Sanjiao Channel

1
WAIGUAN SJ-5
Outer Pass
Luo-Connecting point of the Sanjiao channel
Confluent point of the Yang Linking vessel
LOCATION
2 cun proximal to Yangchi SJ-4, in the depression between
the radius and the ulna, on the radial side of the extensor
digitorum communis tendons.
LOCATION NOTE
The point is located between the radius and the extensor
digitorum communis tendons, close to the border of the
radius.
NEEDLING
i. Slightly oblique insertion towards the ulnar side or
oblique proximal or distal insertion towards the elbow or
wrist respectively, 0.5 to 1.5 cun, ii. Joined by through-
needling to Neiguan P-6.
Caution: movement of the patients arm or hand after
needling this point can result in a bent needle.
ACTIONS
Expels wind and releases the exterior
Benefits the head and ears
Opens the Yang Linking vessel
Clears heat
Activates the channel and alleviates pain
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 headache, pain of the nape, dizziness,
phlegm inversion dizziness, wind dizziness, hyper-
tension.
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, ulcera-
tion of the mouth, cracked lips, nosebleed, scrofula,
mumps.
Constipation, abdominal pain, oppression and tight-
ness 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, flaccid-
ity of the elbow, soreness and heaviness of the elbow
and wrist, swelling and redness of the arm, paralysis
and numbness 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 the toes, pain of the hundred joints.
COMMENTARY
Waiguan SJ-5, the confluent point of the Yang Linking
vessel, is the most important and frequently used distal
point of the Sanjiao channel with wide clinical applica-
tion. The Yang Linking vessel, which has no points of its
own, links the six yang channels and the Governing
vessel. Yang corresponds to the exterior while yin corre-
sponds to the interior, and the yang channels as a whole
therefore relate more to the exterior portion of the body.
According to the Classic of Difficulties
7
when the Yang
Linking vessel is diseased, there will be severe chills and
fever, whilst the Song of Points for Miscellaneous Diseases
2

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Waiguan SJ-5
Yangchi SJ-4
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CONTENTS
Lung
L. Intestine
Stomach
Spleen
Heart
S. Intestine
Bladder
Kidney
Pericardium
Sanjiao
Gall Bladder
Liver
Conception
Governing
Extra Points
See Notes
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Sanjiao Channel 2
says use Waiguan SJ-5 for all wind, cold, summer-heat
and damp pathogens, headaches and fever. In the Ode of
the Obstructed River the use of Waiguan SJ-5 is referred to
as one of the eight therapeutic methods. In this descrip-
tion of the application of the eight confluent points of the
extraordinary vessels to affect specific symptoms and
areas of the body, Waiguan SJ-5 is indicated for injury by
cold to the exterior accompanied by headache. These
classical references emphasise two of the principle appli-
cations of Waiguan SJ-5 namely: i. dispelling exterior
pathogenic factors, and ii. treating headache.
Exterior pathogenic factors attack the superficial por-
tion of the body first, giving rise to the typical symptoms
of chills and fever, and at this stage of progression the
treatment principle is to release the exterior. In current
clinical practice some authorities emphasise the special
ability of Waiguan SJ-5 to resolve wind-heat and Hegu
L.I.-4 to resolve wind-cold, whilst others take the opposite
view. This inevitably raises the question of when to use
Waiguan SJ-5 and when to use Hegu L.I.-4. Although
there is no clear-cut answer, it is worth noting that whilst
Hegu L.I.-4 is classically indicated for chills and fever
accompanied by absence of sweating (characteristic of
wind-cold), the only reference to sweating and Waiguan
SJ-5 in classical sources is sweating with heat on the
exterior (characteristic of wind-heat). Hegu L.I.-4 be-
longs to yangming channel which dominates the central
portion of the face and is strongly indicated for patho-
genic factors giving rise to sneezing and nasal discharge,
whilst Waiguan SJ-5 belongs to the Sanjiao channel which
traverses the lateral portion of the neck and is indicated
for swelling of the glands (including scrofula and mumps).
When wind-dampness attacks the body, in addition to
chills and fever there is typically pain of the joints, and the
Classic of the Jade Dragon recommends Waiguan SJ-5 for
'chills and fever and pain of the hundred joints'. In terms
of the four levels theory of febrile diseases, Waiguan SJ-5
predominantly treats pathogens at the defensive and qi
levels. In terms of the Sanjiao theory of differentiating
fevers, it focuses on the more exterior upper jiao Lung
pattern, rather than the Pericardium pattern. This is in
contrast to points of its coupled Pericardium channel,
which predominantly treat pathogens at the nutritive and
blood levels according to four level theory, and the Peri-
cardium pattern according to the Sanjiao theory.
As well as chills and fever, Waiguan SJ-5 is indicated for
either wind-cold or wind-heat attacking the eyes and ears
and giving rise to symptoms such as redness, pain and
swelling, lacrimation, deafness and tinnitus etc.
