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Window of Heaven point
Point of the Sea of Qi
Master Tung's Tonsilitis Nine
Meeting of Stomach with Gall Bladder, Yin Qiao Mai, Yang Qiao Mai, Gall Bladder Divergent, Liver Divergent, Stomach Divergent, Spleen Divergent, Heart Divergent, Pericardium Divergent, Large Intestine Divergent and Lung Divergent
Level with the tip of and 1.5 cun lateral to the laryngeal prominance, in the depression between the anterior border of the sternocleidemastoid muscle and lateral border of the thyroid cartilage
Perpendicular insertion 0.5 - 1 cun
Care should be taken not to puncture the carotid artery which must be felt and held laterally during needling. According to several classical texts, this point is contraindicated to moxibustion
"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).
"Moxibustion is prohibited although it is needled to a depth of four-fen. Needling too deeply may unfortunately be fatal" (Huangfu Mi 皇甫謐, 3rd Century, Zhenjiu Jiayi Jing 針灸甲乙經).
Regulates Qi and Blood and lowers rebellion
Benefits the throat and neck
Alleviates pain
Superficial Innervation: Transverse cervical nerve (C2 - C3)
Dermatome Segment: C2, C3
This point, and Futu LI-18 next to it, are the target of most "blood chokes" that aim to shut off the blood flow to the brain leading to rapid loss of consciousness. This point may seal the blood or the breath or both depending on the direction and method of applying pressure.
It is even more vulnerable to slashing attacks and if severed to a depth of 1.5" will result in death in approximately 5-15 seconds (Kaiser, 2019, The Dangers from Knife and Weapon Slashing).
One of the 36 vital points of Feng Yiyuan 馮一元 listed in the Wu Bei Zhi 武備志 (Treatise on Armament Technology) by Mao Yuanyi 茅元儀 (1621). In 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 carotid artery at this point and Qupen St-12 are the vital points of Mao 卯 Rabbit (5 - 7 am) and considered most vulnerable to forceful finger pressure during this time (McCarthy, 2016, Bubishi: The Classic Manual of Combat).
One of the major Dim Mak points because it is easy to get to and its effect is devastating, ranging from knock out to death. It is situated right over the carotid sinus, a baroreceptor which detects increases in blood pressure and then sends a signal via the vagus nerve to the vasomotor area of the brain initiating vasodilation and slowing of the heart rate to return the pressure to normal. Strong pressure or a strike here causes a carotid sinus reflex, resulting in carotid sinus syndrome, where it is fooled into thinking that the pressure is a surge in blood pressure and tells the brain to lower blood pressure immediately. It is so sensitive that massage or stroking here may be used to lower blood pressure by those familiar with the technique. This point should only be used in self-defence and when in grave danger. Even if recovery appears complete, damage to the carotid artery may cause gradual disintegration and increased risk of stroke years later. The right side is usually more sensitive than the left (Montaigue, Dim Mak Locations, Taijiworld.com).
Location of carotid pulse
The Su Wen ch. 46, suggests that the Qi moves in the Yangming under usual circumstances, implying the carotid pulse felt at this point. It contrasts this to abnormal pulses that may appear in the Shaoyang and Taiyang (Wang Bing considers this to mean Tianyou SJ-16 and Tianrong SI-17 at the front and rear of the SCM muscle above this point although other possibilities can exist). These abnormal pulses appear as a sign of "pulsation disease" (Shidong Bing 是动病) that indicates Yang Reversal (Yang Jue 陽厥) where Yang is trapped in the interior resulting in anger and mania and recommends depriving the patient of food to reduce their Qi.
