January 31, 2013

Ren 17 (Conception Vessel 17)

Ren-17, or Conception Vessel 17, is located in the middle of the chest. It is an important point which is involved in clearing and regulating lung qi. Ren-17 is also front-mu for the pericardium. The point responds well to both moxibustion and needling, but there is a risk to needling Ren-17 that many practitioners are unaware of.

Ren-17 is located on the anterior midline, level with the 4th intercostal. It is usually, but not always, midway between the nipples. A more accurate way to locate the point is to find the second rib (the most prominent) and count down to the fourth intercostal.

Indications for this point include asthma, pain and tightness in chest, palpitation, and promoting lactation. It is frequently used in combination with SI-1 for this latter indication, Ren-22 for asthma and cough, and SJ-10 for heart pain.

Moxibustion

Moxa can be very powerful for Ren-17. However care must be used due to the thinness of the skin in this area. Burning can occur very quickly and with little warning. This is a particular concern with elderly patients, whose skin has begun to thin and lose flexibility. An alternative is to use LLLT on the point either with a portable handheld LLLT device such as the Klas unit or with one of the leads in a multi-lead unit like the AM-100.

As always, moxa should not be used for heat conditions. This point often has an enlivening affect for damp or cold conditions. Be very careful if using moxa on asthmatic patients. If you choose to moxa Ren-17 on asthmatic patients, make sure to use smokeless sticks, and ensure that the air flow is carrying the scent of the moxa away from the face.

Needling

There is some uncertainty as to whether or not needling is an appropriate treatment for Ren-17. Several texts advise against using needles on this point, in spite of how important it is. If you do choose to use needles at Ren-17, it is very important that you take proper care. Needling this point improperly could endanger your patient.

There is a relatively common anatomical anomaly that makes this point problematic. Approximately 1 in every 20 people have a hole in their sternum in the area under Ren-17. This hole, called a sternal foramen, cannot be palpated because it is covered by a layer of ligaments. However the ligaments will not prevent a needle from going through a sternal foramen and into the heart. Several people have been injured by being needled improperly at Ren-17, and there has been at least one death.

There is also a smaller risk of pneumothorax. Pneumothorax occurs when a needle pierces the chest cavity and air bubbles enter the hole. These air bubbles put pressure on the lung, collapsing it.

If you choose to use needles on Ren-17, you should always use the transverse (horizontal) technique. The needle should travel in either an inferior or superior direction, not laterally. This eliminates the risk of pneumothorax and reduces the risk of puncturing through a sternal foramen. You can further reduce the risk of a puncture by making sure the needle does not go in too deeply. A transverse depth of 0.5-1 cun is best.

Be very aware of patient reaction and alert for any indication of possible problems In general, moxa is preferable to needling this point, in order to eliminate the chance of injury.

Laser

Low level laser therapy is an excellent modality that can be used to stimulate this point and achieve its effects without the discomfort and danger of using needles or moxibustion. A dosage of 50 Joules should not be exceeded in one session. The normal dosage of 6J should be applied, for details on how to calculate time required to deliver the dosage based on your lasers power please see our Laser time calculator.

Action and Use

Ren-17 is a difficult point to reach deqi for. For this reason, many practitioners will use the point to assist in diagnosis but will not use the point for treatment.

This point will become tender when qi is stagnating. Due to the effects of stagnant qi, this can also be an indication that the patient is likely to suffer from depression, sadness and lack of energy. Treatment of this point is very beneficial to qi. Qi is tonified and strengthened, rebellious qi from the Stomach and Lungs is subdued and stagnation of qi is overcome. It also has the effect of regulating the lungs and Upper Jaio and clearing phlegm.

Patients often react strongly to treatment of Ren-17. They feel invigorated and uplifted. They act with more confidence. As the chest relaxes and lungs clear they are able to breathe more easily, getting more air and benefiting from the increased energy of proper breathing.

Wrapping Up

Ren-17 is an important point that can have many benefits for patients. It clears and strengthens the lungs and can benefit the heart. It plays an important role in regulating and tonifying the body's qi. However care must be taken due to the risks of heart puncture or pneumothorax from needling. When possible, it is preferable to treat with moxa or use other points. Some practitioners also avoid needling Ren-17 do to difficulty finding deqi. Treatment here can elicit strong reaction from patients, who benefit immediately from the invigorating effects of increased flow of qi and expanded lungs.