Triple Burner Meridian
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SJ-21
Safety Warnings
- Dangerous point - requires extra caution
- Deep needling contraindicated - shallow insertion only
Needle Depth
0.3–0.5 cun
Needle Angle
90° (Perpendicular), 45° (Oblique)
Body Area
Ear, Face — Jaw
Location
In the depression anterior to the supratragic notch and slightly superior to the condyloid process of the mandible. The point should be located and needled with mouth open. Tinggong SI-19 and Tinghui GB-2 are located below Ermen TB-21.
Main Actions
- Benefits ears
- Expels Wind
Indications
Commentary
There are three points anterior to the tragus of the ear, Tinghui GB-2 inferiorly, Ermen TB-21 superiorly and Tinggong SI-19 in the center. All three are frequently used to treat various ear problems, such as tinnitus, deafness, pain, itching and discharge in the ear. It is recommended to needle these three point alternately if frequent needling treatments are required.
Ermen TB-21 is an important local point for ear disorder, especially if the original cause is Liver Wind agitating Internally due to Liver Yang Rising.
Other typical manifestation of Interior Wind is deviation of eye and mouth.
Classical Sources
Zhenjiu Dacheng (针灸大成): "Ear Gate, located in front of the raised flesh at the ear notch, in the depression when the mouth is opened. Needle 0.3 cun, retain for three breaths, moxa three cones. The Xia Jing prohibits moxibustion; if moxibustion is appropriate for the condition, use no more than three cones."
Zhenjiu Jiayi Jing (针灸甲乙经): Listed indications include deafness, tinnitus, ear discharge (ting'er), toothache, pain in the jaw and neck, and stiffness of the lips.
Ling Shu: The San Jiao channel pathway passes through the ear region, entering the ear and emerging in front of it, connecting the ear to the channel's pathway from the hand to the head.
How to Locate
It is recommended to open the mouth to locate and needle the point. This allows the condyloid process of the mandible to slide anteriorly to reveal the depression where Ermen TB-21 is located. It is comparatively easy to locate the sulcus between the auricle and the cheek anterior to the tragus. Then locate TB-21 on the level of the supratragic notch on the sulcus.
Caution
This point is located near the superficial temporal artery and auriculotemporal nerve. Always palpate before needling to locate and avoid the arterial pulse. Needle with the patient's mouth open to prevent intra-articular insertion into the temporomandibular joint. After insertion, the patient may close their mouth. Ancient texts caution against moxibustion when there is discharge of pus from the ear. Some classical sources mention potential risk to vision with improper needling technique.
Needle Angle
90° (Perpendicular) / 45° (Oblique)
Depth Category
Shallow
Standard Depth
0.3–0.5 cun
Needling Directions
0.5–1 cun vertically or slightly obliquely in an inferior direction. Needle with the patient’s mouth open so as to avoid intra-articular insertion. After insertion, patients can close their mouth again. Caution: this point is close to the superficial temporal artery and the auriculotemporal nerve.
Expected Deqi Sensation
Local distention and soreness around the ear, sometimes extending throughout the side of the face. The patient may feel pressure or fullness in the ear area during stimulation.
Moxibustion
Questionable
Duration: 5–10 minutes
Cupping
Contraindicated
Bloodletting
N/A
Gua Sha
Contraindicated
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