Acupuncture
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EX-LE-5
Safety Warnings
- Dangerous point - requires extra caution
- Deep needling contraindicated - shallow insertion only
Needle Depth
0.5–1.0 cun
Needle Angle
45° (Oblique), 90° (Perpendicular)
Body Area
Knee
Location
This is a group of 2 points, composed of Dubi ST-35 and Neixiyan EX-LE-4. Both are located inferior to the patella, medial and lateral to the patellar ligament. Dubi ST-35 is the lateral one, while Neixiyan EX-LE-4 is the medial one.
Main Actions
- Expels Wind-Damp
- Reduces swelling and pain
Indications
Knee pain
Weak knees
Knee swollen
Knee numbness
Knee stiffness
Lower limb numbness
Lower limbs atrophy
Commentary
This is a group of two points, composed of Neixiyan EX-LE-4 and Dubi ST-35.
They are very important local points in treating all types of knee disorders, regardless of being Deficiency or Excess, Heat or Cold patterns.
On top of that, they also reduce discomfort around knee joint.
Classical Sources
Beiji Qianjin Yaofang (備急千金要方) - Essential Prescriptions Worth a Thousand Gold for Emergencies (Sun Simiao, 652 CE): First recorded this point, establishing its use for knee disorders.
Waitai Miyao (外台秘要) - Arcane Essentials from the Imperial Library: "For beriberi (脚气), if the heart and abdomen qi is settled but both thighs extending to the knees feel stuffy, moxa Xiyan 7 cones. Located below the kneecap bone where they meet, in the depression lateral to the sinew."
Leijing Tuyi (類經圖翼) - Illustrated Supplement to the Classified Canon: "Xiyan, below the kneecap on both sides in the depressions, needle 5 fen, moxibustion prohibited. Treats cold and painful knees that persist. Some people who received moxa at Xiyan did not recover, therefore moxibustion is prohibited."
Xiao'er Tuina Fangmai Huoying Mizhi Quanshu (小儿推拿方脉活婴秘旨全书): "Xiyan point: When children have fright appearing on their face, urgently pinch here."
How to Locate
It is recommended to flex the knee to better locate the point. There are two eyes of knee located on the level of the lower border of the patella, lateral and medial to the patellar ligament. The medial one is Neixiyan EX-LE-4. The lateral one is Dubi ST-35.
Caution
Do not needle too deeply to avoid intra-articular puncture into the knee joint cavity. This point is located directly adjacent to the knee joint capsule and excessive depth can penetrate the synovial membrane. Once needles are inserted, avoid repositioning the patient's leg as this can cause significant discomfort. Some classical sources (Leijing Tuyi) advise caution with direct scarring moxibustion at this location, though indirect moxa and moxa sticks are generally safe. In patients with knee effusion or severe joint inflammation, use extra caution.
Needle Angle
45° (Oblique) / 90° (Perpendicular)
Depth Category
Medium
Standard Depth
0.5–1.0 cun
Needling Directions
For the medial eye of the knee (Neixiyan EX-LE-4): 0.5–1 cun vertically or obliquely towardsthe lateral eye of the knee. For the lateral eye of the knee (Dubi ST-35): 0.5–1 cun vertically or obliquely towards the medial eye of the knee. Caution: Do not needle too deeply to avoid intra-articular puncture.
Expected Deqi Sensation
Local soreness and distension at the knee, which may spread throughout the knee joint. When needling obliquely toward the center of the knee or through to the opposite Xiyan, the sensation may extend deeper into the joint space.
Moxibustion
Recommended
Duration: 10–15 minutes
Cupping
Recommended
Bloodletting
N/A
Gua Sha
Questionable
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