Directing Vessel
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REN-21
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 sternum, below the upper border of the manubrium sterni and midway between Huagai REN-20 and Tiantu REN-22.
Main Actions
- Opens the chest and descends Lung Qi
- Descends Stomach Qi and removes Food Stagnation
- Benefits the throat
Indications
Coughing
Wheezing
Dyspnoea
Chest pain
Indigestion
Throat pain
Chest fullness
Lateral costal region pain
Rattling sound in the throat
Lateral costal region fullness
Commentary
Like other Directing Vessel points located in the chest midline, Xuanji REN-21 can open chest and descends Rebellious Lung Qi, so as to treat symptoms like wheezing, coughing, dyspnoea with inability to speak as well as chest and lateral costal region pain and fullness. It can also remove painful obstruction in the throat with rattling sound.
In additional to that, REN-21 can be stimulated to descend Rebellious Stomach Qi, in order to ease indigestion and Food Stagnation. For this purpose, it is often used together with Zusanli ST-36.
Classical Sources
Zhenjiu Jiayi Jing (针灸甲乙经) - Systematic Classic of Acupuncture and Moxibustion:
This earliest comprehensive acupuncture text records REN-21 for treating cough, asthma, chest pain, and throat disorders. The point is named after the second and third stars of the Big Dipper (璇玑), reflecting its celestial significance and its location opposite to Zigong (REN-19, Purple Palace).
Name Etymology:
The character 璇 (xuán) means 'rotation' or 'fine jade,' while 玑 (jī) means 'pivot' or 'mechanism.' Together they reference the rotating celestial sphere and an ancient astronomical instrument. The name reflects the point's location where the throat moves during swallowing, and its role in facilitating the smooth flow of Qi through the upper chest.
How to Locate
Locate Xuanji REN-21 on the midline of the sternum, inferior to the bony margin of the manubrium sterni.
Caution
Only transverse needling is recommended to avoid injury to the mediastinum or pleura. Some individuals (5-8% in Western populations) have a sternal foramen, creating a potential pathway to vital structures. Never needle perpendicularly. Use shallow insertion directed superiorly or inferiorly along the channel. The internal thoracic (mammary) artery and vein lie nearby. Located on bone with thin overlying tissue, making technique challenging in thin patients.
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. 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 distention and soreness at the point. Sensation may spread toward the throat or downward into the chest. Due to the bony location on the sternum, deqi may be subtle and require gentle technique.
Moxibustion
Recommended
Duration: 5–10 minutes
Cupping
Questionable
Bloodletting
N/A
Gua Sha
Questionable
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