Conception Vessel 17, Shanzhong, ‘Middle of the Chest’, nowadays often referred to as Ren-17, is the 17th point along the Conception Vessel acupuncture channel, and
On the sternum midline, in the depression level with the 4th intercostal space.
On women with heavy breasts, even when lying supine, the level of the nipples may not be an adequate reference point.
The best way I’ve found is to find the second rib, which is usually more protuberant than the others. Under the second rib is the second intercostal space. Count down to the second intercostal space below this, ie between the fourth and fifth ribs. Usually the point is level with where the medial end of the 4th intercostal space adjoins the sternum. (But even then, it isn’t always exactly there!)
Once you’ve located roughly where it should be, gentle palpate the area just above and below it to discover if there is any tenderness over a slight depression. If so, that’s usually the point.
Needle transversely, ie diagonally, under the skin either upwards, downwards or towards where the discomfort is felt. Depth under the skin up to 1 cun.
In very thin patients, the skin is almost sitting on the underlying bone, so it’s impossible, or very difficult, to find Deqi easily. But you can still moxa it with great results – see below.
Some texts forbid needling Conception Vessel 17. I don’t know why, although it is an important energy point, lying close to the underlying heart so perhaps the ancients feared the needle might enter the heart.
Nowadays we realise that unless, very unusually, someone has a hole in their sternum here, the sternum itself is a firm barrier between outside and the heart.
More likely is that some people have a very powerful response to this point. So needle it cautiously. If someone’s qi is weak, don’t manipulate the needle too strongly. Just get deqi and leave it at that. Perhaps consider moxa instead. However, the point can be very sensitive.
Or you could gently massage it – that can work too.
Gripping, or a sensation pervading locally and within the chest. Sometimes although I’ve been sure I’ve got the point’s deqi, the patient doesn’t seem to notice much happening.
However, later on, it’s clear the treatment worked. Correctly done, the needle sensation spreads to where you direct it.
Moxa is often excellent here. It can have a wonderfully enlivening effect, as if the patient has had a double dose of oxygen, or taken an enormous breath. Use up to 7 cones: not so many if the patient hasn’t had it before.
If using a moxa stick, do so with caution as the skin is often thin here and the patient, especially if elderly, may not notice warmth before burning occurs.
Abundant, free-flowing Qi makes people positive, hopeful and want to get on with life. The point is usually tender in people who are downhearted, depressed, or sad, and its tenderness often suggests lowered spirits. Because of where it is, or because it’s sometimes difficult to get deqi here, it’s often used only to confirm a diagnosis.
However, Ren 17 can have a fantastically invigorating effect, boosting Qi circulation, which itself strengthens Blood and raising Spirits.
So, people’s voices become stronger, tiredness evaporates, and they seem to resist coughs and colds better.
Moxa on Ren 17 makes chest mucus transform and descend.
However, as noted above, I’m cautious of using it where there is excess damp-heat or damp-phlegm in the chest. Where the mucus is white, clear and because of deficiency, this point is great.
Shangzhong also regulates and suppresses rebellious Qi, such as Stomach Qi rebelling as in Oesophageal spasm, vomiting, regurgitation, belchings, acid risings and so on.
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