四瀆 : Sidu : Four Rivers

Classifications:

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

Location:

In the depression between the radius and the ulna, on a line drawn between Yangchi SJ-4 and the lateral epicondyle of the humerus, 7 cun proximal to Yangchi SJ-4.

Needling:

Perpedicular or oblique proximal or distal insertion towards the elbow or wrist respectively 1 - 2 cun

Classical Needling:

"The Shaoyang usually has little Blood and much Qi" (Su Wen 素問 ch. 24) implying this channel should normally be needled.
"The hand Yin and Yang receive their Qi via nearby paths so their Qi arrive swiftly. The depth of piercing must not exceed 2 fen and must not remain inserted for longer than one exhalation" (Ling Shu 靈樞 ch. 12).
"It is needled to a depth of six fen, (the needle) is retained for a duration of seven exhalations, and it is moxaed with three cones" (Huangfu Mi 皇甫謐, 3rd Century, Zhenjiu Jiayi Jing 針灸甲乙經).

TCM Actions:

Benefits the throat and ears

TCM Indications:

• Sudden deafness, sudden loss of voice, toothache, somnolence, fever, no desireto move the limbs.
  
• Inability to move the arm, pain of the arm, lumbar pain due to traumatic injury.

Neuroanatomy:

Superficial Innervation: Posterior cutaneous nerve of the forearm (C5 - C8)

Dermatome Segment: C6, C7

Deeper Structures: Radial nerve (C6 - C8)

Trigger Point Associations:

Muscle:
Extensor carpi radialis brevis

Location Notes:
A similar point on the ulnar side of the bone relates to extensor carpi ulnaris

Pain Referral Pattern:
Along radial aspect of the forearm to the dorsal aspect of the hand and lateral aspect of the elbow

Indications:
Extensor tendonitis of the forearm ; Tennis elbow pain

Martial Applications & Effects of Injury:

See Montaigue, Dim Mak Locations, Taijiworld.com for explanation of effects.

Major Combinations:

• Sudden deafness:
    Sidu SJ-9 with Tianyou SJ-16
    (Wang Zhizhong, 王執中, 1220: Zhen Jiu Zi Sheng Jing, 針灸資生經, Classic of Supporting Life with Acupuncture and Moxibustion).
  
  
• Toothache of the lower jaw:
    Sidu SJ-9 with Yemen SJ-2, Yanggu SI-5, Shangyang LI-1 and Erjian LI-2
    (Sun Simiao, 孫思邈, 625: Bei Ji Qian Jin Yao Fang, 備急千金要方, Essential Prescriptions Worth A Thousand Gold).

Notes:

In Mayan medicine:
Used to combat shoulder pain caused by wind (Garcia, Sierra, Balam, 1999: Wind in the Blood)

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