The Ling Shu Ch. 9, offers a different method of pulse diagnosis where this pulse measures the Yang and the radial pulse measures Yin. By comparing their strengths the location of a disease can be determined and the channel examined for pathology:
- If the carotid pulse is 2x as strong as the radial the disease is in the Shaoyang. If it races it is in the hand branch, otherwise it is in the foot branch
- If the carotid pulse is 3x as strong as the radial the disease is in the Taiyang. If it races it is in the hand branch, otherwise it is in the foot branch
- If the carotid pulse is 4x as strong as the radial the disease is in the Yangming. If it races it is in the hand branch, otherwise it is in the foot branch
- If the carotid pulse is 5x as strong as the radial the disease and is massive and fast then Yang is overflowing and creating an external barrier that blocks Yin
- If the radial pulse is 2x as strong as the carotid the disease is in the Jueyin. If it races it is in the hand branch, otherwise it is in the foot branch
- If the radial pulse is 3x as strong as the carotid the disease is in the Shaoyin. If it races it is in the hand branch, otherwise it is in the foot branch
- If the radial pulse is 4x as strong as the carotid the disease is in the Taiyin. If it races it is in the hand branch, otherwise it is in the foot branch
- If the radial pulse is 5x as strong as the carotid the disease and is massive and fast then Yin is overflowing and creating a closed barrier that blocks Yang, shortening life.
Ling Shu Ch, 21, On Cold and Heat Diseases, recommends releasing harmful Qi from this point in cases where Yang Qi rises rebelliously causing headache, fullness in the chest and inability to breathe. This chapter is the origin of the first five "Window of Heaven" points, although this name was not given until modern times.
Ling Shu Ch. 26, On Miscellaneous Diseases, pressing on this point for pain in the cheeks when piercing the vessels at Jiache St-6 fails to work.
Ling Shu Ch. 52, On the Wei Qi, considers this to be the tip of the foot Yangming meridian with the root being at Lidui St-45.
Ling Shu Ch. 59, On Abnormal Wei Qi, advises this point, Tiantu Ren-22 and Lianquan Ren-23 (referred to as Houzhong) to drain accumulations in the chest. If there are accumulations in the chest and abdomen then these three points are coupled with Qichong St-30 and Zusanli St-36 used for draining accumulations below and Zhangmen Liv-13 in the middle. In severe cases a "chicken claw" technique, using three needles positioned like the character 个 Ge, are to be used. If the pulse is large and wiry and the the abdomen is tense it must not be pierced.
Ling Shu Ch. 75, On Piercing to Regulate True and Evil Qi, recommends this point as part of the "Pushing and Dispersing" treatment. Its indications are when the body is hot and the patient has absurd visions, voices and speaks madly. The foot Yangming channel and the major Luo are observed and balanced. Then the patient lies on their back while the practitioner massages the SCM muscle at this point, gripping with his thumbs down to Qupen St-12 (the supraclavicular fossa in general rather than the specific point). CAUTION: although the text advises gripping for some time this can cut off the blood supply to the brain!
This point would also be on the upper trajectory of the Chong mai in Jeffrey Yuen's descriptions (Yuen, 2005, The Extraordinary Vessels).
In ancient medical practice, pulses were assessed at various points on the body. The Maishu (from Zhangjiashan tomb, closed 186 BCE) advises taking pulses at the ankle, wrist and carotid, associated with the foot Shaoyin, hand Taiyin and hand Shaoyin respectively (Lo, 2018). Disease was located where there was roughness in one pulse but not the others.
This may suggest a system of evaluating the Jing, Qi and Shen or Lower, Middle and Upper Jiao. This pulse would be the pulse for the Shen and Upper Jiao, with the others being assessed at Taixi Kid-3 for the Jing and Lower Jiao, while Taiyuan Lu-9 assessed the Qi and Middle Jiao.
Its alternate name Tianwuhui 天五会, "Heaven's Fivefold Meeting", connects it to Diwuhui GB-42, "Earth's Fivefold Meeting." This implies that these points were originally used as a form of pulse diagnosis and that the latter point may have been located closer to a palpable pulse, such as the dorsalis pedis. Abnormal pulsation at these points were associated with Shidong Bing 是动病, "Pulsation Disease".
This point, seen as symbolic of the air rushing down the infant's throat on its first breath and coming into contact with the world is indicated for difficulty in relating to the physical, material world along with Taiyuan Lu-9 or Lieque Lu-7, Zhongwan Ren-12 and Tainshu St-25. This set of points relates to the First Level of Manifestation of the Soul, roughly equivalent to the base or Muladhara chakra and basic consciousness, the awareness of being alive, materiality, the consolidation of Jing and transformation of Qi into Jing (Yuen, 2005, 3 Spirits & 7 Souls).
