Small Acupuncture Graphic California State Board Acupoint Locations
by Al Stone, based on the experience of Dr. Baljit Khalsa


One of the most difficult tasks to perform at the California state board examinations is the point location portion of the exam.

The problem is that the way in which students are taught to locate the points are often different from the way in which the proctors locate the points at the exam. When asked for details on how these points are actually located, the acupuncture committee always says the same thing. Read CAM. CAM stands for the title of the book; "Chinese Acupuncture and Moxibustion".

We've all read the way in which the points are located in this book, and there are many point location descriptions that are very poorly stated. Very poorly translated. We couldn't find these points if our livelihoods depended on it, which they do.

I attended a workshop that was held by a former proctor for the state board exam, Dr. Baljit Khalsa. He was very clear on how points are located in accordance with CAM as decoded by the state board.

This article describes this decodification of how the AC proctors read the CAM instructions for acupoint location.

Good luck.

Some key points:

The proctors use their hands or use strings. Three proctors have to agree on the location before they ink it with the invisible paint. They don't use cunometers, or elastic bands. Doesn't mean you shouldn't, but since you wanted to know...

Every point description in CAM says to see an illustration. If the illustration is "figure" something. Then its a black and white illustration, usually found on the same page, or nearby the page you're currently reading. If the instructions on the point suggest that you see "col. fig.", that's a reference to a color photograph, which are found at the end of the point location chapter, among the extra points.

The position in which the limb is held when locating the points can alter the location of the points rather dramatically. When we study point location in our schools, we're often taught to hold the arm with the hand over the abdomen when locating points on the large intestine channel, or with the hand over the chest when locating points on the San Jiao channel. We must do away with what we were taught in classes in favor of the position of the arm as illustrated in the CAM book. This is the position that the limb will be when the points are found by the state board exam proctors. Most of the arm positions, you'll find are with the fingers pointing down.

Its all according to the book. However, there are times in which the text description does not agree with the illustration. In this case, the text is given priority. An example is for the point Stomach 34. The illustration shows the leg straight, and the text suggests that the point is located with the leg flexed.

You're damned if you do and you're damned if you don't. If you're a control freak, now would be a good time to work on that. Let's move on...

Horizontal Cun on the upper chest.

If you look to the nipple to determine your lateral four cun, think again. Or rather, stop thinking that. Wiser to use the measurement from the supra-sternal notch (Ren 22) to the acromium as your eight cun, or the supra-sternal notch to Lung 2 for six cun. You can't rely on the nipple line for anything during this test.

Horizontal Cun on the abdomen.

The rectus abdominis muscle is your four cun measurement lateral. On the lateral boarder of this muscle is your spleen line. The midpoint of this muscle is your 2 cun measurement for the stomach channel.

First ICS versus the subclavicular fossa

If a point is in the subclavicular fossa, you find the space directly below the clavicle. If a point is found in the first ICS you go to the sternal angle (aka "Lump of Louie") and locate the first ICS based on the fact that the sternal angle is the meeting point of the second rib. The ICS below the sternal angle is the 2nd ICS. The ICS above it is the first.

Next to the midline, the first ICS is not the same as the subclavicular fossa. The more lateral you go, the more likely it will be, but everybody is different. On some people, there will be a difference between Stomach 13 and 14. On others, there will not.


The Problem Points:

Lung 3 and Lung 4
Lung 3 and 4 don't show up on the test because the "radial" side of the biceps is highly ambiguous. It changes depending on how you hold your hand. You can look to the color figure that the text suggests, but you'll find that the black words and lines for the channel are not lined up well, and so the channel that should run down the lateral side of the biceps, travels down the middle instead, where the pericardium channel should be found. This is a terrible illustration, all because the black ink and the color photograph beneath were not lined up well during the printing stage of this book.

Lung 7
Lung 7 is located in the cleft superior (and adjacent to) the styloid process of the ulna, however, in the diagram, that location is shown to be on the Yin side of the arm, closer to the course of the channel from Lung 5 to Lung 9. Keep that in mind. Bring the point in toward the rest of the Lung channel just a bit so its not so close to the LI channel. An half of an inch should do it.

