8.1 Jueyin Channels: Pericardium (PC) and Liver (LR) Points
Key Takeaways
Hand Jueyin Pericardium (PC 1 to PC 9) acts as the physical and emotional protector of the Heart, dominating chest sensations, blood vessels, and Shen stabilization, with PC 6 (Neiguan) serving as the premier distal Command Point for the chest and epigastrium, Master of Yin Wei Mai, and first-line point for nausea and palpitations.
Needling PC 6 and PC 7 requires strict neurovascular vigilance: both lie between the tendons of flexor carpi radialis and palmaris longus directly overlying the median nerve; encountering an electric-shock sensation or persistent paresthesia warrants immediate needle retraction to prevent traumatic neuroma formation or median neuropathy.
Foot Jueyin Liver (LR 1 to LR 14) regulates the free flow of Qi, stores Blood, and anchors Liver Yang; key empirical points include LR 1 (moxibustion for abnormal uterine bleeding), LR 2 (Son point to drain blazing Liver Fire), LR 3 (Yuan-Source point for systemic Qi stagnation, combined with LI 4 as the Four Gates), and LR 5 (Luo-Connecting point for plum-pit Qi and urogenital damp-heat).
Crucial visceral and vascular safety boundaries include: PC 1 (high pneumothorax risk 1 cun lateral to nipple), LR 10-12 (femoral artery and vein caution within the femoral triangle), and LR 13/14 (strict oblique insertion along the ribs due to puncture risk of hepatosplenomegaly or underlying pleura).
8.1 Jueyin Channels: Pericardium (PC) and Liver (LR) Points
Quick Answer: The Jueyin ("Terminal Yin") channel axis pairs the Hand Jueyin Pericardium with the Foot Jueyin Liver, governing the interior protection of the Heart, circulation of Blood, and the uninhibited movement of Qi throughout all three Jiaos. High-yield points tested on the NCCAOM examination include: PC 1 (Tianchi, 1 cun lateral to the nipple, major pneumothorax risk), PC 3 (Quze, He-Sea, bled for summer-heat and severe gastroenteritis), PC 4 (Ximen, Xi-Cleft for acute chest pain/angina and acute bleeding), PC 5 (Jianshi, transforms phlegm misting the Heart), PC 6 (Neiguan, Luo-Connecting and Master of Yin Wei Mai, primary point for nausea, vomiting, palpitations, and insomnia), PC 7 (Daling, Shu-Stream/Yuan-Source for carpal tunnel and Heart fire), PC 8 (Laogong, clears tongue ulcers and manic-depression), LR 1 (Dadun, moxibustion for uterine bleeding and hernia), LR 2 (Xingjian, sedates blazing Liver fire), LR 3 (Taichong, premier point for Liver Qi stagnation, paired with LI 4 as the Four Gates), LR 5 (Ligou, Luo-Connecting for plum-pit Qi and genital damp-heat), LR 8 (Ququan, nourishes Liver Blood/Yin), LR 13 (Zhangmen, Front-Mu of Spleen and Hui of Zang), and LR 14 (Qimen, Front-Mu of Liver). Critical safety mandates prohibit deep perpendicular needling at PC 6 and PC 7 to prevent median nerve trauma, caution against puncturing the femoral vessels near LR 10-12, and require oblique needling at LR 13-14 to protect against puncturing an enlarged liver or spleen.
Hand Jueyin Pericardium Channel (PC 1 – PC 9)
The Pericardium channel of Hand Jueyin originates internally in the center of the chest, envelops the pericardium (Xin Bao), descends through the diaphragm, and communicates successively with the Upper, Middle, and Lower Jiaos. Its superficial pathway emerges on the chest lateral to the nipple at PC 1 (Tianchi), arches over the axilla, descends the anterior aspect of the upper arm between the biceps brachii muscle bellies, crosses the cubital crease on the ulnar border of the biceps brachii tendon (PC 3 Quze), travels down the volar forearm directly between the tendons of palmaris longus and flexor carpi radialis, crosses the transverse wrist crease (PC 7 Daling), passes through the palm (PC 8 Laogong), and terminates at the tip of the middle finger (PC 9 Zhongchong).
As the "palace guard" of the sovereign Heart, the Pericardium channel is primary in treating:
- Disorders of the Heart and Chest: Angina, chest oppression, palpitations, cardiac arrhythmias, and tachycardia.
- Disorders of the Stomach and Epigastrium: Nausea, vomiting, motion sickness, morning sickness, and esophageal reflux (reflecting the channel's internal connection to the Middle Jiao).
