Hey, this is Nicholas and today we're locating points on the Hand Yang Ming large intestine channel. So I'm gonna see how many of these points I can locate on myself but if I run into trouble I might call in a friend to help me out with an extra set of hands. So to locate points on the large intestine channel we want to start with the proper arm position which is like this. It's like you're a waiter serving a fancy bottle of wine.
Now the reason we do this is it gives us a nice straight line to locate the points on. If you start rotating the arm then that's going to twist the line and make it harder for us to do our measurements. So that's why we start with the arm like this with the palm facing the chest and the radial side of the arm pointing up.
So to make this easier let's go ahead and switch to an overhead view. So large intestine one is located on the radial side of the index finger next to the corner of the nail. Now I know I just made a big deal about arm position but I'm going to go ahead and lay my hand flat just so we can see this one a little bit easier. So what we're doing is we're taking these lines formed by the proximal border of the nail and the radial border of the nail and where they intersect is LI1.
So for needling this point we're going into the fleshy area 0.1 soon from the corner of the nail. But if we're putting a sticker on then part of the sticker is going to cover the nail just because stickers are bigger than needles. Li2 and Li3 are on either side of the metacarpophalangeal joint.
So Li2 is just distal to the joint on the radial border of the bone. Li3 is in the depression just proximal to the head of the second metacarpal bone. Now these points might be a little bit difficult to feel if the fingers are straight, so go ahead and relax the fingers and these depressions will open up.
LI4 is an important point so we want to make sure we're locating it correctly. LI4 is located at the midpoint of the second metacarpal bone close to the radial border of the bone. So find the head of the bone, the base of the bone, and then come halfway for LI4.
So when people have trouble with this, one, they might think that the base of the bone is way down here and this is actually a carpal bone. So slide your finger down the bone and the first bump you feel is the base of the bone. So then find the head and come halfway for LI4.
Another mistake that people make is they come too far out into the webbing. LI4 is fairly close to the bone. If you come out this way that's actually an extra point. It's one of the bas-chi-e.
So try to stay close to the radial border of the second metacarpal bone. And then in my opinion this point is easier to locate and easier to needle with a hand in this position. If you lay the hand flat it's harder to palpate and needling becomes a little bit awkward.
So if the patient is laying their hand flat just turn it on its side and that will make it easier. LI5 is located on the radial side of the wrist in the anatomical snuff box, that is between the tendons of extensor pollicis longus and brevis. So if you extend the thumb Then these two tendons pop out and LI5 is right between them.
And then here you're right at the point where the wrist bends between two bones. So it may not seem like there's a lot of space here, but you can actually needle fairly deeply here because you're going in the empty space between two bones. After that we're going to move up to LI11 because that's going to give us a line for the rest of the points. So LI11 is at the elbow.
midway between lung 5 and the lateral epicondyle of the humerus. So find the tendon thing, find the bony thing, and come halfway for LI11. And when I say the bony thing I don't mean the olecranon process or the tip of the elbow, I mean the bump above it which is the lateral epicondyle of the humerus.
So find the lateral epicondyle, find lung 5, and come halfway for LI11. Now some books will also say that this point is at the lateral end of the transverse cubital crease when the elbow is flexed. Personally, I don't use this very much because the crease can change depending on how much you flex the elbow and then it might be kind of awkward to try to do this on a patient.
So I think it's much easier to just find lung 5 or the biceps brachii tendon, find the lateral epicondyle of the humerus, and then come halfway for LI 11. So now we have large intestine 5 and large intestine 11 and all the other points are going to be on the line connecting the two. Now I'm not sure if I'm going to be able to measure these points by myself with one hand so let's see if I can find a partner to help me out. So here's Li5, here's Li11, and this gives us our line for the large intestine channel.
So Li6 is 3 soon up from Li5. So Li5 to Li11 is 12 soon. Half of 12 is 6. Here's 6 soon. Half of 6 is 3. And so that gives us 3 soon for Li6 on the line from Li5 to Li11. Li7 is 5 soon up.
So again, here's 12 soon. Half of 12 is 6. Half of 6 is 3. So then we can just visually divide it into thirds. So here's 3, 4, 5, 6. We want 5 soon for Li7.
So Li8, 9, and 10, according to the book, Li8 is 4 soon down, Li9 is 3 soon down, and Li10 is 2 soon down. Sometimes it's easier to go the other way. So Li8 is 8 soon up, Li9 is 9 soon up, and Li10 is 10 soon up. So the easiest one to find is Li9.
So here's 12 soon, half of 12 is 6, halfway between 6 and 12 is 9. That gives us Li9 is 9 soon up or 3 soon down on the line between Li5 and Li11. So after we have Li9, Li8 and 10 are just one soon on either side. Here's 12 soon.
Half of 12 is 6. Halfway between 6 and 12 is 9. So this is 6, 7, 8, 9. We want 8 soon for Li8. And then the same thing on the other side for Li10. Li10 is 10 soon up or 2 soon down.