Large Intestine points on the arm
Notice that the elbow is slightly flexed in Figure 61. The point should be located in the arm down position as in Figure 61.

LI 12
This point is a little funny. "Superior to the lateral epicondyle of the humerous" is a tough statement. It should be noted that the epicondyle makes a slope toward its widest part at the elbow. This point is at the beginning of the slope, not at the wide part which is not superior to LI 11. Ultimately, it would likely be more intelligent just to eyeball one cun superior and lateral to LI 11.

LI 13
The 3 cun measurement is based on the Lung channel's nine from the axillary fold to the elbow crease.

LI 14
The 7 cun measurement is based on the Lung channel's nine from the axillary fold to the elbow crease. This point may or may not be at the very end of the deltoid.

Stomach 32
Like Spleen 11, this is not an easy point to find on a standing model at a test. If this point is used, it could easily be thrown out because of the number of people who could potentially get it wrong.

Stomach 33
First, determine 19 cun (from the greater trochanter to the patellar crease). Remove one cun from your measurement tool, such as a string. Fold the string into half, and then fold it into thirds to obtain a valid three cun measurement for the thigh. Now, use that three cun measurement to measure from the laterosuperior border of the patella, upwards toward the ASIS as suggested in CAM. And don't forget to glex the knee when you finally set the 3 cun measurement down on to the model.

Stomach 34
While standing, have the model stand on their tip toes to bring out the tendon that connects to the top of the knee, as shown in figure 69 of CAM. Place your finger there, lateral to the tendon, and have the model sit down. Then, eyeball 2 cun up from the superior lateral corner of the patella, using the model's hand if you chose, staying lateral to that tendon. That's Stomach 34. Still a crap shoot, but its all I have to work with.

Spleen 10
Guestimate 2 cun based on the width of fingers or any other method you chose. Then, with the knee flexed at 90 degrees, travel up the leg and toward the midline (i.e. toward the groin) at a 45 degree angle from the mediosuperior border of the patella.

Look for the highest point of the bulge of the muscle located 2 cun above and medial to the patella. The highest point means the part of the muscle that extends the furthest away from the femur. That's your point. I don't think the placing of the palm on the knee is as good as eyeballing the highest point of the bulge. The proctors are looking for that bulge. So should you.

Spleen 11
This point was used recently in a test. It drew so much criticism that it was thrown out. It shouldn't be used again. If it is, rejoice, because you'll get that point, for sure.

Spleen 14
How do you measure 1.3 cun? There is no official means.

Spleen 15
The lateral border of the muscle rectus abdominus determines your measurement for the four cun lateral on the abdomen. Keep that in mind for your Stomach and Kidney channel measurements too. The mamilary line is next to impossible to determine with the model standing up, and it is an estimation at best given the wide variety of chest sizes of both sexes.

Small Intestine 7
You'll see from figure 80 that the arm is pointing down. That's the method by which the proctors will chose to locate the points. You should too. The 12 cun for the Yang channels on the lower arm are based on 12 cun that extend from approximately Lung 5 to LI 5. Once you've got your twelve cun, then pull that measurement over to the Yang side of the arm and put the point on the line connecting SI 5 and SI 8.

Outer-Shu points:
Since the three cun measurement is based on the medial extremity of the scapula, labels should be placed half on the scapula and half off (medial to) the scapula. That way the label fully covers the correct point, nothing else.

UB 56
Because UB 57 is based on a structure (the gastrocnemius muscle), the instructions for this point cannot suggest a specific cun measurement below UB 40. You find UB 55, which is 2 cun below UB 40, and then you find UB 57 which may or may not be 8 cun below the transverse crease of the popliteal fossa. It is below the gastrocnemius muscle.

UB 57
The book says that it is found below the belly of the gastrocnemius, about 8 cun below UB 40. Well, which is it? Below the gastroc, or 8 cun below. The answer is that the proctors first find the gastroc, if it is not about 8 cun below, then they'll find the 8 cun mark and place the dot in between the gastroc location and the 8 cun location. Better to shoot for the gastroc, rather than 8 cun mark.

UB 58
7 cun above UB 60 is more important than 1 cun inferior and lateral to UB 57, though both should be taken into account.

