it remains in two elbows. Yuen's theory of the Divergent meridians suggests that they store pathogens at the major joints, depleting our resources while they do, which would make this a potential point for for the Heart/Small Intestine Divergent.

In Tung acupuncture the Xin Men, Heart Gate, point is located near this point, 1.5 cun distal from the elbow on the Small Intestine channel. It is indicated for all kind of Heart conditions (Chu, 2015).

In Mayan medicine:
Pierced to treat pain in the shoulder caused by cold wind (Garcia, Sierra, Balam, 1999: Wind in the Blood)

Medieval phlebotomy point (John de Foxton, 1408: Liber Cosmographiae, maa.cam.ac.uk; Hans von Gersdorff, 1517: Feldtbüch der Wundartzney, www.nlm.nih.gov)

In ayurvedic medicine:
Kurpara marma point
Size: 3 angula (cun)
Structure: Joint
Effect of Injury: Disability (vaikalyakar marma)
(Harish Johari, 1996, Ayurvedic Massage, Sanatan Society; Anupama Bhattacharya, n.d. Marma Shastra)

In Siddha medicine this point is referred to as Kaimuttuvarmam, "elbow vital spot" (Sieler, 2015, Lethal Spots, Vital Secrets, p.167).

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

In Thai massage:
Point along the outer Kalatharee sen line running from the lateral malleolus, up the sides of the leg, along the outer bladder channel, over the shoulder blade and down to the hands (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