- Mental and Emotional (Shen) Pathologies: Insomnia, anxiety, mania, delirium, and agitation.
Pericardium Channel Point Master Reference
| Point | Pin Yin | Location | Category / Dynamic | Primary Actions & Indications | Needling Depth, Angle & Safety Cautions |
|---|---|---|---|---|---|
| PC 1 | Tianchi | 1 cun lateral to nipple, in the 4th intercostal space, 5 cun lateral to anterior midline | Meeting point of PC, GB, LR, and San Jiao channels | Unbinds chest, dissipates phlegm nodules, treats axillary swelling, cough, mastitis | 0.2–0.4 cun oblique or transverse-lateral. Deep perpendicular puncture carries severe risk of pneumothorax. Never puncture medially toward the pleural cavity. |
| PC 2 | Tianquan | On anterior arm, 2 cun inferior to anterior axillary fold, between the two heads of biceps brachii | Local point | Unbinds chest, quickens Blood, cough, chest fullness, pain in medial aspect of arm | 0.5–1.0 cun perpendicular. Avoid brachial vessels. |
| PC 3 | Quze | On transverse cubital crease, in depression on ulnar side of biceps brachii tendon | He-Sea (Water) | Clears Heat at the Ying/Xue levels, cools Blood, clears Summer-Heat, arrests vomiting and diarrhea | 0.5–1.0 cun perpendicular, or prick with lancet to bleed for acute gastroenteritis, sunstroke, or high fever. Avoid brachial artery. |
| PC 4 | Ximen | On volar forearm, 5 cun superior to transverse wrist crease (PC 7), between tendons of flexor carpi radialis and palmaris longus | Xi-Cleft point | Premier point for acute chest pain, myocardial ischemia, angina pectoris, acute hemoptysis, hematemesis, epistaxis, severe emotional agitation | 0.5–1.0 cun perpendicular. Angle slightly proximally or distally if tendons are taut. |
| PC 5 | Jianshi | On volar forearm, 3 cun superior to transverse wrist crease, between tendons of flexor carpi radialis and palmaris longus | Jing-River (Metal) | Transforms Phlegm in the Upper Jiao, phlegm misting the Heart portals, epilepsy, manic-depression, malaria, irregular menses | 0.5–1.0 cun perpendicular. Median nerve caution. |
| PC 6 | Neiguan | On volar forearm, 2 cun superior to transverse wrist crease, between tendons of flexor carpi radialis and palmaris longus | Luo-Connecting point; Confluent/Master of Yin Wei Mai; Command Point of Chest and Epigastrium | Premier point for nausea, vomiting, morning sickness, motion sickness, cardiac arrhythmias, palpitations, chest constriction, insomnia, anxiety | 0.5–1.0 cun perpendicular, or oblique 1.0–1.5 cun proximally. Median nerve caution: see clinical safety protocol below. |
| PC 7 | Daling | In midpoint of transverse wrist crease, between tendons of flexor carpi radialis and palmaris longus | Shu-Stream (Earth); Yuan-Source point; Son/Sedation point | Clears Heart Fire, calms Shen, halitosis, insomnia, manic agitation, carpal tunnel syndrome, palmar heat | 0.3–0.5 cun perpendicular. Median nerve caution: lies directly over the median nerve in carpal tunnel; avoid vigorous manipulation. |
| PC 8 | Laogong | On palm, between 2nd and 3rd metacarpal bones, proximal to MCP joints; where tip of middle finger rests when closing fist | Ying-Spring (Fire); Horary point (7–9 PM) | Drains blazing Heart Fire and Pericardium Heat, severe aphthous ulcers / mouth sores, halitosis, tongue stiffness, manic psychosis, delirium | 0.3–0.5 cun perpendicular. Tender point; warn patient before insertion. |
| PC 9 | Zhongchong | On center of tip of middle finger, 0.1 cun proximal to free border of nail (or at absolute finger apex) | Jing-Well (Wood); Mother/Tonification point | Clears Heat, revives consciousness, coma, apoplexy, sunstroke, febrile convulsions in children, tongue stiffness | 0.1 cun perpendicular or prick to bleed with a three-edged needle/lancet. Emergency resuscitation point. |
Median Nerve Neurovascular Safety: PC 6 and PC 7
A central focus of the NCCAOM Acupuncture with Point Location (ACPL) module is the clinical anatomy of the volar forearm and wrist crease. PC 6 (Neiguan) and PC 7 (Daling) lie directly superficial to the median nerve, which runs between the tendons of the flexor carpi radialis (radially) and palmaris longus (ulnarly).