Kidney 9
The five cun here is based on the thirteen from Spleen 9 to the medial malleolus.

Kidney 10
Find the point with the knee flexed to locate the tendons, then place the sticker with the model standing up straight.

Kidney points below the umbilicus have happened before. Be aware of that.

PC 4
This point is initially located on the line that connects PC 3 and PC 7. However, if it is not between the tendons, it should be relocated to fall between the two tendons. That's what the proctor told us. I'm a little slow to except this one. I think that the letter of the description in CAM is pretty clear. The first sentence talks about the line from PC 3 to PC 7. Secondly it talks about the tendons. Seems like the line is more important. Sorry that this is ambiguous. After four years of TCM training, you should be used to it by now.

San Jiao Points on Lower Arm
The arm is in the down position as shown Figure 96. Again the 12 is based on the length from the crease of the elbow and the wrist crease on the Yin side of the arm where it is most easy to locate.

SJ 13
Draw a line from SJ 10 to SJ 14. SJ 13 is located at the point where this line intersects the border of the deltoid. I personally think of this as the inferior border of the deltoid muscle, but because the border is as much vertical as it is horizontal, the makers of CAM called it the posterior border. Same difference. The intersection of the border of the deltoid muscle with the line drawn from SJ 10 to SJ 14.

GB 14
This point has shown up in past exams. It could again. The middle of the eyebrow can change for a variety of reasons. You should orient the point directly above the pupil of the eye.

GB 21
Follow the order of the instructions in the book. First, locate the midpoint of the line that extends from Du 14 to the acromium. Then roll up to the highest point of the shoulder. This isn't really the portion of the shoulder that is the highest, which would be closer to the neck, but this is the top of the shoulder, the superior aspect, still directly above the midpoint of the line described prior.

GB 22
The arm should extend away from the body 90 degrees (making it horizontal) when finding the axila point to begin the 12 cun measurement that extends to the tip of the 11th floating rib.

GB 31
Because the length of arms and hands vary widely, it is safer for everyone involved to use the 7 cun measurement for this point.

Regarding what "lateral aspect of the thigh" means, please see "Fig 106". In this diagram, you'll see that the point is immediately posterior to the shaft of the femur. Although this can be a little difficult to palpate, we do have a clue as to what "lateral aspect of the thigh" officially means. Posterior yet immediately adjacent to the femur.

GB 33
This point is rarely found 3 cun above GB 34. It is a little further than that on everyone in the workshop I attended. Rather, there are some reasonably specific physical landmarks that should serve to limit any ambiguity regarding this point.

This point is in the depression at the bottom, or inferior end of the groove between the lateral condyle of the tibia and the tendon of the muscle biceps femoris. These two landmarks create a depression that rises up the thigh. Within this groove, five cun above the popliteal crease, is where you'll find GB 32.

You could say that GB 33 is the Liver 8 of the Gall Bladder channel.

Liver 5
The question with this point is whether the point is located on the bone as some more esoteric practitioners teach, or posterior to the bone which would enable a more perpendicular needle insertion. The answer is in figure 110 of CAM. The point is located, officially posterior to the tibia. However, since the point is posterior and adjacent, practically touching the bone, it would be prudent to place your label half on the bone and half off the bone so as to put the actual point right in the middle of the label.

Liver 8
This point frequently shows up in state board exams. The point is located with the knee bent as shown in figure 111. Notice that the knee is bent about 90 degrees.

Ren 20
This one presents a problem because of the poor quality of translation of CAM. The book reads: "On the anterior midline, at the midpoint of the sternal angle, at the level with the first intercostal space." Because the sternal angel is between the first and second intercostal space, these instructions don't make sense. Instead, find the point at the level of the first intercostal space above the midpoint of the sternal angle on the anterior midline.

Ren 15
This point is described as below the xiphoid process, 7 cun above the umbilicus. Because the length of the xiphoid process varies widely, it is better to locate this point based on 7 cun above the umbilicus, with the sternal-xiphoid junction determining your 8 cun measurement, rather than locating the point by finding the bottom of the xiphoid process.


While you're worrying about whether or not you'll pass the test, perhaps you should take a moment to consider the best way to fail it...


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