All of the points in this sequence are related to drawing the breath down to the abdomen. The inclusion of Tianshu St-25, the Front Mu of the Large Intestine, instead of any Kidney points, brings to mind the Su Wen Ch. 8 that described the Large Intestine as "transmitter of the Way".
In Sufism this level would relate to the Valley of the Quest described by Attar in the Conference of the Birds as:
"When you descend into the valley of quest
A hundred difficulties will assail you in that empire;
Here for years you must endeavour, you must try
Because in this field elements inverted lie..."
Here the mystic must set up the foundation with diligent practice and patience as they begin their spiritual journey.
The reference to inverted elements brings to mind several descriptions of inverting the process of creation (from the One to multiplicity) to reattain the original unity in Neidan texts.
When combined with Chongyang St-42 and Taixi Kid-3 (dispersing) it relates to the Fifth Level of Manifestation of the Soul or the Vishuddha throat chakra concerned with true expression of yourself as an Authentic Character or Realized Being (ibid.).
Both Renying St-9 and Chongyang St-42 are on branches of the Chong Mai, the extraordinary vessel that runs between the Ren (Yin) and Du (Yang) vessels and combines elements of them both. Taixi Kid-3 is also one of the few points that simultaneously accesses Kidney Yin and Yang, representing this combination's focus on the unity of Yin and Yang, as opposed to some of the other combinations which select points that are an extreme of Yin or Yang.
In Sufism this level would relate to the Valley of Unity described by Attar in the Conference of the Birds as:
"When faces are turned to this desert and wake
All heads are raised from a single neck;
If many you behold or few in the valley
They are all but one, they are one wholly ...
Everything can be summarized into one substance
Everything is one word, even in different shapes"
Here everything becomes a single unity.
It is interesting to note how this point represents the breath and is combined with abdominal points (Zhongwan Ren-12 and Tianshu St-25) during the first stage of the mystical path, and with Taixi Kid-3 during the stage of becoming a "True Man". This reflects the line in Zhuangzi that says "The breathing of the true man comes from his heels, while ordinary men generally breathe from their throats" representing a progression from throat breathing to abdominal breathing to Embryonic Breathing (also called pronounced Taixi in Chinese).
In the Jade Purity tradition it would also make an appropriate addition to the first trinity of Ghost Points (ibid.).
In Tung's acupuncture the Tonsilitis Nine (Hou E Jiu) points are located between these two points. The centre point is located at the superior notch of the thyroid cartilage with two more 1.5 cun lateral which would be approximately at the location of St-9. Two more points are located 1 cun above and 1 cun below each of these three. They are indicated for tonsilitis, throat pain, thyroiditis, throat itching and phlegm obstructing the throat. All are pricked to bleed. Due to their close proximity to the thyroid cartilage and blood vessels the skin must be pinched up and pricked to prevent unintended damage (McCann, 2014, Pricking the Vessels).
This technique, properly performed, could be safer, avoiding the risk of patient's moving or the practitioner accidentally brushing a retained needle and pushing it deeper than intended.
One of the 18 tender spots used in the diagnosis of fibromyalgia (Wang, Acupuncture and Traditional Chinese Medical Approaches for Fibromyalgia, Acupuncture Today, vol.6 no.3, 2005).
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:
Manya dhamni marma point
Size: 4 angula (cun)
Structure: Blood vessels
Effect of Injury: Disability (vaikalyakar 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 Mantha and associate it with the doshas: Prana Vayu, Udana Vayu, Vyana Vayu, Sadhaka Pitta and Tarpaka Kapha.
They give the following functions:
- Regulates thyroid and parathyroid functions
- Enhances cervical lymphatic circulation
- Regulates blood pressure and cardiac functions
- Benefits pharynx and larynx
- Relieves neck tension
- Clears the mind
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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Eascote, Pinner, Greater London. HA5 1SP
Tel/WhatsApp: +44 (0) 7946 174 829
Email: steve@steve-woodley.co.uk