Here's 12 soon. Half of 12 is 6. Halfway between 6 and 12 is 9. So this is 9 soon, 12 soon, 9, 10, 11, 12. We want 10 soon for Li10. So here we have all our points are on the line from Li5 to Li11. Li6 is 3 soon up. Li7 is 2 soon above that.
8, 9, and 10 are all 1 soon apart. And then we have a 2 soon gap between Li10 and Li11. So here we're back with the upper arm and again LI-11 is located halfway between Lung 5 and the lateral epicondyle of the humerus. For LI-12 we're going to start here and come one soon up and one soon back to give us LI-12.
Now how do we measure one soon? Well we really don't need to. We're just feeling for this nice little corner pocket right above the lateral epicondyle of the humerus.
So we can feel down until we... fall in this depression for LI12. Next we're going to skip up to LI15 because again we need to establish this line for our points on the upper arm. So LI15 is located in depression anterior and inferior to the acromion process. So basically what's happening here is I have an anterior deltoid coming off the lateral end of the clavicle, a middle deltoid coming off the acromion process, and a posterior deltoid coming off the spine of the scapula.
So for LI-15, we're looking for the depression between the anterior and middle delt, right below the acromion process. So if you have somebody with really good muscle definition, you can actually see these depressions. The one in front is LI-15 and the one in back is Sanjau-14.
Now me, I've been eating too many peanut M&Ms, but let's see if I can abduct the shoulder and make this easier to see. So this line. is my acromion process.
This is my anterior delt and my middle delt. So LI-15 is in this depression anterior and inferior to the acromion process. So when you're working with a partner what you can do is abduct the shoulder and maybe pull it out and that way you'll be able to see and palpate these depressions. So when it comes to needling this point we actually have two options.
We can needle perpendicularly into the joint towards the armpit to really get into the shoulder joint or we can thread the needle downwards towards the elbow to get to the fibers of the deltoid muscle. But the point is either way you do it you don't want to needle into bone. So if you're looking for this point and you feel bone under your finger you probably need to come down a little bit so that you're inferior to the acromion process.
So now we can see that Li 15 is directly above Li 11 so if I start at Li 11 and come straight up I'm going to fall into this depression for Li 15 And so then this gives us a line for the Li channel on the upper arm So coming back to Li 13, Li 13 is located three soon above Li 11 on the line connecting Li 11 to Li 15. So cubital crease to axillary fold is nine soon and we divide it into thirds to get three soon. And just make sure when you're measuring you're measuring from the axillary fold, not Li 15. Li 14 is above Li 11 at the insertion point of the deltoid muscle. So this one doesn't really have a soon measurement, you just have to palpate for it. So start at LI11 and just come up towards LI15 until you hit the border of the deltoid muscle. So now we can see that LI11, LI13, LI14, and LI15 are all in the line.
LI12 is off the line, one soon posterior. LI16 is on top of the shoulder between the lateral end of the clavicle and the scapular spine. Now this one's going to be easier to see on the skeleton, but I'll see if I can show you on myself.
So basically we have the clavicle in front and the spine of the scapula in the back, and these come together to form a V. Li16 is in the corner of this V. Some people call this the dusty corner. If you're having trouble with this one, sometimes what I do is I start at the top of the trap and then follow the ridge of the trap down until you just fall into this dusty corner. Now if people make a mistake here it's usually that they come too far forward. So this point is farther back than what you think it is and this is because the channel is actually wrapping around the back of the neck to connect to do 14. So this is LI-16 in the dusty corner.
Next we're coming to the neck and we're actually going to find LI-18 first. LI-18 is level with the laryngeal prominence. between the sternal and clavicular heads of the SCM.
So if you're having trouble finding the SCM, one thing you can do is have the person turn the head all the way to the side and this will make the SCM pop out. But if you're doing it this way, make sure that after you find the borders you have the person turn their head back straight and then put the sticker on. Because this muscle actually moves a lot, so if you turn the head and put the sticker on here By the time you turn the head back the sticker might be in the wrong place.
The other thing you can do is remember that the M in SCM means mastoid process. So you can come up here and feel for the anterior and posterior borders of the mastoid process and then palpate down onto the muscle. And then LI18 is level with the laryngeal prominence between the two borders. So LI17 is on the posterior border of the SCM, one soon inferior to LI-18.
So how do we measure one soon? Well you really don't have to. This is kind of the point where the neck meets the shoulder and the shoulder meets the neck and we're on the posterior border of the SCM.
After that we're on the face. LI-19 is below the lateral margin of the nostril level with DU-26. So this is the lateral margin of the nostril. And level with do 26 just means I'm coming a third of the way down the upper lip.
So I'll see if I can put a sticker here but I don't know if this will work. Yeah that looks pretty silly. I'm going to take that off.
Li 20 is located in the nasolabial groove level with the midpoint of the ala nasi. So naso means nose, labia means lip. So the nasolabial groove is this line that runs from the nose to the corner of the lip. I feel like Harrison Ford has a really good nasolabial groove and as he's been getting older and more grumpy his nasolabial groove has become more prominent. So the ala nase is this ball part of the nostril so we want to find the midpoint and then come out laterally into the nasolabial groove and that's LI-20.
So that's LI-20 and that's the large intestine