下關 : Xiaguan : Below the Joint

Classifications:

Trigger point (Travell & Simons, 1998, Trigger Point Manual; Melzack, Stillwell & Fox, 1977)

Meetings:

Meeting of Stomach with Gall Bladder

Location:

At the lower border of the zygomatic arch, in the depression anterior to the condyloid process of the mandible.

Needling:

Perpendicular insertion slighly inferiorly 0.5 - 1 cun
Transverse insertion to join with such points as Tinggong S.I.-19, Jiache ST-6, Quanliao S.I.-18 for diseases of the ear, teeth, face and jaw

Classical Needling:

"The Yangming usually has much Qi and much Blood" (Su Wen 素問 ch. 24) implying this channel can normally be needled or bled.
"The foot Yangming is to be pierced 6 fen deep and remain inserted for ten exhalations" (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. Moxibustion is prohibited when there is earwax in the ear" (Huangfu Mi 皇甫謐, 3rd Century, Zhenjiu Jiayi Jing 針灸甲乙經).

TCM Actions:

Benefits the ears, jaw and teeth
Activates the channel and alleviates pain

TCM Indications:

• Deafness, tinnitus, ear pain, itching and purulent discharge from the ear.
  
• Lockjaw, dislocation of the jaw.
  
• Toothache, pain of the teeth of the lower jaw, swelling and pain of the gums (of the lower jaw), pain of the cheek and face, swelling of the cheek, yawning, deviation of the mouth and eye, Visual Dizziness.

Neuroanatomy:

Superficial Innervation: mandibular branch of trigeminal nerve (CN V3)

Dermatome Segment: CN V3 mandibular branch of trigeminal

Trigger Point Associations:

Muscle:
Masseter and lateral pterygoid

Location Notes:
Lateral pterygoid trigger points would be located slightly anterior and anterior and posterior to the classical location.

Pain Referral Pattern:
Masseter: Angle of jaw, temple and ear, and if located slightly inferior to upper molars and cheek (Travell & Simons, 1998). Teeth, jaw and occiput (Melzack et al, 1977).
Lateral pterygoid: Cheek and condyloid process.

Indications:
Facial myalgia ; Toothache ; Headache ; Tempero-mandibular joint pain

Martial Applications & Effects of Injury:

A Qi drainage point that will case knockout if struck precisely with a small weapon like a one-knuckle punch. It produces a feeling down the same side of the neck and then a loss of power in the legs. It may also cause ear problems that can last for years (Montaigue, Dim Mak Locations, Taijiworld.com).

This is one of the eight striking points in Northern Praying Mantis Kung Fu. These are the nonfatal areas on an attacker's body that can be struck when just defending or wanting to defeat an attacker, described as "The points under the ears on the jawbone hinge" (Olson, 2010, The Complete Guide to Northern Praying Mantis Kung Fu) and "the hollow between cheek and earlobe" by Wong Honfan (1946; in Ravenswood Academy, 2020, The Eight Forbidden Strikes of Praying Mantis Fist). A Chinese news site also places it here and at Ermen SJ-21 (Zhongwu Sports, 2018, Chinese martial arts "eight hits and eight don't hits").

Major Combinations:

• Tinnitus and deafness:
    Xiaguan St-7 with Yangxi LI-5, Guanchong SJ-1, Yemen SJ-2 and Yanggu SI-5
    (Haungfu Mi, 皇甫謐, 282: Zhen Jiu Jia Yi Jing, 針灸甲乙經, Systematic Classic of Acupuncture and Moxibustion).
  
  
• Deafness:
    Xiaguan St-7 with Huizong SJ-7 and Yifeng SJ-17
    (Haungfu Mi, 皇甫謐, 282: Zhen Jiu Jia Yi Jing, 針灸甲乙經, Systematic Classic of Acupuncture and Moxibustion).
  
  
• Toothache and tooth decay:
    Xiaguan St-7 with Daying St-5, Yifeng SJ-17 and Wangu SI-4
    (Wang Zhizhong, 王執中, 1220: Zhen Jiu Zi Sheng Jing, 針灸資生經, Classic of Supporting Life with Acupuncture and Moxibustion).
  
  
• Hemiplegia with deviation of the mouth and eye:
    Xiaguan St-7 with Shangguan GB-3
    (Wang Zhizhong, 王執中, 1220: Zhen Jiu Zi Sheng Jing, 針灸資生經, Classic of Supporting Life with Acupuncture and Moxibustion).
  
  
• Yawning and pain of the lower teeth:
    Xiaguan St-7 with Daying St-5 and Yifeng SJ-17
    (Sun Simiao, 孫思邈, 625: Bei Ji Qian Jin Yao Fang, 備急千金要方, Essential Prescriptions Worth A Thousand Gold).
  
  
• Facial paralysis:
    Xiaguan St-7 with Yifeng SJ-17, Dicang St-4, Jiache St-6, Sibai St-2 and Hegu LI-4 (Deadman, Al-Khafaji and Baker, 2001, A Manual of Acupuncture).

Notes:

In "ear clearing technique" for clearing heat from the ears, one needle is inserted from Ermen SJ-21 to Tinghui GB-2 while another is inserted from Xiaguan St-7 to Tinggong SI-19 (Liu Yan, 2008, Diagrams of Acupuncture Manipulations, p.114).

Jin's Three Needles for Discolouration are located at this point, Quanliao SI-18 and Taiyang. They are indicated for melasma, liver spots, discolorations of the face and usually accompanied by electrical stimulation and B12 injections (eLotus, 2021).

Medieval phlebotomy point (John de Foxton, 1408: Liber Cosmographiae, maa.cam.ac.uk)

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

Venesection point, called Rna Ba'i Nang Ljon (Ear's Internal Tree) measured by finding the vena temporalis superficialis anterior to the ear or vena transversa facei approx. 2 cun anterior to the ear at the level of the external meatus. Its is indicated for:

- Inner ear infection wit pus and pain
- Deafness
- Hearing problems
- Lateral head pain
- Tsha Ba (Heat) in the Kidneys
- Unilateral face pain

(Chenagtsang & Nguyen, 2017, Sowa Rigpa Points).

In Thai massage:
Acupressure point where the Lawusang (left) and Ulanga (right) sen lines terminate.
Indicated for headache and mouth disorders (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