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| VOLAR FOREARM ANATOMICAL RELATIONSHIPS (PC 6 & PC 7) |
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| Radial (Lateral) Ulnar (Medial) |
| | | |
| [Radial Artery] [Flexor Carpi] (MEDIAN NERVE) [Palmaris] | |
| (LU 9) Radialis PC 6/7 Longus | |
| Tendon Tendon | |
| \ / | |
| +----> Needle Path <-----+ | |
| | | |
| (DEEP NEEDLING) | |
| v | |
| [Direct Median Nerve Injury] | |
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Mandatory Safety Protocols for PC 6 & PC 7:
- Palpation and Tendon Separation: Instruct the patient to make a fist and flex the wrist slightly. This immediately highlights the two prominent tendons. Relax the wrist before inserting the needle.
- Needle Sensation Differentiation: The desired needle sensation (De Qi) is a localized, dull, distending ache, soreness, or fullness within the muscle compartment. If the patient reports a sudden, sharp, electric-shock sensation radiating into the index finger, middle finger, or radial side of the ring finger, the needle tip has made contact with the median nerve.
- Immediate Corrective Action: Upon elicitation of an electric shock or burning paresthesia, withdraw the needle immediately by several millimeters, alter the angle slightly toward the ulnar border, or remove it entirely. Never retain or manipulate a needle that elicits neural shooting sensations; chronic mechanical microtrauma can induce traumatic neuroma formation or permanent median neuropathy (simulating carpal tunnel syndrome).
Foot Jueyin Liver Channel (LR 1 – LR 14)
The Liver channel of Foot Jueyin originates at the lateral dorsal nail corner of the great toe at LR 1 (Dadun), ascends along the dorsum of the foot between the 1st and 2nd metatarsal bones (LR 3 Taichong), passes anterior to the medial malleolus (LR 4 Zhongfeng), climbs the medial aspect of the lower leg, crosses posterior to the Spleen channel 8 cun superior to the medial malleolus, proceeds along the medial knee (LR 8 Ququan) and medial thigh, encircles the external genitalia, enters the lower abdomen, connects with the Stomach, enters its pertaining organ the Liver and couples with the Gallbladder, traverses the diaphragm, branches into the costal and hypochondriac regions (LR 14 Qimen), ascends the neck, connects with the eye system (Mu Xi), emerges on the forehead, and reaches the vertex of the head to intersect Du 20 (Baihui). A deep internal branch leaves the Liver, crosses the diaphragm, and enters the Lung to reconnect with Hand Taiyin, closing the continuous 24-hour channel cycle.
Liver Channel Point Master Reference
| Point | Pin Yin | Location | Category / Dynamic | Primary Actions & Indications | Needling Depth, Angle & Safety Cautions |
|---|---|---|---|---|---|
| LR 1 | Dadun | On dorsal aspect of big toe, 0.1 cun proximal to lateral corner of toenail | Jing-Well (Wood); Horary point (1–3 AM) | Regulates Lower Jiao Qi, arrests bleeding; moxibustion is the premier therapy for uterine bleeding (beng lou), hernia (Shan disorder), enuresis | 0.1 cun perpendicular or prick to bleed. Moxibustion (3–5 cones or moxa stick) is specifically indicated for abnormal uterine hemorrhage. |
| LR 2 | Xingjian | On dorsum of foot, between 1st and 2nd toes, 0.5 cun proximal to margin of web | Ying-Spring (Fire); Son/Sedation point | Premier point to sedate blazing Liver Fire and subdue Liver Yang: severe temporal throbbing headache, bloodshot red burning eyes, bitter taste, rage, epistaxis | 0.5–0.8 cun oblique proximally between metatarsal heads. Strongly draining manipulation. |
| LR 3 | Taichong | On dorsum of foot, in hollow distal to junction of 1st and 2nd metatarsal bases | Shu-Stream (Earth); Yuan-Source point | Premier point for Liver Qi stagnation, emotional depression, sighing, PMS, dysmenorrhea, dizziness, hypertension; Four Gates with LI 4 | 0.5–1.0 cun perpendicular or oblique toward sole. Deep puncture may pierce plantar vessels. |
