外關 : Waiguan : Outer Pass

Classifications:

Luo-Connecting point
Confluent point of the Yang Wei Mai, coupled with Zulinqi GB-41
Binding point of the hand Shaoyang Sinews

Location:

2 cun proximal to Yanchi SJ-4, in the depression between the radius and the ulna, on the radial side of the extensor digitorum communis tendons.

Needling:

Slightly oblique insertion towards the ulnar side or oblique proximal or distal insertion towards the elbow or wrist respectively 0.5 - 1.5 cun, or joined by through needling to Neiguan P-6.

Warnings:

Movement of the patient's arm or hand after needling this point can result in a bent needle.

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 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 three fen, (the needle) is retained for a duration of seven exhalations, and it is moxaed with three cones" (Huangfu Mi 皇甫謐, 3rd Century, Zhenjiu Jiayi Jing 針灸甲乙經).

TCM Actions:

Expels Wind and releases the Exterior
Benefits the head and ears
Opens the Yang Wei Mai
Clears Heat
Activates the channel and alleviates pain

TCM Indications:

• Injury by cold, chills and fever, sweating with heat on the exterior, febrile disease.
  
• Headache, thunder head wind, head wind, Kidney deficiency headache, one-sided headache, pain of the vertex, frontal headahce, pain of the nape, dizziness, phlegm inversion dizziness, wind dizziness, hypertension.
  
• Deafness, impaired hearing, tinnitus, pain of the ear, itching of the ear, redness, pain and swelling of the root of the ear.
  
• Redness, pain and swelling of the eyes, cold and pain of the eyes, Superficial Visual Obstruction, lacrimation on exposure to wind, cold lacrimation.
  
• Swelling and pain of the cheek, stiffness of the tongue with difficulty in speaking, toothache, ulceration of the mouth, cracked lips, nosebleed, scrofula, mumps.
  
• Constipation, abdominal pain, oppression and tightness of the chest, pain of the lateral costal region, vomiting blood, knotting of heat in the five zang and six fu.
  
• Pain of the shoulder and back, stiff neck, pain of the ribs and lateral costal region, numbness and pain of the elbow and arm, contraction of the elbow, flaccidity of the elbow, soreness and heaviness of the elbow and wrist, swelling and redness of the arm, hemiplegia, severe pain of the fingers with inability to grasp objects, coldness numbness and pain of the hands and feet, tremor of the hand, redness, swelling and pain of the ankle, pain of teh toes, pain of the hundred joints.

I Ching Hexagram:

䷓ Guan 觀 Observing

Shared with Daling Pc-7. Balanced by ䷡ (Ligou Liv-5 or Qiuxu GB-40).

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

Neuroanatomy:

Superficial Innervation: Posterior cutaneous nerve of the forearm from C5 - C8

Dermatome Segment: C7, C8

Deeper Structures: Median nerve from C5 - T1

Martial Applications & Effects of Injury:

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

Major Combinations:

• Pain of the head and eyes:
    Waiguan SJ-5 with Houxi SI-3
    (Wu Yiding, 吳亦鼎, 1853: Shen Jiu Jing Lun, 神灸經論, Principles of Divine Moxibustion).
  
  
• Impaired hearing and deafness:
    Waiguan SJ-5 with Huizhong SJ-7
    (Sun Simiao, 孫思邈, 625: Bei Ji Qian Jin Yao Fang, 備急千金要方, Essential Prescriptions Worth A Thousand Gold).
  
  
• Impaired hearing and deafness:
    Waiguan SJ-5 with Tinghui GB-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).
  
  
• Deafness:
    Waiguan SJ-5 with Zhongzhu SJ-3, Shanguang LI-1, Erheliao SJ-22, Tinghui GB-2, Tinggong SI-19, Hegu LI-4 and Zhongchong Pc-9
    (Xu Jun, 許浚, 1611: Dong Yi Bao Jian, 東醫寶鑑, Precious Mirror of Oriental Medicine).
  
  
• Deafness and tinnitus:
    Waiguan SJ-5 with Tianchuang SI-16
    (Wang Zhizhong, 王執中, 1220: Zhen Jiu Zi Sheng Jing, 針灸資生經, Classic of Supporting Life with Acupuncture and Moxibustion).
  
  
• Abdominal pain:
    Waiguan SJ-5 with Daling Pc-7
    (Yu Long Ge, 玉龍賦, Song of the Jade Dragon. First recorded in Wang Guorui, 王國瑞, 1329: Bian Que Shen Ying Zhen Jiu, Yu Long Jing, 扁鵲神應針灸玉龍經, Bian Que's Spiritual Guide to Acupuncture and Moxibustion, Classic of the Jade Dragon).
  
  
• Abdominal pain and constipation:
    Waiguan SJ-5 with Zhigou SJ-6 and Daling Pc-7
    (Yu Long Fu, 玉龍賦, Ode of the Jade Dragon. First recorded in Gao Wu, 高武, 1529: Zhen Jiu Yu Jing, 針灸聚英, Glorious Anthology of Acupuncture and Moxibustion).
  
  
• Pain of the lateral costal region:
    Waiguan SJ-5 with Zhigou SJ-6 and Zhangmen Liv-13
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Inability to bed the elbow and fingers:
    Waiguan SJ-5 with Zhongzhu SJ-3, Quchi LI-11 and Shousanli LI-10
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Atrophy disorder and numbness of the arm:
    Waiguan SJ-5 with Tianjing SJ-10 and Quchi LI-11
    (Sun Simiao, 孫思邈, 625: Bei Ji Qian Jin Yao Fang, 備急千金要方, Essential Prescriptions Worth A Thousand Gold).
  
