天谿 : Tianxi : Heavenly Stream

Location Guides:

Classifications:

Front Shu of the Breast

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

Meetings:

Meeting of Spleen with Small Intestine Divergent, Heart Divergent and Pericardium Divergent

Location:

On the lateral side of the chest, in the forth intercostal space, 6 cun lateral to the midline.

Needling:

Transverse-oblique insertion along the intercostal space 0.5 - 1 cun

Warnings:

Perpendicular insertion, especially in thin patients, carries a substanstial risk of inducing a pneumothorax.

Classical Needling:

"The Taiyin usually has much Qi and little Blood" (Su Wen 素問 ch. 24) implying this channel should normally be needled.
"The foot Taiyin is to be pierced 3 fen deep and remain inserted for four exhalations" (Ling Shu 靈樞 ch. 12).
"Locate it with (the patient) lying supine. It is needled to a depth of four fen and is moxaed with five cones" (Huangfu Mi 皇甫謐, 3rd Century, Zhenjiu Jiayi Jing 針灸甲乙經).

TCM Actions:

Regulates and descends Qi
Benefits the breasts and promotes lactation

TCM Indications:

• Fullness and pain of the chest and lateral costal region, shortness of breath, cough, rattling of phlegm in the throat, Running Piglet Qi (奔豚氣, Ben Tun Qi), hiccup.
  
• Breast abscess, failure of breast milk to flow, insufficient lactation.

Neuroanatomy:

Superficial Innervation: Lateral cutaneous thoracic nerve from T5

Dermatome Segment: T5

Trigger Point Associations:

Muscle:
Intercostals

Location Notes:
Intercostals can produce trigger points anywhere in the intercostal space

Pain Referral Pattern:
Locally and towards the sternum. The more posterior the point the stronger its tendency to radiate pain to the front

Indications:
Aching pain exacerbated by deep inhalation and activities such as sneezing and coughing

Martial Applications & Effects of Injury:

Striking this point causes a shock wave to rise up into the head and the whole upper body with great Qi loss. Like Shidou Sp-17, it can also stop the heart if struck hard enough (Montaigue, Dim Mak Locations, Taijiworld.com).

Major Combinations:

• Abscess, ulceration and swelling of the breast:
    Tianxi Sp-18 with Xiaxi GB-43
    (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:

One of the twelve Shu points of the breast mentioned in the Su Wen Ch. 58 and identified by Wang Bing.

If the Shu points of the breast relate to elemental organ systems like the Shu of the chest, then the imagery of water in the name of this point, "Heavenly Stream", indicate the Kidneys. And if the Shu points of the breast are related to the transformation of food and air into bodily Qi and Blood, then this point is responsible for introducing Yuan Qi to Zong Qi in order to form Zhen Qi.

The indication of Running Piglet Qi (奔豚氣, Ben Tun Qi), a form of panic attack brought about by accumulation of Cold in the Lower Jiao, also indicate fear and a connection to the Kidneys.

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