| LR 4 | Zhongfeng | 1 cun anterior to medial malleolus, in depression medial to tibialis anterior tendon | Jing-River (Metal) | Clears Damp-Heat from Lower Jiao, genital pain, dysuria, hypochondriac distension | 0.3–0.5 cun perpendicular. Palpate tendon before insertion. |
| LR 5 | Ligou | 5 cun superior to medial malleolus, on medial border of tibia | Luo-Connecting point | Regulates Liver Qi, clears Damp-Heat; premier point for Plum-Pit Qi (globus hystericus), vulvar itching, leukorrhea, priapism, testicular swelling | 0.3–0.5 cun transverse / subcutaneous along posterior or medial border of tibia. Periosteal needle contact can cause sharp local pain. |
| LR 6 | Zhongdu | 7 cun superior to medial malleolus, on medial border of tibia | Xi-Cleft point | Acute hypochondriac pain, acute hepatitis, uterine bleeding, painful Shan disorder | 0.3–0.5 cun transverse / subcutaneous along tibial border. |
| LR 8 | Ququan | At medial end of popliteal crease, in depression anterior to semimembranosus and semitendinosus tendons | He-Sea (Water); Mother/Tonification point | Premier point to tonify Liver Blood and Liver Yin, nourish sinews, clear Lower Jiao Damp-Heat (dysuria, genital itching), medial knee pain | 1.0–1.5 cun perpendicular with knee flexed. Avoid great saphenous vein. |
| LR 10 | Zuwuli | 3 cun inferior to ST 30, on anterior border of adductor longus muscle | Local point | Clears Lower Jiao Damp-Heat, relaxes sinews, treats enuresis, groin pain | 0.5–1.0 cun perpendicular. Femoral artery and vein caution. |
| LR 11 | Yinlian | 2 cun inferior to ST 30, on anterior border of adductor longus muscle | Local point | Regulates menses, benefits Lower Jiao, infertility, thigh/groin contracture | 0.5–1.0 cun perpendicular. Femoral artery and vein caution. |
| LR 12 | Jimai | In groin, 2.5 cun lateral to Ren 2, in crease of groin inferior to pubic tubercle | Local point | Alleviates pain, clears Cold from Liver channel, hernia, uterine prolapse, scrotal pain | 0.5–0.8 cun perpendicular. Extreme caution: lies directly medial to femoral vein. Avoid deep needle manipulation. |
| LR 13 | Zhangmen | On lateral side of abdomen, below free end of the 11th floating rib | Front-Mu of Spleen; Hui-Meeting point of Zang | Harmonizes Liver and Spleen, resolves food stagnation, abdominal distension, diarrhea, borborygmus, hepatomegaly | 0.5–1.0 cun strictly oblique or transverse. Severe caution: deep perpendicular puncture risks lacerating an enlarged spleen (left) or enlarged liver (right). |
| LR 14 | Qimen | Directly below nipple, in the 6th intercostal space, 4 cun lateral to anterior midline | Front-Mu of Liver; meeting point of LR, SP, and Yin Wei Mai | Frees Liver Qi, harmonizes Liver and Stomach, hypochondriac pain, breast distension, sighing, regurgitation | 0.3–0.5 cun strictly oblique along the intercostal space. Severe caution: deep perpendicular insertion risks pneumothorax or puncturing the liver. |
Clinical Point Combinations: The Four Gates (Si Guan)
The combination of bilateral LR 3 (Taichong) and bilateral LI 4 (Hegu) is clinically designated as the Four Gates (Si Guan). This is among the most frequently tested multi-point prescriptions on the NCCAOM examination.
Energetic Synergy of the Four Gates
- LI 4 (Hand Yangming): Originates in the upper body, governs Qi, excels at opening the sensory portals, moving Yang Qi, and addressing pain in the head, face, and neck.
- LR 3 (Foot Jueyin): Originates in the lower body, governs Blood and the smooth spreading of Qi, excels at descending Yang, clearing stagnation, and regulating the interior viscera.
- Combined Action: Together, LI 4 and LR 3 open all twelve channels, break up stubborn Qi stagnation, harmonize Qi and Blood, subdue interior Wind, alleviate generalized pain, and release psycho-emotional constraint (severe irritability, depression, stress-induced somatic tension).
