Directing Vessel
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REN-20
Safety Warnings
- Dangerous point - requires extra caution
- Deep needling contraindicated - shallow insertion only
Needle Depth
0.3–0.5 cun
Needle Angle
10-15° (Transverse)
Body Area
Chest
Location
On the midline of the chest, on the level of the 1st intercostal space.
Main Actions
- Opens the chest and regulates Qi
- Descends the Qi
Indications
Asthma
Dyspnoea
Wheezing
Coughing
Chest pain
Chest fullness
Difficulty swallowing
Lateral costal region pain
Commentary
The main function of this point is to open the chest and remove Qi Stagnation, so as to relieve pain and fullness in the chest and Lateral costal region. Often together with Qihu ST-13, it treats the lateral costal region pain.
It can be stimulated to descend Rebellious Qi so as to treat coughing, vomiting, wheezing, short of breath, and difficulties to swollen foods. Sometimes the patients are so short of breath that they aren't able to speak. In this case, apply Huagai REN-20 together with Shanzhong REN-17.
Classical Sources
Zhenjiu Jiayi Jing (針灸甲乙經 - Systematic Classic of Acupuncture and Moxibustion):
- "Huagai is in a depression 1 cun below Xuanji, where the Qi of the Ren Mai emerges. Locate it with the head tilted back."
- "For coughing with rebellious Qi rising, wheezing and inability to speak – Huagai masters this. For fullness in the chest and ribs with pain pulling into the chest – Huagai masters this."
Zhenjiu Dacheng (針灸大成 - Great Compendium of Acupuncture and Moxibustion):
- "Masters: wheezing with Qi rising, coughing with rebellious wheezing, throat bi-syndrome (obstruction), throat swelling, inability to swallow fluids, fullness and pain in the chest and ribs."
Bai Zheng Fu (百症賦 - Ode of a Hundred Patterns):
- "Long-standing rib and flank pain – Qihu and Huagai have spirit (effectiveness)."
How to Locate
Identify Shangzhong REN-17 in the middle of the two nipples, on the level of the 4th intercostal space. Locate the 1st intercostal space by counting three space up. Or locate the 1st intercostal space by palpation or counting down from the clavicle. Huagai REN-20 is on the midline of the sternum.
Caution
Located directly over the sternum at the sternal angle (junction of manubrium and body of sternum). While the bone provides some protection, transverse needling must stay superficial to avoid slipping between ribs toward the pleural cavity. In thin patients, there may be minimal tissue depth, making even transverse insertion challenging. The internal mammary (thoracic) artery and vein run behind the sternum – deep perpendicular needling is contraindicated. Always needle transversely along the channel direction (superiorly or inferiorly).
Needle Angle
10-15° (Transverse)
Depth Category
Shallow
Standard Depth
0.3–0.5 cun
Needling Directions
0.5 cun transversely in a superior or inferior direction along the Channel. Caution: only transverse needling is recommended in order not to injure the mediastinum or the pleura, especially for patients with a sternal foramen.
Expected Deqi Sensation
Local distension or dull ache around the sternum. Due to the thin tissue over bone at this location, obtaining strong deqi (needle sensation) can be difficult. Some practitioners report the sensation may spread slightly across the upper chest.
Moxibustion
Recommended
Duration: 5–15 minutes
Cupping
Questionable
Bloodletting
N/A
Gua Sha
Contraindicated
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