  
• Sabre lumps of the axilla:
    Waiguan SJ-5 with Zhigou SJ-6, Yuanye GB-22 and Zulinqi GB-41
    (Zhang Jiebin, 張景岳, 1624: Lei Jing Tu Yi, 類經圖翼, Illustrated Supplement to the Classic of Categories).
  
  
• Problems relating to the Sixth Level of Manifestation of the Soul, equivalent to the Ajna Chakra:
    Waiguan SJ-5 with Yangchi SJ-4 and Yingu Kid-10
    (Yuen, 2005, 3 Spirits & 7 Souls, see notes below).
  
  
• Emotional disturbance at the Yuan level (subconscious repression):
    Waiguan SJ-5 with Dazhong Kid-4, plus moxa on the Yin Source point and bleed the Yang Luo point related to the emotion involved
    (Yuen, 2004, The Luo Vessels, see notes below).

Notes:

One of the most commonly used distal points of the San Jiao channel for exterior pathogens, especially of a wind-heat variety, headache and pain in the channel.

Despite only Zhongzhu SJ-3 mentioning benefiting the eyes, the indications for this point include redness, pain, swelling of eyes, tearing and superficial obstruction. As the Luo point it can be understood to clear Heat and invigorate Blood. As the confluent point of the Yang Wei Mai it can be understood to release the Exterior, especially in cases where the Yang Qi is stagnated internally and so failing to reach the Exterior in order to repel the pathogen, leaving it stuck in the Shaoyang or Taiyang levels. Therefore it can be used for eye or ear problems when the problem is due to Heat, Blood Stasis, Exterior Wind-Heat invasion and Shaoyang/Taiyang disorders.

Ling Shu Ch. 6 suggests piercing the Luo points if a disease is in the Yang of the Yin realm (e.g. the Fu organs) implying this point for disorders of the San Jiao.

Ling Shu Ch. 10, On Channels, describes the diseases relating to the Luo emanating from this point as:
Repletion: Elbows suffer cramps
Depletion: Unable to contract the lower arm
(Unschuld, 2016).

Ling Shu Ch. 19, On the Four Seasonal Qi, advises using the channels and Luo vessels for diseases which occur in spring. They are pierced deeply if severe and more shallow if mild. For the other seasons:
- in summer choose the Yang channels and Luo located in the partings between the skin and flesh
- in autumn choose the Shu-Stream points unless the disease in the Fu organs, then use the He-Sea points
- in winter choose Jing-Well and Ying-Spring opening and retain the needle.

Ling Shu Ch. 21, On Cold and Heat Diseases, repeats the advice to use Luo in spring but and adds that they can also treat diseases of the skin. For the other seasons it differs slightly from Ch. 19:
- in summer choose the partings in skin structures which also treat the muscle and flesh
- in autumn Taiyuan Lu-9 is chosen and can treat the sinews and vessels (this may also apply to other Shu-Stream points for this purpose, text is unclear)
- in winter one chooses the main channel points which also treat the bones and marrow.

When combined with Yangchi SJ-4 and Yingu Kid-10 this point relates to the Sixth Level of Manifestation of the Soul or the Ajna chakra concerned with the Realm of Immortality and the Will to Create endless possibilities. It asks what we would create if we were to live forever? The other two pool Yin and Yang and this point emanates the resulting mixture outwards via the Yang wei mai and the San jiao as an irrigation system.
This stage also relates to the formation of the spiritual embryo and attainment of immortality in meditation practice (Yuen, 2005, 3 Spirits & 7 Souls).

In Sufism this level would relate to the Valley of Bewilderment described by Attar in the Conference of the Birds as:

"Behold! The next is the valley of bewilderment
Here pain and regret ever rave and thunder;
When the pilgrim in this vortex descends
He loses the path in amazement and awe;
He will say 'I know nothing of such riddle,
I know not this or that, I'm blank in
the middle' ..."

Here the mystic awakens to a new reality that is both wonderful and bewildering and is filled with pain and discontent as their previous sense of worldly identity collapses.

Like the other even (Yin) sets there is one point representing Yang (Yangchi SJ-4), one representing Yin (Yingu Kid-10) and one that unifies them (Waiguan SJ-5).

Dazhong Kid-4 and Waiguan SJ-5 release emotions from the repressed (Yuan-Qi) level in Jeffrey Yuen's system of using the Luo to harmonise emotions.

The full protocol is to:
- Tonify the Yuan-Source point of the Yin meridian that relates to the emotional disposition being expressed.
- Bleed or plum blossom the Luo related to the level of expression (Waiguan SJ-5 and Dazhong Kid-4 in this example) in a figure 8 (e.g. Right arm -> Left leg -> Right leg -> Left arm) starting with the side with dominant symptoms. If unsure all levels can be released.
- Bleed or plum blossom the Luo of the Yang meridian connected to the Yuan-Source point tonified at the beginning (Yuen, 2004, The Luo Vessels lecture transcript, NESA; Chin, 2003, The Luo Vessels).

I think of it as tonifying the organ to bring the emotion up and then releasing it from the Luo via its transverse connection, like in a guest-host protocol, with the additional Luo being added to focus on the level of release.

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