Waiguan SJ-5 is classically indicated for many different
kinds of headache, including temporal, vertex, frontal
and occipital headaches as well as headache due to Kid-
ney deficiency, head wind and thunder head wind (se-
vere headache with a thundering sound in the head). The
widespread action of Waiguan SJ-5 on such varied kinds
of headache may be explained by a number of different
factors: i. as stated above, Waiguan SJ-5 is an important
point to expel pathogenic factors and may be used in the
treatment of headache due to penetration by wind-cold,
wind-heat or wind-damp; ii. the Yang Linking vessel
links all the yang channels (the occipital region is gov-
erned by the Governing vessel and taiyang channel, the
temporal region by the Yang Linking vessel and shaoyang
channel, and the frontal region by yangming channel); iii.
the Sanjiao channel specifically connects with such im-
portant points for headaches as Benshen GB-13 through to
Fengchi GB-20, Touwei ST-8 and Fengfu DU-16; iv. the
Sanjiao and Gall Bladder shaoyang channels are linked
according to six channel theory, and the Sanjiao channel
intersects the Gall Bladder channel at points Tongziliao
GB-1, Shangguan GB-3, Hanyan GB-4, Xuanli GB-6 and
Jianjing GB-21, whilst the Gall Bladder and Liver channels
are interiorly-exteriorly coupled. Waiguan SJ-5 is there-
fore an especially important point in the treatment of
headaches due to Liver disharmony, especially when this
gives rise to one-sided temporal headache (shaoyang
region). For this purpose Waiguan SJ-5 is often combined
with Gall Bladder channel points such as Zulinqi GB-41
(predominantly for headaches due to Liver qi stagnation,
including premenstrual headaches), and Yangfu GB-38
and Xiaxi GB-43 (predominantly for headaches due to
Liver fire or Liver yang rising).
The Yang Linking vessel passes behind the ear whilst
the Sanjiao channel both encircles and enters the ear.
Waiguan SJ-5 is therefore an important point in the treat-
ment of various ear disorders including tinnitus, deafness,
earache and itching of the ear, and along with Zhongzhu
SJ-3 is one of the principal distal points in the treatment of
disorders of this region.
The Sanjiao channel belongs to fire and its internal
pathway passes through all the three jiao. According to
Methods of Acupuncture and Moxibustion from the Golden
Mirror of Medicine Waiguan SJ-5 resolves knotting of heat
in the five zang and six fu. Its action on clearing heat from
the middle and lower jiao is reflected in its ability to treat
constipation, abdominal pain, pain of the lateral costal
region and vomiting, but it is especially effective in treat-
ing heat disorders of the head (swelling and pain of the
cheek, nosebleed, toothache, ulceration of the mouth,
cracked lips etc.) and clearing heat and fire poison from
the Sanjiao channel in the neck (scrofula and mumps).
Waiguan SJ-5 is also a vital point in the treatment of a wide
variety of channel disorders affecting the shoulder, arm,
elbow, wrist, hand and fingers. In this respect it acts
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Lung
L. Intestine
Stomach
Spleen
Heart
S. Intestine
Bladder
Kidney
Pericardium
Sanjiao
Gall Bladder
Liver
Conception
Governing
Extra Points
See Notes
Sanjiao Channel
3
almost like a point of the hand yangming Large Intestine
channel, and is often incorporated with Jianyu L.I.-15,
Quchi L.I.-11 and Hegu L.I.-4 in the treatment of painful
obstruction, atrophy disorder and hemiplegia of the upper
limb. The action of Waiguan SJ-5 on the elbow region is
emphasised in the Great Compendium of Acupuncture and
Moxibustion which gives specific indications for excess
and deficiency of the luo-connecting points. In the case of
Waiguan SJ-5 these are contraction of the elbow (excess)
and flaccidity of the elbow (deficiency).
Finally, Waiguan SJ-5 is the luo-connecting point of the
Sanjiao channel from where the luo-connecting channel
rises to converge with the Pericardium channel in the
chest. Although this strengthens the Sanjiao-Pericardium
relationship, with the exception of oppression and tight-
ness of the chest there are no specific indications of this
linkage. In clinical practice, however, the points Neiguan
P-6 and Waiguan SJ-5 are often joined by through-nee-
dling for pain of the chest which radiates to the back.
COMBINATIONS
Pain of the head and eyes: Waiguan SJ-5 and Houxi
SI-3 (Divine Moxibustion).
Impaired hearing and deafness: Waiguan SJ-5 and
Huizong SJ-7 (Thousand Ducat Formulas).
Impaired hearing and deafness: Waiguan SJ-5 and
Tinghui GB-2 (Supplementing Life).
Deafness: Waiguan SJ-5, Zhongzhu SJ-3, Shangyang
L.I.-1, Erheliao SJ-22, Tinghui GB-2, Tinggong SI-19,
Hegu L.I.-4 and Zhongchong P-9 (Precious Mirror).
Deafness and tinnitus: Waiguan SJ-5 and Tianchuang
SI-16 (Supplementing Life).
Abdominal pain: Waiguan SJ-5 and Daling P-7 (Song
of the Jade Dragon).
Abdominal pain and constipation: Waiguan SJ-5,
Zhigou SJ-6 and Daling P-7 (Ode of the Jade Dragon).
Pain of the lateral costal region: Waiguan SJ-5,
Zhigou SJ-6 and Zhangmen LIV-13 (Great Compen-
dium).
Inability to bend the elbow and fingers: Waiguan
SJ-5, Zhongzhu SJ-3, Quchi L.I.-11 and Shousanli
L.I.-10 (Great Compendium).
Atrophy disorder and numbness of the arm:
Waiguan SJ-5, Tianjing SJ-10 and Quchi L.I.-11 (Thou-
sand Ducat Formulas).
Sabre lumps of the axilla: Waiguan SJ-5, Zhigou SJ-6,
Yuanye GB-22 and Zulinqi GB-41 (Illustrated Supple-
ment).
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CONTENTS
Lung
L. Intestine
Stomach
Spleen
Heart
S. Intestine
Bladder
Kidney
Pericardium
Sanjiao
Gall Bladder
Liver
Conception
Governing
Extra Points
See Notes