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| THE FOUR GATES (SI GUAN) SYNERGY |
+----------------------------------------------------------------------------+
| LI 4 (Hand Yangming) + LR 3 (Foot Jueyin) |
| Upper Body / Qi Domain | Lower Body / Blood Domain |
| Clears Head, Face, Portals | Smoothes Qi, Anchors Yang |
| \ | / |
| +-----------------+-----------------+ |
| | |
| v |
| [Universal Systemic Homeostasis: Expels Pain, Smooths All Channels] |
| *Contraindication Warning: Strictly Prohibited During Pregnancy* |
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Caution
Obstetric Contraindication: LI 4 is one of the classically forbidden points in pregnancy because of its strong downward-moving action, so the Four Gates combination is avoided during pregnancy. LR 3 is not on the classical forbidden list, but needle it gently in pregnant patients.
Anatomical Danger Zones: Thoracic, Inguinal, and Organomegaly
- PC 1 (Tianchi) Pneumothorax Hazard: Located 1 cun lateral to the nipple in the 4th intercostal space. The thoracic pleura and lung tissue lie only a fraction of an inch deep to the pectoralis major and intercostal musculature. Needling must be restricted to a shallow transverse or oblique angle (0.2–0.4 cun) directed laterally along the intercostal space. Never needle perpendicularly.
- The Femoral Triangle (LR 10, LR 11, LR 12): The femoral sheath houses the femoral artery, femoral vein, and femoral nerve (lateral to medial mnemonic: NAVEL - Nerve, Artery, Vein, Empty space, Lymphatics). LR 12 (Jimai) is located immediately medial to the femoral vein. Practitioners must palpate the femoral pulse before needle insertion; if a pulse is palpated under the fingertip, the needle must be placed medial to the vascular bundle. Perpendicular deep insertion can cause arterial puncture, retroperitoneal hemorrhage, or pseudoaneurysm formation.
- Organomegaly and Costal Margin Points (LR 13 & LR 14):
- LR 14 (Qimen): Sits in the 6th intercostal space. In healthy patients, deep perpendicular puncture pierces the parietal pleura, visceral pleura, and lung, causing a traumatic tension pneumothorax. On the right side, or in any patient with hepatomegaly (enlarged liver due to hepatitis, cirrhosis, or congestive heart failure), a perpendicular needle will penetrate the liver parenchyma, causing severe internal bleeding.
- LR 13 (Zhangmen): Sits at the tip of the 11th rib. In patients with splenomegaly (enlarged spleen due to mononucleosis, portal hypertension, or hematologic malignancies), the spleen extends far below the left costal margin; perpendicular needling can rupture the splenic capsule, requiring emergency laparotomy.
A practitioner is needling PC 6 (Neiguan) on a patient suffering from severe postoperative nausea. As the needle reaches a depth of 0.8 cun, the patient suddenly gasps and describes an intense, electric-shock sensation radiating into the middle and index fingers. Which course of action is required to prevent neurovascular injury?
Advance the needle another 0.2 cun to anchor it into the interosseous membrane
Immediately withdraw the needle slightly and alter the angle away from the median nerve
Retain the needle in place for 20 minutes without further manipulation to achieve strong De Qi
Apply strong clockwise twirling manipulation to disperse the local nerve entrapment
A patient presents with severe temporal throbbing headaches, flushed face, bloodshot red eyes, extreme irritability, a bitter taste in the mouth, and a wiry, rapid pulse. The tongue is red with a dry yellow coating. Which distal Liver channel point is the most appropriate primary selection to sedate this pattern?
LR 1 (Dadun) with indirect moxibustion
LR 3 (Taichong) with gentle even supplementation
LR 2 (Xingjian) with reducing needle manipulation
LR 8 (Ququan) with tonifying needle manipulation
When needling PC 1 (Tianchi) and LR 14 (Qimen) on the thoracic wall, which specific needle direction and depth must be observed to avoid the life-threatening complication of traumatic pneumothorax?
Strictly oblique or transverse insertion of 0.2 to 0.5 cun along the intercostal spaces, strictly avoiding deep perpendicular insertion
Perpendicular insertion of 1.0 to 1.5 cun to stimulate the intercostal nerve plexus directly
Perpendicular insertion of 0.8 cun while instructing the patient to take a deep forced inspiration and hold their breath
Deep oblique insertion directed medially toward the sternum to avoid the lateral pleural cupola
A 34-year-old female presents complaining of a constant sensation of a foreign object lodged in her throat that cannot be swallowed or coughed up, which worsens when she is emotionally stressed. She also reports severe vulvar pruritus with thick, foul-smelling vaginal discharge. Which Liver channel point possesses specific empirical actions to address both of these clinical complaints simultaneously?
LR 2 (Xingjian)
LR 3 (Taichong)
LR 13 (Zhangmen)
LR 5 (Ligou)
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