Sunday, August 14, 2016

Kunlun BL-60, the Urinary Bladder Sinew Channel, and Muscle Tension Headaches

“Kunlun BL-60 is the fire point of the taiyang Bladder channel and an important point to clear and descend excess wind, fire and yang from the upper part of the body.” So states Deadman in the commentary for this point in A Manual of Acupuncture. He goes on: “The principle 'for disease of the head select [points from] the feet' applies well to the point. Kunlun BL-60 is able to clear heat and lead down excess yang from the head in cases of headache, heat in the head, redness, pain and swelling of the eyes, bursting eye pain, nosebleed and toothache, and to extinguish wind from the head in cases of epilepsy and lockjaw.”

What I would like to consider in this post is the actions of this point on muscle tension headaches, specifically on reducing tension in a group of muscles that often become dysfunctional together as part of this pattern of tension headaches. These muscles individually refer pain to the posterior neck and occiput, the temple region, and the region of the orbit of the eye. Collectively, their referral patterns overlap and can create a composite pattern of pain that many of our patients describe when they come in for treatment. These muscles are the trapezius muscles (primarily the upper fibers but also the lower fibers can contribute to headaches), the suboccipital muscles, the sternocleidomastoid (SCM), and the temporalis muscle.

Fig. 1: TrP pain referrals of the upper trapezius, the suboccipital muscles, the SCM (sternal head), the temporalis, and the SCM (clavicular head). Image from Myofascial Pain and Dysfunction: The Trigger Point Manual by Janet Travell and David Simons.

Fig. 2: Urinary Bladder sinew channel image from
A Manual of Acupuncture, by Peter Deadman
What unifies these muscles from a channel theory perspective is the Urinary Bladder sinew channel. An uprising of Yang, and a flaring of Fire and stirring of Wind, often with disharmony in the Liver network, manifests as contraction in the muscles listed above. These muscles are all part of the Urinary Bladder sinew channel. This channel unites these muscles together in a type of disharmony that causes muscle tension headaches.

The sinew channel would indeed include the suboccipitals along with the chain of myofascial tissue, creating a myofascial meridian, and rising up the back of the body (Fig. 4). This is an obvious muscle to include in any channel description involving the trajectory of the Urinary Bladder channel. And this myofascial meridian also includes the thoracolumbar fascia, the thick aponeurotic structure in the lumbar region. But, other structures attaching to the thoracolumbar fascia explain several branches of this sinew channel. This includes the latissimus dorsi and the lower fibers of the trapezius (Fig. 3). The latissimus dorsi has obvious fascial connections to the pectoralis major which, in turn, connects with the SCM. The trapezius, accounting for the LI-15 and GB-21 binding regions depicted by Deadman and discussed in the Lingshu, blends in with the fascia of the scalp and connects to the temporalis muscle. Excess Yang rises up and all of these muscles become dysfunctional and contribute to the building pain many people feel throughout the day. It can also contribute to the typical guarding posture that is seen with increased stress which is referred to as upper cross syndrome (a posture with a forward head and protraction of the scapula).

Fig.3: Image modified from Netter's Atlas of Human Anatomy. Sinew Channel interpretations by the author, Brian Lau, AP, C.SMA

Fig. 4: A dissection of the Superficial Back Line from Anatomy Trains. This image includes, from left to right, the plantar fascia, the fascia of the periosteum of the calcaneus, the Achilles tendon, the gastrocnemius and soleus, the hamstrings, the sacrotuberous ligament and posterior sacral ligaments, the erector spinae and suboccipitals, and the galea aponeurotica or the fascia of the skull. This is very similar to the myofascial of the main branch of the the Urinary Bladder sinew channel.

According to A Manual of Acupuncture, actions of BL-60 include:
  • Clears heat and lowers yang
  • Pacifies wind and leads down excess
  • Activates the entire Bladder channel and alleviates pain
  • Relaxes the sinews and strengthens the lumbar spine
  • Promotes labor

This point, frequently combined with SI-3, serves as a great distal point to treat muscle tension headaches. This should be combined with proper needling of the motor points of the involved muscles and with treatment of the root of the disharmony (BL-60 treats the manifestation of Yang rising, so the practitioner should look to the pattern of excess and deficiency present with the patient, also). Many of the motor points of the muscles involved coincide with points that many acupuncturists already use, but the techniques and depth required to reach and affect muscle spindle relationships in the muscles is not always adequately preformed. The motor points are briefly described, but this type of information is best left to a classroom discussion. I will be teaching a foundation course in Sports Medicine Acupuncture for the neck and shoulder in Manhattan and in the Tampa Bay area in the new year (dates to be determined soon). For other classes and for Sports Medicine Acupuncture Certification (SMAC), you can look at the schedule on the SMA website.

  • Upper trapezius – motor point 2 is GB-21; the muscle can be grasped and held away from the rib cage, and it can be needled from SJ-15 with the needle pointed up (away from the pleura) towards GB-21. Motor point 1 is about halfway between SI-15 and -16 and is needled (with the patient supine) through the anterior edge of the muscle from anterior to posterior and with a slightly upward direction. This is through the fibers in the region where the muscle turns from being horizontal to more vertical as it ascends the neck.
  • Suboccipitals – accessed from GB-20. Deadman describes palpation with the finger angled towards the nose (this goes into the suboccipital triangle), the finger angled towards the contralateral eye (this accesses the rectus capitis posterior major), or the finger angled towards Yintang (this angles the needle towards the attachments of muscles such as the trapezius to the occiput). We discuss some other needle angles and depth in Sports Medicine Acupuncture classes, but there are safety issues with the vertebral artery that makes a classroom setting much better for this discussion. 
  • SCM – both heads can be needled from ST-9. However, it is imperative that the needle direction is lateral and that the needle ascends through the muscle of the SCM and does not travel medial to the muscle towards the carotid artery. Note: this is a different technique than ST-9 describe in A Manual of Acupuncture which discusses needling between the carotid and the thyroid cartilage. SJ-16, though not a motor point, is another reactive point that affects the clavicular head of the SCM. Palpate for the most reactive region and angle slightly anterior into the muscle.
  • Another motor point to consider is the piriformis motor point. This point is halfway between BL-54 and BL-53. It is an empirical motor point and it eases pain in the BL-10 region (describing the method of treating below to affect above). And it can also reduce tension in the pectoralis minor (a midday-midnight [zi wu liu zhu] relationship) and assist in opening the chest and correcting the typical upper cross syndrome seen).
  • Note: these motor points are listed in Motor Point Index - An Acupuncturist's Guide to Locating and Treating Motor Points.

It is worth noting that the sinew channels converge and that many of the muscles discussed are part of other channels and can be addressed via distal points on other channels. The trapezius, for instance, is a muscle where the Large Intestine, Sanjiao, and Gallbladder sinew channels also converge. There are many other instances where you would consider Shaoyang or Yangming point combinations for other type of disharmonies affecting this muscles; points such as GB-39 and LI-10 come to mind. The above discussion was specifically about a series of muscles related to muscle tension headaches and their dysfunction, which can be seen as a disharmony affecting the Urinary Bladder sinew channel.

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