Sunday, August 7, 2016

LI 15 (Jianyu) and Channel Relationships: A Point Reached by the Lung sinew channel and the Small Intestine Luo-Connecting Channel

"Jianyu L.I.-15, a meeting point of the Large Intestine channel with the Yang Motility vessel, is also reached by the Lung and Bladder sinew channels, the Large Intestine divergent channel and the Small Intestine luo-connecting channel. Jianyu L.I.-15 is considered the preeminent point for treating the shoulder, and clinically the majority of shoulder disorders affect this region."1 This is a quote from the commentary of LI 15 in A Manual of Acupuncture by Peter Deadman. There is a lot of information in this opening paragraph; a look at the anatomy will help to elucidate it. 
Fig. 1: Image from A Manual of Acupuncture,
by Peter Deadman. Illustrating the
The Lung sinew channel which
"enters the bottom of the armpit"
 but also "connects to the front 
of the shoulder joint"

In this post we will start with the Lung sinew channel and the Small Intestine luo-connecting channel. This will highlight the relationship of LI 15 to shoulder problems. The Lung sinew channel includes the biceps brachii. The Lung sinew channel is continuous, via myofascial connections, from the thenar muscles to the pectoralis minor, subclavius, and intercostal muscles. The biceps brachii are part of this sinew channel and it is specifically the short head of the biceps which blends with the pectoralis minor. However, as described classically and seen in the illustration from A Manual of Acupuncture, the long head of the biceps can be interpreted to be included. The long head has a fascial connection to the supraspinatus.2

Interestingly, the supraspinatus muscle is part of the Small Intestine sinew channel and its muscle belly is accessible at SI 12 (which is the motor point of the supraspinatus).3 However, its musculotendinous junction is reached by LI 16 and its humeral attachment is reached from LI 15.
Fig 2: Note the transverse ligament which is illustrated
as a separate structure. Compare it to Fig 3. where it
does not appear to be a separate structure. In a cadaver
specimen, it is observed to be a continuous sling as describe
in this post.
The long head of the biceps brachii (part of the Lung sinew channel) lies in the bicipital groove where it is held in place by a ligamentous structure called the transverse humeral ligament. While not described this way in anatomy texts, the transverse ligament is actually a fascia sling composed of the superficial fibers of the subscapularis tendon, a muscle of the Heart sinew channel, and longitudinal fibers of the supraspinatus tendon.4,5 Overactivity in the subscapularis muscle can contribute to pain in the long head of the biceps as the additional tension, transmitted through the transverse ligament, compresses the muscle and its tendon sheath and can be an aggravating factor for bicipital tenosynovitis (inflammation of the tendon sheath of the long head of the biceps).



So LI 15 is a fascial meeting point of the supraspinatus (SI sinew channel) and subscapularis (HE sinew channel), and this point is classically described as a meeting point of the Small Intestine luo-connecting channel, a point that would connect the Small Intestine channel with its internally related Heart channel.
Fig. 3: The anterior view of the scapula and humerus with the rib cage removed.  This image is modified from Atlas of Human Anatomy by Frank Netter.  LI 15 is on the anterolateral border of the acromion process of the scapula. When located this way, there is little space felt between the acromion process and the greater tubercle of the humerus. Anatomy illustrations are somewhat misleading and the above illustration seems to put LI 15 much farther inferior to the acromion. This is not the case. If the tip of your finger is on the point, it side should be in contact with the acromion process

Needling at LI 15 accesses the region where the supraspinatus tendon attaches and where the transverse ligament crossed over the biceps tendon. Therefore this point can be used when there is pain from supraspinatus tendinopathy and/or from bicipital tenosynovitis. These are two of the most frequent shoulder conditions, so it can be seen why LI 15 is so useful. Which other points are used in addition will be based on which pathology is being treated, which muscles are overactive and which are inhibited, and, based on this, how well the glenohumeral joint is functioning. Frequently used points include SI 12 (the motor point of the supraspinatus), SI 11 and the motor points of the infraspinatus, SI 9.5 (the motor point of the teres minor and half way between 9 and 10), and HE 1 (the motor point of the subscapularis).6 There are other direct techniques which can be used for specific conditions.

Many practitioners would agree that distal LI channel points are often used for shoulder problems such as supraspinatus tendinopathy and bicipital tenosynovitis. Obviously the LI channel flows through LI 15. But, as mentioned above, LI 16 accesses the myotendinous junction of the supraspinatus and the Large Intestine channel then intersects with SI 12 en route to LI 17.

A specific distal point commonly used for shoulder problems is LI 11. This point can be threaded to connect with HE 3 (or vice versa) which would help connect the Large Intestine channel (which intersects with SI 12 and the supraspinatus) with the Heart channel (which connects with the subscapularis) and helps balance the relationship of these to important shoulder joint muscles.

References:

1. Deadman, Peter, Mazin Al-Khafaji, and Kevin Baker. A Manual of Acupuncture. Hove, East Sussex, England: Journal of Chinese Medicine Publications, 2007. Print.

2, Myers, Thomas W. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. 3rd ed. Edinburgh: Churchill Livingstone, 2014. Print.

3 Lau, Brian. "Anatomy of the Sinew Channels: Head, Neck and Upper Extremities." Sports Medicine Acupuncture Certification: Module 2 Anatomy/Palpation/Cadaver Lab. Pacific College of Oriental Medicine, Chicago. 24 Apr. 2016. Lecture

4, Gleason, P.D. "The Transverse Humeral Ligament: A Separate Anatomical Structure or a Continuation of the Osseus Attachment of the Rotator Cuff?" American Journal of Sports Medicine 34.1 (2005): 72-77. Web.

5, Stecco, Carla, and Warren I. Hammer. Functional Atlas of the Human Fascial System. Edinburgh: Elsevier, 2015. Print.

6. Callison, M. (2007). Motor Point Index: An Acupuncturist's Guide to Locating and Treating Motor Points. San Diego, CA: AcuSport Seminar Series LLC.






3 comments:

  1. Nice post. Thanks for sharing for sharing such a useful post.

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  2. Mind... Blown.
    I have never threaded LI11 to HE3.
    I really should see you needle!
    Do you use electric stimulator?

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  3. I don't use e-stim. But you can thread from HE3 or from LI11. Actually, I believe this is mentioned in Deadman's A Manual of Acupuncture and this book is fairly conservative in terms of needle depth and technique. I suspect that this is due to the author not wanting to have practitioners cause harm if they don't have adequate training. It's probably best to be conservative in writing or web based demos, in my opinion.

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