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Location Guides: |
Great Luo of the Spleen (Nei Jing)
Exit point
Trigger point (Travell & Simons, 1998, Trigger Point Manual)
On the mid-axillary line, in the seventh intercostal space (note: some sources locate this point in the sixth intercostal space)
Transverse-oblique insertion along the intercostal space 0.5 - 1 cun
Perpendicular insertion, especially in thin patients, carries a substanstial risk of inducing a pneumothorax.
"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).
"It is needled to a depth of three fen and is moxaed with three cones" (Huangfu Mi 皇甫謐, 3rd Century, Zhenjiu Jiayi Jing 針灸甲乙經).
Regulates Qi and Blood and firms the sinews and joints
Unbinds the chest and benefits the lateral costal region
Hexagram attributions are my own with an explanation given in the glossary.
Superficial Innervation: Lateral cutaneous thoracic nerve from T6 or T7
Dermatome Segment: T6, T7
Muscle:
Latissimus dorsi, serratus anterior or intercostals
Location Notes:
For latissimus dorsi trigger point palpation or needling needs to be directed into the latissimus dorsi muscle posteriorly. Can also be located posteriorly on the back just lateral to the inferior angle of the scapula.
Melzack (1977) locates the serratus anterior point at Shidou sp-17, but Travell & Simons (1998) diagram clearly shows it to be on the axillary line at the 6th intercostal space.
Pain Referral Pattern:
Latissimus dorsi: To inferior corner of scapula and down posterior and ulnar side of the arm
Serratus anterior: Around point and to inferior medial border of scapula
Indications:
Mid-thoracic backache unresponsive to stretching and movement (latissimus dorsi) or chest pain, especially on deep or heavy breathing (serratus anterior)
Striking this point does great electrical, physical and Qi damage, spreading out over the chest and cause imbalance of the Qi of the whole body. If done hard enough the recipient will fall into a coma and not recover until treated. Physically the liver and lungs can be damaged and the ribs broken. Combined with Renying St-9 to cause knock out, extreme Spleen damage, the lungs to contract and suffocation (Montaigue, Dim Mak Locations, Taijiworld.com).
In seizing martial arts (Qin Na) this point is a breath sealing point (Bi Qi, 閉氣). It is struck with a Phoenix Eye Fist or elbow causing the lung to contract and seal the breath (Yang, 1995, Tai Chi Chin Na; Yang, 2004, Analysis of Shaolin Chin Na, 2nd Edition).
Its categorisation as the Great Luo may be due to its position as the point where the Spleen channel, which controls Blood, exits to enter the Heart channel.
Ling Shu Ch. 10 describes the diseases relating to the Luo emanating from this point as:
Repletion: Entire body aches
Depletion: All the joints relax
(Unschuld, 2016).
This point creates the connection between Blood and the lower Jiao via the Bao mai which drains Blood stasis from this point, the great Luo of the Spleen, to the Dai mai, first via the Luo of the Ren Jiuwei Ren-15 to the Du, and then from the Luo of the Du Chanqiang Du-1 to the Dai mai to create symptoms of Blood stagnation with Shen disturbance often seen in gynaecological disorders (Yuen, 2005, The Eight Extraordinary Vessels).
The Ling Shu and the Nan Jing disagree on the location of the Great Luo of the Spleen. The Nan Jing places it at Yuanye GB-22 while the Ling Shu places it 3 cun lower at this point. Ann Cecil-Sterman (2012, Advanced Acupuncture) prefers to use Yuanye GB-22 for Luo treatments.
This point has been assigned the hexagram ䷋ Obstruction partly because this hexagram is not represented by any other Late Heaven point. However, there is a reasoning to this attribution too since the Great Luo of the Spleen is the final barrier to pathogenic influences leaving the regular meridian system and entering the Extraordinary system via the Du and Ren Luo. Hence it is represented by ䷋ Obstruction, with the trigrams of the Du and Ren, and being a master Luo point, it is assigned the Luo Trigram as its outer nature, and being the Trigram of a Source point as its inner. These attributions are my own.
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:
Apalapa marma point
Size: 1/2 angula (cun)
Effect of Injury: Premature death (kalantarpranahar marma)
(Harish Johari, 1996, Ayurvedic Massage, Sanatan Society; Anupama Bhattacharya, n.d. Marma Shastra)
Lad and Durve (2008) in Marma Points of Ayurveda call this point Stanya Parshava and associate it with the doshas: Vyana Vayu, Avalambaka Kapha, Udana Vayu and Ranjaka Pitta.
They give the following functions:
- Benefits the breasts
- Regulates lactation
- Relieves congestion in breast tissue
- Enhances lymphatic circulation
The right side is connected to the liver and right chamber of the heart, the left side with the spleen and left chamber of the heart.
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
Steve Woodley Acupuncture & Traditional Medicine
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